This is one of the few studies carried out in Afghanistan that talks about women and abortion. To the best of our knowledge, this study is the first of its kind, which looks at the knowledge, attitude, and practice of women on abortion in Herat province in Afghanistan. Afghanistan is one of the Islamic countries where abortion is illegal unless it's done to save the mother's life .
Our study found that more than half of women have overall good knowledge about abortion and abortion laws, with 56.6% know the correct gestation period to undergo induced abortion, whereas 74.2% of women did not know the legal conditions under which abortion is allowed in Afghanistan. Studies conducted in various countries with almost the same demographic characteristics show different results. The studies in Iran about knowledge of women show that 68% of women have knowledge about abortion laws, 49% of them know about crime and wergild for self-induced abortion and for illegal providers . The results vary when studies from non-Islamic LMICs (low-and-middle-income countries) are considered. A study conducted in Bihar and Jharkhand in India shows that 41% of women know about the legality of abortion while few of them know about abortion methods. In addition, the study conducted in Brazil shows that only 47% of people have correct knowledge about abortion . Similar studies conducted in Zambia, South Africa, Ethiopia, and Mexico found that 16%, 32%, 45%, and 48%, respectively, have the correct knowledge about abortion laws' legality [3, 14-15].
In addition to this, the study conducted in developed countries like the USA on women with low income showed that only 25% know about the abortion laws, whereas 67% of women have the correct knowledge of the age limit for abortion .
This study evaluated the attitude of women towards abortion. According to the survey, 62.8% of women think abortion is a sin even if there is a danger to the mother's health, and 74% believe it shouldn't be legal and accessible to everyone. Our results are supported by various studies conducted in other Islamic countries. The study conducted in Saudi Arabia on 32 families about the attitudes on prenatal diagnosis and abortion found that 28 out of 32 families rejected the idea of abortion at first instance . In the study conducted in Palestinian territories, most of the women considered abortion as Haram (religiously forbidden) . In another study about the perception of medical and health sciences students in Jordan, 53.1% of the students considered abortion a murder . The number was high in the study conducted in Turkey, where abortion laws are more liberal with no restriction on abortion without reason . It was found that 80.7% of the respondents believed that abortion is a sin and 74.9% of them felt that abortion, a kind of murder .
Additionally, given that Turkey has a unique position owing to its blend of Islamic laws on abortion and secular laws from the Western society, it approves abortion on demand to the 10th week of gestation. However, therapeutic abortion can still be performed beyond 10 weeks of gestation to save the life of the mother and avoid serious complications of the fetus upon the decision of a committee of physicians. This contrasts with the concept of the Turkish Presidency of Religious Affairs on abortion that perceives abortion on demand as a sin and not a right. This greatly affects the attitude of women and healthcare providers towards abortion in Turkey . Also, the study conducted in Iran on midwives shows that 68.7% of them have extremely weak to moderate attitudes towards abortion . In contrast, the studies conducted in USA about the attitudes of abortion shows that 80% of women support that abortion should be legalized in all situations, which differs much from our results . Another study in the USA having a large sample size shows that only 4.1% of participants were against the legalization of abortion .
We also found that 59.2% of women think that abortion should not be done even if the pregnancy results from rape. There is a difference in the attitude related to this among various Islamic countries. A study conducted in Turkey shows that only 28.9% of women in the study think that abortion is a sin if it is due to rape . A similar study in Palestine showed that 88.3% of women felt justified if women undergo an abortion due to rape .
Our 58% of the respondents believed that safe abortion services should be made legally accessible to everyone in health centers, whereas 42% were of contrary opinion. In another study carried out in Ethiopia, 56% of the women preferred that abortion on demand should be legalized while 41.9% preferred it not to be legalized, even though Ethiopia amended a law that permits abortion under certain special circumstances. This points out a possibility that attitude and lack of knowledge is a hindrance to safe abortion use .
Total 91.4% of the women perceived abortion as a subject that should not be discussed in front of everyone, whereas 8.6% thought it should be discussed in front of everyone. This points towards the stigma associated with abortion. According to a study carried out in Uruguay, decriminalization of abortion contributed towards the reduction of abortion stigma .
A survey found that citizens of the Asian Islamic states and North Africa are less likely to approve of abortion than those grown up in Western Europe and North America .
In our study, the association of age and knowledge about abortion was not found to be significant. We found percentage of people having good knowledge of abortion in 18-24, 25-34, 35-44, 45-54 and >54 year age groups are 57.5%, 51.5%, 48.6%, 58.6% and 74.5% respectively. The results have been supported by various studies. Studies conducted in Iran also show no significant association of age and knowledge about abortion and its laws . A study conducted in Zambia found no association between age and knowledge about abortion . Similarly, studies conducted in Lagos among female students have found no significant association between abortion and age group . Also, no association was found in the study conducted among the females in Nepal . However, some studies have found a significant association between knowledge and age. A study conducted in Ethiopia among college students found a significant association of age and knowledge, with the age group of >25 have more knowledge about abortion .
In our study, there was a significant correlation between ethnicity and knowledge. We found that 64.7% of Pashtuns have good knowledge about abortion, whereas 52.5% of Tajiks have good knowledge about abortion. We haven't found any study which correlates ethnicity and knowledge of abortion.
We found a significant association between the education of the participant, her husband, her mother, her father, and knowledge about abortion. The more educated an individual, her husband, and mother are, the more knowledge they have about abortion. A study conducted in Iran also shows a significant correlation between education and knowledge about abortion and its laws . But the study conducted in Iran on midwives shows no significant correlation between Education levels and knowledge about abortion . Another study conducted in Mexico among youths also shows a significant correlation between the knowledge of abortion and levels of education .