Willingness to perform induced abortion and associated factors among graduating midwifery, medical, nursing, and public health officer students of University of Gondar, Northwest Ethiopia: institution based cross sectional study

Over 25 million unsafe abortions occurred every year worldwide, the majority (97%), occurred in developing countries, attributing 4.7–13.2% of maternal deaths annually [1, 2]. In Ethiopia about 36% of adolescents, 39% of women within 20–24 years of age, 54% of women within 25–29 years of age and 78% of women who are 35 and older years of age commit clandestine abortion which is potentially unsafe [3]. Induced abortion (safe termination) services are recognized as key interventions in reducing maternal mortality and morbidity associated with unsafe abortion procedures [4, 5]. However, health care providers in Sub-Saharan Africa (SSA) have moral, social and gender based reservations that affect their willingness towards performing induced abortion [6]. As a result, complication of unsafe abortion is among the leading cause of maternal morbidities and mortalities in the region [7].

The government of Ethiopia revised and liberalized the abortion law in 2005 to increase the accessibility of safe termination services by taking the amount of unsafe abortion and its health detrimental consequences on maternal health [8]. However, a major reduction of morbidity and mortality from the complication of unsafe abortion has not yet been achieved [9]. The shortage of health care providers who can provide comprehensive abortion care (CAC) is still critical and this is again exacerbated by the unwillingness of some health care providers to provide induced abortion services due to various religious, cultural and biological factors [10, 11].

Graduating students’ willingness towards induced abortion provision is an important influence on their intention and capacity to provide induced abortion services during their future careers [12]. Even though there is no concrete evidence in Ethiopia, studies done in Asia and Africa revealed a significant level of unwillingness towards performing induced abortion by graduating students in their future careers. For instance, medical students involved in a study done in Maharastra (India) described fear due to social norms and illegality of the procedure to provide abortion in their future practice [13]. Another study done in South Africa (SA) revealed only 23% of students were willing to perform induced abortions once they are qualified [14]. Thus, this study will have a fundamental role in pinpointing recommendations to develop positive attitude among graduating students towards providing safe abortion care services thereby reducing maternal morbidity and mortality.

This study assessed willingness of graduating midwifery, medical, nursing and PHO students towards providing induced abortion services and found 290 students out of 424 students willing to perform induced abortion for indications supported by law, making a proportion of 68.4% (95%Cl: 64.2, 72.9). This finding was in line with findings in California-66.21% [16] and Poland-70% [17].

The result was high when compared with a study done in Argentina-3.34% [18]. This was mainly due to lack of accurate information about legal frameworks of abortion care provision by the Argentinian side. The finding was also high when compared with another study done in Canada [19] where fewer than 30% of students planned to provide any type of abortion. The possible explanation might be Lack of perceived social support for providing CAC and lack of interest to specialize in health care fields containing abortion by Canadian students. The result was also high when compared with a study done Turkey-50.1% [20] and Iran-43.7% [21] respectively. This difference might be due to religious preferences as these two countries are being governed by strict Islamic doctrines. The magnitude was again high when compared with the finding Ireland-58.8% [22]. This might be due to the difference in the year of study of students as the later were not graduating students.

Male students were about five times (AOR = 4.89, 95%CI: 3.02, 7.89) more likely to provide induced abortion services than their female counterparts. This finding is contrary to the findings of previous studies done in Iran [23]. The possible explanation might be long-lasting male dominance in every aspects of participation in our country when compared with Iran.

Concerning students’ religion, being orthodox were about ten times (AOR = 10.41, 95%CI: 3.02, 21.57) more likely to show willingness to induced abortion services than being protestant. Being Muslim was also about six times (AOR = 5.73, 95%CI: 1.37, 15.92) more likely to show willingness to induced abortion services than being protestant. This finding is in line with the findings of the studies done SSA [6], SA [14], Iran [21] and Ethiopia [10]. This might be tailored to the fact that religious restrictions of newly introduced Protestantism might have been practiced better than those of relatively older doctrines.

Those students who had religious attendance less than once a week irrespective of the type of religion were two times (AOR = 2.00, 95% CI: 1.20, 3.34) more likely to show willingness to induced abortion services than those who had more than once a week religious attendance. This finding was consistent with the finding of the study done in Iran and Chile (20, [15]). The possible explanation might be the more students attend religious activities the more they become conservative in providing induced abortion services as they might directly link it with doing sin and vice versa.

According to this study willingness of graduating students towards performing induced abortion was good when compared with other findings. However female students, protestant followers and those students with more than once a week religious attendance should be encouraged to support women’s access to induced abortion services by referring them to other health care professionals willing to provide induced abortion services.