Prognostic factors of time to first abortion after sexual debut among fragile state Congolese women: a survival analysis

Abstract

Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to investigate the prevalence of abortion, the reasons women had abortions, median years to first abortion after sexual debut and examine the factors of time to first abortion among women of reproductive age in the Republic of Congo.

Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p < 0.05.

Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women's age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34, 67, 86 and 94% higher risk of abortion respectively, when compared with women from poorest households (all p < 0.05). Women currently in union/living with a man and formerly in union had 41 and 29% reduction in the risk of abortion respectively, when compared with those never in union (all p < 0.05). In addition, women with primary and secondary+ education had 42 and 76% higher risk of abortion respectively, when compared with women with no formal education (all p < 0.05).

Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women's characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

Keywords: Pregnancy; Termination; Unintended; Unsafe abortion; Unwanted; Women’s health.

Fig. 1

Main reason for putting an end to pregnancy

Fig. 2

Kaplan-Meier failure estimates of time to first abortion by age

Fig. 3

Kaplan-Meier failure estimates of time to first abortion by residence

Fig. 4

Kaplan-Meier failure estimates of time to first abortion by household wealth quintiles

Fig. 5

Kaplan-Meier failure estimates of time to first abortion by marital status

Fig. 6

Kaplan-Meier failure estimates of time to first abortion by education

Fig. 7

Kaplan-Meier failure estimates of time to first abortion by region

Fig. 8

Kaplan-Meier failure estimates of time to first abortion by health insurance

Fig. 9

Kaplan-Meier failure estimates of time to first abortion by media use

Fig. 10

Kaplan-Meier failure estimates of time to first abortion by religion

Fig. 11

Kaplan-Meier failure estimates of time to first abortion by history of contraceptive use

Fig. 12

Kaplan-Meier failure estimates of time to first abortion by parity

Fig. 13

Kaplan-Meier failure estimates of time to first abortion by age at first birth

Fig. 14

Kaplan-Meier failure estimates of time to first abortion by age at first marriage/union

Fig. 15

Kaplan-Meier failure estimates of time to first abortion by age at sexual debut

Fig. 16

Kaplan-Meier failure estimates of time to first abortion by number of life time sexual partners