Individual and contextual factors associated with abortion among reproductive age women in sub-Saharan Africa: Insights from 24 recent demographic and health surveys

Introduction: Despite the Sustainable Development Goal to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, abortion remains one of the top five causes of maternal mortality in low and middle-income countries. However, there is a lack of comprehensive data on the pooled prevalence and determinants of abortion in sub-Saharan Africa (SSA). Therefore, this study aims to investigate the pooled prevalence and determinants of abortion among women of reproductive age in 24 SSA countries using the most recent Demographic and Health Surveys. Methods: The most recent Demographic and Health Survey (DHS) data from 24 Sub-Saharan African (SSA) countries were analyzed, using a weighted sample of 392,332 women of reproductive age. To address the clustering effects inherent in DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was employed. The results were reported as adjusted odds ratios with 95% confidence intervals to indicate statistical significance. Additionally, the model with the lowest deviance was identified as the best fit for the data. Results: The pooled prevalence of abortion in SSA were 6.93% (95%CI: 5.38, 8.48). Older age (AOR = 3.71; 95%CI: 3.46, 3.98), ever married (AOR = 3.87; 95%CI: 3.66, 4.10), being educated (AOR = 1.35; 95%CI: 1.28, 1.44), having formal employment (AOR = 1.19; 95%CI: 1.16, 1.23), traditional contraceptive use (AOR = 1.27; 95%CI: 1.19, 1.36) and media exposure (AOR = 1.37; 95%CI: 1.32, 1.41) found to be a predisposing factors for abortion. While high parity (AOR = 0.72; 95%CI: 0.68, 0.76), rural residence (AOR = 0.87; 95%CI: 0.85, 0.91), and rich (AOR = 0.96; 95%CI: 0.93, 0.99) wealth index were a protective factors. Conclusion: The study found that the pooled prevalence of abortion in Sub-Saharan Africa is 7%. Potential interventions include comprehensive sexual education to inform and empower women, increased access to modern contraceptives to reduce unintended pregnancies, improved healthcare services especially in rural areas, economic empowerment through education and employment opportunities, media campaigns to disseminate information and reduce stigma, and policy development to ensure safe and legal access to abortion services. These interventions aim to improve reproductive health outcomes and reduce unsafe abortions in SSA.