Published in PLOS One on 2026-06-17, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Amanuel Yoseph, Lakew Mussie, Mehretu Belayneh, Francisco Guillen-Grima
Source: PLOS One • DOI 10.1371/journal.pone.0349603
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Abortion remains a significant public health concern in Ethiopia, contributing to maternal morbidity and mortality. Understanding the individual- and community-level determinants of abortion is essential to inform targeted interventions. This study aimed to assess the prevalence and multilevel determinants of abortion among women of reproductive age in Hawela Lida District, Southern Ethiopia.
A community-based cross-sectional survey was conducted from February to March 2025 among 3,526 women of reproductive age who experienced a pregnancy within the 12 months preceding the survey. Data were collected using a structured, pretested questionnaire and analyzed with Stata v18. Multilevel mixed-effects logistic regression was employed to identify individual- and community-level determinants, adjusting for potential confounders. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.
The overall prevalence of abortion was 18.5% (95% CI: 15.8–24.8). At the individual level, women without formal education were more likely to experience abortion than those with formal education (AOR = 2.61; 95% CI: 1.36–4.54). Women with unplanned pregnancies (AOR = 2.72; 95% CI: 1.62–4.68) and those who were non-autonomous in decision-making (AOR = 2.21; 95% CI: 1.51–5.02) also had higher odds of abortion. At the community level, rural residence (AOR = 2.19; 95% CI: 1.65–4.23), greater distance to the nearest health facility (AOR = 2.34; 95% CI: 1.21–5.01), and low mass media exposure (AOR = 1.82; 95% CI: 1.23–4.12) were significantly associated with abortion.
Abortion in Hawela Lida District was associated with both individual and community factors, including women’s education, pregnancy planning, autonomy, place of residence, mass media exposure, and health facility accessibility. Integrated interventions that strengthen family planning, promote women’s empowerment, improve service accessibility, and provide accurate reproductive health information are urgently needed to reduce abortion prevalence and improve maternal health outcomes in Ethiopia.
Introduction
Abortion remains a critical global public health concern, contributing significantly to maternal morbidity and mortality, particularly in low- and middle-income countries [1]. Although the global maternal mortality ratio has declined substantially over the past two decades, unsafe abortion continues to account for nearly 13% of maternal deaths worldwide [1,2]. Sub-Saharan Africa bears a disproportionate share of this burden, where restrictive abortion laws, limited access to safe services, and sociocultural barriers converge to increase women’s vulnerability [3]. Ethiopia, despite progressive policy reforms such as the 2005 revision of its abortion law, continues to face a high incidence of unsafe abortions, highlighting the persistence of systemic gaps in reproductive health service delivery [4,5].
Previous studies in Ethiopia and other parts of the world have identified a range of factors associated with abortion, spanning individual, household, and community levels [6,7]. At the individual level, education, economic status, and reproductive autonomy have consistently emerged as important determinants [8,9]. Unplanned pregnancies, often linked to limited contraceptive use and unmet family planning needs, remain a major driver of abortion globally [10]. At the community level, disparities between rural and urban settings, accessibility of health facilities, and exposure to mass media also shape reproductive decisions [11,12]. However, much of the existing evidence relies on single-level analyses, which fail to account for the hierarchical nature of determinants embedded within broader community structures [13]. This analytical limitation reduces the capacity to fully capture contextual influences on abortion practices.
Reading this evidence
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This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Amanuel Yoseph, Lakew Mussie, Mehretu Belayneh, Francisco Guillen-Grima. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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- Evidence brief: Exploring the association between home delivery and under-five mortality in Ethiopia: A bivariate multilevel mixed-effects analysis
- Evidence brief: Level of completion of the maternal health care continuum and its determinants among rural women in East Shoa Zone, Eastern Ethiopia: A multilevel analysis
- Evidence brief: Barriers to healthcare access among women in sub-Saharan Africa: A pooled analysis of multi-country DHS data (2019–2023)
