Unveiling 10‐Year Dynamics of Pregnancy Termination Across Sub‐Saharan Africa : A Multilevel Study

Background and Aims
Sub-Saharan African (SSA) women face significant reproductive health challenges, including unwanted pregnancies and unsafe abortions. Despite the high prevalence of pregnancy termination in the continent, multilevel determinants and recent data trends remain understudied. This study addresses these gaps by leveraging recent Demographic and Health Survey (DHS) data and advanced statistical techniques.

Methods
This study involves secondary analysis using DHS data collected between 2010 and 2021 from 33 countries in Sub-Saharan Africa. The analysis focused on pregnancy termination among women aged 15–49, comprising a weighted sample of 470,330 individuals. The data underwent a weighting process, considering sampling weight, primary sampling units, and strata. We utilized a multilevel binary logistic regression model to evaluate the correlation between individual and community-level variables and the probability of pregnancy termination. Given the nested structure of the models, comparisons were made using the deviance statistic (−2 log-likelihood ratio). All analyses were performed using STATA version 17. Variables with a p-value ≤ 0.2 in the bivariable multilevel analysis were included in the multivariable model. The final results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to indicate the strength and statistical significance of associations.

Results
The overall prevalence of pregnancy termination among reproductive-age women in SSA was 6.96% (95% CI: 6.89%, 7.03%), with the highest (13.59%) and lowest (3.83%) prevalence reported in Ghana and Ethiopia, respectively. The odds of pregnancy termination among rural resident women were 8% lower (AOR = 0.92, 95% CI: 0.89, 0.95) compared to urban residents. Women in Southern Africa had 9% decreased odds of pregnancy termination than women in Eastern Africa. Compared to women from East Africa, women in Western and Central Africa were 1.21 (AOR = 1.21, 95% CI: 1.18, 1.25) and 1.40 (AOR = 1.40, 95% CI: 1.35, 1.44) times higher odds of pregnancy termination, respectively.

Conclusion
The study reveals a notably high rate of pregnancy termination in SSA, which is particularly worrisome due to the legal limitations on abortion services in many SSA countries. Expanding access to contraception and comprehensive sexual health education is crucial to reducing unintended pregnancies across the region. Additionally, a reassessment of the strictness of abortion service restrictions is critical to encourage women to obtain these services from qualified professionals.