Intersecting outcomes of pregnancy: a population-based analysis of abortion, miscarriage, and stillbirth among Ghanaian women of reproductive age

Intersecting outcomes of pregnancy: a population-based analysis of abortion, miscarriage, and stillbirth among Ghanaian women of reproductive age | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intersecting outcomes of pregnancy: a population-based analysis of abortion, miscarriage, and stillbirth among Ghanaian women of reproductive age Samuel Salu, David Mensah Otoo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8358965/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Despite existing evidence linking abortion to subsequent reproductive complications, limited studies in Ghana have examined its relationship with miscarriage and stillbirth. This study aimed to examine the association between a history of abortion and the likelihood of miscarriage and stillbirth among Ghanaian women of reproductive age. Methods: The study analysed data from the 2017 Ghana Maternal Health Survey (GMHS), which included 24,881 women aged 15-49 years. Weighted descriptive statistics and bivariate analyses were performed to illustrate the distribution of pregnancy outcomes. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between history of abortion, miscarriage and stillbirth. A p-value <0.05 was considered statistically significant. Results: The prevalence of abortion, miscarriage, and stillbirth were 19.7%, 15.6%, and 4.8%, respectively. Further analysis revealed that women with a history of abortion were significantly more likely to experience miscarriage (aOR = 2.96; 95% CI: 2.84–3.10) and stillbirth (aOR = 1.89; 95% CI: 1.70–2.14) compared to those without a history of abortion. Conclusion: History of abortion emerged as a strong predictor of subsequent miscarriage and stillbirth among women of reproductive age. This finding emphasised that, strengthening post-abortion care, improving antenatal surveillance, and expanding access to reproductive health education are essential measures to reducing pregnancy losses and improving overall maternal outcomes. Abortion Miscarriage Stillbirth Pregnancy Women Ghana Key message What is already known : Globally and across sub-Saharan Africa, abortion, miscarriage, and stillbirth remain major contributors to maternal morbidity and mortality. Unsafe or complicated abortions can result in uterine or cervical damage and infections, increasing the risk of adverse outcomes in subsequent pregnancies. In Ghana, despite persistent rates of induced abortion and pregnancy loss, there is limited national evidence linking prior abortion to later miscarriage or stillbirth. What this study adds: Using data from the 2017 Ghana Maternal Health Survey (n = 24,881), this study provides population-level evidence demonstrating that women with a history of abortion were significantly more likely to experience subsequent miscarriage (AOR = 2.96) and stillbirth (AOR = 1.89). The findings quantify the intersection of multiple adverse pregnancy outcomes in Ghanaian women of reproductive age and highlight the reproductive health continuum linking a history of abortion to later pregnancy outcomes. How this might affect research, practice or policy: These results highlight the need for improved post-abortion care, preconception counseling, and targeted antenatal surveillance for women with previous abortions. Strengthening reproductive-health services, promoting safe abortion practices within the legal framework, and addressing gaps in family-planning uptake could reduce pregnancy losses and inform Ghana’s maternal-health and reproductive-rights policies. Background Abortion whether induced or spontaneous is a significant reproductive health event that may have implications for future pregnancy outcomes, including miscarriage and stillbirth ( 1 ). Globally, approximately 73 million induced abortions occur each year, accounting for nearly 61% of unintended pregnancies ( 2 ). While safe abortion procedures pose minimal risk when properly performed, evidence shows an association between prior abortions particularly unsafe ones and adverse outcomes in subsequent pregnancies ( 3 , 4 ). In sub-Saharan Africa, the burden of unsafe abortion is especially high due to limited access to safe services and persistent stigma ( 5 , 6 ). Although abortion is legally permissible under specific conditions in Ghana, access remains constrained, and unsafe abortion practices are common, particularly among younger and unmarried women ( 7 , 8 ). In many cases, these unsafe abortion practices result into complications such as pelvic inflammatory disease, uterine perforation, and sepsis, which may have lasting effects on fertility and future pregnancy outcomes ( 2 ). The WHO estimates that over 6 million unsafe abortions occur annually in the region, many of which result in long-term reproductive health complications ( 2 ). Findings from extant literature have linked prior abortion to adverse perinatal outcomes and pregnancy complications ( 9 – 11 ). However, in Ghana, studies have largely focused on the predictors of abortion ( 7 , 12 , 13 ). Despite these observations, there is limited empirical research in Ghana examining the direct association between history of abortion and adverse pregnancy outcomes, particularly miscarriage and stillbirth. This study, therefore, seeks to fill this gap by examining whether a history of abortion is a significant predictor of miscarriage and stillbirth in Ghana. Findings from this research will provide evidence to guide clinical risk assessment during antenatal care, inform reproductive health policy, and support the design of targeted public health interventions to reduce pregnancy losses and improve overall maternal outcomes. Methods Data source and study design This study utilized data from the 2017 Ghana Maternal Health Survey (GMHS), a nationally representative survey conducted between June 15 and October 12, 2017. The survey was implemented by the Ghana Statistical Service (GSS) and the Ghana Health Service (GHS), with technical support from ICF International under the Demographic and Health Surveys (DHS) Program ( 14 ). Designed as a cross-sectional study, the GMHS aimed to generate reliable estimates of key maternal and reproductive health indicators across Ghana ( 14 ). Four types of questionnaires were administered: the household questionnaire, the women’s questionnaire, the verbal autopsy questionnaire, and the health facility questionnaire. The present analysis was based on data from the women’s questionnaire, which targeted women aged 15–49 years ( 14 ). Respondents provided detailed information on pregnancy history, outcomes (live birth, miscarriage, stillbirth, and abortion), and the timing of pregnancies. Participation was voluntary, and only women who provided informed consent were interviewed. Data were collected at a single point in time, enabling the assessment of maternal and reproductive health indicators among Ghanaian women of reproductive age ( 14 ). Sampling procedure and study participants The GMHS utilized a stratified two-stage cluster sampling design based on the 2010 Population and Housing Census to ensure national representativeness. In the first stage, 900 enumeration areas (EAs) were selected using probability proportional to size, comprising 466 urban and 434 rural EAs, stratified by region and type of residence ( 14 ). In the second stage, 30 households were systematically chosen from each EA, yielding a total of 27,001 households. All women aged 15–49 years who were either permanent residents of the selected households or who had spent the night prior to the survey in those households were considered eligible for interview. Out of 25,304 eligible women identified, interviews were successfully completed with 25,062 respondents ( 14 ). For the present analysis, data were cleaned to ensure completeness and validity. After data cleaning, the final analytical sample comprised 24,881 women. Study variables Outcome variables The primary outcome variables in this study were miscarriage and stillbirth . In the GMHS dataset, miscarriage was recorded as “ever had a miscarriage” and stillbirth as “ever had a stillbirth.” The original response options were coded as “Yes” ( 1 ) and “No” ( 2 ). For the purpose of this analysis, the variables were recoded to enhance analytical consistency, with “No” coded as 0 and “Yes” coded as 1 . Explanatory variable The main explanatory variable in this study was history of abortion, captured in the dataset as “ever had an abortion.” The variable had two response options: “Yes” and “No.” For analytical purposes, these responses were recoded, with “No” coded as 0 and “Yes” coded as 1. Covariates Based on the availability of variables in the dataset, 11 covariates were considered in our estimation. Each variable was carefully recoded to align with the study’s analytical objectives. Age was categorized into seven groups: 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, and 45–49 years. Marital status was grouped into three categories: Currently in union, previously in union, and never been in union. Educational attainment was classified into four levels: No education, Primary, JHS, SHS, and Tertiary. Place of residence was dichotomized as urban or rural, while region was classified into three ecological zones: Coastal, Forest, and Savannah. Place of delivery was grouped as (Home, Public Health Facility, and Private Health Facility). Size of child at birth was categorized as (Smaller than average, Average, or Larger than average). Finally, distance to a nearby health facility was measured as either a big problem or not a big problem. Statistical analysis All statistical analyses were conducted using STATA version 17.0 (StataCorp, College Station, TX, USA). Sampling weights were applied to adjust for unequal probabilities of selection and to ensure that the findings were representative at both the national and regional levels. To ensure nationally representative estimates, sample weights were applied. Specifically, the Stata command “ svyset” was used to account for the complex sampling design. Descriptive statistics were used to summarize the socio-demographic characteristics of respondents. A Chi-square test was employed to examine associations between categorical variables and the outcomes of interest, providing estimates in terms of percentages and 95% confidence intervals (CIs). For the bivariate analysis, the main explanatory variable was examined independently using logistic regression to assess its relationship with the two outcome variables. The results were presented as crude odds ratios (cORs) with corresponding 95% CIs and p-values. Subsequently, a multivariable logistic regression model was employed to adjust for potential confounding factors using the covariates to evaluate how these factors influenced the observed associations between the explanatory variable and the outcome variables. Prior to model fitting, multicollinearity among covariates was assessed using the Variance Inflation Factor (VIF = 1.32), and no variable exceeded the threshold of 5, indicating no multicollinearity concerns. The multivariable logistic regression model generated adjusted odds ratios (aORs) with corresponding 95% CIs and p-values. Statistical significance was defined as p < 0.05, and results were interpreted within the context of their confidence intervals. Results Socio-demographic characteristics of respondents About 4793 (19.3%) of the respondents were within the ages of 15–19 years and about 8951 (36.0%) had JHS education. Regarding place of residence, 13689 (55.0%) dwells in urban areas and close to half 12053 (48.4%) were from costal ecological zones. Marital status showed that the majority 14220 (57.2%) were currently in union and about 8133 (68.4%) delivered in health facilities. Close to half 4893 (41.8%) had baby size larger than average and more than half 16824 (67.6%) had ever given birth. Most respondents 366 (89.7%) identified themselves as Christians, with Akans 203 (49.8%) representing the most dominating ethnic group. In terms of distance to health facility, about 5856 (23.5%) reported that it was a big problem. About 4,889 (19.7%) of the respondents have had an abortion before, 1188 (4.8%) had ever had still birth and 4101 (15.6%) have ever had miscarriage (Table 1 ). Table 1 Demographic characteristics of respondents Characteristics Weighted frequency (n) Weighted Percentage (%) Age 15–19 4793 19.3 20–24 4188 16.8 25–29 4172 16.8 30–34 3660 14.7 35–39 3280 13.2 40–44 2471 9.9 45–49 2317 9.3 Educational level No Education 4529 18.2 Primary 4959 19.9 JHS 8951 36.0 SHS 4537 18.2 Tertiary 1906 7.7 Place of residence Urban 13689 55.0 Rural 11192 45.0 Ecological zone Coastal 12053 48.4 Forest 9599 38.6 Savannah 3230 13.0 Marital Status Currently in Union 14220 57.2 Previously in Union 2286 9.2 Never Been in Union 8375 33.7 Place of delivery Home 2408 20.3 Public Health Facility 8133 68.4 Private Health Facility 1354 11.4 Size of child at birth Smaller than Average 2120 18.1 Average 4697 40.1 Larger than Average 4893 41.8 Distance to nearby health facility Big Problem 5856 23.5 Not a Big Problem 19025 76.5 Ever given birth No 8057 32.4 Yes 16824 67.6 Ever had abortion No 19992 80.3 Yes 4,889 19.7 Ever had still birth No 23693 95.2 Yes 1188 4.8 Ever had miscarriage No 20780 83.5 Yes 4101 15.6 Prevalence distribution of miscarriage and still birth across sociodemographic characteristics The study reported prevalence of miscarriage to be 15.6%. Miscarriage was significantly associated with several sociodemographic characteristics. Age showed a strong association, with prevalence increasing steadily from 1.1% among women aged 15–19 to a peak of 30.7% among those aged 40–44. Education level was also statistically significant with higher prevalence observed among women with no educational level (20.3%) and primary education level (20.4%). Marital status revealed that women currently or previously in a union had higher prevalence of miscarriage (both around 23%). A significant association, with high prevalence was also observed among women in forest areas (17.7%) and those who delivered in private health facilities (19.7%). Additionally, women who had a history of abortion reported higher prevalence (21.6%) of miscarriage. The prevalence of stillbirth among participants was 4.8%. The prevalence increased with age from 0.3% in the 15–19 age group to about 10% among women aged 40–44 and 45–49. Women with no education had the highest prevalence of stillbirth. Those in rural areas (5.5%), currently or previously in unions (7%), as well as those having a history of abortion (6.0%) reported higher prevalence of stillbirth (Table 2 ). Table 2 Prevalence distribution of miscarriage and still birth across sociodemographic characteristics Characteristics Miscarriage % [95% Cl] p-value Still birth % [95% Cl] p-value Age < 0.0001 < 0.0001 15–19 1.1 [0.8, 1.5] 0.3 [0.2, 0.6] 20–24 7.9 [6.8, 9.1] 1.8 [1.3, 2.4] 25–29 16.4 [15.0, 17.9] 3.5 [2.9, 4.3] 30–34 20.6 [19.0, 22.3] 6.1 [5.1, 7.2] 35–39 25.6 [23.7, 27.6] 7.8 [6.7, 8.9] 40–44 30.7 [28.3, 33.3] 10.0 [8.6, 11.5] 45–49 29.5 [27.0, 32.2] 9.8 [8.2, 11.7] Educational level < 0.0001 < 0.0001 No Education 20.3 [18.9, 21.7] 8.2 [7.3, 9.2] Primary 20.4 [18.8, 22.0] 6.1 [5.3, 7.0] JHS 15.2 [14.2, 16.3] 3.9 [3.4, 4.4] SHS 11.8 [10.6, 13.1] 2.6 [2.0, 3.4] Tertiary 14.5 [12.5, 16.8] 2.6 [1.8, 3.6] Place of residence 0.1871 0.0002 Urban 16.9 [16.1, 17.7] 4.2 [3.8, 4.6] Rural 16.0 [15.0, 17.0] 5.5 [5.0, 6.0] Ecological zone < 0.0001 0.3588 Coastal 16.4 [15.4, 17.4] 4.8 [4.3, 5.4] Forest 17.7 [16.7, 18.8] 4.9 [4.4, 5.5] Savannah 13.2 [12.2, 14.3] 4.3 [3.8, 4.8] Marital Status < 0.0001 < 0.0001 Currently in union 23.0 [22.1, 24.0] 6.8 [6.3, 7.4] Previously in union 23.3 [21.1, 25.7] 7.1 [5.9, 8.6] Never been in union 3.5 [3.1, 4.1] 0.6 [0.4, 0.9] Place of delivery 0.0449 0.0180 Home 16.3 [14.7, 18.1] 5.1 [4.1, 6.3] Public health facility 19.1 [18.0, 20.2] 7.4 [6.7, 8.2] Private health facility 19.7 [16.8, 23.0] 6.4 [4.7, 8.7] Size of child at birth 0.4984 0.2521 Smaller than average 19.2 [17.1, 21.5] 6.1 [5.0, 7.6] Average 17.8 [16.4, 19.4] 4.9 [4.2, 5.8] Larger than average 18.8 [16.9, 20.7] 5.0 [4.2, 5.9] Distance to nearby health facility 0.4364 0.8557 Big problem 16.0 [14.8, 17.4] 4.8 [4.2, 5.5] Not a big problem 16.6 [15.9, 17.4] 4.8 [4.4, 5.2] Ever given birth < 0.0001 < 0.0001 No 5.8 [5.2, 6.5] 0.9 [0.7, 1.2] Yes 21.6 [20.7, 22.5] 6.6 [6.2, 7.1] Ever had abortion < 0.0001 0.0012 No 15.2 [14.5, 15.9] 4.5 [4.1, 4.9] Yes 21.8 [20.3, 23.4] 6.0 [5.2, 6.9] Association between history of abortion and miscarriage and stillbirth In the bivariate analysis, women who had a history of abortion were significantly associated with miscarriage (COR = 1.61, 95% CI: [1.48, 1.76]) and stillbirth (COR = 1.28, 95% Cl: [1.10, 1.50]) as compared to women with no history of abortion. After adjusting for potential confounding variables, the observed associations remain significant. Women with a history of abortion were associated with approximately three-fold increased odds of miscarriage (AOR = 2.96, 95% Cl: [2.84, 3.10]). The odds increased with age as the 20–24 years age group reported 3 times higher odds (AOR = 2.72, 95% Cl: [1.64, 4.52]) and 12 times higher odds among those within 45–49 years (AOR = 11.77, 95% Cl: [6.90, 17.76]). The odds were higher among women with primary education (AOR = 1.24, 95% Cl: [1.07, 1.44], JHS educational level (AOR = 1.24, 95% Cl: [1.07, 1.44]) and SHS (AOR = 1.34, 95% Cl: [1.11, 1.62]). Rural residents had significantly lower odds (AOR = 0.84, 95% CI: [0.75, 0.94]) compared to urban residents. Those residing in the forest zones had increased odds (AOR = 1.13, 95% Cl: [1.00, 1.29]) compared to those in coastal zones. Women who had never been in a union also had lower odds (AOR = 0.53, 95% Cl: [0.41, 0.70]) compared to those currently in a union. Regarding stillbirth, women with a history of abortion were associated with approximately two-fold increased odds of stillbirth (AOR = 1.89, 95% Cl: [1.70, 2.14]). The odds increased significantly as age increased, those in the 20–24 years age group had 3 times higher odds (AOR = 3.23, 95% Cl: [0.98, 10.64]) and 14 times among those within 40–44 years (AOR = 14.45, 95% Cl: [4.39, 47.59]). Educational level showed significant protective associations, respondents with SHS (AOR = 0.59, 95% Cl: [0.41, 0.86]) and tertiary (AOR = 0.55, 95% Cl: [0.35, 0.86]) education level repoted lower odds compared to those with no education. Women living in the savannah zones had lower odds (AOR = 0.68, 95% Cl: [0.54, 0.87]). Those who delivered in public health facilities (AOR = 1.45, 95% Cl: [1.15, 1.83]) and private health facilities (AOR = 1.78, 95% Cl: [1.24, 2.55]) were also associated with significantly higher odds compared to women who delivered in the home (Table 3 ). Table 3 Association between history of abortion and miscarriage and stillbirth Explanatory variable Miscarriage Still birth cOR [95% Cl] aOR [95% Cl] cOR [95% Cl] aOR [95% Cl] Ever had abortion No Ref Ref Ref Ref Yes 1.61 [1.48, 1.76] *** 2.96 [2.84, 3.10] *** 1.28 [1.10, 1.50] ** 1.89 [1.70, 2.14] *** Age 15–19 Ref Ref 20–24 2.72 [1.64, 4.52] *** 3.23 [0.98, 10.64] *** 25–29 4.76 [2.89, 7.84] *** 5.83 [1.79, 19.00] *** 30–34 6.31 [3.84, 10.39] *** 8.41 [2.57, 27.47] *** 35–39 8.03 [4.87, 13.23] *** 12.37 [3.79, 40.32] *** 40–44 9.53 [5.73, 15.86] *** 14.45 [4.39, 47.59] *** 45–49 11.77 [6.90, 17.76] *** 13.55 [3.97, 46.21] *** Educational level No Education Ref Ref Primary 1.24 [1.07, 1.44] ** 0.85 [0.65, 1.09] JHS 1.28 [1.11, 1.48] *** 0.81 [0.63, 1.04] SHS 1.34 [1.11, 1.62] ** 0.59 [0.41, 0.86] ** Tertiary 1.15 [0.92, 1.44] 0.55 [0.35, 0.86] ** Place of residence Urban Ref Ref Rural 0.84 [0.75, 0.94] ** 1.14 [0.93, 1.39] Ecological zone Coastal Ref Ref Forest 1.13 [1.00, 1.29] ** 0.91 [0.73, 1.14] Savannah 0.93 [0.81, 1.07] 0.68 [0.54, 0.87] ** Marital Status Currently in Union Ref Ref Previously in Union 0.89 [0.72, 1.10] 1.01 [0.71, 1.44] Never Been in Union 0.53 [0.41, 0.70] *** 0.62 [0.36, 1.07] Place of delivery Home Ref Ref Public Health Facility 1.10 [0.97, 1.25] 1.45 [1.15, 1.83] ** Private Health Facility 1.13 [0.92, 1.38] 1.78 [1.24, 2.55] ** Size of Child at Birth Smaller than Average Ref Ref Average 0.90 [0.78, 1.03] 0.68 [0.54, 0.86] Larger than Average 0.97 [0.85, 1.11] 0.70 [0.56, 0.88] Distance to nearby health facility Big Problem Ref Ref Not a Big Problem 0.96 [0.86, 1.05] 1.09 [0.89, 1.32] cOR = crude odd ratio; aOR = adjusted odd ratio; CI = confidence interval; Ref = reference point Discussion This study explored the relationship between a history of abortion and the occurrence of miscarriage and stillbirth. The prevalence of abortion in this study was 19.7%. This finding is consistent with a study from South Africa which reported a prevalence of 19% ( 15 ). Similarly, research in India also indicated a prevalence of 21% ( 16 ). Contrastingly, in regions of China, a study indicated a lower prevalence of 16.7% ( 17 ). Another study found that about 56.6% of abortions were repeat incidents, often stemming from unintended pregnancies ( 18 ). Research in SSA provides a broader context, indicating that about 37% of women with unplanned pregnancies terminate their pregnancies ( 19 ). These findings are corroborated by a study which revealed that about 25% of the respondents in Ghana and 9% of the respondents in Mozambique reported having ever had a pregnancy terminated ( 20 ). These findings highlight that abortion remains a common reproductive health issue in many low- and middle-income countries. The prevalence of miscarriage was reported to be 15.6%. This finding is lower when compared with similar studies, which reported a prevalence of 17.9% in Jordan ( 21 ), 18.9% in Kenya ( 22 ) and 20.5% in Sudan ( 23 ). The higher prevalence observed across these countries may be attributed to factors such as higher maternal age at conception, increased prevalence of infectious diseases, inadequate antenatal monitoring, and a higher burden of obstetric complications, all of which are known contributors to pregnancy loss. Conversely, the prevalence observed in this study was higher than that reported in Manitoba (11.3%) ( 24 ) and India (7.3%) ( 25 ), with a more recent study in India documenting an even lower prevalence of 4.9% ( 26 ). Similarly, ( 27 ) reported a prevalence of 5% in Sierra Leone. The plausible explanation for the lower prevalence reported in these studies may reflect better access to comprehensive maternal healthcare, early detection and management of pregnancy complications, improved reproductive health education, and better socioeconomic conditions. The relatively moderate prevalence in the current study therefore likely reflects a middle ground between settings with strong health systems and those facing persistent maternal health challenges, emphasizing the continuing need for strengthened antenatal surveillance and early intervention to reduce pregnancy losses. The study also found that the prevalence of stillbirth was 4.8%. This is lower when compared to studies in Ethiopia (14.5%) ( 28 ) and Nigeria (6.2%) ( 29 ). The relatively higher prevalence reported in these studies may be due to the variations in the inclusion of high-risk populations and the persistence of preventable causes such as malaria in pregnancy, anemia and prolonged labor which are common in these areas. Differences in obstetric referral efficiency and access to life-saving interventions during labor may also explain the observed high prevalence across these studies. In contrast, the prevalence found in this study was higher than that reported in China (0.18%) ( 30 ), Brazil (0.5%) ( 31 ) and Nepal (2.46%) ( 32 ). This could be due to the fact that these countries have achieved remarkable reductions in stillbirths through consistent improvements in maternal health surveillance, early risk assessment, and effective community-level education on danger signs in pregnancy. Furthermore, better perinatal data systems in such countries ensure early detection and intervention for fetal distress which substantially lowers stillbirth rates. We found that women with a history of abortion had approximately three times higher odds of experiencing a miscarriage compared to those without such a history. This finding is in line with a longitudinal study by ( 33 ) who found an association between first pregnancy abortions and future pregnancy outcomes, suggesting that women who have had abortions are at increased risk for adverse pregnancy outcomes, including higher rates of miscarriage. This is supported by the findings of ( 34 ) who revealed that recurrent miscarriages following one or two previous losses elevate the likelihood of future pregnancy complications such as miscarriage, with probabilities rising notably with multiple prior losses. Similarly, a cohort analysis by ( 35 ) showed that women with previous abortion experiences exhibited higher odds of gestational diabetes, which is a recognized risk factor for miscarriage. Recent data from a study among Chinese women also demonstrated an increased risk for adverse pregnancy outcomes, including miscarriages, among those with a history of spontaneous abortions ( 36 ). Substantially, other studies have investigated the biological and physiological underpinnings connecting abortion and subsequent miscarriage risk. For instance, research by ( 37 ) noted that women who have had prior spontaneous miscarriages may exhibit uterine anomalies which are recognized risk factors for miscarriage. This observation indicates that prior abortions might aggravate these risks due to associated complications such as scarring or abnormalities in the uterine lining ( 38 ). Additionally, some studies have indicated that increased psychological distress linked to past pregnancies can exacerbate the risk for complications in future pregnancies ( 39 , 40 ). Our findings also showed that women with a history of abortion had about twice the odds of experiencing a stillbirth compared to those who never had a history of abortion. This finding aligns with a growing body of literature which identified both spontaneous and induced abortions as relevant risk factors for recurrent stillbirths ( 41 ). Similar findings by ( 42 ) reported a significant correlation between prior abortions and the occurrence of stillbirth, identifying that the risk of stillbirth among mothers with a history of abortion was elevated to 8.72 times higher than among mothers without such a history. This suggests that a preceding abortion may indicate underlying issues that ultimately contribute to adverse outcomes in subsequent pregnancies. Extant literature has particularly emphasized that unresolved maternal health conditions or complications stemming from previous pregnancy losses may complicate future gestations, potentially due to underlying issues like hormonal imbalances ( 43 ). It has also been noted that women with a history of reproductive failures may carry a higher degree of reproductive health issues, such as autoimmune diseases, adversely affecting fetal outcomes ( 43 ). Supporting this viewpoint, research by ( 44 ) found that adverse childhood experiences exacerbated fetal loss rates, indicating that maternal health and psychosocial factors are crucial in assessing the broader ramifications of previous abortions. Additionally, existing literature indicated that a history of stillbirth is a known risk factor for subsequent stillbirth, further reinforcing the concept that past pregnancy losses correlate with future risks ( 45 ). In broader terms, these findings resonate with evidence indicating that a history of pregnancy loss, including both abortions and stillbirths, is linked with increased complications in subsequent pregnancies, although specific figures may vary across studies ( 46 ). Implications for policy and practice The findings of this study have important implications for maternal and reproductive health policy and clinical practice. The relatively high prevalence of abortion and its strong association with subsequent miscarriage and stillbirth emphasize the need for a more comprehensive reproductive health framework that prioritizes preventive, educational, and post-abortion care interventions. Policymakers should strengthen family planning services to reduce unintended pregnancies, ensuring equitable access to a wide range of contraceptive options particularly for young and low-income women. Integrating post-abortion counseling and follow-up care into maternal health programs is crucial to detect and manage potential complications early, thereby reducing risks in future pregnancies. From a clinical standpoint, health professionals should routinely document women’s reproductive histories, including prior abortions and use this information to identify those at higher risk of adverse pregnancy outcomes. This can guide the provision of personalized antenatal monitoring, uterine health assessments, and psychological support for women with a history of pregnancy loss. Furthermore, enhancing antenatal surveillance systems to ensure timely screening for gestational complications such as diabetes, hypertension, and infections could reduce miscarriage and stillbirth rates subsequently. At the policy level, investments in maternal health infrastructure, particularly in rural and low-resource areas, remain essential to improving early risk detection and referral systems. The findings also call for intersectoral collaboration between reproductive health, mental health, and social welfare programs to address the psychosocial distress and stigma often associated with abortion and pregnancy loss. Collectively, these measures will help strengthen Ghana’s maternal health system, reduce preventable pregnancy losses, and accelerate progress toward Sustainable Development Goal 3.1, which aims to lower global maternal mortality and ensure safe pregnancies for all women. Conclusion In conclusion, this study found that a history of abortion significantly increases the risk of adverse pregnancy outcomes, with women who had ever undergone an abortion being about three times more likely to experience a miscarriage and twice as likely to experience a stillbirth compared to those without such a history. The study also recorded significant prevalence rates of abortion, miscarriage, and stillbirth, indicating that pregnancy loss remains a substantial reproductive health concern. These findings suggest that previous abortions may predispose women to subsequent complications through physiological, hormonal, or uterine changes, compounded by inadequate post-abortion care and limited antenatal monitoring. The results highlight the need for improved post-abortion follow-up, strengthened antenatal surveillance, and targeted reproductive counseling to prevent recurrent pregnancy losses and enhance maternal health outcomes. Declarations Ethical approval and consent to participate Ethical clearance was not required for this study since the DHS dataset utilized is publicly accessible. The data were obtained from the DHS Program after completing the required registration and obtaining authorization. All ethical principles governing the use of secondary data for research were strictly observed. Comprehensive details regarding the ethical standards and data use policies of the DHS Program are available at the following link: http://goo.gl/ny8T6X . Consent for publication Not applicable Patient and Public Involvement No patients or members of the public were involved in the design, conduct, reporting, or dissemination of this research. AI use statement AI assistance was used solely for language structuring and grammatical refinement. The tool was employed to enhance clarity and coherence in the manuscript. No AI-generated content, data analysis, interpretation or substantive intellectual contribution was made. The authors maintained full responsibility for the study design, data analysis, interpretation, and all scientific conclusions. Competing interests None Funding None Author Contribution SS and DMO conceptualized the study, designed the analyses, curated the data and performed the formal analyses, drafted the initial manuscript, reviewed the initial manuscript for its accuracy and critically reviewed and revised the drafted manuscript. All authors have reviewed the final manuscript and approved its submission. Acknowledgement We acknowledge the Measure DHS for granting us free access to the dataset used in this study. Data Availability The datasets generated and/or analyzed in this study are available in the Measure DHS repository: [https://www.dhsprogram.com/methodology/survey/survey-display-506.cfm](https:/www.dhsprogram.com/methodology/survey/survey-display-506.cfm) References Jurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage. BMJ. 2013 June;22(7913):f3676. WHO. Abortion [Internet]. 2024 [cited 2025 Apr 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/abortion Simmonds K, Jody S. Patient education: Abortion (pregnancy termination) (Beyond the Basics) - UpToDate [Internet]. 2025 [cited 2025 Apr 10]. Available from: https://www.uptodate.com/contents/abortion-pregnancy-termination-beyond-the-basics/print Kerns JL, Brown K, Nippita S, Steinauer J. Society of Family Planning Clinical Recommendation: Management of hemorrhage at the time of abortion. Contraception. 2024;129. Bankole A, Remez L, Owolabi O, Philbin J, Williams P. From Unsafe to Safe Abortion in Sub-Saharan Africa: Slow but Steady Progress. 2020. Ziraba KK, Izugbara C, Levandowski BA, Gebreselassie H, Mutua M, Mohamed SF, et al. Unsafe abortion in Kenya: A cross-sectional study of abortion complication severity and associated factors. BMC Pregnancy Childbirth. 2015;15(1):1–11. Atakro CA, Addo SB, Aboagye JS, Menlah A, Garti I, Amoa-Gyarteng KG, et al. Contributing factors to unsafe abortion practices among women of reproductive age at selected district hospitals in the Ashanti region of Ghana. BMC Womens Health. 2019;19(1):1–17. Keogh SC, Otupiri E, Castillo PW, Li NW, Apenkwa J, Polis CB. Contraceptive and abortion practices of young Ghanaian women aged 15–24: evidence from a nationally representative survey. Reprod Health. 2021;18(1):1–17. Sun H, Mao J, Su X, Du Q. Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies. BMC Public Health. 2023;23(1):1–10. Jia D, Sun F, Han S, Lu L, Sun Y, Song Q. Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis. J Obstet Gynaecol Res. 2024;50(3):281–97. Zhang S, Lu C, Zhao Q, Xiang Y, He W, Qu Y, et al. The association between a history of induced abortion for nonmedical reasons and maternal and neonatal perinatal outcomes: a retrospective cohort study. J Matern Fetal Neonatal Med. 2025;38(1):2466207. Baruwa OJ, Amoateng AY, Biney E. Induced abortion in Ghana: prevalence and associated factors. J Biosoc Sci. 2022;54(2):257–68. Klu D, Atiglo DY, Manyeh AK, Immurana M, Dalaba M. Determinants of Choice of Abortion Methods among Women in Ghana; Does Knowledge on legality of Abortion Matter? medRxiv. 2020 July 4;2020.07.02.20144923. GSS GHS, Ghana Maternal Health Survey ICF. 2017. 2018 Aug 1 [cited 2025 July 11]; Available from: https://www.dhsprogram.com/publications/publication-fr340-other-final-reports.cfm Ajayi AI, Ahinkorah BO, Seidu AA, Adeniyi OV. Prevalence and correlates of induced abortion: results of a facility-based cross-sectional survey of parturient women living with HIV in South Africa. Reprod Health [Internet]. 2022 Dec 5 [cited 2025 Oct 11];19(1):220. Available from: https://doi.org/10.1186/s12978-022-01520-9 Bongfen MC, Abanem EEB. Abortion practices among women in Buéa: a socio-legal investigation. 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Individual and contextual factors associated with abortion among reproductive age women in sub-Saharan Africa: Insights from 24 recent demographic and health surveys. PLOS ONE [Internet]. 2024 Dec 12 [cited 2025 Oct 11];19(12):e0315262. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315262 Dickson KS, Adde KS, Ahinkorah BO. Socio – economic determinants of abortion among women in Mozambique and Ghana: evidence from demographic and health survey. Arch Public Health [Internet]. 2018 July 19 [cited 2025 Oct 11];76(1):37. Available from: https://doi.org/10.1186/s13690-018-0286-0 Al-Alami Z, Abu-Huwaij R, Hamadneh S, Taybeh E. Understanding Miscarriage Prevalence and Risk Factors: Insights from Women in Jordan. Med Lith [Internet]. 2024 July 1 [cited 2025 May 9];60(7). Available from: https://doi.org/10.3390/medicina60071044 Dellicour S, Aol G, Ouma P, Yan N, Bigogo G, Hamel MJ et al. Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya. BMJ Open [Internet]. 2016 Apr 1 [cited 2025 Oct 10];6(4):e011088. Available from: https://bmjopen.bmj.com/content/6/4/e011088 Hassan BA, Elmugabil A, Alhabrdi NA, Ahmed ABA, Rayis DA, Adam I. Maternal age and miscarriage: A unique association curve in Sudan. Afr J Reprod Health [Internet]. 2022 Aug 16 [cited 2025 Oct 10];26(7):15–21. Available from: https://www.ajol.info/index.php/ajrh/article/view/229736 Strumpf E, Lang A, Austin N, Derksen SA, Bolton JM, Brownell MD et al. Prevalence and clinical, social, and health care predictors of miscarriage. BMC Pregnancy Childbirth [Internet]. 2021 Mar 5 [cited 2025 Oct 10];21(1):185. Available from: https://doi.org/10.1186/s12884-021-03682-z Kuppusamy P, Prusty RK, Chaaithanya IK, Gajbhiye RK, Sachdeva G. Pregnancy outcomes among Indian women: increased prevalence of miscarriage and stillbirth during 2015–2021. BMC Pregnancy Childbirth [Internet]. 2023 Mar 8 [cited 2025 Oct 10];23(1):150. Available from: https://doi.org/10.1186/s12884-023-05470-3 Das M, Patidar H, Singh M. Understanding trimester-specific miscarriage risk in Indian women: insights from the calendar data of National Family Health Survey (NFHS-5) 2019-21. BMC Womens Health [Internet]. 2024 Jan 23 [cited 2025 Oct 10];24(1):63. Available from: https://doi.org/10.1186/s12905-023-02838-7 Matheron H, Westendorp J, van Duinen A, Mansaray M, Daskalska L, Sankoh O et al. The burden of miscarriages and perinatal deaths in Sierra Leone, data from a nation-wide household survey (PRESSCO 2020). 2022 [cited 2025 Oct 10]; Available from: https://www.authorea.com/users/457980/articles/554598-the-burden-of-miscarriages-and-perinatal-deaths-in-sierra-leone-data-from-a-nation-wide-household-survey-pressco-2020?commit=b17e16cd4a0a402daf848e37cc14207862369f95 Mengistu S, Debella A, Mulatu T, Mesfin F, Danusa KT, Dheresa M. Stillbirth and Associated Factors Among Women Who Gave Birth at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Front Pediatr [Internet]. 2022 May 12 [cited 2025 Oct 10];10. Available from: https://www.frontiersin.org/journals/pediatrics/articles/ 10.3389/fped.2022.820308/full Okunowo AA, Smith-Okonu ST. The Trend and Characteristics of Stillbirth Delivery in a University Teaching Hospital in Lagos, Nigeria. Ann Afr Med [Internet]. 2020 Dec [cited 2025 Oct 10];19(4):221. Available from: https://journals.lww.com/aoam/fulltext/2020/19040/the_trend_and_characteristics_of_stillbirth.2.aspx Xue RH, Zhang Y, Tang D, Li YX, Li J, Zhang L. Stillbirth in Shanghai, China: prevalence, fetal sex disparities, and gestational age trends over a decade. 2025 [cited 2025 Oct 10]; Available from: https://www.authorea.com/users/478527/articles/1334935-stillbirth-in-shanghai-china-prevalence-fetal-sex-disparities-and-gestational-age-trends-over-a-decade?commit=b44e120b1c495a84e5ce9c1014c006f8133739fd Marques LJP, Silva ZP, da, Alencar GP, da Paixão ES, Blencowe H, de Almeida MF. Prevalence and risk of stillbirth according to biologic vulnerability phenotypes in the municipality of São Paulo, Brazil: A population-based cohort study. Int J Gynecol Obstet [Internet]. 2024 [cited 2025 Oct 10];165(2):442–52. Available from: https://onlinelibrary.wiley.com/doi/abs/ 10.1002/ijgo.15102 Khadka D, Dhakal KB, Dhakal A, Dhakal Rai S. Stillbirths among Pregnant Women Admitted to Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2022 Sept 1;60(253):761–5. Studnicki J, Longbons T, Reardon DC, Fisher JW, Harrison DJ, Skop I et al. The Enduring Association of a First Pregnancy Abortion with Subsequent Pregnancy Outcomes: A Longitudinal Cohort Study. Health Serv Res Manag Epidemiol [Internet]. 2022 Jan 1 [cited 2025 Oct 10];9:23333928221130942. Available from: https://doi.org/10.1177/23333928221130942 Patki A, Chauhan N. An Epidemiology Study to Determine the Prevalence and Risk Factors Associated with Recurrent Spontaneous Miscarriage in India. J Obstet Gynecol India [Internet]. 2016 Oct 1 [cited 2025 Oct 10];66(5):310–5. Available from: https://doi.org/10.1007/s13224-015-0682-0 Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland. Acta Diabetol [Internet]. 2023 June 1 [cited 2025 Oct 10];60(6):845–9. Available from: https://doi.org/10.1007/s00592-023-02047-6 Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Tian X et al. Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: findings from the China Kadoorie Biobank. BMC Med [Internet]. 2017 Aug 8 [cited 2025 Oct 10];15(1):148. Available from: https://doi.org/10.1186/s12916-017-0912-7 Poorolajal J, Cheraghi P, Cheraghi Z, Ghahramani M, Irani AD. Predictors of miscarriage: a matched case-control study. Epidemiol Health [Internet]. 2014 Nov 20 [cited 2025 Oct 10];36:e2014031. Available from: https://e-epih.org/journal/view.php?doi=10.4178/epih/e2014031 Parks E, Martinez CL. Abortion Complications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Oct 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430793/ Giannandrea SAM, Cerulli C, Anson E, Chaudron LH. Increased Risk for Postpartum Psychiatric Disorders Among Women with Past Pregnancy Loss. J Womens Health [Internet]. 2013 Sept [cited 2025 Oct 10];22(9):760–8. Available from: https://www.liebertpub.com/doi/ 10.1089/jwh.2012.4011 Sarwar AH, Singh B, Kishore S, Priyanka FNU, Ali A, Pariya FNU et al. History of Pregnancy Loss as a Risk Factor for Myocardial Infarction. Cureus [Internet]. 2021 Aug 18 [cited 2025 Oct 10];13(8). Available from: https://cureus.com/articles/65310-history-of-pregnancy-loss-as-a-risk-factor-for-myocardial-infarction Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and meta-analysis. BMJ [Internet]. 2015 June 24 [cited 2025 Oct 10];350:h3080. Available from: https://www.bmj.com/content/350/bmj.h3080 Zolfizadeh F, Soltani M, Soltani S, Kamali S, Tabatabaee HR, Nasiri N et al. The Correlation Between Stillbirth and Related Risk Factors: A Case-Control Study. Hormozgan Med J [Internet]. 2019 Sept 24 [cited 2025 Oct 10];23(3):e92616–e92616. Available from: https://hmj.hums.ac.ir/Article/92616 Onal EI, Mohammed G, Kaya E, Onal A, Castro-Delgado R. Determinants of Miscarriage and Induced Abortion Among Married Syrian Refugee Women in Türkiye: A National Population-Based Study. Disaster Med Public Health Prep [Internet]. 2025 Jan [cited 2025 Oct 10];19:e246. Available from: https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/determinants-of-miscarriage-and-induced-abortion-among-married-syrian-refugee-women-in-turkiye-a-national-populationbased-study/8551BCC539CBEE0A059842A7A56CB0A6 Liu W, Sun W, Yang L, Huang Y, Zhu S, Xiao W et al. Paternal and maternal exposures to adverse childhood experiences and spontaneous fetal loss: a nationwide cross-sectional analysis. BMC Public Health [Internet]. 2024 Apr 15 [cited 2025 Oct 10];24(1):1047. Available from: https://doi.org/10.1186/s12889-024-18477-y Christou A, Mbishi J, Matsui M, Beňová L, Kim R, Numazawa A et al. Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017–2020: a cross-sectional assessment with a nested case–control study. Reprod Health [Internet]. 2023 Oct 21 [cited 2025 Oct 10];20(1):157. Available from: https://doi.org/10.1186/s12978-023-01703-y Horn J, Tanz L, Stuart J, Markovitz A, Skurnik G, Rimm E et al. Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study. BJOG Int J Obstet Gynaecol [Internet]. 2019 [cited 2025 Oct 10];126(1):33–42. Available from: https://onlinelibrary.wiley.com/doi/abs/ 10.1111/1471-0528.15452 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8358965","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578568119,"identity":"ec2dcd97-511c-4c23-9d22-5ebb48b1962c","order_by":0,"name":"Samuel Salu","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Salu","suffix":""},{"id":578568121,"identity":"ef7e1948-b47f-488d-840b-e40672b93300","order_by":1,"name":"David Mensah Otoo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDCCA0DEg8SVA5MPCGsxgHONwWQCAS0MyFoSG0AUPi18x88YHnhT8UeOX+zwsYc/au6kzw87/BBoi52cbgN2LZJncgwOzjljYCw5Oy3dmOfYs9yNt9MMgFqSjc0OYNdicCAt4TBvm0Hihts5ZtIMbIdzN85OAGk5kLgNl5bzz2Ba8r9J/vh3ON1wdvoH/FpuJB+A2cImwdt2OEFeOge/LZI3Hh8A+sUY5Bczad6+w4YbpHMKDiQY4PYL3/nE5g9vKuTk+KWTn0n++HZYXn52+uYPHyrs5HBpwRYgYJJY5SAg30CK6lEwCkbBKBgJAABfzGx0QycS6gAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"Mensah","lastName":"Otoo","suffix":""}],"badges":[],"createdAt":"2025-12-14 15:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8358965/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8358965/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100986406,"identity":"92ebdf97-84de-4654-a1b0-74c07b7a7c17","added_by":"auto","created_at":"2026-01-23 13:19:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104461,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/71ad3de0144897e456aab393.docx"},{"id":100986405,"identity":"cf89cec6-3e92-4ed5-865c-7b8dc950f613","added_by":"auto","created_at":"2026-01-23 13:19:02","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4770,"visible":true,"origin":"","legend":"","description":"","filename":"a316268e662d4419a7e21aef4f8e4cda.json","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/b43bc233833ff156609f7ddf.json"},{"id":100986407,"identity":"270b8881-42c5-44ea-866e-ee0cb4b2e6a1","added_by":"auto","created_at":"2026-01-23 13:19:02","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":148255,"visible":true,"origin":"","legend":"","description":"","filename":"a316268e662d4419a7e21aef4f8e4cda1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/84a3c7d009f9d4b0fc9a95b1.xml"},{"id":100986409,"identity":"14d9b97b-6c67-46d7-a26f-fb1fc25c6434","added_by":"auto","created_at":"2026-01-23 13:19:02","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":145272,"visible":true,"origin":"","legend":"","description":"","filename":"a316268e662d4419a7e21aef4f8e4cda1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/98f76f6181f1051d6503ee4d.xml"},{"id":100986408,"identity":"20ec07e2-be74-48ea-9886-278e7a642972","added_by":"auto","created_at":"2026-01-23 13:19:02","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159324,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/56a17fa9417b668111f494d0.html"},{"id":102295040,"identity":"6ef7c46d-50a5-4205-912c-234abd671a58","added_by":"auto","created_at":"2026-02-10 10:07:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1521842,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8358965/v1/99d2821f-36bc-4c9d-ba9e-67b7065d4f5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intersecting outcomes of pregnancy: a population-based analysis of abortion, miscarriage, and stillbirth among Ghanaian women of reproductive age","fulltext":[{"header":"Key message","content":"\u003cp\u003e\u003cstrong\u003eWhat is already known\u003c/strong\u003e: Globally and across sub-Saharan Africa, abortion, miscarriage, and stillbirth remain major contributors to maternal morbidity and mortality. Unsafe or complicated abortions can result in uterine or cervical damage and infections, increasing the risk of adverse outcomes in subsequent pregnancies. In Ghana, despite persistent rates of induced abortion and pregnancy loss, there is limited national evidence linking prior abortion to later miscarriage or stillbirth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds:\u003c/strong\u003e\u0026nbsp; Using data from the 2017 Ghana Maternal Health Survey (n = 24,881), this study provides population-level evidence demonstrating that women with a history of abortion were significantly more likely to experience subsequent miscarriage (AOR = 2.96) and stillbirth (AOR = 1.89). The findings quantify the intersection of multiple adverse pregnancy outcomes in Ghanaian women of reproductive age and highlight the reproductive health continuum linking a history of abortion to later pregnancy outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHow this might affect research, practice or policy:\u003c/strong\u003e These results highlight the need for improved post-abortion care, preconception counseling, and targeted antenatal surveillance for women with previous abortions. Strengthening reproductive-health services, promoting safe abortion practices within the legal framework, and addressing gaps in family-planning uptake could reduce pregnancy losses and inform Ghana\u0026rsquo;s maternal-health and reproductive-rights policies.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eAbortion whether induced or spontaneous is a significant reproductive health event that may have implications for future pregnancy outcomes, including miscarriage and stillbirth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Globally, approximately 73\u0026nbsp;million induced abortions occur each year, accounting for nearly 61% of unintended pregnancies (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While safe abortion procedures pose minimal risk when properly performed, evidence shows an association between prior abortions particularly unsafe ones and adverse outcomes in subsequent pregnancies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa, the burden of unsafe abortion is especially high due to limited access to safe services and persistent stigma (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although abortion is legally permissible under specific conditions in Ghana, access remains constrained, and unsafe abortion practices are common, particularly among younger and unmarried women (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In many cases, these unsafe abortion practices result into complications such as pelvic inflammatory disease, uterine perforation, and sepsis, which may have lasting effects on fertility and future pregnancy outcomes (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The WHO estimates that over 6\u0026nbsp;million unsafe abortions occur annually in the region, many of which result in long-term reproductive health complications (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFindings from extant literature have linked prior abortion to adverse perinatal outcomes and pregnancy complications (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, in Ghana, studies have largely focused on the predictors of abortion (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Despite these observations, there is limited empirical research in Ghana examining the direct association between history of abortion and adverse pregnancy outcomes, particularly miscarriage and stillbirth.\u003c/p\u003e \u003cp\u003eThis study, therefore, seeks to fill this gap by examining whether a history of abortion is a significant predictor of miscarriage and stillbirth in Ghana. Findings from this research will provide evidence to guide clinical risk assessment during antenatal care, inform reproductive health policy, and support the design of targeted public health interventions to reduce pregnancy losses and improve overall maternal outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source and study design\u003c/h2\u003e \u003cp\u003eThis study utilized data from the 2017 Ghana Maternal Health Survey (GMHS), a nationally representative survey conducted between June 15 and October 12, 2017. The survey was implemented by the Ghana Statistical Service (GSS) and the Ghana Health Service (GHS), with technical support from ICF International under the Demographic and Health Surveys (DHS) Program (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Designed as a cross-sectional study, the GMHS aimed to generate reliable estimates of key maternal and reproductive health indicators across Ghana (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFour types of questionnaires were administered: the household questionnaire, the women\u0026rsquo;s questionnaire, the verbal autopsy questionnaire, and the health facility questionnaire. The present analysis was based on data from the women\u0026rsquo;s questionnaire, which targeted women aged 15\u0026ndash;49 years (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Respondents provided detailed information on pregnancy history, outcomes (live birth, miscarriage, stillbirth, and abortion), and the timing of pregnancies. Participation was voluntary, and only women who provided informed consent were interviewed. Data were collected at a single point in time, enabling the assessment of maternal and reproductive health indicators among Ghanaian women of reproductive age (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling procedure and study participants\u003c/h3\u003e\n\u003cp\u003eThe GMHS utilized a stratified two-stage cluster sampling design based on the 2010 Population and Housing Census to ensure national representativeness. In the first stage, 900 enumeration areas (EAs) were selected using probability proportional to size, comprising 466 urban and 434 rural EAs, stratified by region and type of residence (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In the second stage, 30 households were systematically chosen from each EA, yielding a total of 27,001 households. All women aged 15\u0026ndash;49 years who were either permanent residents of the selected households or who had spent the night prior to the survey in those households were considered eligible for interview. Out of 25,304 eligible women identified, interviews were successfully completed with 25,062 respondents (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For the present analysis, data were cleaned to ensure completeness and validity. After data cleaning, the final analytical sample comprised 24,881 women.\u003c/p\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOutcome variables\u003c/h2\u003e \u003cp\u003eThe primary outcome variables in this study were \u003cem\u003emiscarriage\u003c/em\u003e and \u003cem\u003estillbirth\u003c/em\u003e. In the GMHS dataset, miscarriage was recorded as \u003cem\u003e\u0026ldquo;ever had a miscarriage\u0026rdquo;\u003c/em\u003e and stillbirth as \u003cem\u003e\u0026ldquo;ever had a stillbirth.\u0026rdquo;\u003c/em\u003e The original response options were coded as \u003cem\u003e\u0026ldquo;Yes\u0026rdquo;\u003c/em\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and \u003cem\u003e\u0026ldquo;No\u0026rdquo;\u003c/em\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). For the purpose of this analysis, the variables were recoded to enhance analytical consistency, with \u003cem\u003e\u0026ldquo;No\u0026rdquo; coded as 0\u003c/em\u003e and \u003cem\u003e\u0026ldquo;Yes\u0026rdquo; coded as 1\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExplanatory variable\u003c/h3\u003e\n\u003cp\u003eThe main explanatory variable in this study was history of abortion, captured in the dataset as \u003cem\u003e\u0026ldquo;ever had an abortion.\u0026rdquo;\u003c/em\u003e The variable had two response options: \u003cem\u003e\u0026ldquo;Yes\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;No.\u0026rdquo;\u003c/em\u003e For analytical purposes, these responses were recoded, with \u003cem\u003e\u0026ldquo;No\u0026rdquo;\u003c/em\u003e coded as 0 and \u003cem\u003e\u0026ldquo;Yes\u0026rdquo;\u003c/em\u003e coded as 1.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eBased on the availability of variables in the dataset, 11 covariates were considered in our estimation. Each variable was carefully recoded to align with the study\u0026rsquo;s analytical objectives. Age was categorized into seven groups: 15\u0026ndash;19, 20\u0026ndash;24, 25\u0026ndash;29, 30\u0026ndash;34, 35\u0026ndash;39, 40\u0026ndash;44, and 45\u0026ndash;49 years. Marital status was grouped into three categories: Currently in union, previously in union, and never been in union. Educational attainment was classified into four levels: No education, Primary, JHS, SHS, and Tertiary. Place of residence was dichotomized as urban or rural, while region was classified into three ecological zones: Coastal, Forest, and Savannah. Place of delivery was grouped as (Home, Public Health Facility, and Private Health Facility). Size of child at birth was categorized as (Smaller than average, Average, or Larger than average). Finally, distance to a nearby health facility was measured as either a big problem or not a big problem.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted using STATA version 17.0 (StataCorp, College Station, TX, USA). Sampling weights were applied to adjust for unequal probabilities of selection and to ensure that the findings were representative at both the national and regional levels. To ensure nationally representative estimates, sample weights were applied. Specifically, the Stata command \u0026ldquo;\u003cem\u003esvyset\u0026rdquo;\u003c/em\u003e was used to account for the complex sampling design. Descriptive statistics were used to summarize the socio-demographic characteristics of respondents. A Chi-square test was employed to examine associations between categorical variables and the outcomes of interest, providing estimates in terms of percentages and 95% confidence intervals (CIs).\u003c/p\u003e \u003cp\u003eFor the bivariate analysis, the main explanatory variable was examined independently using logistic regression to assess its relationship with the two outcome variables. The results were presented as crude odds ratios (cORs) with corresponding 95% CIs and p-values. Subsequently, a multivariable logistic regression model was employed to adjust for potential confounding factors using the covariates to evaluate how these factors influenced the observed associations between the explanatory variable and the outcome variables. Prior to model fitting, multicollinearity among covariates was assessed using the Variance Inflation Factor (VIF\u0026thinsp;=\u0026thinsp;1.32), and no variable exceeded the threshold of 5, indicating no multicollinearity concerns. The multivariable logistic regression model generated adjusted odds ratios (aORs) with corresponding 95% CIs and p-values. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and results were interpreted within the context of their confidence intervals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of respondents\u003c/h2\u003e \u003cp\u003eAbout 4793 (19.3%) of the respondents were within the ages of 15\u0026ndash;19 years and about 8951 (36.0%) had JHS education. Regarding place of residence, 13689 (55.0%) dwells in urban areas and close to half 12053 (48.4%) were from costal ecological zones. Marital status showed that the majority 14220 (57.2%) were currently in union and about 8133 (68.4%) delivered in health facilities. Close to half 4893 (41.8%) had baby size larger than average and more than half 16824 (67.6%) had ever given birth.\u003c/p\u003e \u003cp\u003eMost respondents 366 (89.7%) identified themselves as Christians, with Akans 203 (49.8%) representing the most dominating ethnic group. In terms of distance to health facility, about 5856 (23.5%) reported that it was a big problem. About 4,889 (19.7%) of the respondents have had an abortion before, 1188 (4.8%) had ever had still birth and 4101 (15.6%) have ever had miscarriage (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeighted frequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWeighted Percentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological zone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoastal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSavannah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreviously in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever Been in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic Health Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Health Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSize of child at birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmaller than Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarger than Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to nearby health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot a Big Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver given birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had abortion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had still birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had miscarriage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence distribution of miscarriage and still birth across sociodemographic characteristics\u003c/h2\u003e \u003cp\u003eThe study reported prevalence of miscarriage to be 15.6%. Miscarriage was significantly associated with several sociodemographic characteristics. Age showed a strong association, with prevalence increasing steadily from 1.1% among women aged 15\u0026ndash;19 to a peak of 30.7% among those aged 40\u0026ndash;44. Education level was also statistically significant with higher prevalence observed among women with no educational level (20.3%) and primary education level (20.4%). Marital status revealed that women currently or previously in a union had higher prevalence of miscarriage (both around 23%). A significant association, with high prevalence was also observed among women in forest areas (17.7%) and those who delivered in private health facilities (19.7%). Additionally, women who had a history of abortion reported higher prevalence (21.6%) of miscarriage.\u003c/p\u003e \u003cp\u003eThe prevalence of stillbirth among participants was 4.8%. The prevalence increased with age from 0.3% in the 15\u0026ndash;19 age group to about 10% among women aged 40\u0026ndash;44 and 45\u0026ndash;49. Women with no education had the highest prevalence of stillbirth. Those in rural areas (5.5%), currently or previously in unions (7%), as well as those having a history of abortion (6.0%) reported higher prevalence of stillbirth (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence distribution of miscarriage and still birth across sociodemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiscarriage\u003c/p\u003e \u003cp\u003e% [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStill birth\u003c/p\u003e \u003cp\u003e% [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1 [0.8, 1.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3 [0.2, 0.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.9 [6.8, 9.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8 [1.3, 2.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.4 [15.0, 17.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5 [2.9, 4.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.6 [19.0, 22.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.1 [5.1, 7.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.6 [23.7, 27.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8 [6.7, 8.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.7 [28.3, 33.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0 [8.6, 11.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.5 [27.0, 32.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.8 [8.2, 11.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.3 [18.9, 21.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.2 [7.3, 9.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.4 [18.8, 22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.1 [5.3, 7.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.2 [14.2, 16.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.9 [3.4, 4.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.8 [10.6, 13.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6 [2.0, 3.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.5 [12.5, 16.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6 [1.8, 3.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.9 [16.1, 17.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2 [3.8, 4.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.0 [15.0, 17.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5 [5.0, 6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological zone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoastal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.4 [15.4, 17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8 [4.3, 5.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.7 [16.7, 18.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.9 [4.4, 5.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSavannah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.2 [12.2, 14.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3 [3.8, 4.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently in union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.0 [22.1, 24.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8 [6.3, 7.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreviously in union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.3 [21.1, 25.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.1 [5.9, 8.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever been in union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.5 [3.1, 4.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6 [0.4, 0.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.0449\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0180\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.3 [14.7, 18.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.1 [4.1, 6.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.1 [18.0, 20.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.4 [6.7, 8.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.7 [16.8, 23.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4 [4.7, 8.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSize of child at birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.2521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmaller than average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.2 [17.1, 21.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.1 [5.0, 7.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.8 [16.4, 19.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.9 [4.2, 5.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarger than average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.8 [16.9, 20.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0 [4.2, 5.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to nearby health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.8557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.0 [14.8, 17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8 [4.2, 5.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot a big problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.6 [15.9, 17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8 [4.4, 5.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver given birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.8 [5.2, 6.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9 [0.7, 1.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.6 [20.7, 22.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6 [6.2, 7.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver had abortion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.2 [14.5, 15.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5 [4.1, 4.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.8 [20.3, 23.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0 [5.2, 6.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between history of abortion and miscarriage and stillbirth\u003c/h2\u003e \u003cp\u003eIn the bivariate analysis, women who had a history of abortion were significantly associated with miscarriage (COR\u0026thinsp;=\u0026thinsp;1.61, 95% CI: [1.48, 1.76]) and stillbirth (COR\u0026thinsp;=\u0026thinsp;1.28, 95% Cl: [1.10, 1.50]) as compared to women with no history of abortion.\u003c/p\u003e \u003cp\u003eAfter adjusting for potential confounding variables, the observed associations remain significant. Women with a history of abortion were associated with approximately three-fold increased odds of miscarriage (AOR\u0026thinsp;=\u0026thinsp;2.96, 95% Cl: [2.84, 3.10]). The odds increased with age as the 20\u0026ndash;24 years age group reported 3 times higher odds (AOR\u0026thinsp;=\u0026thinsp;2.72, 95% Cl: [1.64, 4.52]) and 12 times higher odds among those within 45\u0026ndash;49 years (AOR\u0026thinsp;=\u0026thinsp;11.77, 95% Cl: [6.90, 17.76]). The odds were higher among women with primary education (AOR\u0026thinsp;=\u0026thinsp;1.24, 95% Cl: [1.07, 1.44], JHS educational level (AOR\u0026thinsp;=\u0026thinsp;1.24, 95% Cl: [1.07, 1.44]) and SHS (AOR\u0026thinsp;=\u0026thinsp;1.34, 95% Cl: [1.11, 1.62]). Rural residents had significantly lower odds (AOR\u0026thinsp;=\u0026thinsp;0.84, 95% CI: [0.75, 0.94]) compared to urban residents. Those residing in the forest zones had increased odds (AOR\u0026thinsp;=\u0026thinsp;1.13, 95% Cl: [1.00, 1.29]) compared to those in coastal zones. Women who had never been in a union also had lower odds (AOR\u0026thinsp;=\u0026thinsp;0.53, 95% Cl: [0.41, 0.70]) compared to those currently in a union.\u003c/p\u003e \u003cp\u003eRegarding stillbirth, women with a history of abortion were associated with approximately two-fold increased odds of stillbirth (AOR\u0026thinsp;=\u0026thinsp;1.89, 95% Cl: [1.70, 2.14]). The odds increased significantly as age increased, those in the 20\u0026ndash;24 years age group had 3 times higher odds (AOR\u0026thinsp;=\u0026thinsp;3.23, 95% Cl: [0.98, 10.64]) and 14 times among those within 40\u0026ndash;44 years (AOR\u0026thinsp;=\u0026thinsp;14.45, 95% Cl: [4.39, 47.59]). Educational level showed significant protective associations, respondents with SHS (AOR\u0026thinsp;=\u0026thinsp;0.59, 95% Cl: [0.41, 0.86]) and tertiary (AOR\u0026thinsp;=\u0026thinsp;0.55, 95% Cl: [0.35, 0.86]) education level repoted lower odds compared to those with no education. Women living in the savannah zones had lower odds (AOR\u0026thinsp;=\u0026thinsp;0.68, 95% Cl: [0.54, 0.87]). Those who delivered in public health facilities (AOR\u0026thinsp;=\u0026thinsp;1.45, 95% Cl: [1.15, 1.83]) and private health facilities (AOR\u0026thinsp;=\u0026thinsp;1.78, 95% Cl: [1.24, 2.55]) were also associated with significantly higher odds compared to women who delivered in the home (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between history of abortion and miscarriage and stillbirth\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExplanatory variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMiscarriage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eStill birth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecOR [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaOR [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecOR [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR [95% Cl]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver had abortion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61 [1.48, 1.76] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.96 [2.84, 3.10] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28 [1.10, 1.50] **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.89 [1.70, 2.14] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.72 [1.64, 4.52] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.23 [0.98, 10.64] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.76 [2.89, 7.84] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.83 [1.79, 19.00] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.31 [3.84, 10.39] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.41 [2.57, 27.47] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.03 [4.87, 13.23] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.37 [3.79, 40.32] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.53 [5.73, 15.86] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.45 [4.39, 47.59] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.77 [6.90, 17.76] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.55 [3.97, 46.21] ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.24 [1.07, 1.44] **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 [0.65, 1.09]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.28 [1.11, 1.48] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81 [0.63, 1.04]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.34 [1.11, 1.62] **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59 [0.41, 0.86] **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15 [0.92, 1.44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55 [0.35, 0.86] **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84 [0.75, 0.94] **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.14 [0.93, 1.39]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEcological zone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoastal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 [1.00, 1.29] **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91 [0.73, 1.14]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSavannah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93 [0.81, 1.07]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68 [0.54, 0.87] **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreviously in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89 [0.72, 1.10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01 [0.71, 1.44]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever Been in Union\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53 [0.41, 0.70] ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62 [0.36, 1.07]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic Health Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10 [0.97, 1.25]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45 [1.15, 1.83] **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Health Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13 [0.92, 1.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78 [1.24, 2.55] **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSize of Child at Birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmaller than Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90 [0.78, 1.03]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68 [0.54, 0.86]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarger than Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97 [0.85, 1.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.70 [0.56, 0.88]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistance to nearby health facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot a Big Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96 [0.86, 1.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.09 [0.89, 1.32]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ecOR\u0026thinsp;=\u0026thinsp;crude odd ratio; aOR\u0026thinsp;=\u0026thinsp;adjusted odd ratio; CI\u0026thinsp;=\u0026thinsp;confidence interval; Ref\u0026thinsp;=\u0026thinsp;reference point\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the relationship between a history of abortion and the occurrence of miscarriage and stillbirth. The prevalence of abortion in this study was 19.7%. This finding is consistent with a study from South Africa which reported a prevalence of 19% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Similarly, research in India also indicated a prevalence of 21% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Contrastingly, in regions of China, a study indicated a lower prevalence of 16.7% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Another study found that about 56.6% of abortions were repeat incidents, often stemming from unintended pregnancies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Research in SSA provides a broader context, indicating that about 37% of women with unplanned pregnancies terminate their pregnancies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These findings are corroborated by a study which revealed that about 25% of the respondents in Ghana and 9% of the respondents in Mozambique reported having ever had a pregnancy terminated (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These findings highlight that abortion remains a common reproductive health issue in many low- and middle-income countries.\u003c/p\u003e \u003cp\u003eThe prevalence of miscarriage was reported to be 15.6%. This finding is lower when compared with similar studies, which reported a prevalence of 17.9% in Jordan (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), 18.9% in Kenya (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and 20.5% in Sudan (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The higher prevalence observed across these countries may be attributed to factors such as higher maternal age at conception, increased prevalence of infectious diseases, inadequate antenatal monitoring, and a higher burden of obstetric complications, all of which are known contributors to pregnancy loss. Conversely, the prevalence observed in this study was higher than that reported in Manitoba (11.3%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and India (7.3%) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), with a more recent study in India documenting an even lower prevalence of 4.9% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Similarly, (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) reported a prevalence of 5% in Sierra Leone. The plausible explanation for the lower prevalence reported in these studies may reflect better access to comprehensive maternal healthcare, early detection and management of pregnancy complications, improved reproductive health education, and better socioeconomic conditions. The relatively moderate prevalence in the current study therefore likely reflects a middle ground between settings with strong health systems and those facing persistent maternal health challenges, emphasizing the continuing need for strengthened antenatal surveillance and early intervention to reduce pregnancy losses.\u003c/p\u003e \u003cp\u003eThe study also found that the prevalence of stillbirth was 4.8%. This is lower when compared to studies in Ethiopia (14.5%) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and Nigeria (6.2%) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The relatively higher prevalence reported in these studies may be due to the variations in the inclusion of high-risk populations and the persistence of preventable causes such as malaria in pregnancy, anemia and prolonged labor which are common in these areas. Differences in obstetric referral efficiency and access to life-saving interventions during labor may also explain the observed high prevalence across these studies. In contrast, the prevalence found in this study was higher than that reported in China (0.18%) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Brazil (0.5%) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and Nepal (2.46%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This could be due to the fact that these countries have achieved remarkable reductions in stillbirths through consistent improvements in maternal health surveillance, early risk assessment, and effective community-level education on danger signs in pregnancy. Furthermore, better perinatal data systems in such countries ensure early detection and intervention for fetal distress which substantially lowers stillbirth rates.\u003c/p\u003e \u003cp\u003eWe found that women with a history of abortion had approximately three times higher odds of experiencing a miscarriage compared to those without such a history. This finding is in line with a longitudinal study by (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) who found an association between first pregnancy abortions and future pregnancy outcomes, suggesting that women who have had abortions are at increased risk for adverse pregnancy outcomes, including higher rates of miscarriage. This is supported by the findings of (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) who revealed that recurrent miscarriages following one or two previous losses elevate the likelihood of future pregnancy complications such as miscarriage, with probabilities rising notably with multiple prior losses. Similarly, a cohort analysis by (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) showed that women with previous abortion experiences exhibited higher odds of gestational diabetes, which is a recognized risk factor for miscarriage. Recent data from a study among Chinese women also demonstrated an increased risk for adverse pregnancy outcomes, including miscarriages, among those with a history of spontaneous abortions (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSubstantially, other studies have investigated the biological and physiological underpinnings connecting abortion and subsequent miscarriage risk. For instance, research by (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) noted that women who have had prior spontaneous miscarriages may exhibit uterine anomalies which are recognized risk factors for miscarriage. This observation indicates that prior abortions might aggravate these risks due to associated complications such as scarring or abnormalities in the uterine lining (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Additionally, some studies have indicated that increased psychological distress linked to past pregnancies can exacerbate the risk for complications in future pregnancies (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings also showed that women with a history of abortion had about twice the odds of experiencing a stillbirth compared to those who never had a history of abortion. This finding aligns with a growing body of literature which identified both spontaneous and induced abortions as relevant risk factors for recurrent stillbirths (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Similar findings by (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) reported a significant correlation between prior abortions and the occurrence of stillbirth, identifying that the risk of stillbirth among mothers with a history of abortion was elevated to 8.72 times higher than among mothers without such a history. This suggests that a preceding abortion may indicate underlying issues that ultimately contribute to adverse outcomes in subsequent pregnancies.\u003c/p\u003e \u003cp\u003eExtant literature has particularly emphasized that unresolved maternal health conditions or complications stemming from previous pregnancy losses may complicate future gestations, potentially due to underlying issues like hormonal imbalances (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). It has also been noted that women with a history of reproductive failures may carry a higher degree of reproductive health issues, such as autoimmune diseases, adversely affecting fetal outcomes (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Supporting this viewpoint, research by (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) found that adverse childhood experiences exacerbated fetal loss rates, indicating that maternal health and psychosocial factors are crucial in assessing the broader ramifications of previous abortions.\u003c/p\u003e \u003cp\u003eAdditionally, existing literature indicated that a history of stillbirth is a known risk factor for subsequent stillbirth, further reinforcing the concept that past pregnancy losses correlate with future risks (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). In broader terms, these findings resonate with evidence indicating that a history of pregnancy loss, including both abortions and stillbirths, is linked with increased complications in subsequent pregnancies, although specific figures may vary across studies (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eImplications for policy and practice\u003c/h2\u003e \u003cp\u003eThe findings of this study have important implications for maternal and reproductive health policy and clinical practice. The relatively high prevalence of abortion and its strong association with subsequent miscarriage and stillbirth emphasize the need for a more comprehensive reproductive health framework that prioritizes preventive, educational, and post-abortion care interventions. Policymakers should strengthen family planning services to reduce unintended pregnancies, ensuring equitable access to a wide range of contraceptive options particularly for young and low-income women. Integrating post-abortion counseling and follow-up care into maternal health programs is crucial to detect and manage potential complications early, thereby reducing risks in future pregnancies.\u003c/p\u003e \u003cp\u003eFrom a clinical standpoint, health professionals should routinely document women\u0026rsquo;s reproductive histories, including prior abortions and use this information to identify those at higher risk of adverse pregnancy outcomes. This can guide the provision of personalized antenatal monitoring, uterine health assessments, and psychological support for women with a history of pregnancy loss. Furthermore, enhancing antenatal surveillance systems to ensure timely screening for gestational complications such as diabetes, hypertension, and infections could reduce miscarriage and stillbirth rates subsequently.\u003c/p\u003e \u003cp\u003eAt the policy level, investments in maternal health infrastructure, particularly in rural and low-resource areas, remain essential to improving early risk detection and referral systems. The findings also call for intersectoral collaboration between reproductive health, mental health, and social welfare programs to address the psychosocial distress and stigma often associated with abortion and pregnancy loss. Collectively, these measures will help strengthen Ghana\u0026rsquo;s maternal health system, reduce preventable pregnancy losses, and accelerate progress toward Sustainable Development Goal 3.1, which aims to lower global maternal mortality and ensure safe pregnancies for all women.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study found that a history of abortion significantly increases the risk of adverse pregnancy outcomes, with women who had ever undergone an abortion being about three times more likely to experience a miscarriage and twice as likely to experience a stillbirth compared to those without such a history. The study also recorded significant prevalence rates of abortion, miscarriage, and stillbirth, indicating that pregnancy loss remains a substantial reproductive health concern. These findings suggest that previous abortions may predispose women to subsequent complications through physiological, hormonal, or uterine changes, compounded by inadequate post-abortion care and limited antenatal monitoring. The results highlight the need for improved post-abortion follow-up, strengthened antenatal surveillance, and targeted reproductive counseling to prevent recurrent pregnancy losses and enhance maternal health outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003eEthical clearance was not required for this study since the DHS dataset utilized is publicly accessible. The data were obtained from the DHS Program after completing the required registration and obtaining authorization. All ethical principles governing the use of secondary data for research were strictly observed. Comprehensive details regarding the ethical standards and data use policies of the DHS Program are available at the following link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://goo.gl/ny8T6X\u003c/span\u003e\u003cspan address=\"http://goo.gl/ny8T6X\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003ePatient and Public Involvement\u003c/h2\u003e \u003cp\u003eNo patients or members of the public were involved in the design, conduct, reporting, or dissemination of this research.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAI use statement\u003c/strong\u003e \u003cp\u003eAI assistance was used solely for language structuring and grammatical refinement. The tool was employed to enhance clarity and coherence in the manuscript. No AI-generated content, data analysis, interpretation or substantive intellectual contribution was made. The authors maintained full responsibility for the study design, data analysis, interpretation, and all scientific conclusions.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSS and DMO conceptualized the study, designed the analyses, curated the data and performed the formal analyses, drafted the initial manuscript, reviewed the initial manuscript for its accuracy and critically reviewed and revised the drafted manuscript. All authors have reviewed the final manuscript and approved its submission.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe acknowledge the Measure DHS for granting us free access to the dataset used in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed in this study are available in the Measure DHS repository: [https://www.dhsprogram.com/methodology/survey/survey-display-506.cfm](https:/www.dhsprogram.com/methodology/survey/survey-display-506.cfm)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJurkovic D, Overton C, Bender-Atik R. Diagnosis and management of first trimester miscarriage. BMJ. 2013 June;22(7913):f3676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Abortion [Internet]. 2024 [cited 2025 Apr 10]. 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BMC Public Health [Internet]. 2024 Apr 15 [cited 2025 Oct 10];24(1):1047. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-024-18477-y\u003c/span\u003e\u003cspan address=\"10.1186/s12889-024-18477-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristou A, Mbishi J, Matsui M, Beňov\u0026aacute; L, Kim R, Numazawa A et al. Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017\u0026ndash;2020: a cross-sectional assessment with a nested case\u0026ndash;control study. Reprod Health [Internet]. 2023 Oct 21 [cited 2025 Oct 10];20(1):157. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/abs/\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/1471-0528.15452\u003c/span\u003e\u003cspan address=\"10.1111/1471-0528.15452\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Abortion, Miscarriage, Stillbirth, Pregnancy, Women, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-8358965/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8358965/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDespite existing evidence linking abortion to subsequent reproductive complications, limited studies in Ghana have examined its relationship with miscarriage and stillbirth. This study aimed to examine the association between a history of abortion and the likelihood of miscarriage and stillbirth among Ghanaian women of reproductive age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study analysed data from the 2017 Ghana Maternal Health Survey (GMHS), which included 24,881 women aged 15-49 years. Weighted descriptive statistics and bivariate analyses were performed to illustrate the distribution of pregnancy outcomes. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between history of abortion, miscarriage and stillbirth. A p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe prevalence of abortion, miscarriage, and stillbirth were 19.7%, 15.6%, and 4.8%, respectively. Further analysis revealed that women with a history of abortion were significantly more likely to experience miscarriage (aOR = 2.96; 95% CI: 2.84–3.10) and stillbirth (aOR = 1.89; 95% CI: 1.70–2.14) compared to those without a history of abortion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eHistory of abortion emerged as a strong predictor of subsequent miscarriage and stillbirth among women of reproductive age. This finding emphasised that, strengthening post-abortion care, improving antenatal surveillance, and expanding access to reproductive health education are essential measures to reducing pregnancy losses and improving overall maternal outcomes.\u003c/p\u003e","manuscriptTitle":"Intersecting outcomes of pregnancy: a population-based analysis of abortion, miscarriage, and stillbirth among Ghanaian women of reproductive age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 13:18:57","doi":"10.21203/rs.3.rs-8358965/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-28T14:55:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180782239574554747786517031721481165199","date":"2026-01-22T07:30:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-21T13:25:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T08:11:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T00:22:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T00:21:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-14T15:10:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ada9010-df7a-43a7-891b-8ce548cd0e11","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T13:18:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 13:18:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8358965","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8358965","identity":"rs-8358965","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}