Trend of Unintended Pregnancy, Induced Abortion and Associated Factors among Adolescents in Ethiopia: Evidence from the 2000, 2005, 2011 and 2016 EDHS Data

Abstract Background Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Trends of unintended pregnancy and induced abortion are higher in developing countries and more than 90% of adolescent births occur in low income countries. Objectives This study determined the trend of unintended pregnancy, induced abortion and associated factors among adolescents in Ethiopia from 2000 to 2016. Methods Trends in the prevalence of unintended pregnancy and abortion among adolescents were investigated based on a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000 (n=741), 2005 (n=708), 2011 (n= 616), and 2016 (n=479). The combined dataset was used to increase the statistical power of the study in order to detect any association between the study factors and the outcomes, and to examine trends in unintended pregnancy and abortion over the study period (2000–2016). The percentage changes with corresponding 95% CI of the outcome variables were calculated by independent factors to examine the changes over the study period using chi-squared test for trend. Multilevel logistic regression analysis was done to identify factors associated with unintended pregnancy and abortion among adolescents. Results The prevalence of unintended pregnancy among Ethiopian adolescents aged 15-19 years decreased significantly from 41.4% (95% CI: 35.7, 47.2%) in 2000 to 25.1% (95% CI: 18.9, 31.4%) in 2016 (p-value=0.0001). Factors associated with a lower likelihood of unintended pregnancy among adolescents included being aged above 17 years old (AOR=0.30; 95% CI: 0.17-0.51) and married (AOR=0.14; 95% CI:0.07-0.28).While, parity (AOR= 1.68; 95%CI:1.02-2.75), resided in large central (AOR=3.32; 95%CI:1.86-5.63), and metropolis (AOR=3.12; 95%CI:1.20-8.12) regions were significantly associated with higher odds of untended pregnancy. The prevalence of abortion also decreased significantly from 8.3% (95% CI: 5.2, 11.4%) in 2000 to 4.1% (95% CI:1.3, 6.9%) in 2016 (p-value=0.04). Middle wealth index (AOR=0.14; 95% CI: 0.03-0.64), rich wealth (AOR=0.09; 95% CI: 0.01-0.74), female head household (AOR=0.11; 95%CI: 0.01-0.91) and rural resident (AOR=0.08; 95%CI: 0.01-0.45) were factors significantly associated with lower likelihood of abortion. Conclusion Although, the prevalence of unintended pregnancy and abortion among adolescents decreased significantly from 2000 to 2016, still both are public health problems in Ethiopia. Factors associated with higher unintended pregnancy were being below 18 years old, unmarried, higher parity, large central and metropolis regions. Belonging to poorer wealth index, urban resident and male headed households were factors associated with higher abortion rate. Hence, it is important to provide continuous sex education, contraception education and health information about the consequences of unintended pregnancy and abortion for adolescent girls in Ethiopia.