Prevalence and Abortion Methods Employed by Women Working in Flower Farms of Batu Town, Ethiopia

Abstract

Background: Each year, throughout the world, approximately 210 million women become pregnant and among these, 75 million pregnancies end in stillbirth, or spontaneous or induced abortion. This study was aimed to assess the prevalence of abortion, its associated factors and preferences of health care usage among women of reproductive age working in flower farms of Batu town, Oromia Regional State, Ethiopia. Methods: Institutional based cross sectional study was conducted from May 10 to 25, 2012 on 345 women of reproductive age who had history of pregnancy in the last six years while working in flower farms of Batu town. The study subjects were selected by simple random sampling. The data were collected by interviewer administered questionnaire for quantitative method. Quantitative data were coded and entered into and analyzed using SPSS for windows version 16.0. Binary logistic regression was done to test association between selected independent variables and outcome variable. Results: Abortion was reported by 87(25.6%) of those women. Out of these, 34(39.1%) were induced and 53(60.9%) spontaneous abortion. Women whose last pregnancy were unwanted were about 7.9 times more likely to have an abortion than those women whose last pregnancy were wanted (AOR [95% CI] =7.9[2.3, 26.8]). Women who had two and above births in the last six years were more likely to have an abortion compared to women who had one birth (AOR [95% CI] =4.9[2.3, 10.7]). Conclusions: Having more births in the last six years and having the last pregnancy unwanted were predictors of abortion in this study. Reaching more target group in encouraging women to utilize family planning especially condom and seek appropriate health care when it is needed is recommended.

Full text

Science Journal of Public Health
2015; 3(3): 404-409
Published online May 12, 2015 (http://www.sciencepublishinggroup.com/j/sjph)
doi: 10.11648/j.sjph.20150303.26
ISSN: 2328-7942 (Print); ISSN: 2328-7950 (Online)
Prevalence and Abortion Methods Employed by Women
Working in Flower Farms of Batu Town, Ethiopia
Desalegn Bekele
1, *
, Mohammed Taha
2
, Fasil Tessema
2
1
School of Medicine, Dire-Dawa University, Dire-Dawa, Ethiopia
2
Department of Epidemiology and Biostatistics, College of Public Health & Medical Sciences, Jimma University, Jimma, Ethiopia
Email address:
desalegn333@gmail.com (D. Bekele), tahamohammed2009@gmail.com (M. Taha), alazarfasil@yahoo.com (F. Tessema)
To cite this article:
Desalegn Bekele, Mohammed Taha, Fasil Tessema. Prevalence and Abortion Methods Employed by Women Working in Flower Farms of
Batu Town, Ethiopia. Science Journal of Public Health. Vol. 3, No. 3, 2015, pp. 404-409. doi: 10.11648/j.sjph.20150303.26
Abstract:
Background: Each year, throughout the world, approximately 210 million women become pregnant and among
these, 75 million pregnancies end in stillbirth, or spontaneous or induced abortion. This study was aimed to assess the
prevalence of abortion, its associated factors and preferences of health care usage among women of reproductive age working
in flower farms of Batu town, Oromia Regional State, Ethiopia. Methods: Institutional based cross sectional study was
conducted from May 10 to 25, 2012 on 345 women of reproductive age who had history of pregnancy in the last six years
while working in flower farms of Batu town. The study subjects were selected by simple random sampling. The data were
collected by interviewer administered questionnaire for quantitative method. Quantitative data were coded and entered into and
analyzed using SPSS for windows version 16.0. Binary logistic regression was done to test association between selected
independent variables and outcome variable. Results: Abortion was reported by 87(25.6%) of those women. Out of these,
34(39.1%) were induced and 53(60.9%) spontaneous abortion. Women whose last pregnancy were unwanted were about 7.9
times more likely to have an abortion than those women whose last pregnancy were wanted (AOR [95% CI] =7.9[2.3, 26.8]).
Women who had two and above births in the last six years were more likely to have an abortion compared to women who had
one birth (AOR [95% CI] =4.9[2.3, 10.7]). Conclusions: Having more births in the last six years and having the last pregnancy
unwanted were predictors of abortion in this study. Reaching more target group in encouraging women to utilize family
planning especially condom and seek appropriate health care when it is needed is recommended.
Keywords:
Abortion, Preference of Health Care Usage, Flower Farms
1. Background
An estimated 43.8 million abortions occurred in 2008;
about 86% of all abortions took place in the developing
world. In this year, more than 97% of abortions in Africa
were unsafe [1].
One in eight pregnancy-related deaths worldwide is
caused by unsafe abortion [2]. Thirteen percent of all
maternal deaths could be prevented by implementing
appropriate post abortion care and helping couples obtain
family planning information and services [3-5]. Preventing
unplanned pregnancies alone could avert around one quarter
of maternal deaths, including those that result from unsafe
abortion [6].
Worldwide, births to unmarried adolescent mothers are
far more likely to be unintended and those outside marriage
are more likely to end in abortion. They are, therefore, more
likely to suffer serious complications and even death [7- 9].
The estimated abortion rate in 2008 was 38 per 1,000
women aged 15–44 in Eastern Africa, 36 in Middle Africa
and 28 per 1,000 in Western Africa; virtually all of the
procedures in these sub regions were unsafe [10]. In Africa,
one in every 150 abortions leads to death, compared to one
in every 85,000 procedures in the developed world [2].
Women faced with an unintended pregnancy often self-
induced abortions or obtain clandestine abortions from
medical practitioners, paramedical workers, or traditional
healers [3]. Undesired pregnancies and induced abortion
due to sexual violence and interruption of family planning
services are among underlying risk factors for maternal
deaths and illness [4, 11-13].
As of 2008 estimate in Ethiopia, more than seven in 10

Science Journal of Public Health 2015; 3(3): 404-409 405
women who want to avoid pregnancy either do not practice
contraception or use a relatively ineffective traditional
method [14]. Unsafe abortion was one of the top 10 causes
of hospital admissions accounts for nearly 60% of all
gynecologic admissions and almost 30% of all obstetric and
gynecologic admissions [15].
About half of all health facilities in Ethiopia provide
induced abortion services. However, the proportion is much
higher for public hospitals (76%) and private or
nongovernmental organization (NGO) facilities (63%) than
for public health centers (41%). These proportions are
likely changing rapidly, as efforts are being made to expand
abortion services in public facilities. Currently, private and
NGO facilities provide the induced abortions [16].
The reason for teenage pregnancy and abortion varies
from country to country and from region to region within
the same country. Factors that are associated with teenage
pregnancy and abortion include rapid urbanization, low
socioeconomic status, low access to contraceptive, low
educational and career aspiration, residence in a single
parent home and poor family relationship [17].
Due to the expansion of flower farm industries in
Ethiopia in which the majority of the workers are women of
reproductive age exposed to sexual risk behaviors, little was
known about the magnitude of abortion and its associated
factors. The problem of abortion and the preference of care-
seeking behavior among women working in flower farm
areas (particularly, in the Batu town) have not been assessed.
It was necessary and timely to study this important issue on
women working in flower farms. This study was therefore
aimed at investigating the prevalence of abortion, its
associated factors and preference of health care usage
among child-bearing women in flower farms.
2. Methods
2.1. Study Area and Period
Institutional based cross-sectional study design was
employed from May 10 to 25, 2012 in flower farms of Batu
town, which is located 169 km from Addis Ababa along the
main road connecting Addis Ababa to Hawasa in the East
Shewa Zone of Ethiopia. Adjacent to Lake Ziway, the
economy of the town is based on fishing and horticulture [18].
There are five flower farms around Batu town, namely Share
Ethiopia, Ziway Rose, Herberg Rose, Braam Rose and AQ
Rose; all are situated in the Southern part of the town having:
- 2654, 1268, 1099, 508 and 1249 workers respectively. Out
of these, 1956, 965, 766, 375 and 900 were childbearing
women found in the respective flower farms. This means a
total of 4,962 women in the flower farms were in child
bearing age [19].
2.2. Source Population
Before the actual study, census was conducted for nine
days to get the number of women who have ever been
pregnant in the last six years. During the census, interview
using short listed questionnaire was applied to get the total
number of women experienced pregnancy. It was found that
1,732 women had experienced pregnancy at least once in the
last six years.
The study population was selected women in the
reproductive age group who had history of pregnancy in the
last six years while working in the flower farms.
2.3. Sample Size and Sampling Procedures
The sample was estimated using sample size determination
formula, [n
o
= (Zα/2)
2
p(1-p)/d
2
] for single population
proportion using the following assumptions. A prevalence
level of (50%) for abortion; and desired precision of 5%, 95%
confidence level and 10% non-response rate were considered.
Hence, the sample size was calculated as [n
o
= (Zα/2)
2
p (1-p)
/d
2
] = (1.96)
2
x(0.5x0.5)/(0.05)
2
=384.
Since the source
population was less than 10,000, the correction formula to
estimate final sample size (N
f
) from finite source population
(N=1,732) was employed.
Nf = n
o
/ (1+ n
o
/N) =384/ (1+384/1732) =314
With 10% non-response rate the final sample size was 345
women.
Simple random sampling was used in selecting the study
subjects. All five flower farms of Batu town were stratified
by their farm names (Share Ethiopia, Ziway Rose, Herberg
Rose, Braam Rose and AQ Rose) and the flower farms were
the strata in which study subjects were selected. Number of
study subjects who fulfilled inclusion criteria in each flower
farms was proportional to population sample size and was
selected by simple random sampling using the list of
women identified during census as sampling frame.
To strengthen quantitative data, 15 in-depth interviews
were conducted with key informants, who have worked in
the flower farms at least for the last six months and whose
their position were department head or staff of health
clinics in the flower farms.
2.4. Data Collection Procedures
Structured and pre-tested questionnaire was prepared first
in English and then translated into local language (Amharic
and Afan Oromo) for quantitative data collection. Five
female diploma nurses conducted face to face interviews and
one BSc. nurse supervised the data collection process.
Training was given to the data collectors (Nurses) and
supervisor on the aim of the study, data collection tool and art
of interviewing. Semi-structured interviewer guide were used
to collect data from head of health clinics and were tape
recorded.
2.5. Data Processing and Analysis
Quantitative data were analyzed using SPSS for windows
version 16.0. Descriptive statistics were done using
frequencies and proportions in tables and figures. Binary
logistic regression was also done to test association between
selected independent variables and the outcome variable. P-

406 Desalegn Bekele et al.: Prevalence and Abortion Methods Employed by Women Working in Flower Farms of Batu Town, Ethiopia
value of less than 0.05 was used to declare statistical
significance.
Qualitative data were transcribed & summarized in to
themes and analyzed manually. The results were presented in
narratives triangulated with the quantitative results.
2.6. Ethical Considerations
Ethical clearance was obtained from Jimma University,
College of Public Health and Medical Sciences, Ethical
Clearance and Review Committee. Official permissions and
letter of cooperation were obtained from the respective Batu
flower farms. Study subjects were informed about the
purpose of the study, their right to refuse and to withdraw.
Written consent was obtained from each study subjects
before the data collection and audio was recorded.
3. Results
3.1. Socio-Demographic Characteristics
From a total of 345 women who were identified for the
study, 340 were participated in the study yielding the
response rate of 98.6%. Five incomplete questionnaires were
removed from the analysis.
More than half of the respondents 198(58.4%) were found
between the age group of 20-24 years. The mean age of the
respondents was 24.5years (SD=5.042). Large number of the
respondents were Orthodox Christian 144(42.4%), while
232(68.2%) of the respondents were married, 75(22.1%)
were never married. The educational status of the large
number of the respondents was grade 5-8 138(40.6%).
Monthly income of half of the respondents 183(53.8%) were
between 551-600 Birr.
3.2. Experience of Abortion
Among a total of 340 women who were participated in
the study, 250(73.5%) respondents had one pregnancy. Out
of those who were pregnant, 53(15.6%) of the respondents
reported as their last pregnancy were unwanted. From those
women who ever pregnant in the last six years, 68(20.0%)
of them were not had history of birth. From those who ever
had birth, 70(25.7%) of them had more than two births. Of
all respondents, only 135(39.7%) were ever used
contraceptive. In this study, abortion was reported by
87(25.6%) from those who were ever pregnant women in
the last six years. Out of those women who reported
abortion, 54(62.1%) and 33(37.9%) of them had their
abortion at gestational age below three months and above
three months, respectively. Around 27(79.4%) of induced
abortion reported by the respondents were due to unwanted
pregnancy. Among the reasons given by the respondents for
induced abortion were pre-marital pregnancy 11 (32.4%)
and did not want more children 14(41.2%) (Table 1).
Table 1. Pregnancy and abortion experience of women working in flower
farms of Batu town, Ethiopia, May 2012.
Variables Number %
Pregnancy terminated before 28 weeks of gestation in the last six years:
n=340
Yes 87 25.6
No 253 74.4
Gestational Age abortion takes in the last 6 yrs : n=87
=<3 months 54 62.1
> 3 months 33 37.9
Type of Abortion: n=87
Induced 34 39.1
Spontaneous 53 60.9
This is also supported by in-depth interview obtained from
32 years old women who has worked in the flower farm
clinic for more than three years. She reported that sometimes
pregnant women come to their clinic and ask for the
procedures to terminate the pregnancy. She said: “when we
tell them to think and change their decision, they will not
come again to us. We understood later as they terminate the
pregnancy in the community.”
Another 29 years old women working in the flower farm
clinic noted that abortion is recognized as major problem in
Batu flower farms. She stressed that the problem is more
prevalent among unmarried young girls. She said:
“.....Majority of the girls comes from rural areas of the
country and when they arrive to Batu town, they start and
practice unsafe sex with more than one man. Women prefer
to interrupt the pregnancy than to have a child if it is
unwanted. We hear such information directly or indirectly
during ‘acha le acha’/peer group discussion on coffee
ceremony with the female flower farm workers.”
3.3. Preferences for Health Care Usage among Women
Those women who had induced abortion in the last six
years were also asked for the place they had induction and
11(32.4%) of the respondents had their induction at their own
house. Induction performed by traditional healers accounts to
16(29.4%). This result can be supported by in-depth
interview. “…Sometimes women come to our clinic with
different health problems including post abortion
complications. When we assess and ask for the main cause
for the problem, they told us as they had abortion somewhere
else at the house of traditional healers or private clinics” in-
depth interviewee said.
But above 70% of the respondents, 67(77.0%) who
experienced abortion visited modern health institution for
post abortion services. The preferences of health facilities
visited for post abortion care by those women who had
abortion were health center 17 (25.4%), clinic 31(46.3%),
and hospital 19(28.4%)(Table 2).

Science Journal of Public Health 2015; 3(3): 404-409 407
Table 2. Preferences of health care usage for induced abortion and PAC
among women working in flower farms of Batu town, Ethiopia, May 2012.
Variables Number %
Preference of health care for abortion: n=34
Health facility 15 44.1
At home 11 32.4
At home of the abortionist 8 23.5
Other people helped that induced abortion n:34
Traditional abortionist 10 29.4
Themselves 8 23.5
Health professional 16 47.1
Visit modern health institution for PAC: n=87
Yes 67 77.0
No 20 23.0
Type of modern health institution visited: n=67
Health center 17 25.4
Clinic 31 46.3
Hospital 19 28.4
3.4. Factors Associated with Experience of Abortion
As indicated in Table 3 only age group, marital status,
work years in the farm and last pregnancy wanted were found
to be statistically significant in bivariate analysis. When
controlled for potential confounders, women whose their last
pregnancy were unwanted were about 7.9 times more likely
to have an abortion than those women whose their last
pregnancy were wanted (AOR [95% CI] =7.9[2.3, 26.8]).
Similarly, women who had two and above births in the last
six years were more likely to have an abortion compared to
women who had one births in the last six years (AOR [95%
CI] =4.9[2.3, 10.7]) (Table 3).
Table 3. Bivariate and multivariate analysis of factors associated with experience of abortion among women working in flower farms of Batu Town, Ethiopia,
May 2012.
Variables Experience of Abortion COR (95% C.I.) P-value AOR (95%C.I.)
Yes(n=87) No (n=253)
Age group 0.030
15-24 63(23.1) 210(76.9) 0.3(0.1, 0.8)* 0.013 0.2(0.02, 1.6)
25-34 16(30.8) 36(69.2) 0.4(0.1, 1.3) 0.115 0.5(0.04, 5.0)
35-44 8(53.3) 7(46.7) 1 1
Marital status 0.007
Never married 25(33.3) 50(66.7) 1 1
Married 47(20.3) 185(79.7) 0.5(0.3, 0.9)* 0.021 0.7(0.2, 2.6)
Divorced 10(47.6) 11(52.4) 1.8(0.7, 4.9) 0.233 0.5(0.05, 5.5)
Widowed 5(41.7) 7(58.3) 1.4(0.4, 5.0) 0.574 0.1(0.01, 4.5)
Work years in the farm 0.047
=<2 years 23(20.0) 92(80.0) 0.4(0.2, 0.9)* 0.015 0.7(0.2, 3.3)
3-4 years 37(24.7) 113(75.3) 0.6(0.3, 1.1) 0.077 0.9(0.3, 3.0)
5-6 years 27(36.0) 48(64.0) 1 1
Ever use of contraceptives 0.160
Yes 29(21.5) 106(78.5) 1 1
No 58(28.3) 147(71.7) 1.4(0.9, 2.4) 0.5(0.2, 1.5)
Last pregnancy wanted 0.001
Yes 57(19.9) 230(80.1) 1 1
No 30(56.6) 23(43.4) 5.3(2.8, 9.7)* 7.9(2.3, 26.8)**
No of births in the last 6 yrs 0.002
One 19(9.4) 183(90.6) 1 1
Two &above 20(28.6) 50(71.4) 3.9(1.9,7.8)* 4.9(2.3, 10.7)**
*= Statistically significant at p< 0.05
**=Statistically significant at p<0.05 when adjusted for other variables
4. Discussion
In this study, abortion was reported by 25.6% of those
pregnant women. Another study done in maternal health
review in Uganda showed that approximately 15-23% of
female youths 15-24 years of age who had ever been
pregnant had an abortion [20]. The difference might be due to
the fact that this study included all reproductive age groups
(15-49) while study in Uganda was on youth (15-24 years).
The findings of this study are also comparable with many
studies done in Ethiopia. The first one is study done in three
regional state of Ethiopia, which overall 15.1% of the
respondents were had at least one abortion episode [21]. The
second is study done in northwest of Ethiopia in which 19%
of the respondents have had abortions [22]. But, the
prevalence of abortion in this study is higher than all of the
studies aforementioned. The difference might be due the fact
that in this study, the study subjects were female reproductive
age who might have not get access to contraceptive or
exposed to chemicals during flower production, which leads

408 Desalegn Bekele et al.: Prevalence and Abortion Methods Employed by Women Working in Flower Farms of Batu Town, Ethiopia
to unwanted pregnancy and abortion respectively.
In this study, no association was found between experience
of abortion as educational status of women increased or
decreased which is in line with study done in Harar [22], in
which education did not have significant association with
induced abortion.
As the finding of this study, women whose last pregnancy
were unwanted were more likely to have an abortion than
those women whose last pregnancy were wanted, which is
similar with the report of study done in Ethiopia in which
women with no history of unwanted pregnancy were less
likely to report abortion in the past [21]. This shows as
unwanted pregnancy is a main reason for women to
experience an abortion.
According to the finding, 39.7% of the respondents were
ever used contraceptive which is comparable with studies
done in Harar in which ever use of modern contraceptive was
found to be 25.7% among the sexually active group [23]. The
slight differences might be due the fact that in this study,
respondents are those women who ever experienced one or
more pregnancy and expected to have high exposure to
contraceptive use than sexually active group.
The study also revealed that women with high number of
parity were found to have association with experience of
abortion which is in different with study done in northwest
Ethiopia [22], in which increase in number of births, there
were a decrease in the number of mothers who had abortion.
The possible explanation for this could be the differences in
study subjects.
In this study from those women who had induced abortion
in the last six years, only 44.1% of the respondents had their
abortion at health facility. This study is in line with study
done in Northwest Ethiopia [22], in which induction was
conducted at their own houses by 54.7% and at the
abortionist house by 40.6%. Another study is study done in
Nigeria in close to 20% of the women carried out the
abortions themselves [24]. This indicates that for one or
many reasons majority of women who had induced abortion
perform induction out of health facilities.
This study revealed that around 79.4% of induced
abortions reported by the respondents were unwanted
pregnancy which is in line with study done in Addis Ababa
[25-26], in which unwanted pregnancy was the main reason
given for undergoing induced abortion of about 95%.
In this study the main reasons given by the respondents for
induced abortion were pre-marital pregnancy 32.4% and did
not want more children 41.2% which is similar with studies
done in Nigeria and Northwest Ethiopia, in which the women
gave reason for induction were bad timing was the most
frequent, after which the most common reasons were the
desire to remain in school, the high cost of having more
children, and the feeling that the pregnancy was not socially
acceptable [22, 24].
5. Limitations of the Study
The study suffers from the usual limitation of a cross
sectional study in detecting causes and affect relationship.
Moreover, the nature of the sensitivity of the issue (abortion)
and past history on abortion might be affected by recall bias
and underestimated the prevalence of abortion. However,
numerous scientific procedures such as supervision, pretest
of data collection tool, and adequate training of data
collectors and supervisor were employed to minimize the
possible effects.
6. Conclusions
According to this study finding, the prevalence of abortion
among women working in flower farms of Batu town was
25.6%. Percentage for spontaneous abortion is large in this
study. The reason might be, women would like to report
induced abortion as spontaneous abortion or due to the nature
of work environment in which they might be exposed to
different chemicals. Having more births in the last six years
and having the last pregnancy unwanted were predictors of
abortion in this study. Above half of the women in flower
farms that had induced abortion were not used health facility
for abortion.
Sexual and reproductive health education for newly
employed workers may be helpful to create awareness and
reaching more target group in encouraging to utilize family
planning especially condom and seek appropriate health care
when it is needed. Much more effort should be done in
building the capacity and strengthening collaboration with
traditional abortionist, health facilities, flower farms,
governmental and Nongovernmental organization in
improving accessibility of quality safe abortion services. The
government of Ethiopia should also work in making
contraceptive methods access for women to alleviate
premarital pregnancy.
In addition, to quantify true magnitude of pregnancy and
abortion, different strategy with different study design need
to be conducted in this area.
Acronyms and abbreviations
NGO: Non Governmental Organization
PAC: Post Abortion Care
SPSS: Statistical Package for Social Science
WHO: World Health Organization
Authors’ Contributions
DB has played a great role with regard to the conception,
design, data collection, analysis, interpretation and wrote the
draft manuscript. MT and FT has made a substantial
contribution of the study concept and design, developed the
research protocol, acquisition, data collection, analysis and
interpretation of data and reviewed the draft and final
manuscript for important content. All authors read and
approved the final version of the manuscript.

Science Journal of Public Health 2015; 3(3): 404-409 409
Acknowledgments
Our sincere thank goes to Jimma University, College of
Public Health and Medical Sciences, Department of
Epidemiology and Biostatistics for the approval of the ethical
clearance and their technical support. We would also like to
thank all managers of Batu flower farms and all those women
who agreed to participate in this study including data
collectors and supervisor.
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