Safe abortion service utilization and associated factors among homeless women in Southwest Ethiopia, A Cross sectional mixed methods study

Abstract

Back ground: Homeless women are the most vulnerable group for unwanted pregnancy. However, their issues are not being addressed in government plan. Despite the fact that Ethiopia has a penal code regarding safe abortion care, studies show that homeless women low access this service. Therefore, the aim of this study is to assess utilization of safe abortion service and associated factors among homeless women. Methods: Community based cross sectional mixed methods study was done in three towns of southwest Ethiopia (Jimma, Bonga and Mizan-aman) from May 20 to July 2 / 2021 G.C. A total of 122 participants were included in the quantitative part. Participants were chosen by snow balling technique and data was collected through face to face interview. To enter and analyze data, Epi-data 3.1 and SPSS 21 were used, respectively. Descriptive analysis was performed initially and then binary logistic regression. An AOR with 95% CI and P-value <0.05 was used to declare significant association. In-depth interviews on 12 key informants were done for qualitative portion and then data was transcribed and analyzed using thematic content analysis. Result: The magnitude of safe abortion service utilization among homeless women was found to be 34 (27.9%). After controlling for confounders in multiple logistic regressions, average daily income (AOR = 5.873, P-value = 0.003, CI [1.834, 18.801]), poor knowledge towards safe abortion (AOR = 0.256, P-value = 0.037, CI [0.071, 0.920]) and perceived unaffordability of cost of abortion at health facility (AOR = 0.108, P-value = 0.000, CI [0.034, 0.345]) were significantly associated with safe abortion. The qualitative findings of this study revealed that homeless women’s personal characteristics, health provider related factor and health system factors all had influence on homeless women’s utilization of safe abortion service. Conclusion: Safe abortion service utilization among homeless women in the study area was low. Average daily income, knowledge towards safe abortion and perceived cost of abortion at health facility were significantly associated with safe abortion.