ABSTRACT
Background and Aims
Globally, approximately 25 million unsafe abortions occur annually, with 97% in developing countries, accounting for 67% of maternal deaths. Unsafe abortion practices exacerbated by traditional methods and even unsafe procedures performed by healthcare professionals. This study aimed to assess the knowledge of medical female undergraduates at the University of Dodoma regarding unsafe abortion and its complications, and to identify associated socioeconomic factors.
Methodology
Analytical cross‐sectional study was conducted among 344 female medical undergraduates from the School of Medicine and Dentistry (SOMD) and the School of Nursing and Public Health (SONPH) at the University of Dodoma between February and September 2024. A convenient sampling technique was employed. Data were collected using self‐administered questionnaires. Data were analyzed using SPSS version 26, employing descriptive analysis, cross‐tabulations, and logistic regression.
Results
Of the 344 respondents, 74.7% were aged 18–25 years, and 86.9% were single. Two‐thirds (66.6%) knew a female undergraduate who had an unsafe abortion, with self‐medication (57.6%) being the most common method. First‐year students were identified as being at the highest risk (45.9%). The majority (73.0%) demonstrated good overall knowledge of unsafe abortion complications, with SOMD students (82.6%) showing significantly better knowledge than SONPH students (63.4%) (p < 0.001). Regarding personal experience, 11.0% of respondents reported a past pregnancy, and 52.6% of these resulted in abortion, primarily performed by quack doctors (70.0%) using oral medication (70.0%). Economic factors played a role, as 65.3% from low‐income families indicated they would abort an unplanned pregnancy compared to 2.9% from high‐income families (p < 0.001). Key social factors contributing to abortion decisions included the desire to complete studies (78.2%), fear of disappointing parents (66.6%), and societal unacceptability of pre‐marital pregnancy (75.9%).
Conclusion
Generally study participants possess good knowledge about the complications of unsafe abortion. However, a significant proportion still engages in unsafe abortion practices, largely driven by socioeconomic pressures such as economic instability, the desire to continue education, and fear of social stigma and parental disapproval.
Keywords: abortion, Dodoma, knowledge, medical students
1. Introduction
The World Health Organization (WHO) defines unsafe abortion as a procedure for ending a pregnancy performed by individuals lacking the essential medical skills or in the places with poor medical standards and/or quality, or both [1]. Unsafe abortion exposes women to life‐threatening reproductive health complications [2], the traditional practice of unsafe abortion in different societies may predispose women of reproductive age into morbidity, mortality, psychosocial effects in their life, economic problems due to impact of treatment, excessive vagina bleeding, genital injuries such as perforation of the uterus, infections leading to sepsis, inability to get child (infertility), prolonged hospital stay and increased risk of acquiring and transmissions of sexually transmitted disease (STD) and HIV/AIDS [3].
The health impacts and complications resulting from unsafe abortion practices can be addressed by practicing complex post abortion care model which was developed since 1994, all health complications of unsafe abortion are well preventable if post‐abortion services done safe accordingly [4]. Component of post abortion care include emergency treatment, family planning, counseling, reproductive and other health services, lastly is community and services provider partnership [5]. Same reasons which predispose young women to terminate their pregnancies may include: desire to complete their education to reach their dream, they don't want to have pregnancies while are still student, the need to have children only after being married, unstable relationship with their partners, economic instability, and fearing that they will lack enough support from her partner after being pregnancy. All of these tell why female abort [1].
Previous studies shown approximately 25 million of unsafe abortion occur globally every year, 97% of them came from developing nations, they account about 67% of maternal deaths. This goes hand in hand with data reported by World Health Organization where by about 45% of pregnancy termination in the world are unsafe and 95% of them take place in low‐ and middle‐income countries [6]. Study from Nepal shown that out of 21.1% of all abortion occurred, 16% of them are unsafe and practiced more by educated women commonly those who are less than 35 years of age [7] and maternal mortality due to unsafe abortion reported to be 23/100,000 in Latin America and Caribbean and 12/100,000 in Southern Asia. All of these statistics shown how much unsafe abortion is the problem globally.
It estimated that in every 2 min globally maternal death happened, of which 70% of them are from Sub Saharan Africa [6]. In Africa, about 4 million unsafe abortions carried out every year mostly on poor rural areas among young women who have limited information about safe abortion. About 99% of all abortion occurred in Africa are unsafe with risk of maternal death 1 in every 150 unsafe procedures, this is highest rate compared to other continent in the world [8]. The Sustainable Development Goal (SDG) aim to reduce global maternal death to about 70 per 100,000 in 2030. Therefore, local countries must improve their health system to minimize mortality rate which reported to be higher in Africa [8, 9].
Tanzania has high unacceptable maternal death of about 454 for every 100,000 live births, same of them are unsafe and unconsciously exacerbated by attempts of birth control using traditional methods and medication despite of educational level of same people [6]. Tanzania shown that 50% of women admitted to the hospital due to abortive complications after unsafe abortion from traditional provider who induce it by traditional methods (e.g., placing a grass which can induce abortion into the vagina) while another half came from professional health care who tend to perform the procedure unsafely, so even a medical practitioner perform it unsafely [5, 10]. World Health Organization (WHO) reported that the estimated number of unsafe abortions rose from approximately 225,000 in 2012 to 377,000 in 2019; the reasons for this increase are not fully elucidated in the source but may reflect persistent gaps in access to safe reproductive health services [11].
Despite generally sound theoretical knowledge among medical students, the incidence of unsafe abortion in this population remains high, indicating that knowledge alone does not translate into safe practice. Medical female undergraduates are a particularly important population to study because their professional training positions them to influence reproductive health practices among their peers and, later, within the communities they will serve. Despite this, evidence on their own knowledge and lived experience of unsafe abortion, and on the socioeconomic factors that shape their decisions, remains limited, particularly in abortion‐restrictive settings such as Tanzania. This study, therefore, aimed to assess the knowledge of medical female undergraduates at the University of Dodoma regarding unsafe abortion and its complications, and to identify the socioeconomic factors associated with this knowledge and with unsafe abortion practice.
2. Methodology
This study employed an analytical cross‐sectional study design, conducted among female medical undergraduates at the University of Dodoma (UDOM) from February to September 2024. UDOM, a public university located east of Dodoma town center, Tanzania, covers approximately 15,000 acres and comprises six colleges, three schools (including the School of Medicine and Dentistry ‐ SOMD, and the School of Nursing and Public Health ‐ SONPH), and two institutes. The study population specifically included female undergraduates pursuing Doctor of Medicine (MDs) from SOMD, and Bachelor of Science in Nursing (BSN) and Bachelor of Science in Clinical Nutrition and Dietetics (BsCND) from SONPH. Inclusion criteria stipulated participation from medical female undergraduates at SOMD and SONPH who provided informed consent. Exclusion criteria were applied to medical female undergraduates aged less than 18 years and those disagreed to take part in the study.
A convenient sampling technique was adopted, purposively focusing on female medical undergraduates from SOMD and SONPH, given their specific academic focus relevant to the study's objectives and their presence at the university during data collection. Out of a total of 3739 medical students, comprising 2016 from SONPH, and 1723 from SOMD, there were 386 female undergraduates from SOMD and 718 from SONPH. The sample size was determined using the formula N = (Z 2 × P × (100 − P))/e 2, where N is the sample size, P (estimated proportion of the youth) was 34.13% (0.34 in decimal), and e (maximum error allowed) was 5%. This calculation yielded a final sample size of 344 medical female students, with an equal distribution of 172 students from SOMD and 172 from SONPH.
Data collection was facilitated through a self‐administered questionnaire distributed electronically via official WhatsApp class groups, utilizing KOBO tool technology for smartphone completion. The questionnaire was structured into three sections: demographic data (including school, year of study, age, marital status, religion, and academic program), questions on knowledge of unsafe abortion, and inquiries about socioeconomic factors contributing to unsafe abortion. Data management involved direct entry and cleaning in SPSS version 26. To ensure validity and reliability, the questionnaire was designed based on research objectives, semi‐structured, and reviewed by the study supervisor. Furthermore, the English version was translated into Kiswahili to minimize misinterpretation by respondents.
Variables were defined as follows: The dependent variable was “Knowledge on Unsafe Abortion.” The independent variables, or associated factors, included demographic factors (school, year of study, age, marital status, and religion) and socioeconomic factors (economic status, sexual relationship, peer pressure, and use of contraception). Dependent variables were measured through questions assessing knowledge of unsafe abortion among female undergraduates, while independent variables were measured through questions on demographic information and socioeconomic factors within the questionnaire.
Data analysis was performed using SPSS software version 26, descriptive analysis, including frequencies and percentages are presented in tables. Cross‐tabulations and logistic regression were employed to determine associations between knowledge of unsafe abortion among medical female undergraduates and the demographic and socioeconomic factors.
3. Results
3.1. Socio‐Demographic Characteristics
A Total of 344 medical female undergraduates, 172 (50.0%) from SOMD and 172 (50.0%) from SONPH were involved in the study. Out of the 344 respondents, 257 (74.7%) were aged between 18 and 25 years old, and 76 (22.1%) between 26 and 33 years. The majority 299 (86.9%) of respondents, were single followed by 31 (9.0%) of respondents who were cohabiting; and 12 (3.5%) of them who were married. Among 344 of respondents, 269 (78.2%) were Christian and 75 (21.8%) were Muslims. the distribution of 344 of medical female undergraduates from two schools showed that, 86 (25.0%) were third year students, 79 (23.0%) were second year students, 77 (22.4%) were first year students. The result according to the academic program showed that, 172 (50.0%) were MD female undergraduates, 89 (25.9%) were BSCN female undergraduates and 83 (24.1%) were CND female undergraduates. The socio‐demographic characteristics of the respondents are shown in Table 1.
Table 1.
Socio‐demographic characteristics of respondents.
| Socio‐demographic characteristics | Frequency (n) | Percent (%) |
|---|---|---|
| Age | ||
| 18–25 | 257 | 74.7% |
| 26–33 | 76 | 22.1% |
| 34–41 | 11 | 3.2% |
| Name of school | ||
| SOMD | 172 | 50.0% |
| SONPH | 172 | 50.0% |
| Academic program | ||
| MD | 172 | 50.0% |
| BSCN | 89 | 25.9% |
| CND | 83 | 24.1% |
| Year of study | ||
| 1st year | 77 | 22.4% |
| 2nd year | 79 | 23.0% |
| 3rd year | 86 | 25.0% |
| 4th year | 69 | 20.1% |
| 5th year | 33 | 10.4% |
| Marital status | ||
| Married | 12 | 3.5% |
| Single | 299 | 86.9% |
| Cohabiting | 31 | 9.0% |
| Divorced | 2 | 0.6% |
| Religion | ||
| Muslim | 75 | 21.8% |
| Christian | 269 | 78.2% |
Abbreviations: SOMD, School of Medicine and Dentistry; SONPH, School of Nursing and Public Health.
3.2. General Knowledge on Unsafe Abortion
Of the total 344 respondents, two‐thirds 229 (66.6%) knew the female undergraduate who had unsafe abortion while one‐third 115 (33.4%) did not know. Furthermore, 198 (57.6%) of female medical undergraduates identified self‐medication as common methods used by their fellow female students to undergo unsafe abortion followed by going to the traditional herbalists, 61 (17.7%). In addition, the results showed that, 160 (46.5%) of all of the medical students were at risk of undergoing unsafe abortion. However, the first year students were at the high risk of unsafe abortion 158 (45.9%) compared to other years of studies of female medical undergraduates (Table 2).
Table 2.
General knowledge of respondents on unsafe abortion.
| Frequency (n) | Percent (%) | |
|---|---|---|
| Do you know unsafe abortion? | ||
| Yes | 344 | 100% |
| No | 0 | 0.0% |
| Where do female go for abortion in your compound? | ||
| Health facilities | 35 | 10.2% |
| Self‐medication | 198 | 57.6% |
| Herbalist | 61 | 17.7% |
| Homes | 50 | 14.5% |
| Do you know any person who had unsafe abortion in your school? | ||
| Yes | 229 | 66.6% |
| No | 115 | 33.4% |
| Which year of study of females in your school are commonly at risk of unsafe abortion? | ||
| 1st year | 158 | 45.9% |
| 2nd year | 8 | 2.3% |
| 3rd year | 6 | 1.7% |
| 4th year | 6 | 1.7% |
| 5th year | 6 | 1.7% |
| All of female undergraduates | 160 | 46.5% |
3.2.1. Knowledge on Complications of Unsafe Abortion
The study showed that 292 (84.9%) of respondents had the knowledge that severe bleeding per vagina is one of the complications of practicing unsafe abortion, while 282 (82.0%) of respondents knew anemia as the complication of unsafe abortion. On the other hand 266 (77.3%) of respondents knew that inability to conceive is a complication of unsafe abortion, whereas 262 (76.2%) and 243 (70.7%) of respondents knew that uterine rupture and genital tract infections respectively, were among of the health complications of practicing unsafe abortion (Table 3).
Table 3.
Knowledge on complication of unsafe abortion.
| Frequency (n) | Percent (%) | |
|---|---|---|
| Practicing unsafe abortion can result into genital tract infections? | ||
| Yes | 243 | 70.7% |
| No | 62 | 18.0% |
| I don't know | 39 | 11.3% |
| Unsafe abortion practices can cause uterine rupture? | ||
| Yes | 262 | 76.2% |
| No | 53 | 15.4% |
| I don't know | 29 | 8.4% |
| Practicing unsafe abortion can result into anemia? | ||
| Yes | 282 | 82.0% |
| No | 44 | 12.8% |
| I don't know | 18 | 5.2% |
| Practicing unsafe abortion can result into inability to conceive in women? | ||
| Yes | 266 | 77.3% |
| No | 49 | 14.2% |
| I don't know | 29 | 8.5% |
| Practicing unsafe abortion can result into severe bleeding per vagina? | ||
| Yes | 292 | 84.9% |
| No | 41 | 11.9% |
| I don't know | 11 | 3.2% |
3.2.2. Health Complications of Unsafe Abortion Mentioned by Respondents
Among 344 of respondents, 174 (49.4%) knew the person who developed some complications of unsafe abortion and were able to mention those complications. Among the 174 respondents, 83 (47.7%) mentioned severe bleeding as the complication; while 36 (20.7%) mentioned anemia as the complication. the other, 30 (17.2%) of respondents mentioned infection was the complication while 15 (8.6%) mentioned uterine rupture as the complication and 10 (5.7%) mentioned that, infertility was the health complication (Table 4).
Table 4.
Health complications of unsafe abortion mentioned by respondents.
| Frequency (n) | Percent (%) | |
|---|---|---|
| Do you know any female in your college who developed health complications of after practicing unsafe abortion? | ||
| (A) NO | 170 | 49.4% |
| (B) YES | 174 | 50.6% |
| What was the complications | ||
| Bleeding | 83 | 47.7% |
| Anemia | 36 | 20.7% |
| Infertility | 10 | 5.7% |
| Infection | 30 | 17.2% |
| Uterine rupture | 15 | 8.6% |
3.3. Level of Knowledge About Complications of Unsafe Abortion
Out of the 344 participants, 142 (82.6%) of SOMD medical female undergraduates had good knowledge compared to 109 (63.4%) of SONPH female undergraduates about complications of practicing unsafe abortion (see Table 1), with p value < 0.001, showing that there is strong relationship between school and level of knowledge. Among 344 of respondents, 142 (82.6%) of Medical doctors MD) had good knowledge about complications of unsafe abortion, followed by BSCN, in which 65 (73.0%) of them had good knowledge about complications of unsafe abortion, while 44 (53.0%) of CND had good knowledge about complications of practicing unsafe abortion.
The study showed that, respondents aged 26–33 years old, 56 (73.7%) had good knowledge about complications of unsafe abortion as compared to 70 (27.2%) of respondents aged 18–25 years old. The study also showed that 27 (81.8%) of fifth year medical female undergraduates had good knowledge about complications of unsafe abortion compared to first year medical female undergraduates in which 53 (68.8%) of them had good knowledge about complications of unsafe abortion. Among 299 single medical female undergraduates, 224 (74.9%) of them had good knowledge about complications of unsafe abortion while 7 (58.3%) of married medical female undergraduates, had good knowledge about complications of unsafe abortion. Among 344 of respondents, 201 (74.7%) of Christian medical female undergraduates had good knowledge about complications of practicing unsafe abortion compared to 50 (66.7%) of Muslim female undergraduates.
The level of knowledge about complications of practicing unsafe abortion is summarized in Table 5.
Table 5.
Level of knowledge about complications of practicing unsafe abortion.
| Respondents characteristics | Level of knowledge about complications | p‐value | |
|---|---|---|---|
| Good N (%) | Poor N (%) | ||
| Age | |||
| 18–25 | 187 (72.8%) | 70 (27.2%) | |
| 26–33 | 56 (73.7%) | 20 (26.3%) | 0.987 |
| 34–41 | 8 (72.7%) | 3 (27.3%) | |
| School name | |||
| SOMD | 142 (82.6%) | 30 (17.4%) | < 0.001 |
| SONPH | 109 (63.4%) | 63 (36.6%) | |
| Academic program | |||
| MD | 142 (82.6%) | 30 (17.4%) | |
| BSCN | 65 (73.0%) | 24 (27.0%) | < 0.001 |
| CND | 44 (53.0%) | 39 (47.0%) | |
| Year of study | |||
| 1st year | 53 (68.8%) | 24 (31.2%) | |
| 2nd year | 59 (74.7%) | 20 (25.3%) | |
| 3rd year | 62 (72.1%) | 24 (27.9%) | 0.710 |
| 4th year | 50 (72.5%) | 19 (27.5%) | |
| 5th year | 27 (81.8%) | 6 (18.2%) | |
| Marital status | |||
| Married | 7 (58.3%) | 5 (41.7%) | |
| Single | 224 (74.9%) | 75 (25.1%) | 0.106 |
| Cohabiting | 18 (58.1%) | 13 (41.9%) | |
| Divorced | 2 (100%) | 0 (0.0%) | |
| Religion | |||
| Muslim | 50 (66.7%) | 25 (33.3%) | 0.165 |
| Christian | 201 (74.7%) | 68 (25.3%) | |
3.4. Total Level of Knowledge of Complications on Unsafe Abortion of Respondents
Among 344 of respondents, the majority 251 (73.0%) of respondents had good knowledge about complications of unsafe abortion and 93 (27.0%) of participants had poor knowledge about complications of unsafe abortion (Table 6).
Table 6.
Total level of knowledge of complications on unsafe abortion of respondents.
| Total level of knowledge | Frequency (n) | Percent (%) |
|---|---|---|
| Good | 251 | 73.0% |
| Poor | 93 | 23.0% |
3.5. Practice of Unsafe Abortion by Respondents
A total of 38 (11.0%) respondents had pregnancy, of which 20 (52.6%) of them aborted their pregnancy and of those who aborted 14 (70.0%), aborted by quack doctors, and 5 (25.0%) aborted at hospital. The majority, (70.0%) who aborted their pregnancies, oral medication was the common method used by the respondents to terminate their pregnancy followed by those aborted by inserting drugs virginally were 5 (25.0%) (Table 7).
Table 7.
Where and how respondents committed unsafe abortion.
| Frequency (n) | Percent (%) | |
|---|---|---|
| Have you ever been pregnant? | ||
| Yes | 38 | 11.0% |
| No | 306 | 89.0% |
| If you have ever been pregnant, what was the outcome? | ||
| (a) Kept it | 18 | 47.4% |
| (b) Aborted it | 20 | 52.6% |
| Common methods used | ||
| By inserted drugs via the vagina. | 5 | 25.0% |
| By inserting herbal preparation | 0 | 0.0% |
| By drinking concoction | 1 | 5.0% |
| By oral medication only | 14 | 70.0% |
| If you aborted, where was the abortion done? | ||
| Home | 1 | 5.0% |
| Quack doctors | 14 | 70.0% |
| Hospital | 5 | 25.0% |
3.6. Contributing Factors to Unsafe Abortion
3.6.1. Economic Factors Contributing to Unsafe Abortion
The results showed that 144 (41.9%) of medical female undergraduates perceived themselves as living in low income families, while 166 (48.3%) and 34 (9.9%) lived in middle income families and high‐income families, respectively (Table 8).
Table 8.
Self‐perception regarding family level of income.
| Frequency (n) | Percent (%) | |
|---|---|---|
| Low income family | 144 | 41.9 |
| middle income family | 166 | 48.3 |
| high‐income family | 34 | 9.9 |
The majority, 29 (85.3%) of respondents who lived‐in high‐income family decided to keep the pregnancy if they got unplanned pregnancy while 94 (65.3%) of respondents who lived in low income family decided to abort if they got unplanned pregnancy with p‐value < 0.001 (Table 9).
Table 9.
Family economic status against abortion decision.
| What will be your decision, if you get unplanned pregnancy? | Total | p‐value | |||||
|---|---|---|---|---|---|---|---|
| Keep it | Abort it | I don't know | |||||
| Self‐perception regarding family level of income | Low income family | Frequency (n) | 19 | 94 | 31 | 144 | < 0.001 |
| Percent (%) | 13.2% | 65.3% | 21.5% | ||||
| Middle income family | Frequency (n) | 75 | 57 | 34 | 166 | ||
| Percent (%) | 45.2% | 34.3% | 20.5% | ||||
| High‐income family | Frequency (n) | 29 | 1 | 4 | 34 | ||
| Percent (%) | 85.3% | 2.9% | 11.8% | ||||
A total of 153 (44.5%) of respondents reported that, they were unable to care their baby if they got unplanned pregnancy when they were continuing with studying, while 111 (32.3%) of respondents reported that they were able to care of their baby if they got unplanned pregnancy when they were continuing with studying (Table 10).
Table 10.
Respondents' ability to take care their babies.
| Frequency (N) | Percent (%) | ||
|---|---|---|---|
| If you get unplanned pregnancy could you be able to take care of your baby? | Yes | 111 | 32.3% |
| No | 153 | 44.5% | |
| I don't know | 80 | 23.2% | |
3.6.2. Social Factors Contributing to Unsafe Abortion
The major reasons why medical female undergraduates decided to abort the unplanned pregnancy were: desire to complete their study 269 (78.2%), Fear to disappoint their parents 229 (66.6%) and unacceptability of pregnancy before marriage 261 (75.9%). Other driving force to medical female undergraduates to decide abort their pregnancy in universities were: Stigmatization from society 117 (34.0%). Fear from parent to stop their support to their daughter, 66(19.2%) and fear of being expelled if they got pregnancy when they were studying 68 (19.8%) (Table 11).
Table 11.
Social factors associated to unsafe abortion practices.
| Frequency (n) | Percent (%) | ||
|---|---|---|---|
| What do you think your parent can do, if you got unplanned pregnancy? | Help you to keep it | 108 | 31.4% |
| Help you to abort it | 18 | 5.2% | |
| Expelled from home | 68 | 19.8% | |
| Stop their support to you | 66 | 19.2% | |
| I don't know | 84 | 24.4% | |
| Do you think you will disappoint your parent, if you get pregnancy when you are studying? | Yes | 229 | 66.6% |
| No | 115 | 33.4% | |
| Do your society accept unwanted pregnancy? | Yes | 6 | 1.7% |
| No | 261 | 75.9% | |
| I don't know | 77 | 22.4% | |
| What is response of your community, if one gets pregnancy before marriage? | Stigmatize | 117 | 34.0% |
| Comfort | 87 | 25.3% | |
| No reaction | 37 | 10.8% | |
| I don´t know | 103 | 29.9% | |
| Do you think that female students who decide to abort are due to desire to complete their study? | Yes | 269 | 78.2% |
| No | 75 | 21.8% | |
4. Discussion
This study showed that majority of female undergraduates had good knowledge about complications of unsafe abortion. This findings resemble to the findings obtained from a descriptive cross‐sectional study done among female students in tertiary education institutions in Kitwe, Zambia regarding knowledge, attitude and practices of unsafe abortion, which showed that, 69.2% of the respondents had good knowledge on unsafe abortion while 30% of them had poor knowledge on unsafe abortion [12]. This is also similar to a cross‐section study conducted in Texila American University, in Lusaka, Zambia on assessing factors contributing to unsafe abortion practice among women of productive age in which the majority of women indicated having good knowledge 86%, and 14% had poor knowledge on complications of unsafe [13]. These similarities of results could be due to the similarity in their level of education of the study population of those studies.
However, a cross‐sectional study done in Sarbamangala Secondary School, Kavre among adolescent students on knowledge of unsafe abortion, showed that, majority of participants (78.5%) had inadequate knowledge; 20.2% had moderate knowledge and only (1.3%) had adequate knowledge regarding the practice of unsafe abortion [14]. This difference of knowledge between these two studies might be due to different levels of education between the study populations in those study, as well as age of the respondents. Because, from the result revealed that 81.8% of fifth year female undergraduates had good knowledge compared to 68.8% first year female undergraduates.
The results showed that 84.9% of respondents had the knowledge that severe bleeding per vagina was one of the complications of practicing unsafe abortion and 76.2% of respondents knew that uterine rupture; 70.7% genital tract infection and, 77.3% infertility (inability to conceive in women) were the among of the health complications of unsafe abortion. This is similar to the findings obtained in Jimma zone, South West Ethiopia in which the most mentioned complications were vaginal bleeding (82.4%), infection (68.9%) uterine rupture (78.1%), and infertility (80.3%) [15]. This study also showed that, among of 174 (49.4%) of respondents who knew the person who developed some complications of unsafe abortion from their schools were able to mention and majority 83 (47.7%) of respondents mention severe bleeding was the complication; 36 (20.7%) mentioned anemia; and 30 (17.2%) mentioned infection. But, those results were different from a descriptive cross‐sectional study done in Kampala, Uganda on knowledge and attitudes about induced abortions in which (60.2%) of youth females knew persons who became ill after practicing unsafe abortion. The commonly mentioned complication was loss of life (death) followed by bleeding from vagina [16]. This difference could be due the level of provision of post‐abortion care in these two countries.
Desire to complete their study was identified by 269 (78.2%) of respondents as the major reasons why medical female undergraduates decided to abort if they got unplanned pregnancy. Others were: Fear to disappoint their parents 229 (66.6%) and, unacceptability of pregnancy before marriage, 75.9% and stigmatization from society, 34.0%. This is coherent with a cross‐sectional study conducted at the University of Namibia which showed that, the major reasons for having an abortion were, avoidance of stigmatization from society on unplanned pregnancy before one got married [17]. In Tanzania and most African countries, abortion is illegal and socially unacceptable [18], this drive most of young female to terminate the unwanted pregnancy unsafely.
This study also showed that, 85.3% of respondents who lived in high‐income family decided to keep the pregnancy while 65.3% of respondents who lived in low income family decided to abort if they got unplanned pregnancy. In addition, a total of 153 (44.5%) of respondents reported to be unable to take care compared to 111 (32.3%) who responded to had ability to take care; while 80 (23.2%) of the respondents were not sure if they were able or not. Those results resembles to a cross‐sectional study done in Nakuru county Kenya which revealed that, women with low level of economic status had more prevalence of deciding unsafe abortion than the high‐income women [19].
4.1. Limitations of the Study
This study, while providing valuable insights, has several limitations. First, the use of a convenient sampling technique limits the generalizability of the findings to a broader population beyond medical female undergraduates at the University of Dodoma. The results may not be representative of all female students in Tanzania or even other universities. Second, the reliance on self‐administered questionnaires via WhatsApp groups may introduce social desirability bias, where respondents might provide answers they perceive as more acceptable rather than their true experiences or beliefs, especially concerning sensitive topics like abortion practices. Third, the study was cross‐sectional, meaning it captured data at a single point in time. This design prevents the establishment of cause‐and‐effect relationships between the identified factors and the practice of unsafe abortion. Long‐term studies would be necessary to understand temporal relationships. Lastly, the study focused solely on female undergraduates and did not include male students or other demographics, potentially missing important perspectives and contributing factors from other segments of the university community or society at large.
5. Conclusion
This study reveals that while medical female undergraduates at the University of Dodoma possess a commendable level of knowledge regarding the complications of unsafe abortion, the practice remains prevalent among them. A substantial majority of students demonstrated good understanding of the severe health risks, including severe bleeding, anemia, infections, uterine rupture, and infertility. Despite this knowledge, a notable percentage of respondents had experienced unplanned pregnancies and resorted to unsafe abortion methods, primarily through self‐medication or unregulated practitioners.
The findings highlight that socioeconomic factors are powerful drivers behind these decisions. The overwhelming desire to complete education, coupled with fears of disappointing parents, losing financial support, and facing societal stigmatization, significantly influences the choice to terminate a pregnancy. Furthermore, students from lower‐income backgrounds were more likely to consider abortion if faced with an unplanned pregnancy. The alarming rate of unsafe abortions, even among those with medical knowledge, underscores the complexity of the issue, extending beyond mere awareness. It suggests that punitive measures alone are insufficient, and a more comprehensive approach is needed. There is an urgent need for multi‐faceted interventions that address both the knowledge gap and the underlying social and economic pressures driving young women to unsafe practices. This includes enhancing access to safe family planning services, providing better support systems for pregnant students, and fostering a more understanding and less judgmental societal environment.
Author Contributions
Majani Edward: conceptualization, investigation, methodology, supervision, writing – original draft, writing – review and editing. Muksini Mohamedi Shante: conceptualization, methodology, investigation, writing – original draft. Ally Ally Hamisi: writing – original draft, investigation.
Funding
The authors have nothing to report.
Ethics Statement
The study protocol was approved by the University of Dodoma Ethical Clearance Committee with reference number SFU/Re.Pub/Eth.App/Vol.1/1.
Consent
This study adhered to Declaration of Helsinki, written informed consent obtained from all participants before their involvement in the study.
Conflicts of Interest
The authors declare no conflicts of interest.
Declaration of AI Use
AI‐assisted technologies were used for language editing only, and the authors confirm that they reviewed and take responsibility for all content.
Transparency Statement
The lead author, Majani Edward, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data Availability Statement
The data supporting the findings of this study are available upon reasonable request from the corresponding author.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this study are available upon reasonable request from the corresponding author.