Abstract
Objectives
This study was aimed at assessing the magnitude of induced abortion and associated factors among students in Hawassa University, southern region, Ethiopia, 2019.
Methods
An institutional-based cross-sectional study was conducted among a total of 422 students selected on the bases of a probability simple random sampling method. A pretested structured questionnaire was used to collect data. Analysis was made with SPSS 20. Descriptive summary and inferential statistics (binary logistic regression) were used with a 95% CI and P value of less than 5% as a level of significance. Findings were presented in tables, figure, and texts. Confidentiality of information was also secured.
Results
The prevalence of induced abortion in the study setting was 68.7% (95% CI: 64.15%-73.2%). Participants who used emergency contraceptives had 12 times higher odds of undergoing abortion than those who did not use emergency contraceptives at AOR: 11.95, 95% CI: 5.615-25.326, P < 001.
Conclusions
A higher prevalence of induced abortion was observed in the study setting. Contraceptive use was the predictor of induced abortion identified. Concerned bodies were recommended to work on the identified determinant of induced abortion in the study setting.
1. Introduction
Abortion has been an old experience carried out so far by human beings. It has been practiced throughout the world illegally. Globally, it was estimated that around 30 million induced abortions were performed annually [1]. Globally, from 210 million pregnancies that occur annually, about 22% end up in induced abortion [2].
In sub-Saharan Africa (SSA), many women use abortion as a means of family planning methods. With restrictive abortion laws and limited contraceptive access, unsafe abortion accounted for 13% of maternal deaths in SSA [3]. About 9% of maternal deaths in sub-Saharan Africa are attributed to complications of unsafe abortion [4].
An estimated 620,300 induced abortions were performed in Ethiopia annually. The annual abortion rate was 28 per 1,000 women aged 15-49, with the highest in urban areas [5]. Induced abortion is one of the mechanisms to deal with unwanted pregnancy. The university students in Ethiopia dealt with unwanted pregnancy by undertaking induced abortion to terminate pregnancy secretly to avoid stigma following premarital pregnancy [6].
Ethiopia is one of the countries that allowed women to obtain safe and legal abortion under some conditions; these conditions included the following: if the pregnancy was from rape, if there is physical or mental disability, if it would put women on physical health or life risk, or if the woman is younger than 18 and unprepared to give birth [7].
Though most studies in Ethiopia were health facility-based on patients seeking health service, reproductive health service, particularly abortion-related issues, was not well emphasized. So, the current study assessed the magnitude of induced abortion and associated factors among students at Hawassa University during the year 2019.
2. Subjects and Methods
2.1. Study Setting and Period
The study was conducted in Hawassa University, located in Southern Nations, Nationalities, and People's Region (SNNPR). It is located 278 kilometers south of Addis Ababa, the capital of Ethiopia. The university is one of the governmental universities located in the southern region of Ethiopia. The university has 7 colleges, with a total of 155,965 populations of which 19,500 were female population. The study was conducted from February to May 2019. An institutional-based cross-sectional study was done. The female students in Hawassa University during the year of 2018/2019 were the source population whereas female students of Hawassa University who were available from February to May 2019 were the study population. Participants were selected on the basis of a simple random sampling technique, where the sampling frame was once determined from registries of the university. Though there were conducted studies, the researcher took 50%, as an estimator of prevalence of induced abortion, to have the maximum sample size. A single population proportion formula was utilized to compute the sample size with its respective standard deviation and margin of error. Accordingly, with the consideration of a 10% nonresponse rate, the final sample was found at 422. A structured pretested self-administered questionnaire was employed among the participants in Amharic (original language) after checking for consistency with English by linguistic professionals. The tool was first developed by the researchers after rigorous reviewing of literatures on the topic, and then, inputs of senior researchers were incorporated into the developed tool. For the coherence, clarity, and conciseness of the questionnaire, native speakers reviewed the tool. The outcome variable was induced abortion measured as follows: abortion is termination of pregnancy before 28 weeks of pregnancy [8]. For the purpose of the current study, induced abortion is “students who terminated their pregnancy intentionally either on their own or by another person” [9].
2.2. Statistical Analysis
Data was entered and further analyzed with SPSS version 20. Descriptive statistics were employed as a summary measure. Associations between covariates and dependent variables were investigated with binary logistic regression with a 95% confidence interval (95% CI) and P value less than 5% as the level of significance. Bivariate logistic regression was done first; then, to take control of effects of confounding variables, multivariate logistic regression was also done.
3. Results
3.1. Sociodemographic Characteristics of the Respondents
Four hundred twenty-two participants participated in this study with a 100% response rate. Regarding years of education, 17%, 41.2%, 30.6%, 8.8%, and 5.5% of the students were 1st year, 2nd year, 3rd year, 4th year, and 5th year students, respectively. Concerning the departments, 32% were engineering, 15.6% were health, and 33.4% were social science, and the remaining 11.1% were agriculture students. More than half (61.6%) of students lived in the campus dormitory; 37.7% of students lived outside the campus. Less than half (42.2%) of students got income from their parents, 29.9% of the students got an income from relatives, and 27.7% of students got income from other sources (Table 1).
Table 1.
Sociodemographic characteristics of female students in Hawassa University, SNNPR, Ethiopia, April 2019.
| Characteristics | Categories | Number | % |
|---|---|---|---|
| Age in years | 18-20 | 25 | 5.9 |
| 21-23 | 344 | 81.5 | |
| 24-26 | 53 | 12.6 | |
|
| |||
| Year of education | 1st year | 74 | 17.5 |
| 2nd year | 174 | 41.2 | |
| 3rd year | 129 | 30.6 | |
| 4th year | 37 | 8.8 | |
| 5th year | 8 | 1.9 | |
|
| |||
| Respondent department | Engineering | 135 | 32.0 |
| Health | 66 | 15.6 | |
| Social science | 141 | 33.4 | |
| Agriculture | 47 | 11.1 | |
| Other | 33 | 7.8 | |
|
| |||
| Respondent places they live | In the campus dormitory | 260 | 61.6 |
| Outside the campus | 159 | 37.7 | |
| With my parents | 3 | 7 | |
|
| |||
| Respondent source of income | Parents | 179 | 42.4 |
| Relatives | 126 | 29.9 | |
| Others∗ | 117 | 27.7 | |
∗Friends, boyfriends, and sugar daddy.
3.2. Behavioral Characteristics of Participants
Eighty-two percent of students had history of sexual intercourse. The reasons behind their start of sexual intercourse were the following: 40.3% influence of economic problems, 46.4% peer pressure, 44.1% alcohol consumption, 38.9% personal desire, and 34.8 influence of khat or drugs (Table 2).
Table 2.
Behavioral characteristics of female students at Hawassa University, SNNPR, Ethiopia, April 2019.
| Variables | Categories | Frequency | % |
|---|---|---|---|
| Had history of sexual intercourse | Yes | 347 | 82.2 |
| No | 75 | 17.8 | |
| Peer pressure was the reason for intention to have sexual intercourse | Yes | 196 | 46.4 |
| No | 226 | 53.6 | |
| Personal desire was the reason for intention to have sexual intercourse | Yes | 164 | 38.9 |
| No | 258 | 61.1 | |
| Influence of alcohol was the reason for initiation of sexual intercourse | Yes | 186 | 44.1 |
| No | 236 | 55.9 | |
| Influence of khat or drug was the reason for initiation of sexual intercourse | Yes | 147 | 34.8 |
| No | 275 | 65.2 | |
| Economic problem was the reason for initiation of sexual intercourse | Yes | 170 | 40.3 |
| No | 252 | 59.7 | |
| Other factors were the reason for initiation of sexual intercourse | Yes | 169 | 40.0 |
| No | 253 | 60.0 |
3.3. Participant's Knowledge about Abortion
As to respondent view about whether participants had heard about emergency contraceptives, majority 406 (96%) had information about it, with most 326 (77%) of the respondents having used the drugs. More than half 265 (62%) of respondents reported that they knew where abortion is legally conducted. Most (77%) of the respondents reported that they used emergency contraceptives following sexual intercourse. Regarding the experience of abortion by the study participants, most (69%) of the participants reported that they had undertaken induced abortion, of which more than half (54%) of the participants used medication for termination of the pregnancy. More than half (53%) of the participants reported that holding off sexual intercourse was their choice when their partner was unwilling to use a condom (Table 3).
Table 3.
Participants' knowledge of a place and complication of abortion at Hawassa University, SNNPR, Ethiopia, April 2019.
| Characteristics | Number | % | |
|---|---|---|---|
| Have you heard about emergency contraceptive drug? | Yes | 406 | 96.2 |
| No | 9 | 2.1 | |
| Not sure | 7 | 1.7 | |
|
| |||
| Did you use emergency contraceptive following sex? | Yes | 326 | 77.3 |
| No | 96 | 22.7 | |
|
| |||
| Have you had abortion? | Yes | 290 | 68.7 |
| No | 132 | 31.3 | |
|
| |||
| Reasons for undertaking abortion | Because it affects my education | 98 | 33.7 |
| Because I cannot raise a child | 96 | 33.1 | |
| To protect social stigma | 65 | 22.4 | |
| Because I got pregnant due to sexual assault | 22 | 7.6 | |
| Others | 11 | 3.2 | |
|
| |||
| Did you know where abortion is performed legally? | Yes | 265 | 62.8 |
| No | 156 | 37.0 | |
| Am not sure | 1 | 0.2 | |
|
| |||
| Respondent place of performing abortion | Community pharmacy | 76 | 26.4 |
| Health center | 104 | 35.8 | |
| Private clinic | 109 | 37.5 | |
| Traditional | 1 | 0.3 | |
|
| |||
| How long since undertaking of abortion? | 1 month | 72 | 24.8 |
| 2 months | 114 | 39.3 | |
| 3 months | 90 | 31.0 | |
| Do not know | 14 | 4.9 | |
|
| |||
| Did you face infection during abortion? | Yes | 87 | 30.0 |
| No | 203 | 70.0 | |
|
| |||
| Did you face bleeding during abortion? | Yes | 15 | 5.1 |
| No | 275 | 94.9 | |
|
| |||
| Type of procedure | Medication | 156 | 53.8 |
| Instrument | 134 | 46.2 | |
|
| |||
| If your partner does not volunteer to use a condom, what would you do? | Stop sexual intercourse | 222 | 52.6 |
| Try to convince them to use condom | 177 | 41.9 | |
| Practice sexual intercourse without using condom | 23 | 5.5 | |
3.4. Magnitude and Associated Factors of Induced Abortion
The magnitude of induced abortion in the study setting was 68.7% (95% CI: 64.15%-73.2%), whereas only less than one-third (31.3%) did not undergo induced abortion (Figure 1). The age of participants, year of education, alcohol use, and use of emergency contraceptives have independently shown a statistical association with the occurrence of induced abortion at P value less than 5%. But in the multivariate logistic regression, only emergency contraceptive use was statistically associated with the occurrence of induced abortion. Participants who used emergency contraceptives had 12 times higher odds of taking induced abortion than those who did not use emergency contraceptives (AOR: 11.95, 95% CI: 5.615-25.326, P < 0.001) (Table 4).
Figure 1.
Magnitude of induced abortion of female students at Hawassa University, SNNPR, Ethiopia, April 2019.
Table 4.
Factors associated with induced abortion among Hawassa University students, SNNPR, Ethiopia, April 2019.
| Characteristics | Abortion | COR (95% CI) | P value | AOR (95% CI) | P value | ||
|---|---|---|---|---|---|---|---|
| Yes | No | ||||||
| Age (grouped) | 18-20 | 11 | 14 | 1 | 0.015 | 1 | 0.369 |
| 21-23 | 238 | 106 | 0.350 (0.154-0.796) | 0.012 | 2.546 (0.682-9.505) | 0.164 | |
| 24-26 | 41 | 12 | 0.230 (0.083-0.637) | 0.005 | 2.717 (0.588-12.558) | 0.201 | |
|
| |||||||
| Years of education | 1st year | 34 | 40 | 1 | 0.000 | 1 | 0.023 |
| 2nd year | 122 | 52 | 0.362 (0.207-0.635) | 0.000 | 7.862 (0.437-141.384) | 0.162 | |
| 3rd year | 96 | 33 | 0.292 (0.160-0.535) | 0.000 | 4.276 (0.249-73.451) | 0.317 | |
| 4th year | 31 | 6 | 0.165 (0.061-0.441) | 0.000 | 3.753 (0.219-64.422) | 0.362 | |
| 5th year | 7 | 1 | 0.121 (0.014-1.037) | 0.054 | 0.816 (0.040-16.617) | 0.895 | |
|
| |||||||
| Monthly income in birr | 300-500 | 48 | 29 | 1 | 0.561 | 1 | 0.270 |
| 501-700 | 117 | 52 | 0.736 (0.418-1.294) | 0.287 | 0.571 (0.274-1.190) | 0.135 | |
| 701-900 | 106 | 42 | 0.656 (0.366-1.175) | 0.156 | 0.473 (0.216-1.032) | 0.060 | |
| ≥901 | 19 | 9 | 0.784 (0.313-1.962) | 0.603 | 0.837 (0.269-2.607) | 0.759 | |
|
| |||||||
| Alcohol use | Yes | 152 | 34 | 3.175 (2.018-4.994) | 0.000 | 0.730 (417-1.278) | 0.271 |
| No | 138 | 98 | |||||
|
| |||||||
| Use of emergency contraceptives | Yes | 272 | 54 | 21.827 (12.101-39.370) | 0.000 | 11.95 (5.615-25.326) | 0.000 |
| No | 18 | 78 | |||||
|
| |||||||
| Have reproductive health education | Yes | 79 | 29 | 1.330 (0.818-2.163) | 0.251 | 0.846 (0.453-1.580) | 0.600 |
| No | 211 | 103 | |||||
4. Discussion
The current study found a higher prevalence of induced abortion among university students observed at 68.7%, which was much higher than the findings of the health facility-based study in Guraghe zone of Ethiopia, which revealed the magnitude of induced abortion at 12.3% [9]. This variation might be due to variation in study settings.
The other study in Ethiopian university students revealed that the rate of induced abortion was found at 65 per 1,000 women. Students with history of alcohol use and first year students had higher risk of abortion than their counterparts. About 23.7% of students reported experience of sexual intercourse, and less than half (44%) of respondents reported ever hearing of emergency contraception, of which 36% of those with sexual experience ever used a condom [10], which was lower than the findings of the current study.
The prevalence of induced abortion among precollege students in Ethiopia was observed at 13.6% [11], which was lower than the findings of the current study. The finding from this study was much higher than the findings in China 8.13% [12], Cameroon 21% [13], southern Ethiopia 43.4% [14], Nigeria 51% [15], and Northwestern Ethiopia 4.8% [16]. This variation might be attributed to differences in the time of investigation of sample size, whereas the current finding was almost consistent with the study in Ghana 64% [17].
Having more than four pregnancies (AOR = 4.28, 95%CI = 1.24‐14.71) and age 30-34 years (AOR = 0.15, 95%CI = 0.04‐0.55) were found to be statistically associated with induced abortion [9]. But in the current study, contraceptive use was the only predictor of induced abortion.
In the other study, being in rural areas (OR = 1.21, 95% CI: 1.04–1.39), ages 18-25 (OR = 0.84, 95% CI: 0.72–0.99) and 30 or older (OR = 1.63, 95% CI: 1.42–1.86), and single individuals (OR = 1.72, 95% CI: 1.05–2.83) were more likely to experience induced abortion [12], where none of the variables showed any statistical association in the current study.
Evidences suggested that history of abortion and use of contraceptive methods were statistically interrelated with each other. Women who had history of abortion were more likely to be those using any methods of contraceptives. A study in Luanda, Angola, supported that history of induced abortion was associated with the use of contraceptive methods. Those women who had a history of induced abortion were 1.23 times more likely to use a modern contraceptive method as compared to those who never had abortion (RR: 1.23, 95% CI: 1.10-1.36) [18].
Desire to stay in school (28%), fear of parents (24%), and shame of being pregnant (26%) were the major depicted determinants of induced abortion. Most of the participants were not aware of where abortion is allowed, and some of them had undertaken illegal abortion [13]. The other study in Cameroon depicted that the prevalence of induced abortion was found at 25% [19], of which the finding was lower than the finding of the current study.
The prevalence of induced abortion in this study was higher than findings from the following: 33.6% Addis Ababa, Ethiopia [20], 5% in Pakistan [21], and 17% in Iran [22].
A study at Felege Hiwot Hospital, Ethiopia, revealed that being nonmarried and student, age less than 24 years, and having previous history of induced abortion and low monthly income were independent predictors of induced abortion [23], whilst in this study, only emergency contraceptive use was statistically associated with the occurrence of induced abortion.
In the current study, participants who used emergency contraceptives had 12 times higher odds of undergoing abortion than those who did not use emergency contraceptives. Surprisingly, a higher magnitude of induced abortion was observed from the current study than most other previous studies.
5. Conclusions
A higher prevalence of induced abortion was observed in the study setting. Contraceptive use was the predictor of induced abortion. Participants who used emergency contraceptives had 12 times higher odds of undergoing induced abortion than those who did not use emergency contraceptives. Interventions focused on identified determinants could be recommended.
Acknowledgments
We would like to acknowledge Universal Medical College and Hawassa University who endorsed us to undertake the study. The authors gratefully thank study participants who participated in the study.
Data Availability
All the required data has been included within the manuscript.
Ethical Approval
Ethical approval was obtained from the ethical clearance committee of Universal Medical College, prior to commencement of the study. Permit to undertake the study was also sought from the Hawassa University Research Review Committee. Confidentiality of the participants was secured through a coding system. The ethics approval was given in accordance with the Declaration of Helsinki. Briefing about the study was highlighted by the data collector.
Consent
Consent for publication was secured from the study participants.
Conflicts of Interest
The authors declare that they have no competing interest.
Authors' Contributions
Addisu Tadesse Sahile was involved in the design, implementation, data collection, and statistical analysis and drafted the manuscript. Mieraf Shiferaw Beyene was involved in the design, data collection, and review of scientific content of the manuscript. Both authors read and approved the final manuscript.
References
- 1.Ngowa J. D. K., Neng H. T., Domgue J. F., Nsahlai C. J., Kasia J. M. Voluntary induced abortion in Cameroon: prevalence, reasons, and complications. Open Journal of Obstetrics and Gynecology. 2015;5(9):475–480. doi: 10.4236/ojog.2015.59069. [DOI] [Google Scholar]
- 2.Ahman E., Shah I. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008. World Health Organization; 2011. [Google Scholar]
- 3.Cohen A. Access to Safe Abortion in the Developing World: Saving Lives while Advancing Rights. 2012.
- 4.Say L., Chou D., Gemmill A., et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323–e333. doi: 10.1016/S2214-109X(14)70227-X. [DOI] [PubMed] [Google Scholar]
- 5.Moore A. M., Gebrehiwot Y., Fetters T., et al. The estimated incidence of induced abortion in Ethiopia, 2014: changes in the provision of services since 2008. International Perspectives on Sexual and Reproductive Health. 2016;42(3):111–120. doi: 10.1363/42e1816. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Moland K. M., Haukanes H., Tadele G., Blystad A. The paradox of access-abortion law, policy and misoprostol. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. 2018;137(2) doi: 10.4045/tidsskr.17.0809. [DOI] [PubMed] [Google Scholar]
- 7.Bayeh E. Human rights in Ethiopia: an assessment on the law and practice of women’s rights. Humanities and Social Sciences. 2015;3(2):83–87. doi: 10.11648/j.hss.20150302.13. [DOI] [Google Scholar]
- 8.Ganatra B., Tuncalp O., Johnston H. B., Johnson B. R., Jr., Gulmezoglu A. M., Temmerman M. From Concept to Measurement: Operationalizing WHO's Definition of Unsafe Abortion. Bulletin of the World Health Organization. 2014;92(3):p. 155. doi: 10.2471/BLT.14.136333. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Tesfaye G., Hambisa M. T., Semahegn A. Induced abortion and associated factors in health facilities of Guraghe zone, southern Ethiopia. Journal of Pregnancy. 2014;2014:8. doi: 10.1155/2014/295732.295732 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Gelaye A. A., Taye K. N., Mekonen T. Magnitude and risk factors of abortion among regular female students in Wolaita Sodo University, Ethiopia. BMC Women's Health. 2014;14(1) doi: 10.1186/1472-6874-14-50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Lentiro K., Gebru T., Worku A., Asfaw A., Gebremariam T., Tesfaye A. Risk factors of induced abortion among preparatory school student in Guraghe zone, southern region, Ethiopia: a cross-sectional study. BMC Women's Health. 2019;19(1):p. 115. doi: 10.1186/s12905-019-0813-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Jiang Y., Han J., Donovan C., et al. Induced abortion among Chinese women with living child-a national study. Advances in Disease Control and Prevention. 2017;2(1):10–15. doi: 10.25196/adcp201712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Bongfen M. C., Bessem Abanem E. E. Abortion practices among women in Buéa: a socio-legal investigation. Pan African Medical Journal. 2019;32 doi: 10.11604/pamj.2019.32.146.17732. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Animaw W., Bogale B. Abortion in university and college female students of Arba Minch town, Ethiopia, 2011. Sexual & Reproductive Healthcare. 2014;5(1):17–22. doi: 10.1016/j.srhc.2013.12.001. [DOI] [PubMed] [Google Scholar]
- 15.Onebunne C. A. C., Bello F. A. Unwanted pregnancy and induced abortion among female undergraduates in University of Ibadan, Nigeria. Tropical Journal of Obstetrics and Gynaecology. 2019;36(2):238–242. doi: 10.4103/TJOG.TJOG_35_19. [DOI] [Google Scholar]
- 16.Senbeto E., Alene G. D., Abesno N., Yeneneh H. Prevalence and associated risk factoprs of induced abortion in Northwet Ethiopia. Ethiopian Journal of Health Development. 2005;19(1):37–44. doi: 10.4314/ejhd.v19i1.9969. [DOI] [Google Scholar]
- 17.Boah M., Bordotsiah S., Kuurdong S. Predictors of unsafe induced abortion among women in Ghana. Journal of Pregnancy. 2019;2019:8. doi: 10.1155/2019/9253650.9253650 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Morris N., Prata N. Abortion history and its association with current use of modern contraceptive methods in Luanda, Angola. Open Access Journal of Contraception. 2018;9:45–55. doi: 10.2147/OAJC.S164736. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Tebeu P.-M., Halle-Ekane G., Da Itambi M., Mbu R. E., Mawamba Y., Fomulu J. N. Maternal mortality in Cameroon: a university teaching hospital report. Pan African Medical Journal. 2015;21(1) doi: 10.11604/pamj.2015.21.16.3912. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Alemayehu B., Addissie A., Ayele W., Tiroro S., Woldeyohannes D. Magnitude and associated factors of repeat induced abortion among reproductive age group women who seeks abortion Care Services at Marie Stopes International Ethiopia Clinics in Addis Ababa, Ethiopia. Ethiopia. Reproductive Health. 2019;16(1) doi: 10.1186/s12978-019-0743-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Sathar Z., Singh S., Rashida G., Shah Z., Niazi R. Induced abortions and unintended pregnancies in Pakistan. Studies in Family Planning. 2014;45(4):471–491. doi: 10.1111/j.1728-4465.2014.00004.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Ranji A. Induced abortion in Iran: prevalence, reasons, and consequences. Journal of Midwifery & Women's Health. 2012;57(5):482–488. doi: 10.1111/j.1542-2011.2012.00159.x. [DOI] [PubMed] [Google Scholar]
- 23.Tilahun F., Dadi A. F., Shiferaw G. Determinants of abortion among clients coming for abortion service at Felegehiwot referral hospital, Northwest Ethiopia: a case control study. Contraception and Reproductive Medicine. 2017;2(1) doi: 10.1186/s40834-017-0038-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All the required data has been included within the manuscript.