Multi-level analysis of pregnancy termination among sexually active married women in developing countries

Pregnancy termination is a global concern affecting millions of women, with less developed countries bearing a disproportionate burden. Despite progress in maternal healthcare, limited access to sexual and reproductive health services, and socio-economic disparities continue to contribute to high prevalence of pregnancy termination. This study aimed at understanding the contextual factors associated with pregnancy termination among married women in less developed countries based on the socio-ecological model.The study analysed data from 61 developing countries' Demographic and Health Surveys (2015-2022) among non-sterile, fecund women (n = 715,281). Univariate, bivariate, and binary multilevel regression analyses were conducted to examine individual, household, and community-level factors associated with pregnancy termination. Model fit was assessed using the Akaike Information Criterion, and Stata 17 was used for statistical analysis.The multilevel regression analysis revealed that pregnancy termination is significantly high (18.5%) in LDCs, and is influenced by individual, household, and community-level. Among the individual factors, older married women (AOR = 2.50, 95% CI: 1.83-1.80-1.87 and AOR = 2.50 95% CI: 2.54-2.56), with primary education or higher (AOR = 1.15, 95% CI: 1.22 - 1.17; AOR = 1.20 95% CI: 1.17-1.22 and AOR = 1.10, 95% CI: 1.07-1.13) and in employment exhibited increased odds of termination. Partners education and higher household wealth were household factors associated with pregnancy termination. At community level, wealth index, media and family planning message exposure and contraceptive use (AOR = 1.05, 95% CI: 1.02-1.08 and AOR = 1.03, 95% CI: 1.01-1.05) were associated with termination.The study reveals that pregnancy termination among married women in LDCs are shaped by a mix of individual, household, and community factors. Women who are older, more educated, and employed are more likely to terminate a pregnancy, as are those with educated partners and from wealthier households. Additionally, increased exposure to media and family planning messaging correlates with higher termination rates. These findings underscore the need for a comprehensive policy approach to enhance women's reproductive health in LDCs. Such a strategy should include individual through to community-level interventions focused on empowering women, engaging men, improving access to family planning services, and implementing destigmatising media campaigns. These combined measures would contribute significantly to ensuring that no woman is left behind in meeting their SRH needs.