Multilevel analysis of factors associated with abortion among adolescents in Uganda insights from UDHS 2022 dataset

Unsafe abortion is a major reproductive health challenge, causing 7.9% of global maternal deaths and 9.6% in East Africa. In Uganda, about 8% of maternal deaths result from unsafe abortions. Early sexual activity, poor access to sex education, restrictive laws and stigma push adolescents into unsafe practices. Limited safe services force many to use dangerous methods leading to severe complications and high maternal mortality. This study examined determinants and prevalence of abortion among Ugandan female adolescents using the 2022 Uganda Demographic and Health Survey dataset of 5,125 females aged 15-24 who had ever engaged in sexual activity. The dependent variable was binary (1 for ever terminated, 0 for never). Weighted data were analyzed using descriptive statistics, ordinary and mixed effect logistic regression models to explore individual- and cluster-level influences. Intra-class correlation and likelihood ratio tests assessed cluster variation. Findings showed 562 adolescents had ever aborted. Those whose first sex was before age 15 were 3.44 times more likely to abort compared to those aged 20-24 while those aged 15-17 were 2.24 times more likely. Married adolescents had twice the odds compared to never married, and cohabiting adolescents were 2.44 times more likely. Compared to those with education beyond secondary, adolescents with no education, primary and secondary schooling were 5.8, 2.99 and 3.01 times more likely to abort. Regional variations accounted for 16.8% of variance, with intra-class correlation of 4.9%. Overall, 11.0% of Ugandan female adolescents reported abortion. Key determinants included age at first sex, marital status, education, contraceptive use and internet use. Region-level factors contributed 4.9% of variation highlighting the need for cluster-level interventions alongside individual approaches.