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Research proposal

1. DETERMINANTS OF ABORTION AND POST-ABORTION CARE SERVICES UTILIZATION AMONG JOURNALISM STUDENTS AT JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY Authors Bruce Mariga HSN211-0090/2020 Mary Kuria HSN211-0068/2021 Ronnie Nimrod HSN211-0061/2021 Vinel Kagonya HSN211-0005/2021

2. Background Abortion refers to the loss of a pregnancy, whether spontaneously or by induction, before viability outside the mother’s womb. Unsafe abortion being one done either by persons lacking the necessary skills or in an environment lacking minimal medical standards or both ( APHRC et al. 2019) . Post Abortion Care (PAC) refers to medical, social, psychological, spiritual care and support given to a person after an abortion. (MoH, 2019). Globally, Unsafe abortions account for 13% of all maternal deaths. Africa accounts for 24.8% of unsafe abortions. (CRR, 2010 )

3. In Kenya 10% of pregnancies end in miscarriages, 2% stillbirths, and less than 1% in induced abortion. Unsafe abortions account for 35% of maternal deaths. (KNBS & ICF, 2023 ) In a study on PAC clients, 86% of the clients likely seek care following an unsafe abortion, half of the patients were under 25 years with 13% being students. Half the students had severe complications (APHRC et al. 2019) .

4. Problem Statement There is a lack of awareness about abortion and related services among students leading to reproductive health risks. Even when aware of these services, students often lack knowledge about post-abortion care and many delay seeking treatment due to fear of stigma or hostility from the medical personnel. The absence of comprehensive sexual education in schools exacerbates this issue, leaving students uninformed about their reproductive rights and available support services (Guttmacher Institute, 2020). Societal stigma often marginalizes students seeking abortion services leading to secrecy and reluctance to seek proper care (Hussain, 2012).

5. Justification Abortion and post abortion care services are important aspects of reproductive health. Sustainable development goal (SDG) 3 on good health and wellbeing and SDG 5 on gender equality address this . JKUAT provides a good study area due to its diverse population in terms of social, cultural and religious values. The students being in the reproductive age bracket are also at high risk of unintended pregnancies. This study will help identify gaps and misconceptions surrounding abortion and post abortion care services among university students. This will inform health education programs when addressing misconceptions by providing accurate information. The findings may also inform future policies to improve reproductive health among the youth including comprehensive abortion and post abortion care services .

6. Research Questions What is the level of knowledge regarding abortion and post-abortion care services among journalism students at JKUAT? What are the attitudes of journalism students at JKUAT toward abortion and post-abortion care services? What are the perceived barriers that prevent journalism students at JKUAT from accessing abortion and post-abortion care services?

7. Objectives Broad Objective To assess the determinants of abortion and post abortion care services utilization among journalism students at JKUAT Specific Objectives To assess knowledge of abortion and post abortion care services among journalism students at JKUAT To determine the attitudes towards abortion and post abortion care services among journalism students at JKUAT To determine perceived barriers to utilizing abortion and post-abortion care services among journalism students at JKUAT.

8. Conceptual Framework

9. Methodology Study Design: Descriptive cross sectional study design was used in this study . Study Population: The population comprised of c urrently enrolled students in the Bachelor of Science in Journalism program at JKUAT . Study Area: The study was conducted at JKUAT in the C ollege of Human R esource D evelopment (COHRED), in the School of communication and development studies Department of media technology and applied communication , Journalism . This is situated on the third floor of the COHRED building . Inclusion Criteria: Those who were enrolled in the B.Sc. in Journalism program at JKUAT. Aged 18 years and above and had provide informed consent . Exclusion Criteria: All members who were under the age of 18 and those who did not provided informed consent to participate in the study .

10. Sample Size and Sampling Method Given the total population of 246 students, using Yamane’s formula, a sample size of 152 students was achieved (confidence level = 95%). The expected non-response rate was then set at 20% and the sample size adjusted to 190 students. Stratified random sampling was then selected and sample allocations distributed proportionately by grouping the study population into various strata based on the year of study. A list of members for each class was obtained and a randomized selection of participants created via excel who were then recruited. A total of 151 responses was achieved as shown in the following table

11. Stratum Student Population Desired allocation Adjusted allocation Responses achieved First year 80 49 62 47 Second year 97 60 75 58 Third year 69 43 53 46 TOTAL 246 152 190 151 Formulas used Yamane’s formula: n = N / (1+ N (e2)). {n=sample size, e=sampling error, N = population size, confidence level = 95 %, e = 0.05 } Adjusted sample size = 1 / (1-non-response rate) x sample size = 1 / (1 - 0.2) x 152 = 190 proportionate allocation for each stratum = (stratum size / population size) x total sample size

12. Ethical Approval: Ethical approval was sought from JKUAT ethical review committee through the dean of students and permission sought from the dean of the school of communication and development studies at the college of Human Resource Development . Data Collection: Selected consented participants were given a link to an online questionnaire to fill out on their own devices and submitted responses automatically recorded into a spreadsheet. Data Analysis: Received data was cleaned and prepared for analysis. Descriptive statistics such as percentages and frequency counts was used to summarize responses. Summative metrics, means and modes were then computed were appropriate. Results were then presented in descriptive statements, tables, charts and graphs .

13. Results Knowledge of abortion and post‐abortion care (PAC) services The overall Knowledge Safety Score had a mean of 3.7 out of a possible 6, suggesting a moderate level of knowledge among the students. 30.5% had high knowledge while 10.6% very low knowledge 49% were unaware of what post-abortion care (PAC) entails Main information sources were social media (55%), institutions (16.6%), friends/family (10.6%), health providers (7.3%) 62.8% knew abortion was illegal in Kenya, 20.9 % thought it was legal and the rest (16.2%) were unsure Reported abortion providers were hospitals (28.9%), clinics (26.8%), OTC meds (19.5%) 84.9% acknowledged need for hospital care post-abortion

14. Results Attitudes toward abortion and PAC. Use of abortion: When asked if they or their friends had ever procured abortion services, majority responded in the affirmative (57.3%) despite more than half (51.4%,) reported to perceive it as unsafe. Pro-abortion sentiment Majority of the respondents had a positive attitude towards abortion with an average pro-abortion sentiment score +1.05. M ost students agreed with the women’s right to abortion (61.1%) and the integration of abortion services into standard healthcare services (54%) while the minority disagreed (23.5%) and (28.7%). A non-trivial section was neutral to these statements (15.4%) and (17.3%). Prior use of abortion services was significantly linked to positive attitudes (p=0.042 )

15. Results Perceived Barriers to accessing abortion and PAC service Seven key barriers were identified and respondents asked to rate how each would deter one’s access to abortion and PAC services, providing insight into their perceived barriers. Each barrier was rated from 1 (very mild influence) to 5 (very strong influence ). The mean score for each barrier was then computed to establish the overall perceived influence.  The Leading reported barriers were stigma (mean 3.68 ) and financial constraints (3.57) The Other barriers included religion (3.51), lack of info (3.46), fear of legal consequences ( 3.39) limited providers (3.39 ) and distrust or poor experience with health care (3.28) A ccessibility of services: 28.5% and 20.5% found it easily accessible and very accessible, 22.5% found it somewhat accessible while the rest (15.23 and 13.2%) found it somewhat inaccessible and very inaccessible

16. Conclusions Most students had moderate knowledge of abortion but major gaps in PAC understanding Social media is main source but spreads myths/confusion Uncertainty about abortion law & safe services pushes students to unsafe providers Majority support abortion rights, but many still perceive it as unsafe Personal/peer experience linked to more positive attitudes & reduced stigma The three leading barriers were stigma, financial burden and religion

17. Recommendations Integrate reproductive health education in universities (focus: safe abortion & PAC) Use student associations & peer-led initiatives to debunk myths Strengthen youth-friendly services in university health units with confidentiality Clarify legal provisions on abortion through public education campaigns Train healthcare staff in stigma reduction Partner with journalism students to run awareness campaigns on PAC Conduct longitudinal studies on long-term impact of interventions

18. References African Population and Health Research Center (APHRC), Ministry of Health (MoH), Ipas, & Guttmacher Institute (GI) (2013). Incidence and complications of unsafe abortion in Kenya: Key findings of a national study. Nairobi, Kenya. MoH. Center for Reproductive Rights (CRR), (2010). In harm’s way; The impact of Kenya’s restrictive abortion law . NY, United States. Kenya National Bureau of Statistics (KNBS), & ICF (2023). Kenya Demographic and Health Survey 2022 . Nairobi, Kenya, and Rockville, Maryland, USA: KNBS and ICF . Ministry of Health (MoH) (2019). Post abortion care: A pocket guide for health care providers. Nairobi, Kenya. MoH . Guttmacher institute. (2016). Characteristics of United States abortion patients in 2014 and changes since 2008. Available on https://www.who.int/reproductive health/ topics/ unsafe- abortion/care/en ( more references available in the complete research proposal )