Attitudes toward abortion and associated factors among adults and young couples: a population-based study in Kurdistan Province, Iran

Abortion is one of the major public health challenges, and attitudes towards it are shaped by the complex interaction of individual, interpersonal, social, and structural factors. Understanding these multilevel factors is essential for designing effective interventions in the field of reproductive health. This study aimed to investigate the attitudes of young people and young couples towards abortion in Kurdistan Province and interpret the factors associated with it based on the social ecological model. This cross-sectional study was conducted on 2524 adults and couples in Kurdistan Province, Iran. Attitudes towards abortion were assessed using the validated Taylor and Whitehead questionnaire. Data analysis included descriptive statistics, bivariate analyses, and hierarchical linear regression to identify factors independently associated with attitudes towards abortion and control for confounding variables. The mean age of the participants was 36.18 ± 9.12 years and the mean attitude score was 30.03 ± 3.95. About 30.6% of the participants reported a history of abortion. In the adjusted model, number of children, education level, employment status, family history of abortion, and age were significantly associated with attitudes toward abortion (P < 0.05), whereas gender was not significantly associated after controlling for other factors. Overall, 43.2% of participants had a supportive attitude and 54.0% had an opposing attitude toward abortion, with similar patterns observed across genders. Attitudes towards abortion in this society are not solely influenced by individual characteristics or gender, but are shaped within a multi-level context of social relations, institutional structures, and macro-policies. Applying the social ecological model provides a comprehensive framework for explaining these attitudes and emphasizes the need to design multi-level, culturally sensitive, and evidence-based interventions to promote reproductive health and reduce the consequences of unsafe abortion.