Induced abortion and its associated factors among female students in sub-Saharan Africa: a systematic review and meta-analysis

Abstract Objective To assess the pooled prevalence of induced abortion and its associated factors among female students in sub-Saharan Africa. Method Comprehensive literature searches were conducted in PubMed, Scopus, The Health Internetwork Access to Research Initiative (HINARI), African Journals Online, and Google Scholar. Articles published from January 1, 2000, to March 30, 2025, were included. Both peer-reviewed published articles and grey literature were included in this review. Two authors extracted all relevant data using a standardized data extraction format in a Microsoft Excel spreadsheet, which was then exported to Stata 17 for analysis. Meta-analysis was conducted using the Der Simonian and Laird random-effects model. Sensitivity analysis was performed to assess the effect of a single study on the overall prevalence. Subgroup analysis and meta-regression were conducted to explore potential sources of heterogeneity. A funnel plot and Egger’s test were used to assess publication bias, which was addressed using trim-and-fill analysis. Result A total of 41 primary studies involving 18,741 female students were included in this systematic review. The pooled prevalence of induced abortion among female students in the sub-Saharan Africa (SSA) region was found to be 13% (95% CI: 9%–18%). In the subgroup analysis, female students from the western sub-region had a higher prevalence compared to other sub-regions. Additionally, tertiary-level students had a higher prevalence of induced abortion compared to secondary-level students. Alcohol consumption was a significant factor associated with induced abortion in this study. Conclusion Female students in sub-Saharan Africa experience a high prevalence of induced abortion, with subgroup analyses indicating higher rates in West Africa and among tertiary students compared with secondary students. Alcohol consumption was associated with induced abortion. These findings should be interpreted with caution due to limitations in study design, small numbers of studies for some factors, and substantial heterogeneity. Nevertheless, the study provides preliminary evidence to inform future research and guide context-specific interventions.