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Cited by 19Reproductive Health and ContraceptionGlobal Maternal and Child HealthInternational Human Rights and Reproductive Law

Induced abortion: a cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique

Open access
Frederico, Mónica, Arnaldo, Carlos, Decat, Peter, Juga, Adelino, Kemigisha, Elizabeth, Degomme, Olivier, Michielsen, Kristien·2020·BMC Women's Health
DOI 10.1186/s12905-020-00988-6PMC PMC7304116
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Abstract

Background: Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities. Methods: A cross-sectional household survey among women aged 15–49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied. Results: A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women’s health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law. Conclusion: Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women’s health. There is a need for widespread sensitization about the new law and its benefits.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 2016–2017 cross-sectional household survey of 1,657 women aged 15–49 in Maputo and Quelimane, 9.2% reported an induced abortion and 28.8% knew the new legal status of abortion. Only 17% perceived legalization as beneficial to women’s health, and knowledge was associated with city, pregnancy history, marital status, and occupation.

Key findings

  • 9.2% of ever-pregnant women reported an induced abortion; Maputo reported 10.6% vs Quelimane 4.5% (p = 0.024). Among 85 women with provider/place data, 59 (69.4%) abortions were classified as safe, 17 (20.0%) as unsafe, and 9 (10.6%) could not be classified.
  • 28.8% knew abortion is legal in Mozambique (33.3% in Maputo vs 14.0% in Quelimane); 43.1% said it was illegal and 28.1% did not know.
  • 17.3% agreed that legal abortion at a health facility is beneficial for women’s health; 69.2% said no and 13.5% did not know.
  • In multiple logistic regression, knowledge of the law was associated with Maputo residence (AOR 5.04, 95% CI 2.75–9.24), ever being pregnant (AOR 3.34, 1.62–6.89), being unmarried (AOR 2.14, 1.05–4.36), and being a student or employed vs unemployed (AOR 2.26, 1.12–4.53; AOR 2.02, 1.07–3.83). Perceived benefit was associated with university education (AOR 6.07, 2.72–13.53) and knowing the law (AOR 2.54, 1.57–4.10); Muslim respondents were less likely to perceive benefit (AOR 0.22, 0.10–0.50).

Methods

  • Cross-sectional household survey among women aged 15–49 in Maputo (2016) and Quelimane (2017), using a four-stage clustered sampling design; 1,657 women were interviewed (827 Maputo, 830 Quelimane) between August 2016 and February 2017.
  • Data were collected with a Portuguese-language questionnaire adapted from WHO instruments and the 2011 Mozambican DHS, pretested with 50 women; measures included sociodemographics, pregnancy outcomes, contraceptive use, and knowledge/attitudes toward the new abortion law.
  • Analyses were weighted and used univariate, bivariate, and multiple logistic regression with the complex samples procedure in SPSS v23; covariates included age, marital status, education, religion, city, occupation, contraceptive use, pregnancy experience, and—for perceived benefits—abortion-law knowledge.

Limitations

  • The paper states that findings from two cities cannot be generalized to the whole country; it did not use internationally validated measures for abortion attitudes; the cross-sectional design cannot determine causality; and sociodemographic differences between cities may produce negative confounding.
  • The paper states that the small number of abortion cases prevented further multivariate analysis on the safety indicator.
  • The paper notes that self-reported abortion may be underreported because of stigma, fear of prosecution or sanction, and negative labeling, which may explain the lower proportion compared with other studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12905-020-00988-6

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

19 of 58 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    These results are similar to findings by Sedgh et al. and Awoyemi et al. that married women were less likely to demand abortion compared to unmarried women.

    “These results are similar to Sedgh et al. [40] and Awoyemi et al. [28] findings which showed that married women were less likely to demand abortion, compared to women who were not married.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [40] Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet. 2016. https://doi.org/10.1016/S0140-6736(16)30380-4. source

      The Results report the opposite global comparison for 2010–14: 36 abortions per 1,000 married women versus 25 per 1,000 unmarried women. The paper notes regional exceptions in sub-Saharan Africa and North America, but it does not report a general finding that married women were less likely to seek abortion; it estimates abortion incidence, not demand. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [28] Awoyemi BO, Novignon J. Demand for Abortion and Post Abortion Care in Ibadan, Nigeria. Health Econ Rev. 2014;4(3):1–9 https://www.healtheconomicsrevview.com/content/4/1/3. Accessed 04 Mar 2016. source
  • Premisereasoning

    Most recent studies on abortion in Mozambique were based on hospital data and were likely to miss a substantial proportion of illegally induced abortions taking place outside health facilities.

    “Because most of these studies were based on hospital data they were more likely to miss out a substantial proportion of illegally induced abortions taking place outside the health facilities.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [15] Gebreselassiea H, Ustá M, Andersen KL, Mitchelld EMH. Clinical diagnosis of completeness of medical abortion by nurses: a reliability study in Mozambique. Contraception. 2012. https://doi.org/10.1016/j.contraception.2011.08.012. source
    • cites [16] Mitchell EMH, Kwizera A, Usta M, Gebreselassie H. Choosing early pregnancy termination methods in urban Mozambique. Soc Sci Med. 2010. https://doi.org/10.1016/j.socscimed.2010.03.025. source
    • cites [17] Ustá MB, Mitchell EM, Gebreselassie H, Brookman-Amissah E, Kwizera A. Who is excluded when abortion access is restricted to twelve weeks? Evidence from Maputo, Mozambique. Reprod Health Matters. 2008. https://doi.org/10.1016/S0968-8080(08)31386-X. source

      The Methods (page not provided) show that this study used records from five public hospitals in Maputo. The paper does not say that most abortion studies in Mozambique were hospital-based or estimate how many illegally induced abortions outside health facilities such studies missed. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
  • Premisecitation

    Studies in some Sub-Saharan African countries indicated a high proportion of induced abortion, ranging from 13 to 32.8% among young women.

    “Furthermore, studies conducted in some Sub-Saharan African countries also indicated a high proportion of induced abortion, ranging from 13 to 32.8% among young women [35, 36].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [35] Chae S, Desai S, Crowell M, Sedgh G, Singh S. Correction: Characteristics of Women Obtaining Induced Abortions in Selected Low- and Middle-Income Countries. PLoS One. 2017. https://doi.org/10.1371/journal.pone.0177149. source

      Table 1 of the correction (page not given) reports that women aged 20–24 accounted for 32.8% of reported abortions in both Congo Republic and Ghana. It gives the percentage distribution of abortions by age, not the proportion of young women who had an abortion, and it does not show a 13% figure for young women in the listed African countries. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [36] Sully EA, Atuyambe L, Bukenya J, Whitehead HS, Blades N, Bankole A. Estimating abortion incidence among adolescents and differences in post abortion care by age: a cross-sectional study of post abortion care patients in Uganda. Contraception. 2018. https://doi.org/10.1016/j.contraception.2018.07.135 Accessed 30 Sept 2018. source

      The Results section reports that 15% of adolescent pregnancies in Uganda ended in abortion, supporting a proportion within the claimed range. The paper does not establish the stated 13–32.8% range across Sub-Saharan African countries; its other country comparisons in the Introduction do not provide those percentages. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    The finding that the abortion law is not known is consistent with studies in Ethiopia and Nigeria where only a third of surveyed women were aware of the legal status of abortion.

    “This is consistent with other studies in Ethiopia [27] and Nigeria [30] where only a third of the surveyed women were aware of the legal status of abortion.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [27] Geleto A, Markos J. Awareness of female students attending higher educational institutions toward legalization of safe abortion and associated factors, Harari Region, Eastern Ethiopia: a cross-sectional study. Reprod Health. 2015. https://doi.org/10.1186/s12978-015-0006-y. source
    • cites [30] Adinma ED, Adinma JIB, Ugboaja J, Iwuoha C, Akiode A, Oji E, Okoh M. Knowledge and perception of the Nigerian abortion law by abortion seekers in South-Eastern Nigeria. J Obstet Gynaecol. 2011. https://doi.org/10.3109/01443615.2011.593645. source
  • Interpretationown data

    The proportion of induced abortion found among women of reproductive age and young women in this study is lower than the proportion found in other African countries.

    “However, the proportion of abortion found among women of reproductive age, as well as among young women is lower than the proportion of induced abortion found in other African countries.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [34] Guttmacher Institute. Fact Sheet: Abortion in Africa. New York; 2016. http://www.guttmacher.org. Accessed 04 Aug 2018.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [35] Chae S, Desai S, Crowell M, Sedgh G, Singh S. Correction: Characteristics of Women Obtaining Induced Abortions in Selected Low- and Middle-Income Countries. PLoS One. 2017. https://doi.org/10.1371/journal.pone.0177149. source

      Table 1 in the Correction (page not specified) reports the age distribution of reported abortions in several African countries, not the proportion of women who had an abortion. The accompanying note describes how those distributions were calculated. Neither passage establishes that the proportion in the citing study was lower than in those countries; searches for abortion prevalence among women of reproductive age and young women found no such comparison. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [36] Sully EA, Atuyambe L, Bukenya J, Whitehead HS, Blades N, Bankole A. Estimating abortion incidence among adolescents and differences in post abortion care by age: a cross-sectional study of post abortion care patients in Uganda. Contraception. 2018. https://doi.org/10.1016/j.contraception.2018.07.135 Accessed 30 Sept 2018. source

      The Results section reports abortion rates by age within Uganda, and the Introduction discusses findings from other African countries. Neither passage compares the proportion of induced abortions in Uganda with proportions in those countries, so our copy does not establish the claimed cross-country difference. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 26
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent qualitative study found that among young women who induced abortion at a health facility, none had followed the legal procedures because they lacked information on the status of the abortion law and its procedures.

    “a recent qualitative study involving young women who had experienced induced abortion found that, among those who induced abortion at a health facility, none had followed the legal procedures because they lacked information on the status of the abortion law and its procedures [14].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Frederico M, Michielsen K, Arnaldo C, Decat P. Factors influencing abortion decision-making. Processes among Young Women. Int J Environ Res Public Health. 2018. https://doi.org/10.3390/ijerph15020329. source

      Results §3.7 reports that none of the women treated at a hospital said legal procedures were followed. The Discussion says women lacked knowledge of the law and procedures, but it does not establish that this was why procedures were not followed at health facilities; it also says providers largely decided the legality of procedures and often failed to inform patients. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Among countries with more liberal abortion laws, abortion rates vary between 7 and 9 per 1000 women aged 15-44 years; in countries with restrictive abortion laws, rates vary between 29 and 46 per 1000 women of reproductive age.

    “Among countries with more liberal abortion laws, the abortion rates vary between 7 and 9 per 1000 women aged 15–44 years. While in countries where abortion law is restrictive the rates vary between 29 and 46 per 1000 women of reproductive age [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Faúndes A, Shah IH. Evidence supporting broader access to safe legal abortion. Int J Gynecol Obstetr. 2015;131:56–9. https://doi.org/10.1016/j.ijgo.2015.03.018 0020-7292. Accessed 22 Oct 2017. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Countries with enabling laws on abortion have less unsafe abortions and fewer complications linked to abortion.

    “Research shows that countries with enabling laws on abortion have less unsafe abortions and fewer complications linked to abortion [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Faúndes A, Shah IH. Evidence supporting broader access to safe legal abortion. Int J Gynecol Obstetr. 2015;131:56–9. https://doi.org/10.1016/j.ijgo.2015.03.018 0020-7292. Accessed 22 Oct 2017. source

      The Introduction and section 2 say that legal abortion combined with accessible safe services can prevent unsafe-abortion complications and reduce morbidity. But section 2 also says unsafe abortion remains a major cause of maternal mortality where abortion is legally permitted but services are inaccessible. The claim omits that access qualification, so enabling laws alone do not establish the stated pattern. (LLM, conf=0.81)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The study settings differ culturally: in Maputo, children belong to the father's family, while in Quelimane, descent is traced through the mother.

    “As was pointed out before, in methods, the study settings differ culturally. In Maputo, children belong to the father’s family, while in Quelimane, the descendance is traced through the mother [41, 42].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [41] Telalagic S. Domestic Production as a Source of Marital Power: Theory and Evidence from Malawi; 2012. https://doi.org/10.17863/CAM.1021. source

      Section 2.3.1, “Kinship: Patriliny and matriliny in Malawi” (page unavailable), describes descent through the father’s or mother’s side and differences in child custody. It discusses Malawi, however, and does not establish the claimed practices in Maputo or Quelimane; searches for both place names found no supporting passage. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [42] Vubo EY. Matriliny And Patriliny Between Cohabitation equilibrium And Modernity In The Cameroon Grassfields. Afr Study Monographs. 2005;26(3):145–82. https://doi.org/10.1.1.585.2431&rep=rep1&type=pdf.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In South Africa, researchers found that only 32% of respondents did not know about the legal status of abortion.

    “In South Africa [31] researchers found that only 32% of respondents did not know about the legal status of abortion in the country.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Morroni C, Myer L, Tibazarwa K. Knowledge of the abortion legislation among south African women: a cross-sectional study. Reprod Health. 2006. https://doi.org/10.1186/1742-4755-3-7. source

  • May combine two claims.

    Premisecitation

    Communities interpret abortion permission as encouragement of promiscuity and perceive abortion as a sinful, murderous, and abominable act.

    “Communities interpret abortion permission as encouragement of promiscuity and perceive abortion as a sinful, murderous, and abominable act [46, 56, 57].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [46] Mojapelo-Batka EM, Schoeman JB. Voluntary termination of pregnancy: Moral concerns and emotional experiences among black South. S Afr J Psychol. 2003. https://doi.org/10.1177/008124630303300302. source
    • cites [56] Esia-Donkoh K, EKM D, Blemano H, Asare H. Who Cares? Pre and Post Abortion Experiences among Young Females in Cape Coast Metropolis, Ghana. Afr J Reprod Health. 2015;19(2):43–51 https://www.researchgate.net/publication/281586963. Accessed 29 Aug 2018.

      The Discussion (page not specified in our copy) says respondents considered abortion “sinful,” “murderous,” and “an abominable act,” in the context of negative community perceptions. It does not say communities interpret permission for abortion as encouragement of promiscuity; searches for that idea found no supporting passage. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [57] Varga CA. Pregnancy Termination among South African Adolescents. Stud Fam Plan. 2002;33(4):283–98 https://www.jstor.org/stable/3181091. Accessed 06 Mar 2019. source

  • May combine two claims.

    Interpretationcitation

    These beliefs, together with the need of the family to maintain social dignity and avoid public censure, constitute a pushing factor for unsafe abortion among young women and the tendency to seek abortion services without following established procedures.

    “These beliefs, together with the need of the family to maintain social dignity and avoid public censure [57], constitute pushing factor for unsafe abortion among young women, as well as the tendency of seeking abortion services without following the established procedures [14].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [57] Varga CA. Pregnancy Termination among South African Adolescents. Stud Fam Plan. 2002;33(4):283–98 https://www.jstor.org/stable/3181091. Accessed 06 Mar 2019. source
    • cites [14] Frederico M, Michielsen K, Arnaldo C, Decat P. Factors influencing abortion decision-making. Processes among Young Women. Int J Environ Res Public Health. 2018. https://doi.org/10.3390/ijerph15020329. source

  • May combine two claims.

    Findingown data

    69.6% of induced abortions were performed at a health facility, while 30.4% were performed outside a health facility.

    “Regarding the place where the abortion was done, 69.6% said that it was performed at the health facility, while 30.4% had an abortion outside of a health facility.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women accurately reported induced abortion and other pregnancy outcomes.

  • May combine two claims.

    Findingcitation

    Of women who reported induced abortion out of a health facility, 63.2% received an abortion by an unskilled provider, which is an unsafe abortion according to the WHO definition.

    “63.2% of women in our sample received an abortion by an unskilled provider, which is, according to the WHO [2012] definition an unsafe abortion.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites WHO [2012]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: Women accurately reported induced abortion and other pregnancy outcomes.

  • May combine two claims.

    Findingown data

    The intention to induce abortion was reported by 8.5% of the surveyed women and differed significantly between the two study sites.

    “The intention to induce abortion was reported by 8.5% of the surveyed women and differed significantly [P < 0.05], between the two study sites.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women accurately reported induced abortion and other pregnancy outcomes.

  • May combine two claims.

    Findingown data

    Among women who induced abortion, 80.8% reported having recurred to formal health providers and 19.2% sought abortion at informal providers.

    “among women who induced abortion, 80.8% reported having recurred to formal health providers such as nurse and doctor, and 19.2% sought abortion at informal providers”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women accurately reported induced abortion and other pregnancy outcomes.

  • May combine two claims.

    Findingown data

    Knowledge of the new law on abortion differed significantly between Maputo and Quelimane, but perceived benefits did not.

    “There was a significant difference [P < 0.001] in the knowledge of the new law on abortion between Maputo and Quelimane, but not in perceived benefits.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Maputo also presented a high proportion of women who knew the new status of the abortion, despite this evidence not being corroborated by perceived benefits.

    “Maputo also presented a high proportion of women who knew the new status of the abortion, despite this evidence not being corroborated by perceived benefits.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Women with a high level of education and those who already knew the new legal status of the abortion law had a higher likelihood to see the benefits of abortion services.

    “As shown in Table 4 it was among women with a high level of education and those who already knew the new legal status of the abortion law where the likelihood to see the benefits of abortion services was high.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In 2014, a more liberal abortion law was established in Mozambique and its guidelines were made available in 2017.

    “In 2014, a more liberal abortion law was established and its guidelines were made available in 2017 [12, 13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Assembleia da República. Boletim da República: Lei n°. 35/2014 de 31 de Dezembro, vol. I Série n. Maputo: 14° Suplemento Imprensa; 2014. p. 105. http://www.wlsa.orgmz/wp-content/uploads/2014/11/lei-35_2014Codigo_Penal.pdf. Aaccessed 03 June 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] Ministério da Saúde. Boletim da República: Diploma Ministerial n°. 60/2017 de 20, vol. I Série n. Maputo: de Setembro; 2017. p. 147. http://www.wlsa.org.mz/wp-content/.../Diploma_ministerial_60-2017.pdf. Accessed 20 Oct 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Maternal mortality ratio in Mozambique is estimated at 408 deaths per 100,000 live births.

    “Maternal mortality ratio (MMR) is high - estimated at 408 deaths per 100,000 live births in Mozambique [5]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Instituto Nacional de Estatística (INE), Ministério da Saude (MISAU). Inquérito Demográfico e de Saúde 2011. Maputo: INE; 2013. http://www.ine.gov.mz. Accessed 22 Sept 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    According to the 2014 Mozambican law, women are allowed to have a legal induced abortion to unintended pregnancy upon request during the first 12 weeks; during the first 16 weeks if the pregnancy results from rape or incest; and during the first 24 weeks if the physical or mental health of the woman is at risk or in cases of disease or anomaly of the fetus.

    “According to that law, women are allowed to have a legal induced abortion to unintended pregnancy under the following conditions: upon the woman’s request during the first 12 weeks of pregnancy; during the first 16 weeks if the pregnancy results from rape or incest; and during the first 24 weeks if the physical or mental health of the woman is at risk or in cases of disease or anomaly of the fetus”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Assembleia da República. Boletim da República: Lei n°. 35/2014 de 31 de Dezembro, vol. I Série n. Maputo: 14° Suplemento Imprensa; 2014. p. 105. http://www.wlsa.orgmz/wp-content/uploads/2014/11/lei-35_2014Codigo_Penal.pdf. Aaccessed 03 June 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] Ministério da Saúde. Boletim da República: Diploma Ministerial n°. 60/2017 de 20, vol. I Série n. Maputo: de Setembro; 2017. p. 147. http://www.wlsa.org.mz/wp-content/.../Diploma_ministerial_60-2017.pdf. Accessed 20 Oct 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Abortion complications contribute to about 6.7% of maternal mortality in Mozambique.

    “abortion complications contribute to about 6.7% of the MMR [6]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] UNFPA. Gravidez na Adolescência Moçambique: Desafios e Respostas de Moçambique. Suplemento do Relatório sobre a Situação da População Mundial. Maputo: UNFPA; 2013. http//www.mozambique.unfpa.org. Accessed 22 June 2017.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patrilineal Maputo, marriage (lobolo) and fatherhood are more important; the man pays bride price and has significant authority in decision making over a woman within marriage.

    “In patrilineal Maputo, however, marriage (lobolo – bride price), and fatherhood are more important. The man pays the bride price and has significant authority in decision making over a woman within marriage [44].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Arnfred S. Feminism & Gendered Boddies: On Female Initiation in Northen Mozambique. In: Arnfred S, editor. Sexuality and gender Politics in Mozambique: Rethinking Gender in Africa. Upspsala: The Nordic Africa Institute and James Currey; 2011. p. 137–51. source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A four-stage clustered sampling procedure was used to sequentially select neighbourhoods, enumeration areas, households, and women.

    “A four-stage clustered sampling procedure was used to sequentially select the neighbourhoods, Enumeration Areas (EA), households and women.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Lack of information about the new legal status of the abortion law in the two study sites may be due to poor dissemination of the law and the fact that its guidelines were only published in September 2017, 3 years after approval.

    “Lack of information about the new legal status of the abortion law in these two study sites may be due to poor dissemination of the law and the fact that its guidelines were only published in September 2017, 3 years after the approval of the new law.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    According to Guttmacher Institute, 24% of pregnancies end in abortion in Southern Africa.

    “According to Guttmacher Institute report, it was estimated that 24% of pregnancies end in abortion in Southern Africa [34], where Mozambique is located.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Guttmacher Institute. Fact Sheet: Abortion in Africa. New York; 2016. http://www.guttmacher.org. Accessed 04 Aug 2018.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All data analyses were performed taking into account the study design using the complex sample procedure in SPSS version 23.

    “All processes of data analyses either univariate, bivariate, or multiple logistic regression were performed taking into account the study design, using the complex sample procedure in SPSS version 23.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Interviewers were trained to understand whether the way a pregnancy ended was forced by the woman or due to natural causes.

    “The interviewers were trained to understand if the way pregnancy ended was forced by women, such as the use of any medicine or had been helped, or if abortion was due to natural causes, such as illness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In matrilineal communities such as Quelimane, marriage and fatherhood are not of great importance, meaning procreation does not imply marriage.

    “For example, in matrilineal communities such as Quelimane marriage, and fatherhood is not of great importance [43], meaning that procreation does not imply “marriage”.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Lesthaeghe RJ. Reproduction and social organization in sub-Saharan Africa: University of California Press; 1989. http://ark.cdlib.org/ark:/13030/ft2m3nb1cw/s. Accessed 10 June 2012.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The questionnaire was adapted from WHO questionnaires and the 2011 Mozambican DHS and was pre-tested with 50 women of reproductive age in Quelimane and Maputo.

    “The questionnaire was adapted from WHO questionnaires [24–26], and the 2011 Mozambican DHS [5]. Before its implementation, the questionnaire was pre-tested with 50 women of reproductive age in Quelimane and Maputo.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [24] World Health Organization. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. WHO/HTM/STB/2008.46. Geneva: World Health Organization; 2008. https://www.stoptb.org. Accessed 08 June 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [25] World Health Organization. Multi-country Study on Women’s Health and life events; Questionnaire, version 9.9. Geneva; 2005. http://www.who.int/gender/violence/who_multicountry_study/Annex3-Annex4.pdf. Accessed 08 June 2015.

      Not checked in the free run.

    • cites [26] World Health Organization. Studying Unsafe Abortion: a practical guide. Geneva: World Health Organization; 1996. http://www.who.int_unsafe_abortion_MSM_96_25. Accessed 08 Oct 2014.

      Not checked in the free run.

    • cites [5] Instituto Nacional de Estatística (INE), Ministério da Saude (MISAU). Inquérito Demográfico e de Saúde 2011. Maputo: INE; 2013. http://www.ine.gov.mz. Accessed 22 Sept 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In August 2018, the Central Hospital of Maputo published a notice stating that pregnancy termination is free and advised women to seek more information at gynaecology services.

    “For example, in August 2018, the Central Hospital of Maputo published a notice stating that pregnancy termination is free and advised women to seek more information at gynaecology services [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Hospital centarl de Maputo. Aviso. Maputo: Ministerio de Saúde; 2018.

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The sample size was calculated to include a representative sample, adjusted to the cluster design effect, and added 5% contingency rate to cover non-response.

    “The sample size was calculated to include a representative sample of the population. The sample size was adjusted to the cluster design effect and added 5% of contingency rate to cover cases of non-response.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationown data

    The consistent odds ratio suggests a stable relationship between the independent variables and the dependent variable, regardless of the type of analysis approach.

    “The consistent odds ratio suggests a stable relationship between the independent variables and the dependent variable, regardless of the type of analysis approach.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    This is a cross-sectional study and cannot fully determine causality between sociodemographic characteristics and knowledge of new abortion law and perceived benefits of abortion permission.

    “This is a cross-sectional study and cannot fully determine causality between sociodemographic characteristics on the one hand and knowledge of new abortion law, and perceived benefits of abortion permission on the other hand.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Students were more likely to know the new status of abortion law maybe because of high promotion of sexual and reproductive health at school through Cantinho do adolescente.

    “In turn, students were more likely to know the new status of abortion law maybe because of the high promotion of sexual and reproductive health at school through the so-called Cantinho do adolescente.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Cantinho is a little corner established in schools across Mozambique, especially at secondary, where students receive counselling, family planning advice, and condoms, and can talk about gender roles, sexual harassment, or early pregnancies.

    “Cantinho is a “little corner”, established in schools across Mozambique, especially at secondary, where students receive counselling, family planning advice, and condoms. There, they can talk about gender roles as well as sexual harassment or early pregnancies [47].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Hanitzsch M, Reiprich G, Vosper A, Matsinhe J. The “bizy” generation takes over A documentation of good practices and experiences linking comprehensive sexuality education and youth health services in Mozambique. 2nd , MINEDH, MISAU, MJD, MGCAS, CNCS/NAC and UNFPA, 2018. http://health.bmz.de/events/Events_2019/looking_back_germanys_support_esa_commitment/181025_Final_brochure_revised_final_Mozambique.pdf. Accessed 19 July 2019.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The results cannot be generalized for the whole country because data were collected in two cities and there are differences in social structures.

    “First, since the data for this study were collected in two cities the results cannot be generalized for the whole country because of the differences in social structures, although they can help to understand how informed these specific communities are.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The lower likelihood of Muslims perceiving benefits may be because Islam discourages abortion and considers it a sin, since a human embryo is an embryonic human being.

    “Muslim were less likely to perceive benefits of the abortion law, maybe because, like all other religions, this religion discourages abortion and considers this practice as sin, since a human embryo is an embryonic human being [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Mojapelo-Batka EM, Schoeman JB. Voluntary termination of pregnancy: Moral concerns and emotional experiences among black South. S Afr J Psychol. 2003. https://doi.org/10.1177/008124630303300302. source

  • May combine two claims.

    Premisecitation

    Abortion can be seen as a threat to the continuation of the family and as rejection of motherhood, seen as the essence of womanhood.

    “Thus, abortion can be seen as a threat to the continuation of the family [46], as well as the rejection of motherhood, seen as the essence of womanhood [46].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Mojapelo-Batka EM, Schoeman JB. Voluntary termination of pregnancy: Moral concerns and emotional experiences among black South. S Afr J Psychol. 2003. https://doi.org/10.1177/008124630303300302. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Information on sexual and reproductive health has been made available by other programs such as Geração BIZ, TuaCena, and mCENAS.

    “Similarly, this information has been made available by other programs such as Geração BIZ [48], TuaCena [49], and mCENAS [50].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [48] Matsinhe JM. Programa Geracao Biz. Investing in Youth: The story of a National SRH program for adolescents and youth in Mozambique. Mozambique: UNFPA; 2011. https://mozambique.unfpa.org/sites/default/files/pub-df/INVESTING_IN_YOUTH__17_10_2011web.pdf. Accessed 19 July 2019.

      Not checked in the free run.

    • cites [49] N’weti. TuaCena: Strengthening Civil Society Engagement to Improve Sexual and Reproductive Health and Service Delivery for Youth: Internal Mid-Term Review Final Report. Mozambique; 2016.

      Not checked in the free run.

    • cites [50] USAID. Mobile Phone Programs For Adolescent And Youth Sexual And Reproductive Health in Low And Middle Income Countries: Research Brief. 2017. https://www.k4health.org/sites/.../youth-mhealth-srh-brief-2.pdf. Accessed 19 July 2019.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An African belief holds that fertility and procreation ensure the continuation of the family from one generation to another.

    “This attitude may be due to an African belief according to which fertility and procreation are a way to ensure the continuation of the family from one generation to another.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Mojapelo-Batka EM, Schoeman JB. Voluntary termination of pregnancy: Moral concerns and emotional experiences among black South. S Afr J Psychol. 2003. https://doi.org/10.1177/008124630303300302. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study tool was pretested for clarity and consistency.

    “However, the study tool was pretested for clarity and consistency.”
    Quote in the paperNot a substantial claim
38 of 38

  • The paper relies on this without support.

    Women accurately reported induced abortion and other pregnancy outcomes.

    “The pregnancy outcome was capture through the questions: Have you ever been pregnant? Subsequently, we asked how many times they have been pregnant? For each pregnancy, we asked how it ended?”

  • The paper relies on this without support.

    Literature about abortion in Mozambique is scarce.

    “In Mozambique the literature about abortion is scarce.”

  • The paper relies on this without support.

    In the majority of sub-Saharan countries, abortion is still restrictive.

    “In the majority of sub-Saharan countries abortion still restrictive; increasingly adolescents are becoming sexually active at an early age, without being well informed on the precaution they need to take to prevent pregnancy.”

  • The paper relies on this without support.

    Increasingly adolescents are becoming sexually active at an early age without being well informed on precautions to prevent pregnancy.

    “In the majority of sub-Saharan countries abortion still restrictive; increasingly adolescents are becoming sexually active at an early age, without being well informed on the precaution they need to take to prevent pregnancy.”

  • The paper relies on this without support.

    The abortion law and its guidelines are known fundamentally by non-governmental organizations working on human rights advocacy for women.

    “The abortion law and its guidelines, although published, they appear to be known, fundamentally, by non-governmental organizations, such as Rede de Defesa dos Direitos Sexuais e Reprodutivos, which work on human rights advocacy, particularly for women.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract claims higher knowledge odds for Muslims contrary to the adjusted model

    Major

    The abstract lists being Muslim among factors associated with higher odds of knowing the law. Table 4 instead gives Muslims an adjusted odds ratio below one, with a confidence interval spanning one.

  • Abstract and results give different pregnancy percentages

    Minor

    The abstract says 75.5% had ever been pregnant, whereas the results give 76.5% for all surveyed women. The results identify 75.5% as the Quelimane percentage.

  • Quelimane current-contraceptive-use percentage differs from Table 3

    Minor

    The narrative gives 48.9% for current use in Quelimane, but Table 3 gives 49.8%.

  • Data-collection end dates differ

    Minor

    The abstract says interviews continued through February 2017, while the sampling section says data collection ended in January 2017.

  • Maputo health facilities do not add up

    Minor

    The listed facility levels account for 32 facilities in Maputo, not the stated total of 39.

    Reported 39 · recomputed 32

5 of 5

Cites

Flagged first, then by citations

1 of the 36 references couldn’t be matched to a known paper.

Research works printed but not linked: 16

  1. UNFPA. Gravidez na Adolescência Moçambique: Desafios e Respostas de Moçambique. Suplemento do Relatório sobre a Situação da População Mundial. Maputo: UNFPA; 2013. http//www.mozambique.unfpa.org. Accessed 22 June 2017.
  2. Associação Moçambicana Para Desenvolvimento da Família (AMODEFA). Estatisticas de Serviços Prestados em Saúde Sexual e Reproductiva. Moçambique: AMODEFA; 2017.
  3. Assembleia da República. Boletim da República: Lei n°. 35/2014 de 31 de Dezembro, vol. I Série n. Maputo: 14° Suplemento Imprensa; 2014. p. 105. http://www.wlsa.orgmz/wp-content/uploads/2014/11/lei-35_2014Codigo_Penal.pdf. Aaccessed 03 June 2015.
  4. Ministério da Saúde. Boletim da República: Diploma Ministerial n°. 60/2017 de 20, vol. I Série n. Maputo: de Setembro; 2017. p. 147. http://www.wlsa.org.mz/wp-content/.../Diploma_ministerial_60-2017.pdf. Accessed 20 Oct 2017.
  5. Direcção Nacional de Planificação. Relatório Nacional do Ministério da Saúde. Maputo: Direcção Nacional de Planificação; 2014.
  6. Chipembe CS, Mangue J, Arnaldo C. Nível e factores associados à mortalidade materna em Moçambique. In: Arnaldo C, Cau BM, editors. Dinâmicas da População e Saúde em Moçambique. Maputo: Edição CEPSA; 2013. p. 89–110.
  7. World Health Organization. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. WHO/HTM/STB/2008.46. Geneva: World Health Organization; 2008. https://www.stoptb.org. Accessed 08 June 2015.
  8. Bitew S, Ketema S, Worku M, Hamu M, Loha E. Knowledge and attitude of women of childbearing age towards the legalization of abortion, Ethiopia. J Sci Innov Res. 2013;2:2 ISSN: 2320–4818. http://www.jsirjournal.com.Accessed: 12.03.2016.
  9. Hospital centarl de Maputo. Aviso. Maputo: Ministerio de Saúde; 2018.
  10. Hanitzsch M, Reiprich G, Vosper A, Matsinhe J. The “bizy” generation takes over A documentation of good practices and experiences linking comprehensive sexuality education and youth health services in Mozambique. 2nd , MINEDH, MISAU, MJD, MGCAS, CNCS/NAC and UNFPA, 2018. http://health.bmz.de/events/Events_2019/looking_back_germanys_support_esa_commitment/181025_Final_brochure_revised_final_Mozambique.pdf. Accessed 19 July 2019.
  11. Matsinhe JM. Programa Geracao Biz. Investing in Youth: The story of a National SRH program for adolescents and youth in Mozambique. Mozambique: UNFPA; 2011. https://mozambique.unfpa.org/sites/default/files/pub-df/INVESTING_IN_YOUTH__17_10_2011web.pdf. Accessed 19 July 2019.
  12. N’weti. TuaCena: Strengthening Civil Society Engagement to Improve Sexual and Reproductive Health and Service Delivery for Youth: Internal Mid-Term Review Final Report. Mozambique; 2016.
  13. USAID. Mobile Phone Programs For Adolescent And Youth Sexual And Reproductive Health in Low And Middle Income Countries: Research Brief. 2017. https://www.k4health.org/sites/.../youth-mhealth-srh-brief-2.pdf. Accessed 19 July 2019.
  14. UNPFA. Programme of Action of The International Conference on Population and Development. UNPFA; 2000. http://www.unfpa.org/public/cache/offonce/home/sitemap/icpd/International-Conference-on-Population-and-Development/ICPD-Programme;jsessionid=9D61F5E25719B55128AAF4A933A93177.jahia01#ch7. Accessed 11 Mar 2018.
  15. KIT Royal Tropical Institute – Unidade de Saúde. Relatório País Moçambique: Avaliação das Necessidades de Advocacia do Aborto Seguro. Para a Associação Moçambicana de Obstetras e Ginecologistas (Amog). Amsterdam: KIT – Health; 2018. https://www.figo.org/.../Mozambique%20Country%20Report%20Portuguese%20trans. Accessed 11 Mar 2019.
  16. Rede de Defesa dos Direitos Sexuais e Reprodutivos/Projecto SAAF (RDDSR). Guia para Activistas sobre Aborto seguro. 2nd ed. Maputo: Edição Parthfinder International e WLSA Moçambique; 2016.

Cited by

Sorted by citations

Related

Authors
Frederico, M., Arnaldo, C., Decat, P., Juga, A., Kemigisha, E., Degomme, O., & Michielsen, K.
Affiliations
  • Eduardo Mondlane University (MZ)
  • Ghent University (BE)
  • Mbarara University of Science and Technology (UG)
Corresponding author
Frederico, Mónica
ORCID
Venue
BMC Women's Health
Publisher
Springer Science and Business Media LLC
Published
2020-06-19
Volume
20
Issue
1
Pages
129-129
ISSN
1472-6874 (ISSN-L)
DOI
10.1186/s12905-020-00988-6
PMC
PMC7304116
OpenAlex
W3036435993
Semantic Scholar
58545eb6958a3a83651e334f6a3edc6fb4d57dff
Cited by
19
References
36
Citations by year
2025: 5 · 2024: 7 · 2023: 4 · 2022: 2 · 2021: 1
FWCI
1.22
Type
journal article
Language
en
Update notices
correction (2024-06-21)
Open access
Licence
Locations
  • BMC Women s Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
  • Lirias (submittedVersion, cc-by)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Document Server@UHasselt (UHasselt) (submittedVersion, cc-by)
Funders
VLIR-UOS
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
Keywords
abortion, abortion law, abortion legalization, abortion attitudes, unsafe abortion, women of reproductive age, contraceptive use, maternal mortality, Maputo, Quelimane, Mozambique
MeSH terms
Abortion, Induced, Abortion, Legal, Adolescent, Adult, Cities, Contraception Behavior, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Human Rights, Health Knowledge, Attitudes, Practice, Legislation as Topic, Middle Aged, Mozambique, Pregnancy, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-19.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-19.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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