Abstract
Background : Despite the presence of legal abortion services in Ghana, unsafe abortion remains common, particularly among young women. Little is understood about what young people know about safe and legal abortion, and if and how they are utilizing it. Methods : To characterize abortion use and address gaps in safe access, from September-December 2013, we conducted a cross-sectional survey with 100 men and 250 women aged 18-24 in Accra, Ghana. Participants were asked about abortion experiences, including prior services, providers, methods, satisfaction, perceived support, and knowledge of laws. Descriptive statistics, Fisher's exact tests, and chi-square tests were performed. Results : Among surveyed youth, most (87% of women, 64% of men) thought abortion was illegal or did not know the law. In total, 30% of women and 14% of men ever had an abortion and partner who had an abortion, respectively. Among women's most recent abortions, medication abortion (61%), surgical methods (26%), and unsafe methods categorized "least safe" (14%) were the initial or only methods used. Most women who accessed medication abortion initially or as their only method saw a pharmacist (40%) or no one (33%). Nearly one-quarter of women (n=16, 24%) who initially took tablets used more than one method. Conclusions : Despite experiences with abortion, most young people in this study were unaware of its legality and unsafe abortions occurred. More needs to be done to ensure young people understand the law and have access to safe methods, and that pharmacists are trained to provide appropriate doses and formulations of medication abortion.
Highlights
One in ten pregnancies ends in unsafe abortion[1]
Many respondents thought abortion was illegal or did not know the law, an unsurprising finding given that the 2017 Ghana Maternal Health Survey found only 11% of women of reproductive age believed abortion was legal[17]
A quarter of women who initially had a medication abortion sought a second method for completion
Summary
One in ten pregnancies ends in unsafe abortion[1]. In Ghana, despite liberalization of abortion law in 1985, which states that abortion is legal when performed by a registered medical practitioner in cases of rape, incest, risk to the life or health (mental or physical) of the woman, or fetal abnormality[2], unsafe abortion is still common[3]. Recognizing the impact of unsafe abortion on Ghana’s high rates of maternal mortality, the Government of Ghana launched the Reducing Maternal Mortality and Morbidity (R3M) program in partnership with a consortium of international health organizations in 2006 to improve access to family planning and comprehensive abortion care services[9]. As part of this effort, more was done to disseminate the law, train providers, and introduce modern technologies for abortion care. More needs to be done to ensure young people understand the law and have access to safe methods, and that pharmacists are trained to provide appropriate doses and formulations of medication abortion
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