Abstract
BackgroundPregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions. This study examines options counselling for abortion seekers in health facilities in Ghana.MethodsAnalytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study.ResultsRespondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P = < 0.001), gestational age (P = < 0.001), previous induced abortions (P = < 0.001), perception of pregnancy at conception (P = < 0.001) and level of education (P = 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P = < 0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to abortion in Ghana.ConclusionsPregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana. Although higher educational attainments significantly exposes women to options counselling for informed decisions, the less educated are disadvantaged in this regard. Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.
Highlights
Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions
Best practice from the British Pregnancy Advisory Service (BPAS) indicates that pregnant women are expected to be allowed to consult widely before and after options counselling and the counselling process requires certain strict competences to be achieved by such counsellors before they can be licensed to handle that job [5]
The sample size (462) was calculated using the formula n = pqz2/d2, where n = sample size, z = level of confidence at 95% =1.96; d = allowable error = 0.05; p = proportion of unintended pregnancies and q = 1-p; p = proportion of unintended pregnancies in Ghana [15] obtained from the 2008 Ghana Demographic and Health Survey (GDHS) = 0.4, and q = 1–0.4 which translated into 0.6.n = 368.7986 which was approximated to 369 plus 25% non-response
Summary
Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions. Studies have shown that such interactions influence the decisions women make when pregnant [7, 8] As such when the counselling is either not done or done incorrectly, it increases the extent of regret for the option taken which sometimes has very devastating consequences on the pregnant woman and significant others [9, 10]. This is rightly so in situations where a pregnancy that is wanted but unintended/unplanned occurs has to be aborted because abortion is the only viable option available to the pregnant woman at the time becomes devastating. This is why the current study is very necessary in pregnancy crisis management in Ghana
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