Abstract
BackgroundUnsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana.MethodsA descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists.ResultsStigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association.ConclusionsStigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.
Highlights
Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally
The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both [1]
Our study shows how this stigma affects providers’ own practice in terms of being reluctant to make it clear that safe, legal services are available at their facility, being reluctant to refer, conducting only post-abortion care and refusing to go on training
Summary
Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. In 1985, a group of doctors in Ghana spearheaded an amendment of the Criminal Code on abortion This led to an amendment in the law in 1985 with the following provisions: 1) Abortion is illegal unless carried out in a hospital or designated clinic by a registered medical practitioner or gynaecological specialist; 2) Abortion is permitted when continuation of the pregnancy will pose serious risk to the life of the pregnant woman or injury to her physical or mental health; 3) Abortion is . The law states that “medical practitioners” are permitted to provide surgical abortions, for both spontaneous and induced abortion, in designated health facilities; they provide postabortion care It does not clearly define who “medical practitioners” are and it was widely interpreted as meaning only doctors
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