Abstract
BackgroundGhana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana.MethodsWe utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision.ResultsLess than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity.DiscussionOverall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care.ConclusionsSAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.
Highlights
Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws [1]
These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care
Using aggregated post-abortion care (PAC) and safe abortion care (SAC) caseloads provided by these Non-governmental organization (NGO), we found that most PAC cases were seen in non-NGO facilities (99%) and 25% of SAC cases were performed by NGOs [12]
Summary
Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws [1]. Access to high quality SAC is not universal in Ghana where there continues to be stigma around obtaining abortions, [5, 6] and poor knowledge of the abortion law by women [7, 8] and some providers [9]. A study using data from the 2017 Ghana Maternal Health Survey estimated that 64% of Ghanaian women who self-reported an abortion during the last five years described the conditions, procedures or providers of their abortion procedures as unsafe [11]. Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally.
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