Poor Urban Settlements Research Articles

“In the dry season, our suffering doubles”: Barriers to water access in poor urban settlements in Ghana

If current trends of water insecurity continue, nearly two-thirds of the world’s population will live in water-scarce conditions by 2025. Nevertheless, qualitative studies on barriers to water access, particularly in informal settlements, remain limited. This study used in-depth interviews to examine the daily barriers to water access faced by urban poor households in Ghana. A total of 30 (n = 30) semi-structured in-depth interviews were conducted with residents in water-insecure areas in Tamale and Accra, Ghana. Four themes emerged from our analysis: lack of financial resources, distance and travel time, land and topography, and poor water infrastructure. Sustainable Development Goal Six cannot be achieved if the water needs of the urban poor, particularly those who dwell in informal settlements, are unmet. Thus, governments and systems must implement measures to eliminate inequalities and inequities in water distribution.

Positive masculinity programmes and sexual and reproductive health behaviours among boys and men in poor urban settlements in Democratic Republic of Congo, Nigeria, and Rwanda.

As Positive Masculinity (PM) Programmes continue to develop globally, it is important to examine their role in Sexual and Reproductive Health and Rights (SRHR) outcomes. This multi-country qualitative study was conducted using in-depth interviews (IDI) and focus group discussions (FGDs) with community members, beneficiaries and implementers of PM programmes. The findings show that PM programmes are designed using a gender lens to make boys and men more aware and conscious of harmful masculinity traits and their effect on SRHR. The beneficiaries of the interventions report imbibing positive SRHR behaviours by being sexually responsible - upholding sexual rights, taking precautions against sexually transmitted Infections (STIs) and learning proper communication with their partners. They also report acting as vanguards of positive gender norms to their families and peers. Although there are challenges in implementing PM programmes, the results of the study suggest that interventions targeting boys and men hold promise for improving boys' and men's health behaviours and promoting gender equality in poor urban settings.

Positive masculinity programmes and sexual and reproductive health behaviours among boys and men in poor urban settlements in Democratic Republic of Congo, Nigeria, and Rwanda

Positive masculinity programmes and sexual and reproductive health behaviours among boys and men in poor urban settlements in Democratic Republic of Congo, Nigeria, and Rwanda

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

Land Occupation, Re-occupation, and Housing Cooperative: Commune Formation by Jakarta’s Urban Poor

This article highlights the tension between direct actions and electoral politics to explain the formation of an urban poor settlement, often referred to as a kampungkota, an emerging term for settlements beyond the modern, planned part, in North Jakarta, Indonesia. The authors interpret kampungkota as a commune and unpack the process of commune formation with reference to the experience of Kampung Akuarium into three different yet interconnected parts. The first is direct action through land occupation by the urban poor in the 1980s. The second is direct re-occupation after the 2016 eviction and the joining-up of the settlers with a wider urban poor organization (the commune of communes). The third is the rebuilding and legalization of the commune, which is collectively managed through a housing cooperative, facilitated by a political contract in the 2017 Jakarta gubernatorial election.

Marginalized community effort to improve environmental quality of poor settlement along riverbank

Currently, many people live in urban areas and more than 30% of them live in slums or squatter settlements. Urbanization is one of the most transformative trends occurring worldwide, especially in developing countries like Indonesia. At present, more than half of the total population in Indonesia lives in urban areas. The dominance of the urban population shows the urgency to make the urban environment inclusive, safe, resilient, and sustainable as it is intended to be realized through Goal No. 11 - SDGs 2030. Cities require large spaces and are a major source of wealth and centers of innovation, culture, and politics. The urban area has become the most important arena for people, including low-income communities that live in informal urban spaces that develop spontaneously. This article will share research experiences on the settlements of marginalized communities. With the help of several institutions, the communities are trying to improve the quality of their settlements to become inclusive, safe, resilient, and sustainable. The method used in this research is the descriptive-qualitative method exploring the potential and resources within urban kampong to improve the quality of urban poor settlements. With the discovery of informal urban space patterns and community efforts to improve the quality of their settlements, a sustainable development strategy can be developed to improve urban areas inhabited by low-income people.

Contextualizing Collaborative Planning: Addressing Water Resilience in the Urban Poor Settlements of Ranchi

The research embarks from the standpoint that unequal geographies of service delivery in the Southern city evidence differentiating practices embedded within dominant rational planning practices. It aligns and responds to the call of Southern urban theorists to develop alternative planning practices by anchoring within the socio- spatial specificities of Southern urbanisms. Foregrounding this objective, the research turns to the collaborative planning model and its pragmatic tradition of resisting the subjugating tendencies of instrumental rationality by admitting new ways of knowing and being from the life-world. Drawing upon a multi-actor collaboration that sought to address the circumstance of water insecurity in the urban poor settlements of Ranchi city, the research uses Healy’s (1997) Forum, Arena and Courts as entry points to frame on-ground recursive and collaborative interventions. These include unpacking the context to frame and implement interventions that sought to enhance water security while operationalising supporting actions that aim to sustain the interventions. Within this framing, the paper draws upon the critiques of the collaborative planning model as standpoints for contextual reinterpretation to foreground a) the importance of empowering strategic actors at the bottom of socio-political hierarchies to lead the process; b) conceptualize consensus as a process rather than an end-point recognizing its intrinsic relationship with conflict; and, c) institutionalizing formalized yet flexible processes for consensus-building. Overall the paper argues that collaborative planning with its focus on the particularities of place and on the human capacity to invent, create, and transform presents a viable starting point for resisting the dominating confines of instrumental rationality in significant ways.

Resisting imperial erasures: Matigari ruins and relics in Nairobi

ABSTRACT Building on ethnographic fieldwork and interdisciplinary theoretical approaches, this article historicizes poor urban settlements in Nairobi as ruins – the product of systemic ruination from the colonial period to the present. In so doing, it offers the provocation to think ‘slum’ dwellers as relics: remains of past/present conterminous ruins who are treated as subhuman hauntings of a foregone time and understood to be constituted by the decayed and unwanted material of city margins. In these embodiments they are perceived as ruining the city, even when they have been produced by longue durée political processes of ruination, captured by vernacular identities such as Matigari. Yet, as I show here, like unexpected relics, the inhabitants of poor urban settlements continue to insert vital bids for survival in city landscapes. And, in these layered movements, they act as mnemonic devices that bridge the oppressions of what are seen as separate times, while shedding light on often normalized colonial city and national governance processes.

Pandemic within a pandemic! Policy Implications of community-based Interventions to mitigate violence against women during COVID-19 in Urban Slums of Lucknow, India.

The COVID-19 pandemic has brought an unprecedented adverse impact on women's health. Evidence from the literature suggests that violence against women has increased multifold. Gender-based violence in urban slums has worsened due to a lack of water and sanitation services, overcrowding, deteriorating conditions and a lack of institutional frameworks to address gender inequities. The SAMBHAV (Synchronized Action for Marginalized to Improve Behaviors and Vulnerabilities) initiative was launched between June 2020 to December 2020 by collaborating with the Uttar Pradesh state government, UNICEF and UNDP. The program intended to reach 6000 families in 30 UPS (Urban Poor settlements) of 13 city wards. These 30 UPS were divided into 5 clusters. The survey was conducted in 760 households, 397 taken from randomly selected 15 interventions and 363 households from 15 control UPS. This paper utilized data from a baseline assessment of gender and decision-making from a household survey conducted in the selected UPS during July 03-15, 2020. A sample size of 360 completed interviews was calculated for intervention and control areas to measure changes attributable to the SAMBHAV intervention in the behaviours and service utilization (pre- and post-intervention). The data analysis showed a significant difference (p-value < 0.001) between respondents regarding women's freedom to move alone in the control and intervention area. It also reflected a significant difference between control and intervention areas as the respondents in the intervention area chose to work for the cause of gender-based violence. The SAMBHAV initiative brought an intersectional lens to gender issues. The community volunteers were trained to approach issues based on gender-based violence with the local public, and various conferences and meetings were organized to sensitize the community. The initiative's overall impact was that it built momentum around the issue of applying the concept of intersectionality for gender issues and building resilience in the community. There is still a need to bring multi-layered and more aggressive approaches to reduce the prevalence of gender-based violence in the community.

Determinants of utilization of antenatal care services among recently delivered women residing in urban poor areas of Rishikesh, Uttarakhand, India-a cross-sectional study.

Objective: To determine the proportion of women having four or more antenatal care (ANC) visits and to assess associated factors (utilization of ANC services) in poor urban settlements in Rishikesh, Uttarakhand. Material and Methods: This was a community-based cross-sectional study. The study population included females who delivered during the last year residing in the target location. The data were collected through the house-to-house method in the four selected areas using a structured pre-tested expert-validated questionnaire. Data analysis was performed using SPSS version 23 using descriptive and multivariate statistical techniques. Results: There was a 59.66% prevalence of four or more antenatal visits (52.01%-66.97%). Only 26.44% of the participants confirmed their husbands' company during their antenatal visits. Socioeconomic status, type of family, mother's educational status, parity, husband's company during the visit, and mother's autonomy were significant factors (P<0.005) associated with the number of ANC visits. In logistic regression, after adjusting for other covariates, the autonomy of the participants and the husband's involvement during the visit were found to be significantly associated with four or more ANC visits. Conclusions: Approximately 60% of participants in poor urban settlements had four or more ANC visits. The findings of our study affirm the involvement of husbands in antenatal visits and women's autonomy as significant determinants of antenatal care utilization.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey.

Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan. The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake. Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities. We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Utilization of Nutritional Supplementation Services and Their Predictors in Pregnant and Lactating Women Living in an Urban Resettlement Colony of Delhi, India: A Cross-Sectional Study.

Introduction Maternal undernutrition during pregnancy and lactating has adverse health consequences for the mother and her child. The Integrated Child Development Services (ICDS) scheme by the Government of India provides supplementary nutrition services to all pregnant and lactating women but its utilization is suboptimal due to inefficient distribution through the health system and beneficiary concerns regarding its usefulness. This study was conducted with the objective of assessing the utilization of nutrition-related ICDS services by pregnant and lactating women in urban poor settlements of Delhi and the sociodemographic factors associated with non-utilization. Materials and methods This was a community-based cross-sectional survey in an urban resettlement colony and slum area located in the northeast district of Delhi. The data collection was conducted from January to May 2022. Eligible participants included pregnant women in their second or third trimester of pregnancy and lactating mothers in their first six months of the postpartum period who were residents of the study setting.Data were collected using face-to-face interviews using a pre-tested and self-designed questionnaire. The primary outcome was the proportion of women utilizing ICDS take-home rations (THR) in the previous month. Results A total of 365 participants were recruited in this study including 208 pregnant and 157 lactating women having a median (IQR) age of 25 (22-28) years.A total of 211 (57.8%) participants reported a history of utilization of ICDS supplementary nutrition services during their current pregnancy or postpartumwith 154 (42.2%) having received THR in the previous month. Among the currently pregnant women, 84 (40.4%) had utilized ICDS THR while in the currently lactating women, 70 (44.6%) had utilized THR in the previous month.On adjusted analysis, multigravid women were less likely to have utilized ICDS compared to primigravida women. Reasons for non-utilization of the ICDS supplementary nutrition services by the mothers were temporary disruption due to cessation of ICDS services by protesting Anganwadi workers (over demand for increased honorarium), difficult access to Anganwadi center, the poor perceived taste of the food provided as THR, and perception by the mothers that they did not require THR. Most women reported sharing the THR with their family members. All pregnant and lactating women were found to be calorie and protein deficient in this study when applying the recommended intake values. No association was observed between the utilization of ICDS in the previous month and the presence of calorie deficiency in both pregnant (p=0.35) and lactating (p=0.24) women. Conclusions More than four in ten eligible pregnant and lactating women in an urban resettlement colony in Delhidid not utilize ICDS supplementary nutrition services with similar rates of utilization in both pregnant and lactating women. Women living in joint families and consequently larger households were less likely to utilize ICDS services. A majority of pregnant and lactating women were calorie and protein deficient even on applying non-pregnant cut-off requirements. The ICDS scheme needs to strengthen information, education, and communication (IEC) strategies and interventions to improve its acceptability and utilization by this vulnerable population.

ASSESSING URBAN POOR RESILIENCE TO NATURAL DISASTERS USING ANALYTIC HIERARCHY PROCESS-BASED MODEL: A CASE STUDY ON KHULNA CITY

This article intends to measure the urban poor’s resilience to natural disasters using an analytical hierarchy process (AHP) based model. It also explores factors affecting differentiated levels of household resilience. It is found that urban poor communities in Khulna city frequently experience urban flooding and waterlogging, caused by heavy rainfall, as a primary hazard and therefore this article emphasizes on differentiated nature of urban poor’s resilience to natural hazards and the factors that shape differentiated nature of resilience. Quantitative research approach has been adopted and AHP-based indexing has been used to measure the level of resilience of the urban poor and contributing factors to their resilience level. The household questionnaire survey has been used as the data collection method and the total sample size of this research is 384 and all the primary data is collected from the six slums in Khulna city which have been selected using different vulnerability criteria like geographical location, size of the slums, and mean sea-level height of the slum. The analytical hierarchy process (AHP) model is used to determine the weight of indicators and dimensions which have been used to calculate resilience. Additionally, the principal component analysis (PCA) is also used to identify the determinant factors. The results revealed that 40.88% and 48.96% of people are low and moderately resilient respectively. The percentage of high resilient people in the low-income settlements in Khulna city is very low as only 10.16% of the households are found as highly resilient in the urban poor settlements. It identifies several factors that have the highest effect on differential level resilience, including access to formal safety nets and social assistance, income and livelihood strategy, illness, debt etc. Highlighting the factors that influence differentiated levels of resilience local government or policymakers can take different policy recommendations to improve the resilience of the urban poor that including strengthening the social security system for the urban poor, creating livelihood opportunities, public health services, etc.

The home environment and parental involvement of preschoolers in Philippi, a low-income area: Do they hinder or support early learning?

Background: Successful interventions targeting families can only occur through informed research findings. It is important that policymakers understand the unique household dynamics that low-income households face and the kinds of assistance they need to foster early learning and development at home.Aim: To investigate the extent of parental involvement in the early learning of preschoolers in Philippi and the role of the home environment in promoting or hindering early learning and development.Setting: This study was conducted in Philippi, one of the biggest poor urban settlements in the city of Cape Town, South Africa.Methods: The researcher visited 20 early childhood development (ECD) facilities and 40 caregivers in Philippi. Face-to-face interviews were conducted with the ECD principals, practitioners and caregivers.Results: The analysis of the results of the study revealed that, for the most part, preschoolers in Philippi live in household environments that do not encourage or support early learning and development. Moreover, parental involvement in such preschoolers is limited by the parents’ unwillingness or inability to take up opportunities for involvement in the facility and to regularly engage in stimulation activities at home.Conclusion: Given their low-income, low-educational status and general lack, parents need a clearer framework on how to become involved and how to provide a conducive household learning environment to preschoolers.

Determinants of Anemia Among Adolescents Girls

ObjectivesTo assess the relative significance of various factors contributing to anemia in adolescent girls of lower socioeconomic status. MethodsA random sample of 100 adolescent girls (15 to 19 years), selected from 300 adolescents girls living in a poor urban settlement, of Navi Mumbai, India have participated in the study. An interviewer-administered questionnaire was used to collect data on sociodemography, anthropometry, three-day dietary intake, food frequency, blood hemoglobin, serum ferritin and stool parasites. ResultsThe prevalence rates of anemia was 30% and among them 95% of the anemic girls were iron deficient. The mean dietary iron intake was 9.4 mg per day, predominantly from the consumption of cereals, pulses, and vegetables. Intake of different nutrients were almost inadequate among the participants. Blood hemoglobin was significantly correlated with Body Mass Index, dietary intake of fat, protein, iron, folic acid and riboflavin. Serum ferritin was related with vitamin B12. The parasitic infestation was low among the study participants. ConclusionsAn inadequate intake of dietary iron, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for anemia and iron deficiency in adolescent girls. Nutrition interventions on identified associated factors are important to reduce the burden of anemia among adolescents girls. Funding SourcesThe researcher had received funds from MGM Institute of Health Sciences, Navi Mumbai for research work.

Resilient WASH development for urban poor: the case of Ahmedabad slums

PurposeClimate variability, accompanied by rapid urbanization and rising population disproportionality, impacts urban poor settlements. This paper aims to analyse the climate resilience for the urban poor in Ahmedabad through the lens of WASH development strategies. To assess the adaptive capacities of urban poor communities, a framework in the form of a vulnerability matrix has been used consisting of four key parameters – tenure, basic services, mobilization and partnership and disaster management capacities. The matrix implicitly recommends area-specific interventions to boost adaptive capacities and improve resilience based on WASH services.Design/methodology/approachThis paper was designed to assess the climate resilience of WASH services in the urban poor settlements of Ahmedabad city. In all, seven slums were selected using a stratified sampling approach considering topography, access to WASH services and urban heat island effect. These slums were then assessed using a theoretical framework having four key parameters – tenure, basic service, mobilization and partnership and disaster management capacities. The data for the analysis was collected from both secondary and primary sources. For the latter, semi-structured interviews with key stakeholders, observational field visits and focused group discussions with the communities were done.FindingsA ladder form of assessment matrix was derived from a thorough literature review and various pre-existing theories. This matrix consists of four key parameters – tenure, basic service, mobilization and partnership and disaster management capacities. The slums were evaluated by applying this framework, and direct and indirect relationships were established between the said parameters.Research limitations/implicationsThis paper was adapted in the light of various obstacles put forward by the Covid-19 pandemic. Some of the interviews with the bureaucrats and external researchers were conducted online, while the engagement with the slum dwellers was in-person, considering appropriate social and/or physical distancing norms. Implications of the Covid-19 second wave restricted the involvement of researchers with the communities at an ethnographic level.Originality/valueThe ladder form of vulnerability assessment framework has been developed and contextualized using the insights from literature review, field visits and multi-stakeholder consultations. It was helpful in identifying aspects that require suitable interventions for improving and imparting resilience among the urban poor settlements. The learnings from this paper are significant for planners and decision-makers in identifying and prioritizing context-specific future projects for a city.

Sustainable Urban Drainage System (SUDS) as Nature Based Solutions Approach for Flood Risk Management in High-Density Urban Settlement

Nature-based Solution (NBS) is an umbrella for ecosystem-based approaches to prevent or mitigate the impacts of hydro-meteorological hazards. The increasing hydro-meteorological disaster occurrence such as floods in Bandung City because of both climate change phenomenon and rapid growth of Bandung City has caused a big impact on people live in slums and high-density settlement. Realizing this risk, Bandung City has implemented strategies to reduce flood risk, including the Sustainable Urban Drainage System (SUDS) as stated on the Bandung City Spatial Plan (RTRW) 2011-2031. However, this measure had not effectively reduced flood risk in Bandung City. Therefore, this research focuses to analyse the implementation of SUDS and how it can capture the concept of NBS, with the study case Cibadak Administrative Village, one of the poor and high-density urban settlements in Bandung City. The result was developed using a mixed method consisting of a descriptive quantitative approach, spatial analysis for satellite imagery, and content analysis technique to analyse each challenge of SUDS implementation. The result indicates the lack of capacity in scale, budget, natural characteristic, and social demographic for SUDS implementation in poor and high-density urban settlement in Bandung, which aligns with the challenge of NBS implementation in the global south.

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana.

This paper examined women's pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion.

Double-Stranded DNA Virus Assemblages in Groundwater in Three Informal Urban Settlements in Sub-Saharan Africa Differ from Each Other

We mapped the double-stranded DNA (dsDNA) virus assemblage in groundwater below sub-Saharan urban poor settlements in Arusha (Tanzania), Dodowa (Ghana), and Kampala (Uganda). Our results indicated that ∼80% of dsDNA virus sequences matched the order of Caudovirales, i.e., indigenous bacteriophages; 1.8% of the dsDNA virus sequences matched those of viral pathogens that infect humans and larger animals, which we defined as so-called above-ground hosts. Within this group, the relative abundances of the genera Chordopoxvirinae, Alphaherpesvirinae, and Betairidovirinae were the highest. Culturable Escherichia coli bacteria were found even in deeper wells, indicating that all water was fecally contaminated. The community assemblages sampled in the cities were statistically significantly different from each other. Dissolved ions, population density, and sanitary status had no significant influence, but pH and latitude did. We concluded that the transport of dsDNA virus in groundwater was location specific but was not determined by input concentrations (i.e., related to population density) or related to groundwater chemistry. We hypothesize that other parameters, like the presence of macropores, cause these variations in these shallow, highly populated, heavily polluted terrestrial groundwater systems. Approximately 34% of Africa has similar hydrogeology, so this may affect many urban areas across the continent.

Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana

BackgroundIncreasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra.MethodsData are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services.ResultsAbout 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies.ConclusionsThe use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services.