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Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana

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Abstract

Background

We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions.

Methods

A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey.

Results

Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra.

Conclusion

Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

Plain English Summary

We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey.

Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

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Data Availability

The raw data and any material related to the study are available upon reasonable request from the corresponding author.

Abbreviations

CAC:

Comprehensive Abortion Care

EpiInfo:

‘Epidemiological Information

GHS:

Ghana Cedis

N/A:

None Applicable

NGOs:

Non-Governmental Organizations

OPD:

Out Patients’ Department

R3M:

Maternal Mortality and Morbidity

STA:

Second-trimester abortion

StatCalc:

Statistical Calculator

USD:

United States Dollar

WHO:

World Health Organization

References

  • Aboagye, P. K., Gebreselassie, H., Asare, G. Q., Mitchell, E. M., & Addy, J. (2007). An assessment of the readiness to offer contraceptives and comprehensive abortion care in the Greater Accra, Eastern and Ashanti regions of Ghana. Chapel Hill, NC: Ipas.

  • Alex, L., & Hammarström, A. (2004). Women’s experiences in connection with induced abortion–a feminist perspective. Scandinavian journal of caring sciences, 18(2), 160–168.

  • Aniteye, P., & Mayhew, S. H. (2013). Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation. Health Research Policy and Systems, 11, 1–14.

  • Appiah-Agyekum, N. N. (2014). Abortions in Ghana: experiences of university students. Health Science Journal, 8(4), 531.

  • Bastianelli, C., Farris, M., Aliberti, C., & Parachini, M. (2014). Second-trimester induced abortions in two tertiary centres in Rome. The European Journal of Contraception & Reproductive Health Care, 19(2), 121–127.

  • Berer, M. (2000). Making abortions safe: a matter of good public health policy and practice. Bulletin of the World Health Organization, 78, 580–592.

  • Boyce, C., Palen, N., & Palmer, A. (2006).A guide to using mystery clients for evaluation input.

  • Brookman-Amissah, E., & Moyo, J. B. (2004). Abortion law reform in sub-saharan Africa: no turning back. Reproductive Health Matters, 12(24), 227–234.

  • Dalvie, S. S. (2008). Second trimester abortions in India. Reproductive Health Matters, 16(sup31), 37–45.

  • Ghana Health Service (2012). Prevention and Management of Unsafe Abortion: Comprehensive Abortion Care Services. Standards and Protocols, Third edition. Accra: Ghana Health Service/Ministry of Health; 2012

  • Ghana Health Service (2012). Prevention and management of unsafe abortion: comprehensive abortion care services standards and protocols.

  • Ghana Health Service. (2014). Reproductive Health Policy and Standards (3rd ed.). Accra: Ghana Health Service/Ministry of Health.

  • Gilligan, C., Kohlberg, L., Lerner, J., & Belenky, M. (1971). Moral Reasoning. Technical Report of the Commission on Obscenity and Pornography: Preliminary studies, 1, 141.

  • Harries, J., Lince, N., Constant, D., Hargey, A., & Grossman, D. (2012). The Challenges of Offering Public Second Trimester Abortion Services in South Africa: Health Care Providers’ perspectives. Journal of Biosocial Science, 44(2), 197–208.

  • Harris, L. H., & Grossman, D. (2011). Confronting the challenge of unsafe second-trimester abortion. International Journal of Gynecology & Obstetrics, 115(1), 77–79.

  • Hodorogea, S., & Comendant, R. (2010). Prevention of unsafe abortion in countries of Central Eastern Europe and Central Asia. International Journal of Gynecology & Obstetrics, 110, S34–S37.

  • Jones, B. S., & Weitz, T. A. (2009). Legal barriers to second-trimester abortion provision and public health consequences. American journal of public health, 99(4), 623–630.

  • Kishen, M., & Stedman, Y. (2010). The role of advanced nurse practitioners in the availability of abortion services. Best Practice & Research Clinical Obstetrics & Gynaecology, 24(5), 569–578.

  • Kjelsvik, M., Sekse, R. J. T., Moi, A. L., Aasen, E. M., Chesla, C. A., & Gjengedal, E. (2018). Women’s experiences when unsure about whether or not to have an abortion in the first trimester. Health care for women international, 39(7), 784–807.

  • Lince-Deroche, N., Constant, D., Harries, J., Blanchard, K., Sinanovic, E., & Grossman, D. (2015). The costs of accessing abortion in South Africa: women’s costs associated with second-trimester abortion services in western Cape Province. Contraception, 92(4), 339–344.

  • London, S. (2015). Ghana’s R3M program is associated with greater provision of safe abortions. International Perspectives on Sexual and Reproductive Health, 41(4), 223.

  • Martin, L. A., Debbink, M. P., Hassinger, J., & Harris, L. H. (2011). Abortion-possible and impossible: Stigma and the narratives of ghanaian doctors who provide abortions. Reflections: Narratives of Professional Helping, 17(3), 79–87.

  • Ministry of Health (2003). National Reproductive Health Service Policy and Standards. The Ministry of Health, Ghana, 2003.

  • Morhee, R. A. S., & Morhee, E. S. K. (2006). Overview of the law and availability of abortion services in Ghana.Ghana medical journal, 40(3).

  • Organisation mondiale de la santé, World Health Organization, & World Health Organisation Staff. (1995). Complications of abortion: technical and managerial guidelines for prevention and treatment. World Health Organization.

  • Puri, M., Lamichhane, P., Harken, T., Blum, M., Harper, C. C., Darney, P. D., & Henderson, J. T. (2012). “Sometimes they used to whisper in our ears”: health care workers’ perceptions of the effects of abortion legalization in Nepal. Bmc Public Health, 12(1), 1–9.

  • Rehnström Loi, U., Gemzell-Danielsson, K., Faxelid, E., & Klingberg-Allvin, M. (2015). Health care providers’ perceptions of and attitudes towards induced abortions in sub-saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC public health, 15(1), 1–13.

  • Republic of Ghana (1960). Criminal Offences Act, Ghana Sect. 58 (2), Act 29; PNDC Law 102, 1985. State Publishing Corporation, Ghana; 1960.

  • Rhoden, N. K. (1985). Trimesters and technology: revamping Roe v. Wade. Yale LJ, 95, 639.

  • Shah, I., & Åhman, E. (2004). Age patterns of unsafe abortion in developing country regions. Reproductive health matters, 12(sup24), 9–17.

  • Sigdel, A., Angdembe, M. R., Khanal, P., Adhikari, N., Maharjan, A., & Paudel, M. (2022). Medical abortion drug dispensing practices among private pharmacy workers in Nepal: a mystery client study. Plos one, 17(11), e0278132.

  • Singh, S., Remez, L., Sedgh, G., Kwok, L., & Onda, T. (2018). Abortion worldwide 2017: uneven progress and unequal AccessAbortion worldwide 2017. uneven Progress and unequal access.

  • Singh, S., Wulf, D., Hussain, R., Bankole, A., & Sedgh, G. (2009). Abortion worldwide: a decade of uneven progress. Guttmacher Institute.

  • Sundaram, A., Juarez, F., Ahiadeke, C., Bankole, A., & Blades, N. (2015). The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care. Health Policy and Planning, 30(8), 1017–1031.

  • Turner, K. L., Hyman, A. G., & Gabriel, M. C. (2008). Clarifying values and transforming attitudes to improve access to second trimester abortion. Reproductive health matters, 16(sup31), 108–116.

  • UNFPA, I. (1994 Oct). Program of Action. ; Paragraph, 8.

  • United Nations/ICPD (1994). International conference on population and development programme of action. International Conference on Population and Development: 1994.

  • World Health Organization (2008). First global conference on task shifting. World Health Organization, 8–10.

  • World Health Organization (2012). Safe abortion: technical and policy guidance for health systems.

  • World Health Organization (2015). Safe abortion: technical and policy guidance for health systems: legal and policy considerations (No. WHO/RHR/15.04). World Health Organization.

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Acknowledgements

The authors are grateful to all individuals who provided information for this study.

Funding

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Authors and Affiliations

  1. Faculty of Science Education, Department of Health Administration and Education, University of Education, Winneba, Ghana

    Fred Yao Gbagbo

  2. Department of Private Law, Faculty of Law, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Renee Aku Sitsofe Morhe

  3. Department of Obstetrics and Gynaecology, University of Health and Allied Sciences, Ho, Ghana

    Emmanuel Komla Senanu Morhe

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  1. Fred Yao Gbagbo
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  2. Renee Aku Sitsofe Morhe
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Contributions

We declare that we are the sole authors of this manuscript. Author one (F.Y.G) conceptualized the study and developed the draft manuscript. Author two (R.S.M) critically reviewed the manuscript and made technical inputs. Author three (E.S.K.M) analyzed the data, interpreted the results, and made further technical inputs. All three authors read and approved the manuscript before submission for publication.

Corresponding author

Correspondence to Fred Yao Gbagbo.

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Ethics approval and consent to participate

All participants gave both written and verbal consent to participate in the study. The Ghana Health Service gave ethical approval for the study (GHS-ERC: 02/09/2016).

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All participants gave both written and verbal consents individually for the publication of the research findings on one condition that their personal and institutional identities remain anonymous.

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The authors declare that they have no competing interests.

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Gbagbo, F.Y., Morhe, R.A.S. & Morhe, E.K.S. Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana. Matern Child Health J 27, 850–860 (2023). https://doi.org/10.1007/s10995-023-03617-4

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