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      Predictors of Unsafe Induced Abortion among Women in Ghana

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      Author(s): 1 , 2 , , 1 , 3 , 4
      Publication date (Electronic):
      Journal: Journal of Pregnancy
      Publisher: Hindawi

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          Abstract

          Background

          Unsafe induced abortion is a major contributor to maternal morbidity and mortality in Ghana.

          Objective

          This study aimed to explore the predictors of unsafe induced abortion among women in Ghana.

          Methods

          The study used data from the 2017 Ghana Maternal Health Survey. The association between women's sociodemographic, obstetric characteristics, and unsafe induced abortion was explored using logistic regression. The analysis involved a weighted sample of 1880 women aged 15-49 years who induced abortion in the period 2012-2017. Analysis was carried out using STATA/IC version 15.0. Statistical significance was set at p <0.05.

          Results

          Of the 1880 women, 64.1% (CI: 60.97-67.05) had an unsafe induced abortion. At the univariate level, older women (35-49 years) (odds ratio=0.50, 95% CI: 0.28-0.89) and married women (odds ratio=0.61, 95% CI:0.44-0.85) were less likely to have an unsafe induced abortion while women who did not pay for abortion service (odds ratio=4.44, 95% CI: 2.24-8.80), who had no correct knowledge of the fertile period (odds ratio =1.47, 95% CI: 1.10-1.95), who did not know the legal status of abortion in Ghana (odds ratio =2.50, 95% CI: 1.68-3.72) and who had no media exposure (odds ratio =1.34, 95% CI: 1.04-1.73) had increased odds for an unsafe induced abortion. At the multivariable level, woman's age, payment for abortion services, and knowledge of the legal status of abortion in Ghana were predictors of unsafe induced abortion.

          Conclusion

          Induced abortion is a universal practice among women. However, unsafe abortion rate in Ghana is high and remains an issue of public health concern. We recommend that contraceptives and safe abortion services should be made available and easily accessible to women who need these services to reduce unwanted pregnancies and unsafe abortion rates, respectively, in the context of women's health. Also, awareness has to be intensified on abortion legislation in Ghana to reduce the stigma associated with abortion care seeking.

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          Most cited references29

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          Unsafe abortion: the preventable pandemic.

          David A Grimes, Janie Benson, Susheela Singh … (2006)
          Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19-20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women's health; in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. Access to safe abortion improves women's health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol, an oxytocic agent, have improved the care of women. Access to safe, legal abortion is a fundamental right of women, irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women.
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            Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries.

            Susheela Singh (2006)
            Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy-related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem. National estimates of abortion-related hospital admissions in women aged 15-44 years were compiled for 13 developing countries: Africa (Egypt, Nigeria, and Uganda), Asia (Bangladesh, Pakistan, and the Philippines), and Latin America and the Caribbean (Brazil, Chile, Colombia, Dominican Republic, Guatemala, Mexico, and Peru). These data were combined with supplementary data from five countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Nigeria, and South Africa) to give estimates for the three world regions. The annual hospitalisation rate varies from a low of about 3 per 1000 women in Bangladesh to a high of about 15 per 1000 in Egypt and Uganda. Nigeria, Pakistan, and the Philippines have rates of 4-7 per 1000, and two countries in Latin America with recent data have rates of almost 9 per 1000. In the developing world as a whole, an estimated five million women are admitted to hospital for treatment of complications from induced abortions each year. This equates to an average rate of 5.7 per 1000 women per year in all developing regions, excluding China. By comparison, in developed countries complications from abortion procedures or hospitalisation are rare. These results help quantify the magnitude of the adverse health effects of unsafe abortion in developing countries and highlight the need for improved access to post-abortion care. The provision of abortion services is changing to include the drug misoprostol and this could reduce the severity of abortion complications and the number of women who are hospitalised. Researchers will need to monitor these changes to provide countries with up-to-date information on illness and death from unsafe abortion. Improved contraceptive services are necessary to prevent unintended pregnancy. However, increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, and remains a high priority for developing countries.
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              Factors associated with abortion-seeking and obtaining a safe abortion in Ghana.

              Aparna Sundaram, Susheela Singh, Fatima Juarez … (2012)
              Although Ghana's abortion law is fairly liberal, unsafe abortion and its consequences remain among the largest contributors to maternal mortality in the country. This study analyzes data from the 2007 Ghana Maternal Health Survey to identify the sociodemographic profiles of women who seek to induce abortion and those who are able to obtain safe abortion services. We hypothesize that women who have access to safe abortion will not be distributed randomly across different social groups in Ghana; rather, access will be influenced by social and economic factors. The results confirm this hypothesis and reveal that the women who are most vulnerable to unsafe abortions are younger, poorer, and lack partner support. The study concludes with policy recommendations for improving access to safe abortion for all subgroups of women, especially the most vulnerable. © 2012 The Population Council, Inc.
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                Author and article information

                Contributors
                Michael Boah:
                ORCID: http://orcid.org/0000-0002-5660-2292
                Journal
                Journal ID (nlm-ta): J Pregnancy
                Journal ID (iso-abbrev): J Pregnancy
                Journal ID (publisher-id): JP
                Title: Journal of Pregnancy
                Publisher: Hindawi
                ISSN (Print): 2090-2727
                ISSN (Electronic): 2090-2735
                Publication date Collection: 2019
                Publication date (Electronic): 3 February 2019
                Volume: 2019
                Electronic Location Identifier: 9253650
                Affiliations
                1Ghana Health Services, Bolgatanga Upper East Region, Ghana
                2Chinese Centre for Endemic Diseases Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
                3Department of Global Health and Development, College of Medicine, Graduate School of Hanyang University, Seoul, Republic of Korea
                4St Patrick Nursing/Midwifery Training College, Offinso, Ashanti Region, Ghana
                Author notes

                Academic Editor: Marco Scioscia

                Author information
                http://orcid.org/0000-0002-5660-2292
                http://orcid.org/0000-0002-8552-0907
                Article
                DOI: 10.1155/2019/9253650
                PMC ID: 6378005
                PubMed ID: 30854238
                SO-VID: 9ad6282b-a11f-4fb7-b8ad-8f708f022c94
                Copyright © Copyright © 2019 Michael Boah et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 November 2018
                Date revision received : 27 December 2018
                Date accepted : 19 January 2019
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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