Abortion, unmet need, and family planning service provision among gynecology patients in Ghana.

摘要

Background. Despite abortion being legal, complications from induced abortion are the leading cause of maternal mortality in Ghana.Aims. The aims of this research are (1) to explore the pathways to unsafe abortion, (2) identify correlates of women with induced abortion complications, and (3) evaluate the effectiveness of group as compared to individual family planning counseling among gynecology patients in Ghana.Methods. The data for this study come from two teaching hospitals in Ghana, Komfo Anokye in Kumasi and Korle Bu in Accra. Qualitative data were collected from postabortion patients, male partners, family planning nurses, and obstetricians/gynecologists on the pathways to unsafe abortion. Baseline data were collected on women with pregnancy-related complications---correlates of induced abortion complications were examined. A randomized, noninferiority trial was conducted among gynecology patients to assess whether group family planning counseling was as effective as individual family planning counseling.Results. Men are seen as the primary force in fertility decisions---men may either control fertility directly through 'orders' to abort or indirectly by denying responsibility. Some women opt to not disclose the pregnancy to their male partners to ensure that their fertility desires are met. Health providers may be barriers to safe abortion in this context.Women with induced abortion complications were more likely to report they were the main decision-makers on household items and were less likely to disclose the incident pregnancy to their male partners as compared to women whose pregnancies ended through spontaneous abortion or other pregnancy complications.Group family planning counseling is noninferior to individual family planning counseling. Measures assessed include intention to use family planning after the most recent pregnancy and knowledge of modern contraceptive methods.Conclusions. The results of this study indicate that the pathway to unsafe abortion in Ghana is complex, and despite abortion's legal status in Ghana, multiple factors serve as barriers to safe abortion services. Induced abortion patients, as compared to other patients, are more likely to report greater decision-making autonomy and pregnancy nondisclosure. Finally, group family planning counseling is an effective strategy for meeting the unmet need for family planning among gynecology patients efficiently.