Ghana abortion care-a model for others: analysis of the 2017 Ghana Maternal Health Survey

Dhanalakshmi Thiyagarajan; Kwaku Asah-Opoku; Sarah Compton

doi:10.1016/j.xagr.2024.100419

Ghana abortion care-a model for others: analysis of the 2017 Ghana Maternal Health Survey

AJOG Glob Rep. 2024 Nov 15;5(1):100419. doi: 10.1016/j.xagr.2024.100419. eCollection 2025 Feb.

Authors

Dhanalakshmi Thiyagarajan¹, Kwaku Asah-Opoku², Sarah Compton¹

Affiliations

¹ Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI (Thiyagarajan and Compton).
² Department of Obstetrics and Gynecology, University of Ghana, Accra, Ghana (Asah-Opoku).

Abstract

Background: About 5% to 13% of maternal mortality is directly related to unsafe abortion care. Despite the cultural stigmatization of abortions, Ghana has progressive abortion laws, healthcare guidelines, and clinical outcomes.

Objective: Our study's primary aim was to characterize abortion outcomes in Ghana. Our secondary aims included investigating factors that led to abortion complications and the treatment of these complications.

Study design: We used data from the 2017 Ghana Maternal Health Survey. We examined questions that focused on the reasons for abortion, methods used for abortion, healthcare setting for abortion, and health issues after abortion. We performed descriptive and inferential statistics, including cross tabulation with chi-square analysis and logistic regression models.

Results: Between 2012 and 2017, 1,425 women reported and completed the abortion-related questions. For those who obtained an abortion for health reasons, 69% had a surgical-based as opposed to herbal or medication-based abortion (P<.001), 94% had a medical facility-based as opposed to non-medical facility-based abortion (P<.001), and 21% had health problems related to the abortion within 1 month (P=.035). Women's reasons for undergoing an abortion did not affect the treatment rates after complications. There was no difference in the occurrence of an abortion-related complication or receipt of treatment for this complication within 1 month after the abortion among those who underwent medical facility-based and those who underwent nonmedical facility based abortion. Those with tertiary-level education or those who knew abortions were legal were more likely to have a surgical and medical facility-based abortion.

Conclusion: Although Ghana has room to improve the safety and accessibility of abortion services, our analysis suggests abortions in Ghana, regardless of reason given for seeking the service or method of abortion, seem to be safe. Translating Ghana's approach to abortion could minimize unsafe abortions globally.

Keywords: abortion guidelines; abortion laws; low- and middle-income countries; maternal mortality; public health; unsafe abortions; unsafe terminations.