Abortion Care in Ghana: A Critical Review of the Literature

In the first years of the new century, the Ministry of Health/Ghana Health Service determined to reduce abortion‐associated morbidity and mortality by increasing access to safe care. This was accomplished by interpreting Ghana's restrictive law so that more women qualified for legal services; by framing this effort in public health terms; by bundling abortion together with contraception and postabortion care in a comprehensive package of services; and by training new cadres of health workers to provide manual vacuum aspiration and medical abortion. The Ministry of Health/Ghana Health Service convened medical and midwifery societies, nongovernmental organizations, and bilateral agencies to implement this plan, while retaining the leadership role. However, because of provider shortages, aggravated by conscientious objection, and because many still do not understand when abortion can be legally provided, some women still resort to unsafe care. Nonetheless, Ghana provides an example of the critical role of political will in redressing harms from unsafe abortion.

Section: Contextmentioning

confidence: 99%

Section: Innovationmentioning

confidence: 99%

Section: Reproductive Health Outcomes Are Among Those Of Concern Inmentioning

confidence: 99%

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Implementing safe abortion in Ghana: “We must tell our story and tell it well”

Chavkin

Baffoe

Awoonor-Williams

2018

“…Their technical content and endorsement proved essential. Participation by the nursing and midwifery societies was key in those countries engaged in task sharing, although some of these were apprehensive about possible loss of turf and they encountered some resistance from members concerned about workload and associated remuneration …”

Section: Recipientsmentioning

confidence: 99%

“…Participation by the nursing and midwifery societies was key in those countries engaged in task sharing, although some of these were apprehensive about possible loss of turf and they encountered some resistance from members concerned about workload and associated remuneration. 31,67,68 In two of the African cases, informants reported that the UN agencies, WHO and UNFPA, had been important partners and that their rigorously developed guidelines for abortion services, including medical abortion, as well as for task sharing had proved highly useful. The Latin American countries studied also drew upon the WHO guidelines, which they modified.…”

Section: Recipientsmentioning

confidence: 99%

Implementing and expanding safe abortion care: An international comparative case study of six countries

Chavkin

Stifani

Bridgman-Packer

et al. 2018

We conducted a comparative case study‐based investigation of health sector strategies that were useful in expanding or establishing new abortion services. We selected geographically diverse countries from across the human development index if they had implemented new abortion laws, or changed interpretations of existing laws or policies, within the past 15 years (Colombia, Ethiopia, Ghana, Portugal, South Africa, and Uruguay). Factors facilitating the expansion of services include use of a public health frame, situating abortion as one component of a comprehensive reproductive health package, and including country‐based health and women's rights organizations, medical and other professional societies, and international agencies and nongovernment organizations in the design and rollout of services. Task sharing and the use of techniques that do not require much infrastructure, such as manual vacuum aspiration and medical abortion, are important for rapid establishment of services, especially in low‐resource settings. Political will emerged as the key factor in establishing or expanding access to safe abortion services.

Determining the accuracy of pregnancy‐length dating among women presenting for induced abortions in Ghana

Shellenberg¹,

Antobam²,

Griffin³

et al. 2017

Objective: To determine the proportion of women presenting for an induced abortion in Ghana who could use a gestational wheel to determine if they had reached at least 13 weeks or fewer than 13 weeks of pregnancy accurately. Methods:The present cross-sectional study was conducted at four facilities in Ghana between February 1, and July 31, 2014. Women aged at least 18 years seeking induced abortions who had not previously been informed of the length of their pregnancy by a clinician were enrolled. Women self-assessed pregnancy duration using a gestational wheel before a clinician assessed the length via clinical assessment and bimanual exam for use as a respective reference point. The proportion of participants who used the wheel successfully was calculated. Results:The study enrolled 780 participants, 770 of whom used the gestational wheel.Of these, 221 (28.7%) could use the wheel without verbal instructions, and 465 (60.4%) described it as easy to use. Agreement in pregnancy-length assessments was recorded for 728 (94.5%) patients. There were 10 (1.3%) and 28 (3.6%) participants who made evaluations with "low-risk disagreement" and "high-risk disagreement" with the clinician assessment, respectively. Conclusion:Almost all participants could use the gestational wheel to date their pregnancies correctly. This tool could help women perform medical abortions safely in the community, reducing morbidity and mortality from unsafe abortions. K E Y W O R D SAbortion; Gestational dating; Ghana; Medical abortion; Misoprostol; Reproductive health | INTRODUCTIONDespite Ghana having relatively liberal laws surrounding induced abortion, evidence has demonstrated that the self-administration of misoprostol by women outside clinical settings is common practice. [1][2][3] Misoprostol alone, when administered according to the regimen recommended by WHO, is an effective medical abortion technique with a success rate of 85% for patients at up to 9 weeks of pregnancy. 4 Although there is limited evidence of the effectiveness of misoprostol for induced abortion of pregnancies at 9-13 weeks, WHO has endorsed using the evidence-based regimen for earlier than 9 weeks of pregnancy for pregnancies between 9 and 13 weeks. 5 Given the safety and simple administration of the regimen, arguments have been made against the need for clinical oversight in the use of misoprostol,This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.