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

Abstract

BackgroundDespite a liberal abortion law, access to safe second trimester abortion services in Ghana are challenging for many women. This study sought to examine 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. MethodsA two-stage mixed quantitative and qualitative study designs were employed in the conduct of this study. The rst 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. ResultsSecond-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 in uence the availability of second-trimester abortion in health facilities in Accra. ConclusionsAlbeit 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 ow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services. BackgroundAccess to safe abortion care according to the World Health Organization in 1995 is a fundamental human right. As essential health care in most nations including Ghana, safe abortion services are expected to be available at high standards that are acceptable and accessible to all people within local jurisdictions. Traditionally, abortion care is divided into two: rst trimester (week 1 through week 13) and