In Ghana, despite the availability of safe, legally permissible abortion services, high rates of morbidity and mortality from unsafe abortion persist. Through interviews with Ghanaian physicians on the front lines of abortion provision, we begin to describe major barriers to widespread safe abortion. Their stories illustrate the life-threatening impact that stigma, financial restraints, and confusion regarding abortion law have on the women of Ghana who seek abortion. They posit that the vast majority of serious abortion complications arise in the setting of clandestine or self-induced second trimester attempts, suggesting that training greater numbers of physicians to perform second trimester abortion is prerequisite to reducing maternal mortality. They also recognized that an adequate supply of abortion providers alone is a necessary but insufficient step toward reducing death from unsafe abortion. Rather, improved accessibility and cultural acceptability of abortion are integral to the actual utilization of safe services. Their insights suggest that any comprehensive plan aimed at reducing maternal mortality must consider avenues that address the multiple dimensions which influence the practice and utilization of safe abortion, especially in the second trimester.
Issues of abortion are critical in Ghana largely due to its consequences on sexual and reproductive health. The negative perception society attaches to it makes it difficult for young females to access services and share their experiences. This paper examines the pre and post-abortion experiences of young females; a subject scarcely researched in the country. Twenty-one clients of Planned Parenthood Association of Ghana (PPAG) clinic at Cape Coast were interviewed. Guided by the biopsychosocial model, the study revealed that fear of societal stigma, shame, and rejection by partners, as well as self-imposed stigma constituted some of the pre and post-abortion experiences the respondents. Other experiences reported were bleeding, severe abdominal pain and psychological pain. The Ghana Health Services (GHS) and other service providers should partner the PPAG clinic to integrate psychosocial treatment in its abortion services while intensifying behaviour change communication and community-based stigma-reduction education in the Metropolis.
"BACKGROUND: Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students' reported likelihood to provide abortion services. METHODS: Final-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted. RESULTS:A total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, for a response rate of 91.8%. In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion. DISCUSSION: Midwifery students at Ghana's public midwifery training colleges report that they are likely to provide CAC. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana."
"ETHNOPHARMACOLOGICAL RELEVANCE: Women in Tanzania use plants to induce abortion. It is not known whether the plants have an effect. AIMS OF STUDY: Collect data on plant use in relation to induced abortion and test the effect of plant extracts on uterine contraction. MATERIALS AND METHODS: During interviews with traditional birth attendants and nurses, plants were identified. Cumulative doses of plant extracts were added to rat uterine tissue in an organ bath, and the force and frequency of contractions recorded. Acetylcholine was used as positive control. RESULTS:21 plant species were tested for effect on uterine contraction. 11 species increased the force of contraction, and 12 species the frequency of contractions. The strongest contractions comparable to the maximum response obtained with acetylcholine were obtained with extracts of Bidens pilosa, Commelina africana, Desmodium barbatum, Manihot esculenta, Ocimum suave, Oldenlandia corymbosa and Sphaerogyne latifolia. 7 species increased both the force and frequency of contractions. CONCLUSION: Several of the plant species induced strong and frequent contractions of the uterus, and can be used to induce an abortion."
Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs.
Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement.
After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman's life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country's newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary's stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their 'duty' to procreate within marriage. Ultimately, the event encapsulated a great deal about elites' attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa's extremely restrictive Abortion and Sterilisation Act (1975).
It is ten years this month since the Choice on Termination of Pregnancy (CTOP) Act of 1996 was enacted. The passing of this Act was in keeping with the South African Constitution and represented a major breakthrough for women's reproductive rights. The Act allows for abortion on request to be performed at a designated health facility. This may be performed by a doctor or, during the first trimester, by a registered midwife who has completed the prescribed training course. In the second trimester, abortions may be performed by doctors up to 20 weeks' gestational age. This applies if the pregnancy endangers a woman's physical or mental health, if there is a risk of fetal abnormality, in the case of rape or incest, or if the continued pregnancy could adversely affect a woman's socio-economic situation. The Act has increased women's legal access to safe abortion services, leading to a dramatic decline in morbidity and mortality associated with unsafe abortions. However, numerous barriers continue to limit service access. One indicator of this is that almost a quarter of abortions are performed after 12 weeks of pregnancy. In addition, there is evidence that some women continue to have abortions outside of designated facilities.
OBJECTIVE: To assess the severity of abortion complications in Malawi and to determine associated risk factors. METHODS: Between July 20 and September 13, 2009, a cross-sectional survey was conducted at 166 facilities providing post-abortion care services. Data were collected for all women with an incomplete, inevitable, missed, complete, or septic abortion. Weighted percentages were calculated to obtain national estimates. RESULTS: In total, 2067 women met the inclusion criteria. Estimates suggest that 80.9% of women who presented for post-abortion care in Malawi in 2009 were married and 64.8% were from rural areas. One-quarter (27.4%) presented with severe or moderate morbidity. Sepsis (13.7%), retained products of conception (12.7%), and fever (12.3%) were the most common complications. The case fatality rate was 387 deaths per 100 000 post-abortion care procedures. Women with severe or moderate complications were significantly more likely to be from rural areas than from urban areas; to have reported interfering with their pregnancy; and to be separated, divorced, or widowed than to be single. CONCLUSION: In 2009, many women seeking post-abortion care in Malawi presented with complications. Advocacy is needed to influence policies that will allow expanded access to safe abortion services for women of all ages and in all areas.