Many Ghanaian women, particularly those who are young or poor, continue to obtain unsafe, illegal abortions, despite Ghana’s relatively moderate abortion law, a nationally representative study indicates.1 About one in 10 women surveyed in 2007 said they had had an abortion in the past five years, and only slightly more than half of their procedures had been safe (55%). The odds that an abortion had been done safely were lower among women who were younger than 30 than among older women (odds ratios, 0.2–0.4), and greater among women in the two highest wealth quintiles than among poorer women (1.8–2.9). Women whose partner had paid at least partially for the procedure also had ele-vated odds of obtaining a safe abortion (3.1).
Since 1985, abortion has been legal in Ghana if a pregnancy is the result of rape or incest, threatens the woman’s life or her physical or mental health, or would result in a child with a serious physical abnormality. However, few women seek legal abortions, not only because of the attendant stigma but also because many are unable to afford services or are unaware that the procedure is legal. To assess the relationship between women’s characteristics and the legality and safety of their abortions, the investigators examined data from the 2007 Ghana Maternal Health Survey, conducted among women aged 15–49.
The analytic sample consisted of 5,747 women who had been pregnant in the five years prior to the survey, including 552 women who had had an abortion during this time period. Women were asked to provide information on their demographic and socioeconomic characteristics, access to media, awareness of abortion’s legal status, and previous pregnancies, births and abortions. If they had had an abortion, they were asked about the type of provider, location and method used. The researchers used logistic regression to identify characteristics associated with having obtained any abortion and with having obtained a safe procedure.
Almost all respondents were aged 20 or older (95%), had at least one child (94%) and were currently or formerly married (91%). Three-quarters were Christian, and six in 10 resided in a rural area. Half of women had little or no access to newspapers, radio or television, and just 3% knew that abortion is legal.
Compared with women in the full sample, those who had had an abortion were more likely to be young, childless and unmarried. More than one-fourth of abortion recipients were younger than 20, two in five were childless and four in 10 had never been married. Ninety percent were Christian, 41% lived in a rural region and only 35% belonged to one of the lowest three wealth quintiles. As in the main sample, the proportion who knew abortion’s legal status was extremely small (6%).
Regression analysis revealed that women were more likely to have had an abortion in the past five years if they were in their 20s than if they were older (odds ratio, 1.8), if they were childless than if they had at least three children (7.0), if they were in the two highest wealth quintiles than in the three poorest ones (1.7–1.8) and if they practiced some form of Christianity rather than Islam (1.9–3.5). The odds of having had an abortion were also elevated among women who had never married (2.3), had had a previous abortion (2.1) or were urban residents (1.4).
Slightly more than half (55%) of the women who had had an abortion had had a safe procedure—that is, it had been a surgical or medication abortion performed by a doctor, nurse or midwife, even if it had occurred outside of a clinic or hospital. Additional regression analyses revealed that teenagers and women in their 20s were less likely than older women to have had a safe abortion (odds ratios, 0.2–0.4). The odds of having obtained a safe procedure were greater among women in the wealthiest and second wealthiest quintiles than among those in the poorest three quintiles (odds ratios, 2.9 and 1.8, respectively), and greater among women whose partner contributed toward the procedure’s costs than among those whose partner had not helped pay for the abortion (odds ratios, 3.1). Neither knowledge of abortion’s legality nor access to media was associated with abortion safety.
The researchers point out several limitations of the study, including the likelihood of underreporting because of stigma and incorrect recall; on the basis of regional data on abortion incidence in West Africa, they estimate that only about 40% of abortions were reported in the Ghana survey, though their analyses suggest that underreporting did not vary by subgroup. In addition, the study examined abortions that had occurred in the past five years, during which time women’s socioeconomic characteristics (which were assessed at the time of the survey) may have changed to some degree. Nonetheless, in addition to underscoring the need for programs aimed at reducing stigma and improving women’s knowledge of and access to legal abortion, especially in poor or rural areas, the researchers recommend greater involvement of partners; outreach efforts to men should emphasize "the importance of their support and … the dangers of unsafe abortions." Future research, they suggest, should examine the national incidence of unsafe abortion and evaluate the success of ongoing programs designed to address this issue.—S. Ramashwar
REFERENCE
1. Sundaram A et al., Factors associated with abortion-seeking and obtaining a safe abortion in Ghana, Studies in Family Planning, 2012, 43(4):273–286.