Prevalence of Over the Counter Medication Abortion in Women with Incomplete Abortions Reporting to Selected Facilities in Greater Accra Region.

Abstract

Abortion can be spontaneous or induced. Induced abortions if not safely done, most often results in complications that are injurious to women and can lead to their death. One of the many reasons for the induction of abortions by women is the stigma associated with abortions which drives women seeking abortion to rely on uncertified and untrained providers, some of whom are friends, Chemical sellers and Pharmacists dispensing medication abortion drugs over the counter without prescriptions. Induced abortions result in a significant number of deaths globally and nationally. The World Health Organization (WHO) estimated that there were 21.6 million unsafe abortions globally in 2008 with 47,000 women dying as a result. In Ghana unsafe abortion is one of the leading causes of maternal mortality. This study compared women with incomplete abortions who used over the counter (OTC) medication abortion to induce their abortion, to women with incomplete abortions without prior use of over the counter medication abortion. The objective of the study was to determine the prevalence of over the counter medication abortion in women with incomplete abortions. The outcome of interest for the study was the presence of complicated incomplete abortions, with a focus on those who report with severe bleeding as a complication. Using consecutive sampling method, a structured questionnaire was used to collect data from women who reported with incomplete abortions to 5 selected health facilities in the Greater Accra Region of Ghana. The study determined that the prevalence of over the counter medication abortion in women with incomplete abortions was 40.6%. It also indicated that the proportion of women reporting to the five facilities with incomplete abortions who had severe bleeding with the use of over the counter medication abortion was 43% (χ2=8.0354 P=0.005) which was statistically significant. It also found that severe bleeding has a significant positive association with over the counter medication abortion. OTC medication abortion users are more likely to be educated to secondary education level, likely to be single, young, and likely to be aged between 20-24 years. They and their partners are less likely to be high income earners or engaged in any income earning venture and likely to be unemployed. If they are earning income, then they are likely to be in the low income class. They are likely to be living with their parents or relatives and likely to be having their first abortion and they will know where they can access safe abortion. These findings bring to light the importance that Food and Drugs Authority and Pharmacy Council need to attach to monitoring of pharmacies and chemical shops to ensure that the go by their authorized roles in the dispensing of medication, such as medication abortion. The two institutions need to correct the rampant over the counter dispensing of medication abortion. Non-Governmental Organizations(NGO) and Ghana Health Service involved in safe abortion care must make the effort to train Pharmacists on their roles in the provision of safe abortion care as stipulated in the Ghana Health Service Standards and Protocols for the provision of comprehensive abortion care. Finally, Safe abortion services available in Ghana must be publicized in ways that the society finds acceptable, considering the social stigma attached to abortion and religious beliefs/teachings about the impropriety of abortion. Safe abortion providers must be well trained and equipped to provide services in a friendly and compassionate manner in order not to drive women who need such services away.