Determinants of Unsafe Abortion among Women of Reproductive Age Group in Ghana, Evidenced from Maternal Health Survey 2017 Data

Abstract

Introduction: Unsafe induced abortion is still a major public health concern in Ghana and many other developing countries. The objective of the study was to identify determinants of induced abortion among women of reproductive age group in Ghana as evidenced from Ghana Maternal Health Survey 2017 data. Methodology: Data of 6,896 women of reproductive age group who had done something to end unwanted pregnancies from 2012 to 2017 was extracted from the Ghana Maternal Health Survey 2017 data. Analysis was done using STATA version 15 (StataCorp LP, College Station, TX). Chi- squared test and logistic regression models were used to measure association and strength of association between unsafe abortion and some independent variables at significance level of P-value <0.05 Results: The study found 59.1% safe induced abortion and 40.9% unsafe abortion carried out from 2012 to 2017 by women of reproductive age (15-49 years). Women aged 20-24 years who were not married, living in urban areas, Christian by religion, educated with Junior high certificate, belonging to fourth wealth index quintile category, history of one parity and were living in Ashanti region formed the largest proportion of the women who had carried out induced abortion. 80.5% women were not using contraceptives by the time they became pregnant thus exposing themselves to unwanted pregnancies while 19.5% of the women were using contraceptives but reported some failures of the contraceptive methods like pills and injectables to protect them against unwanted pregnancy that led them to have induced abortion. Majority, 92.0% of the induced abortions were initiated in environment that do not meet minimum medical standards for sterile procedures by Pharmacists/drug shop sellers (40.4%) and later ended up at health facilities as incomplete, missed or septic abortions. Consequently, 95.4% women had gone to health facility as last place to end unwanted pregnancy, however, only 59.1% of them successfully had safe induced abortion at health facility where mostly medical doctor 35.4% and nurses/midwife only 7.4% respectively provided abortion services at health facilities. Public health facilities 54.1% mostly preferred for the abortion related services compared to private health facilities. Unplanned pregnancy, non-contraceptive use, failure of contraceptive, history of previous induced abortion, poor post abortion care services, cadre of the health workers, age at first sexual intercourse ( Early sexual debut), partners living with the respondents, attitude of the partners towards to having induced abortion, late health problems due to induced abortion, place of treatment for complications due to induced abortion, payment and the year of the induced abortions were significant proximate determinants that influenced induced abortion. While pregnancy before or out of marriage, age at first marital union (Early marriage), polygamy though not commonly practiced 13.3% but had strong association with induced abortions and improper knowledge on safe, legal abortion by women were significant distal determinants that influenced induced abortion among women of reproductive age group in Ghana. Conclusions: In 2006, Ministry of Health launched Reducing Maternal Morbidity and Mortality program aimed at reducing morbidity and mortality due to unsafe abortion. However, non-contraceptive use, lack of proper knowledge on safe, legal abortion contributed to 40.9% of unsafe abortion cases from 2012 to 2017. Many women, 36.3% were denied opportunity to access abortion related services at health facility. Therefore, the health facility environment should be made favorable for safe abortion services including contraceptive services by government through ministry of health and Ghana Health Services by reviewing policies on abortion, build the capacity of the health workers especially the nurses/midwifes, doctors to provide quality Comprehensive Abortion Care services.