Knowledge, Attitudes and Practices of Medical Abortion Amongst Doctors at the Greater Accra Regional Hospital, Accra Ghana

Abstract

Background: Unsafe abortion is a major contributor to maternal morbidity and mortality in Ghana and other developing countries. Safe termination of pregnancy is very crucial to reducing Ghana’s maternal mortality ratio of 15 to 30% maternal deaths with 308 per 100, 000 live births according to the World Bank. Medical abortion is preferred to surgical method of termination of early pregnancy because the procedure is non-invasive with greater privacy and often does not involve hospitalization. Understanding the perspectives of doctors on medical abortion service delivery is pertinent to identifying barriers and enablers to the successful integration of medical abortion into general practice and is critical to increasing access to these services for women. The study sought to determine the knowledge, attitudes, and practices of medical abortion amongst doctors at the Greater Accra Regional Hospital. Method: A hospital-based cross-sectional study was carried out among medical doctors at the Greater Accra Regional Hospital. A self-administered structured questionnaire was used to collect the data. Part one of the questionnaire was used to collect information on the demographics, part two involved questions on knowledge of medical abortion whereas part three included information on the attitude of doctors towards medical abortion The data was analyzed using STATA version 16. Categorical variables were analyzed using frequencies and percentages. Bivariate and multiple regression analysis were used to establish the relationship between factors influencing the practices of medical abortion among the doctors. Results: The mean (± SD) age of the respondents was 35 (± 7.67) years, with a range of 18-50 years. One hundred and sixteen 116 (53.5%) of the participants were male and the majority (60.4%) were married. The majority of the participants (81%) have adequate knowledge about medical abortion, while a few (3.7%) have low knowledge about medical abortion. Results of the study revealed that about (57%) of participants do not carry out elective medical termination of pregnancy. The major reason given for not carrying out elective early medical termination of pregnancy was outside of the scope of practice (48%) and against religious practice (35%). There was significant difference between doctors at the Greater Accra Regional Hospital who practice medical abortion and those who do not practice medical abortion based on age (χ2= 30.44, p<0.0001), marital status (χ2= 11.26, p=0.001), specialization (p<0.0001), grade (p<0.0001), number of years of practice (p<0.0001), comfortable working in medical abortion facility (χ2=8.77, p=0.003), willingness to provide evidence-based dosing regimen (χ2=26.64, p<0.0001), experience complication while administering medical abortion (χ2= 20.59, p<0.0001) and experience of complication of medical abortion offered by another doctor (χ2= 30.25, p<0.0001). After adjusting for confounders, participants who experienced complications while administering medical abortion were 5.56 times more likely to practice medical abortion compared to participants who had not experienced complications while administering medical abortion[AOR=5.56, CI= (2.05-15.10), p value=0.001)] Conclusion: Doctors generally have adequate knowledge about medical abortion. Attitudes of medical doctors and their practice of medical abortion is significantly influenced by personal, religious, and cultural beliefs. Those who have been trained in abortion procedures were more comfortable practicing or referring patients. The study recommends that the Ministry of Health must ensure that health professionals are trained on medical abortion.