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COLLEGE OF HUMANITIES 
 
UNIVERSITY OF GHANA 
 
 
 
MALE PARTNERS’ INVOLVEMENT IN ABORTION AND UPTAKE 
OF POST-ABORTION FAMILY PLANNING SERVICES. 
 
 
 
BY  
 
 
ESINAM AFI KAYI 
 (10329380) 
 
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, 
LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR 
THE AWARD OF PHD POPULATION STUDIES DEGREE. 
 
REGIONAL INSTITUTE FOR POPULATION STUDIES 
 
 
JULY 2018 
 
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ACCEPTANCE 
This thesis is accepted by the College of Humanities, University of Ghana, Legon, in fulfilment 
of the requirement for the award of PhD Population Studies degree. 
 
 
Thesis Supervisors 
 
_______________________       ______________ 
Professor Stephen Owusu Kwankye                 Date 
 
 
 
______________________       ________________ 
Professor Richard M.K. Adanu      Date 
 
 
 
______________________      _________________ 
Dr. Delali M. Badasu         Date 
 
 
 
 
 
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DECLARATION 
I, Esinam Afi Kayi, hereby declare that except for references to other people’s work, which 
have been duly acknowledged, this is the result of my own research and it has neither in part 
nor in whole been presented for another degree. 
 
 
______________________________       _______________ 
ESINAM AFI KAYI        DATE 
 
 
 
 
 
 
 
 
 
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ABSTRACT 
Male involvement in abortion and post-abortion family planning use is pivotal in reducing 
unintended pregnancies while optimising contraceptive use. While literature is extant with the 
positive outcomes of men’s role in abortion and contraceptive use, there is insufficient 
interrogation of the relationship between male partners’ involvement in abortion and post-
abortion family planning uptake. This study sought to examine the relationship between male 
partners’ involvement in abortion and immediate use of post-abortion contraception in the 
Greater Accra Region. The specific objectives were to: explore the extent of male partners’ 
participation in abortion; women's expectations of their partners’ roles in the abortion and 
barriers to partners’ inclusion and participation in abortion.  
Using a sequential mixed method approach, data were obtained first through in-depth 
interviews and participant observations from women and their male partners, followed by a 
survey of only women. The data collection was conducted in four purposively selected health 
facilities in the Greater Accra Region. At the end of the study, 41 interviews were conducted 
and 356 respondents participated in the survey. Thematic analysis of the qualitative data was 
done using the Nvivo software. Multiple logistic regression analysis was performed with SPSS 
to determine the relationship between male partners’ involvement in abortion and uptake of 
post-abortion family planning.  
The results of the study showed three main themes which characterised male partners’ 
involvement during abortion: knowledge of the abortion, the role of male partners during the 
abortion decision-making process, and provision of support for the abortion. Women's 
expectations of receiving financial support from their male partners was highly prioritised over 
the expectation of their partners’ involvement during the abortion decision-making process and 
expectation of emotional support. Some women hoped to receive emotional and material 
support after the abortion whilst others had no expectations of receiving support from their 
partners. Barriers to male partners’ participation and inclusion in the abortion was a result of 
their lack of knowledge of and secrecy surrounding the pregnancy and abortion, partner 
abandonment, ambivalence about the pregnancy outcome, work-related demands, and parental 
responsibility for the pregnancy. Furthermore, communicative support provided by the male 
partners during the abortion process strongly predicted women’s use of post-abortion 
contraception. Women were less likely to adopt a contraceptive method after the abortion if 
they received emotional support from their male partners at the time of the abortion. The 
woman’s employment, self-efficacy and level of family planning knowledge were significantly 
associated with post-abortion family planning uptake whilst male partners’ educational level, 
ethnicity and knowledge of family planning strongly predicted women’s use of post-abortion 
contraception.  
The findings from this study elucidate several theoretical and practical implications. Post-
abortion services should aim at increasing women’s autonomy in contraceptive decision-
making while encouraging inter-couple communication on contraceptive use. Availability of 
on-site family planning consumables, skilled abortion-care providers and comprehensive 
discussions on contraception should be integrated into the package of comprehensive abortion 
care delivery at health facilities in order to increase the prevalence and initiation of post-
abortion contraception.  
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DEDICATION 
This work is dedicated to all the women who participated in this study. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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ACKNOWLEDGEMENTS 
To the GOD who makes all things possible!  
The successful completion of this thesis was made possible through the collective efforts of 
my family, thesis supervisors, RIPS Faculty, friends, and healthcare providers. 
I’m sincerely indebted to my mum, Delasi and Kafui, and Dr. Von Vordzogbe for their prayers, 
support and encouragement during this entire journey. It would have been quite difficult 
without their presence on this journey. My deepest appreciation goes to my supervisory team: 
Professors Stephen Owusu Kwankye and Richard Komla Adanu, and Dr. (Mrs.) Delali Badasu. 
I am very grateful to Prof. Kwankye for all the constructive criticisms, suggestions, counsel 
and encouragement during the difficult moments in researching on this topic. I’m also indebted 
to Prof. Adanu for accepting to be on my supervisory committee during one of the most trying 
times of this journey. Your intellectual contribution has been tremendous! Sincere thanks also 
goes to Dr. Badasu for the guidance, encouragement and constructive inputs in shaping this 
thesis. God bless you all! I wish to acknowledge Prof. Francis Dodoo and Prof. de-Graft Aikins 
for their scholarly contribution to this work during its conceptualization. Special thanks to the 
entire RIPS Faculty for being very academically supportive from the beginning of this 
programme.  
Hearty cheers to all the healthcare providers in all the participating hospitals where data was 
collected especially Aunty Fati, and Sophia of Ga West Municipal Hospital; and to my research 
team Rita, Gifty, Afrah and Charlotte Ofori who selflessly devoted their time and effort to 
assist with the field work. To all my colleagues turned friends at RIPS thank you for being part 
of this successful journey. Finally, to all my genuine friends, family and well-wishers, who are 
not mentioned here, I am grateful. 
This is my testimony; a journey of miracles!
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TABLE OF CONTENTS 
ACCEPTANCE .......................................................................................................................... i 
DECLARATION ....................................................................................................................... ii 
ABSTRACT ............................................................................................................................. iii 
DEDICATION .......................................................................................................................... iv 
ACKNOWLEDGEMENTS ....................................................................................................... v 
TABLE OF CONTENTS .......................................................................................................... vi 
LIST OF FIGURES ................................................................................................................. xii 
LIST OF TABLES ................................................................................................................. xiii 
LIST OF ABBREVIATIONS ................................................................................................. xiv 
CHAPTER ONE ........................................................................................................................ 1 
INTRODUCTION ..................................................................................................................... 1 
1.1 Background of the study .................................................................................................. 1 
1.2 Statement of the Problem ................................................................................................. 3 
1.3 Research Objectives ......................................................................................................... 7 
1.4 Rationale of the study ....................................................................................................... 8 
1.5 Organisation of the study ................................................................................................. 9 
CHAPTER TWO ..................................................................................................................... 11 
REVIEW OF RELEVANT LITERATURE ............................................................................ 11 
2.1 Introduction .................................................................................................................... 11 
2.2 Evolution and definition of male involvement ............................................................... 11 
2.3 Men’s role in reproduction, maternal health and family planning ................................. 13 
2.4 Male involvement in abortion ........................................................................................ 15 
2.5 Impact of male involvement in abortions ....................................................................... 18 
2.6 Predictors of Post-abortion Contraceptive use ............................................................... 19 
2.7 Barriers to male participation in sexual and reproduction issues ................................... 21 
2.8 Legal context of Induced abortion in Ghana .................................................................. 22 
2.9 The Context of Safe Abortion or Comprehensive Abortion Care (CAC) in Ghana ...... 23 
2.9.1 Incidence of abortion in Ghana ............................................................................... 25 
2.9.2 Characteristics of women having an Induced abortion in Ghana ............................ 26 
2.10 Summary of reviewed studies and identified gaps ....................................................... 26 
2.11 Theoretical framework ................................................................................................. 27 
2.11.1 Theory of Planned Behaviour ................................................................................ 28 
2.11.2 Health Belief Model (HBM).................................................................................. 28 
2.11.3 Male role theory ..................................................................................................... 30 
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2.11.4 Applicability of theories ........................................................................................ 30 
2.12 Conceptual Framework ................................................................................................ 33 
2.13 Hypotheses ................................................................................................................... 38 
CHAPTER THREE ................................................................................................................. 39 
METHODOLOGY .................................................................................................................. 39 
3.1 Introduction .................................................................................................................... 39 
3.2 Study strategy ................................................................................................................. 39 
3.3 Qualitative Data.............................................................................................................. 40 
3.3.1 Purpose of conducting qualitative phase ................................................................. 40 
3.3.2 Selection of study site .............................................................................................. 40 
3.3.3 Description of Study Site ......................................................................................... 41 
3.3.4 Sample design .......................................................................................................... 41 
3.3.5 Methods of data collection ...................................................................................... 41 
3.3.5.1 In-depth interviews ........................................................................................... 41 
3.3.5.2 Participant observation...................................................................................... 42 
3.3.6 Inclusion Criteria ..................................................................................................... 43 
3.3.7 Exclusion Criteria .................................................................................................... 43 
3.3.8 Study Participants .................................................................................................... 43 
3.3.9 Participant recruitment and selection ...................................................................... 44 
3.3.10 Sample size ............................................................................................................ 45 
3.3.11 Research Instrument .............................................................................................. 45 
3.3.12 Pre-testing of interview guide................................................................................ 46 
3.3.13 Data collection procedure ...................................................................................... 47 
3.3.14 Participant observations ......................................................................................... 50 
3.3.15 Data management and analysis.............................................................................. 51 
3.3.15.1 Data storage .................................................................................................... 51 
3.3.15.2 Data analysis ................................................................................................... 51 
3.3.15.3 Stages in the analytic process ......................................................................... 52 
3.4 Quantitative phase .......................................................................................................... 53 
3.4.1 Study design ............................................................................................................ 53 
3.4.2 Study sites ................................................................................................................ 54 
3.4.2.1 Korle-Bu Teaching hospital (KBTH) ............................................................... 54 
3.4.2.2 Tema General hospital ...................................................................................... 55 
3.4.2.3 Ga West Municipal hospital.............................................................................. 55 
3.4.2.4 Maamobi General hospital ................................................................................ 56 
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3.4.3 Study population ...................................................................................................... 56 
3.4.4 Sample size determination ....................................................................................... 57 
3.4.5 Sampling technique ................................................................................................. 57 
3.4.6 Data collection instrument ....................................................................................... 58 
3.4.6.1 Data collection procedure ................................................................................. 60 
3.4.7 Measures .................................................................................................................. 64 
3.4.7.1 Independent variable ......................................................................................... 64 
3.4.7.2 Dependent variable ........................................................................................... 65 
3.5 Data management ....................................................................................................... 65 
3.5.1 Coding and recoding of variables ............................................................................ 66 
3.6 Data Analysis ................................................................................................................. 68 
3.7 Ethical consideration ...................................................................................................... 68 
3.8 Study limitations ............................................................................................................ 70 
CHAPTER FOUR .................................................................................................................... 71 
SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS .............................. 71 
4.1 Introduction .................................................................................................................... 71 
4.2 Results from data collection ........................................................................................... 71 
4.3 Incomplete interviews and refusals ................................................................................ 72 
4.4 Socio-demographic characteristics of study participants ............................................... 72 
4.4.1 Age distribution of respondents ............................................................................... 72 
4.4.2 Educational status of respondents ............................................................................ 73 
4.4.3 Marital status of respondents ................................................................................... 74 
4.4.4 Employment and type of occupation ....................................................................... 75 
4.4.5 Religious affiliation of respondents ......................................................................... 76 
4.4.6 Ethnicity................................................................................................................... 76 
4.4.7 Number of living children ....................................................................................... 77 
4.4.8 Residential places of respondents ............................................................................ 77 
4.5 Socio- demographic characteristics of male partners ..................................................... 78 
CHAPTER FIVE ..................................................................................................................... 81 
SEXUAL AND REPRODUCTIVE HEALTH BEHAVIOUR AND PARTNERSHIP 
CHARACTERISTICS OF RESPONDENTS .......................................................................... 81 
5.1 Introduction .................................................................................................................... 81 
5.2 Sexual and reproductive health behaviour ..................................................................... 81 
5.2.1 Reproductive history................................................................................................ 81 
5.2.1.1 Pregnancy history.............................................................................................. 81 
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5.2.1.2 Abortion history of respondents........................................................................ 82 
5.2.1.3 Gestational age of pregnancy ............................................................................ 83 
5.3 Contraceptive practices before abortion ......................................................................... 83 
5.3.1 Use of emergency contraceptive pills ...................................................................... 84 
5.3.2 Use of modern contraceptive methods .................................................................... 86 
5.3.3 Use of traditional or natural family planning method (NFP) .................................. 87 
5.3.4 No contraceptive use ............................................................................................... 89 
5.4 Partnership characteristics .............................................................................................. 92 
5.4.1 Nature of relationship with sexual partner .............................................................. 92 
5.4.1.1 Relationship type and duration of the partnership ............................................ 92 
5.4.1.2 Relationship stability ........................................................................................ 94 
5.4.1.3 Level of relationship commitment .................................................................... 99 
CHAPTER 6 .......................................................................................................................... 106 
MALE PARTNERS’ INVOLVEMENT IN ABORTION AND POST-ABORTION FAMILY 
PLANNING (PAFP) UPTAKE ............................................................................................. 106 
6.1 Introduction .............................................................................................................. 106 
6.2. Male partners’ knowledge of abortion ........................................................................ 106 
6.2.1 Awareness of abortion ........................................................................................... 107 
6.2.2 Communication with male partner about abortion .......................................... 108 
6.2.3 Knowledge of health-seeking behaviour ............................................................... 110 
6.2.4 Knowledge of abortion methods ............................................................................ 111 
6.2.5 Non-awareness of the abortion .............................................................................. 113 
6.3 Role of male partners in abortion decision-making ..................................................... 115 
6.3.1 Approval of abortion ............................................................................................. 116 
6.3.1.1 Male partner as initiator of abortion decision ................................................. 116 
6.3.1.2 Woman-led pregnancy resolution ................................................................... 119 
6.3.1.3 Joint abortion decision .................................................................................... 120 
6.3.2 Disapproval of abortion ......................................................................................... 120 
6.3.4 Lack of male partners’ role in abortion decision-making ...................................... 122 
6.4 Male partners’ support in abortion ............................................................................... 123 
6.4.1 Instrumental support .............................................................................................. 124 
6.4.1.1 Payment for abortion....................................................................................... 124 
6.4.1.2. Accompaniment to the hospital ..................................................................... 126 
6.4.2 Informational support ............................................................................................ 129 
6.4.3 Emotional or behavioural support ......................................................................... 130 
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6.5 Lack of partner support for the abortion ...................................................................... 132 
6.7 Male partners’ involvement in post-abortion family planning uptake ......................... 132 
6.8 Discussion .................................................................................................................... 135 
6.8.1 Discussion of analytic framework ......................................................................... 139 
CHAPTER SEVEN ............................................................................................................... 144 
WOMEN’S EXPECTATION OF PARTNERS’ ROLE IN ABORTION ............................. 144 
7.1 Introduction .................................................................................................................. 144 
7.2 Perceived expectation of partner support pre-abortion ................................................ 144 
7.2.1 Instrumental support .............................................................................................. 144 
7.2.1.1 Payment of abortion expenses ........................................................................ 144 
7.2.1.2 Accompaniment by male partner to the hospital ............................................ 145 
7.2.1.3. Emotional/ affective support .......................................................................... 146 
7.3 Expectation of partner involvement in the abortion decision-making process ............ 146 
7.4 Perceived expectation of partner support post-abortion ............................................... 147 
7.4.1 Affective/emotional support .................................................................................. 147 
7.4.2 Material support ..................................................................................................... 149 
7.4.3 Instrumental support .............................................................................................. 149 
7.5 No expectation of partner support ................................................................................ 150 
7.6 Discussion .................................................................................................................... 150 
CHAPTER EIGHT ................................................................................................................ 154 
RELATIONSHIP BETWEEN PARTNERS’ INVOLVEMENT IN ABORTION AND POST-
ABORTION FAMILY PLANNING UPTAKE .................................................................... 154 
8.1 Introduction .................................................................................................................. 154 
8.2 Results of bivariate analyses ........................................................................................ 154 
8.2.1 Relationship between socio-demographic characteristics and post-abortion family 
planning uptake (PAFP) ................................................................................................. 154 
8.2.2 Relationship between psychosocial variables and PAFP uptake ........................... 156 
8.2.3 Relationship between partnership dynamics and PAFP uptake ............................ 157 
8.2.4 Relationship between reproductive variables and PAFP uptake ........................... 158 
8.3 Results of multiple logistic regression analysis ........................................................... 158 
8.3.1 Model 1: Partner involvement and PAFP uptake .................................................. 158 
8.3.2 Partner involvement, socio-demographic variables and PAFP uptake .................. 160 
8.3.3 Partner involvement, socio-demographics, intermediate variables and PAFP uptake
 ........................................................................................................................................ 169 
CHAPTER 9 .......................................................................................................................... 173 
SUMMARY, CONCLUSION AND RECOMMENDATION .............................................. 173 
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9.1 Introduction .................................................................................................................. 173 
9.2 Summary of findings .................................................................................................... 174 
9.3 Conclusion .................................................................................................................... 176 
9.4 Recommendations ........................................................................................................ 176 
9.5 Theoretical implications of study findings ................................................................... 177 
9.6 Future research ............................................................................................................. 178 
REFERENCES ...................................................................................................................... 180 
APPENDICES ....................................................................................................................... 194 
 
 
 
  
 
 
 
 
 
 
 
  
 
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LIST OF FIGURES 
Figure 3. 1 Trajectory to abortion and abortion-related care: Individual’s termination of 
pregnancy (ToP) related experiences ....................................................................................... 53 
Figure 4. 1 Age distribution of study respondents ................................................................... 73 
Figure 4. 2 Educational level of respondents ........................................................................... 74 
Figure 4. 3 Number of living children of respondents ............................................................. 77 
Figure 5. 1 Abortion history of participants............................................................................. 82 
Figure 5. 2 Diagram depicting indicators of relationship stability………………………………..93 
Figure 6. 1 Diagram depicting male partners’ knowledge of abortion and associated sub-
themes .................................................................................................................................... 107 
Figure 6. 2 Graphical presentation of the Role of Male partners in abortion decision-making
................................................................................................................................................ 116 
Figure 6. 3 Diagrammatic presentation of male partners’ support in abortion ...................... 124 
Figure 6. 4 An analytic framework to understand male partner involvement and support in 
women’s abortion, and likelihood of post-abortion family planning uptake ......................... 140 
 
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LIST OF TABLES 
Table 3. 1 Summary measures of partners’ involvement in abortion and corresponding dimensions.. 65 
TABLE 3. 2 CODED AND RECODED VARIABLES .................................................................... 67 
 
Table 4. 1 Percentage distribution of sample sizes across study facilities ............................... 71 
Table 4. 2 Marital status of respondents .................................................................................. 75 
Table 4. 3 Occupation type of respondents .............................................................................. 76 
Table 4. 4 Religious affiliation of respondents ........................................................................ 76 
Table 4. 5 Ethnicity of respondents ......................................................................................... 77 
Table 4. 6 Age distribution of male partners ........................................................................... 78 
Table 5. 1 Pregnancy history of respondents ........................................................................... 81 
Table 5. 2 Association between type of relationship and duration of relationship .................. 93 
Table 8. 1: Relationship between women’s and male partners’ socio-demographic 
characteristics and PAFP uptake. ........................................................................................... 155 
Table 8. 2 Relationship between psychosocial variables and PAFP uptake .......................... 157 
Table 8. 3 Relationship between partnership dynamics and PAFP uptake ............................ 157 
Table 8. 4 Relationship between reproductive variables and PAFP uptake .......................... 158 
Table 8. 5 Logistic regression between partner involvement and PAFP uptake ................... 159 
Table 8. 6:  Logistic regression of socio-demographic variables and PAFP uptake. ............ 163 
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LIST OF ABBREVIATIONS 
CAC   - Comprehensive abortion Care 
FP   - Family Planning 
GAR   - Greater Accra Region 
GMHS  - Ghana Maternal Health Survey 
ICPD   - International Conference on Population and Development 
MA   - Medical Abortion 
PAC   - Post-abortion Care 
PAFP  - Post-abortion Family Planning  
WHO  - World Health Organization 
 
 
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CHAPTER ONE 
INTRODUCTION 
1.1 Background of the study  
Induced abortion is one of the major public health issues in many countries and it is a common 
reproductive health feature in the lives of women in their reproductive ages (Lohr et al., 2014). 
Estimates from the World Health Organization (WHO) indicate that globally, 210 million 
women become pregnant annually (WHO, 2011). Of this estimate, 135 million result in live 
births; 80 million are unintended pregnancies, 44 million have an induced abortion of which 
22 million are unsafe abortions (WHO, 2011; Sedgh et al., 2012). Recent estimates show that 
56 million induced abortions occur yearly, of which 54.9 percent are unsafe (Sedgh et al., 2016; 
Ganatra et al., 2017).  
Post-abortion family planning has been recommended as integral to reducing the high rates of 
induced abortions due to unintended pregnancies (WHO, 2011; High Impact Practices in 
Family Planning (HIP), 2012; International Federation of Gynaecology and Obstetrics (FIGO), 
International Confederation of Midwives (ICM), International Council of Nurses (ICN), and 
United States Agency for International Development, 2009). The aim of post-abortion family 
planning (PAFP) immediately after an induced abortion is to reduce the risk of unintended 
pregnancies immediately after the abortion since fertility returns quickly thereafter (Wilcox, 
Dunson and Baird, 2000; WHO, 2006). Also, PAFP is aimed at preventing repeat abortions, 
and to reduce the risk of adverse maternal and perinatal outcomes for pregnancies after a 
spontaneous or induced abortion (WHO, 2006; High Impact Practices in Family Planning, 
2012).  
There have also been calls for the inclusion of men in sexual and reproductive health matters 
because of the recognition that men are gatekeepers in women’s use of reproductive health 
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services. For example, at the International Conference on Population and Development (ICPD) 
in 1994, the priority for member states was to promote active male involvement in all sexual 
and reproductive issues (ORC, 2005). The ICPD explicitly called for men’s inclusion in 
women’s reproductive health through three avenues; first, to promote men’s use of 
contraceptives through increased education and distribution; second, promote men’s 
involvement in roles supportive of women’s sexual and reproductive decisions particularly, 
contraception, and third, encourage men’s responsible sexual and reproductive practices to 
prevent and control sexually transmitted infections (STIs) (Basu, 1996; DeJong, 2000). 
In response to a greater inclusion of men in reproductive issues, many countries adopted and 
implemented reproductive health programmes, including family planning services into their 
health systems to improve women’s maternal and reproductive health outcomes (White, 
Greene and Murphy, 2003). Evidence from some health systems show marked improvements 
in the utilization of maternal health services, specifically, family planning services through 
availability of support from men (Brunson, 2010).  
Whilst several studies have examined men’s participation and roles in women’s 
reproductive and sexual issues, there is insufficient interrogation of how men’s involvement in 
abortion influences post-abortion contraception uptake (Schwandt et al., 2013; Altshuler et al., 
2017). The paucity of empirical studies in this area of fertility research particularly in Ghana 
underscores the need to examine the circumstances surrounding male partners’ involvement in 
abortion, and factors which affect post-abortion contraception use. It is hoped that results from 
this study will provide evidence-based information to sexual and reproductive health 
practitioners to design innovative interventions to encourage male participation in women’s 
sexual health. 
 
 
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1.2 Statement of the Problem  
Male involvement is a key component of the WHO’s recommendations on health promotion 
interventions for maternal and child health (WHO, 2015). The argument in support of male 
involvement in maternal healthcare (including family planning use) is based on evidence found 
in patriarchal contexts which demonstrate that men are primary decision makers in fertility and 
sexual decisions (Dodoo, 1993; Ezeh, 1993; Kwambai et al., 2013; Ganle, 2014).  
Since the post-Cairo era, many countries have integrated sexual and reproductive health 
programmes into their health systems to reduce maternal morbidity and mortality, improve 
maternal health outcomes, and also improve the sexual health needs of men (Sternberg and 
Hubley, 2004). However, male participation in reproductive health initiatives in response to 
the ICPD Programme of Action, and the development of new reproductive health paradigms 
have been reportedly low. Some researchers argue that there is limited evidence to indicate 
men’s participation in family planning programmes (Helzner, 1996; Kero et al., 1999). Other 
studies have pointed out that successful family planning programmes and their implications 
from a gender perspective are lacking, which further contributes to limited knowledge of men’s 
roles, responsibilities and involvement in family planning. 
Another concern which is central to the limited evidence of men’s active involvement 
in family planning programmes is related to the nuances associated with the term ‘male 
involvement’ (Helzner, 1996). The lack of universal description and clarity associated with the 
definition of involvement, plus the complex forms it takes in different contexts suggest that of 
‘support’, ‘roles’, and ‘responsibility’. Therefore, while men may not be seen as being part of 
or being involved in reproductive decision-making matters, the kind of overt or covert support, 
direct and indirect roles and responsibilities they provide may be overlooked, underestimated, 
or underreported in that particular context. The deficiency of the clear meaning of involvement 
thus, creates a false sense that men play limited roles in women’s reproduction issues. 
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The ‘male role’ theory provides evidence for men’s involvement in reproductive 
decision-making. The position of the traditional male role theory assumes that men wield 
significant influence on women’s reproductive decisions by virtue of bride wealth payments, 
lineage, and kinship (Ezeh, 1993; Dodoo, 1993, 1998; Isiugo-Abanihe, 1994b; Bankole, 1995; 
Ngom, 1997). Per this assumption, high fertility is valued and encouraged, while attempts to 
reduce fertility are met with male opposition, and social sanctions. Consequentially, the male 
role dominance creates gender disparities in reproductive health with women having limited 
rights to exercise their fertility goals. Ultimately, it will be less likely for men to participate in 
fertility reduction programmes. Neither will they be willing to encourage and support their 
partners’ use of family planning methods to reduce child bearing.  
In furtherance to male opposition in fertility reduction programmes, for instance, family 
planning use, existing empirical evidence indicates that barriers to men’s participation in family 
planning use hinge on fear of their sexual partners’ engagement in extramarital relations, fear 
of side-effects associated with modern contraceptive use, lack of knowledge on contraception, 
socially perceived myths surrounding family planning use and negative provider attitudes 
towards men (Beekle and McCabe, 2006; Mullany, 2006; Peer, Morojele and London, 2013).  
It is evident from several fertility researches conducted in patriarchal settings that the 
high unmet need for modern contraception is a consequence of male role dominance in 
reproduction (Bongaarts and Westoff, 2000; Casterline and Sinding, 2000). Unmet need for 
family planning has been found to be one of the primary causes of induced abortions (Westoff, 
2005; Jones et al., 2006; Smith et al., 2009). Multiple proximate and distal factors account for 
unmet need for family planning. These include lack of contraception knowledge, fear of side 
effects of contraception, misperceptions and myths associated with family planning use 
(Casterline and Sinding, 2000; Campbell, Sahin-Hodoglugil and Potts, 2006; GSS, GHS, IFC 
Macro, 2009; Ochako et al., 2015), contraceptive method failure; social and familial 
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disapproval (Bongaarts and Bruce, 1995); and men’s disapproval and opposition to 
contraception (Bankole and Singh, 1998; Miller, Severy and Pasta, 2004; Dudgeon and Inhorn, 
2004; Yue, O’Donnel and Sparks, 2010). The causes of unmet need are further complicated by 
social and cultural contexts, socio-cultural norms, and the nature of relationships.  
In most patrilineal societies, a substantial amount of empirical evidence suggests that 
men play important roles in reproductive decisions at the ‘micro’ family level as “partners of 
women and fathers of their children” (Dudgeon and Inhorn, 2004). Men influence women’s 
reproductive outcomes in positive ways through increasing family planning utilisation, 
antenatal and maternal health care services (Terefe and Larson, 1993; Abdel-Tawab et al., 
1999; Mullany, 2006; Kululanga et al., 2011; Ganle, 2014; Nyondo et al., 2015). Negative 
outcomes of male participation in women’s reproductive issues have been found to result in 
poor maternal health outcomes and child mortality (Brunson, 2010). With reference to 
abortions, evidence suggests that it is traditionally (or socio-culturally) viewed as a woman’s 
domain and responsibility (Wambui, Ek and Alehagen, 2009). 
In Ghana, the contextual and sociological dimensions of induced abortion decision- 
making are not well understood partly because empirical studies do not fully examine processes 
leading to decisions to abort, while the use of hospital data limits in-depth exploration of such 
issues (Ampofo, 1970; Senah, 2006). Decision-making pertaining to abortions are made within 
the context of ‘utmost secrecy’ (Ahiadeke, 2001) because of social and ethical sensitivities, 
socio-cultural norms, religious differences and political issues surrounding its contentious 
nature. Socio-cultural norms as well as religious differences further define appropriate roles 
for both men and women who decide to have abortions.  
Limited abortion studies conducted in Ghana have not paid much attention to 
investigating the associations between men’s involvement in women’s abortion and post-
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abortion contraception uptake (Bleek, 1981; Bleek & Asante-Darko, 1986; Ahiadeke, 2001; 
Henry and Fayorsey, 2002). For instance, a qualitative study by Schwandt et al. (2013) focused 
on decision-making processes involved in abortion and found that male partners’ involvement 
was mainly through orders to abort the pregnancy and through denial of responsibility of the 
pregnancy. Other studies also focus narrowly on women’s reports of their male partners’ roles 
in the abortion decision-making process but fail to examine the extent of partners’ involvement 
in post-abortion contraceptive decisions (Kumi-Kyereme, Gbagbo, and Amo-Adjei, 2014). 
The limited data on fertility-related issues such as this is quite worrying in Ghana 
because it only reinforces the assumptions that abortion (whether safe or unsafe, legal or illegal) 
is a logical outcome of ending unintended or unwanted pregnancies which is a serious public 
health concern. The difficulty in conducting abortion studies due to the rather personal, and 
sensitive nature of abortions further goes on to limit health practitioners’ understanding of the 
dynamic contextual issues surrounding termination of pregnancies, and contraceptive use 
among post-abortion women. 
In view of the paucity of research in interrogating the linkage between male partners’ 
involvement in abortion and post-abortion family planning uptake1, and drawing on a variety 
of methodological approaches, this study sought to fill the research gap on men’s involvement 
in abortion and post-abortion family planning uptake. It is hoped that the research focus and 
methodological approach utilised in the current study will provide detailed exploratory insights 
on the contextual circumstances surrounding male partners’ involvement in women’s abortion. 
Also, this study contributes to unravelling the progress achieved so far with the provision and 
delivery of legal comprehensive abortion services in the Greater Accra Region of Ghana.  
                                                          
1 Post-abortion family planning is used interchangeably with post-abortion contraception. Uptake is used in 
this context to mean ‘use’. 
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In the light of the foregoing issues discussed, this study sought to answer the following research 
questions: 
i. What are the sexual, and reproductive behaviours and partnership characteristics of 
women seeking abortion? 
ii. What is the extent of male partners’ involvement in abortions and post-abortion 
family planning uptake? 
iii. Do female partners have any expectations about their partners’ roles in the 
pregnancy resolution process? 
iv. What factors limit male partners’ involvement in abortions and post-abortion 
contraception use?   
v. Does male partner participation in abortion influence post-abortion family planning 
use? 
 
1.3 Research Objectives  
The main objective of this study is to examine male partners’ involvement in abortion and post-
abortion family planning uptake as a way of reducing unintended pregnancies and the incidence 
of induced abortions. Specifically, the study seeks to: 
i. Describe women’s sexual, reproductive and partnership characteristics. 
ii. Explore the extent and nature of male partners’ involvement in their female 
partners’ abortion experiences, and post-abortion family planning uptake.  
iii. Examine women’s perspectives of male role expectations in pregnancy termination. 
iv. Identify and explain barriers to male partners’ participation in pregnancy 
termination, and post-abortion family planning uptake. 
v. Investigate the relationship between partners’ involvement in abortion and post-
abortion contraceptive method choice and use. 
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1.4 Rationale of the study 
This study is important and timely because of its implications for programming and policy 
decisions in safe abortion care services delivery in particular, and sexual and reproductive 
health care in general.  
Reducing maternal mortality through the provision of safe and comprehensive abortion 
care has become a public health issue of global importance and concern. It is in line with this 
reasoning that the Ghana Health Service (GHS), in collaboration with a consortium of non-
governmental organisations, implemented guidelines for Comprehensive Abortion Care (CAC) 
in 2006. Included in the CAC model is the provision of post-abortion counselling and family 
planning services as a means to prevent future unplanned pregnancies and future abortions. A 
research of this nature is, therefore, relevant in shedding more light on how effective post-
abortion family planning services are being provided and organised in health facilities 
providing safe abortion care. Study outcomes are informative in guiding abortion service 
providers to be innovative (where necessary) in the delivery of abortion-related services; design 
specific interventions to target male partners, and provide evidence-based information to assist 
in monitoring and evaluating CAC services in facilities where such services are being offered. 
The incidence of abortion and associated morbidity and mortality is considered to be 
highest among women aged 20-24 years (Baird, Billings and Demuyakor, 2000). The 
proportion of women in Ghana who have had an induced abortion has increased over the 
decade. For instance, the 2007 Ghana Maternal and Health Survey (GMHS) reports that 15% 
of women have had an induced abortion in their lifetime. This percentage increased to 20% in 
the 2017 GMHS report. These estimates provide evidence that abortion is still a critical public 
health issue which requires public health interventions. Since post-abortion family planning 
counselling and services are integrated in CAC, a research of this nature would assist in offering 
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critical and useful recommendations to develop friendly services to target men’s participation 
in PAFP counselling. Health providers would also be informed on how to integrate couple-
oriented family planning services into post-abortion care. 
This study further contributes to research and knowledge within the field of 
reproductive health in many respects because the findings will supplement the limited existing 
research in fertility studies especially in respect of male involvement in abortion and post-
abortion contraception; thereby filling the research gaps on such issues. Although a large body 
of research on men’s involvement in, and experiences of abortion provides useful results, 
abortion research in Ghana has not sufficiently interrogated male partners’ involvement and 
support in women’s abortion decisions and experiences; neither has the male-female dyadic 
dimensions involving relationship quality, gender and power differentials, and contraception 
use after abortions been fully explored.  
The relationship between male partners’ participation in abortion and uptake of 
contraception after abortion appears to be complicated because several factors (for instance, 
pregnancy unwantedness by the male partner, perceived barriers to contraceptive use, attitudes 
towards family planning or contraception) might mediate this relationship. Yet, this aspect of 
reproductive decision-making has received limited rigorous attention in Ghana and therefore, 
this study helps fill the research gap in this area of fertility research (specifically, abortion) and 
therefore, the study is not only timely, but important based on these contributions it is 
positioned to make. 
 
1.5 Organisation of the study 
The study is organised into nine chapters: Chapter one presents the background to the study, 
problem statement, research questions and objectives, and rationale of the study. In chapter 
two, a review of relevant literature focussing on the evolution and definition of male 
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involvement, men’s role in reproduction, maternal and child health, impact of male 
involvement in abortions and post-abortion contraception use, predictors of post-abortion 
contraception use, and barriers to male participation in reproductive matters including abortion 
are presented. Also included in this chapter is the theoretical and conceptual framework of the 
study. The theoretical framework provides relevant theories underpinning the study, whilst the 
conceptual framework shows the interrelationships between the variables in the study and how 
they influence the outcome variable (post-abortion contraception uptake). 
Chapter three provides an overview of the methodological approaches employed in the 
collection of primary data for the study. A detailed description of the data collection process, 
involving both quantitative and qualitative strategies has been presented in chronological order. 
Chapter four outlines the results of the study by presenting the socio-demographic 
characteristics of all study participants. In Chapter five, the sexual, reproductive behaviour and 
partnership profile of the study population is presented. Chapter six contains female partners’ 
narrative accounts of their male partners’ participation in abortion and post-abortion 
contraception uptake. The main thematic areas which emerged during the thematic analysis 
together with sub-themes and sample quotes have all been presented. Additionally, barriers 
influencing partner participation in seeking abortion-related care are also presented in this 
chapter. 
Women’s expectations of their partners’ roles during the pregnancy termination is 
examined in the seventh chapter. The eighth chapter outlines results from the bivariate and 
multivariate analyses in the study. Bivariate tests of association with the Chi-square tests and 
binary logistic regression analysis to determine the relationship between male partner 
involvement in abortion and PAFP uptake are presented. Chapter nine is the last chapter in this 
thesis and it outlines a summary of the key findings of the study, conclusion and 
recommendations. 
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CHAPTER TWO 
REVIEW OF RELEVANT LITERATURE 
2.1 Introduction 
Globally, issues on maternal, sexual and reproductive health, particularly safe and unsafe 
abortions, have gained priority attention in many health systems because of their implications 
for public health interventions. The literature reviewed in this chapter focuses on the evolution 
and definition of the concept of male involvement, men’s role in maternal health, reproduction 
and family planning, the impact of male involvement in induced abortions, predictors or 
determinants of post-abortion contraception use, and barriers to male participation in 
reproduction and abortion.  
The legal context of safe abortion in Ghana’s health care system is also presented to provide a 
legal framework for the delivery of abortion care services in Ghana. In addition, the theories 
and models underpinning this study are outlined with explanations for their suitability and 
applicability. Based on the literature review, the conceptual framework for the study is also 
presented.  
 
2.2 Evolution and definition of male involvement  
Prior to the ICPD, fertility programmes aimed at reducing population growth in developing 
countries (including sub-Saharan Africa) targeted women and neglected men’s involvement in 
reproductive matters due to the recognition that men opposed ‘artificial’ or non-traditional 
fertility regulation methods. These programmes also failed to address issues on gender 
inequities in reproduction and women’s status (Kritz and Gurak, 1989). While little progress 
was achieved with the traditional woman-focused approach, concerns arose as to how the 
“unfinished transition” could be attained (Population Council, 1996). 
 
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A number of approaches were used to implement male involvement in reproductive 
health post-ICPD.  “Men as clients” approach was first implemented with emphasis on the 
provision of reproductive health services to men in the same way that women received these 
benefits (Ndong et al., 1999). This approach, however, reflected a limited interpretation of male 
involvement as it advocated a remedial focus on men who have been excluded from traditional 
reproductive health programmes. The second approach viewed “men as partners” to reflect 
men’s position in women’s reproductive health and contraceptive use as either promoters or 
inhibitors (Cates, 1996). Under this approach, men were considered as allies to improve 
contraceptive prevalence rates and other dimensions of reproductive health (Kuseka and 
Silberman, 1990). However, similar to the focus on men as clients, this approach did not 
address the gender inequities that constrain health (Greene et al., 2006).  
The third approach emphasized “men as agents of positive change”. This approach 
reflects the intent and goals of the ICPD where men are regarded as key actors and players in 
women’s sexual and reproductive health. This strategy acknowledges the fundamental role men 
play in supporting women’s reproductive health and in transforming the social roles that 
constrain reproductive health and rights. Additionally, with men seen as agents of positive 
change, this approach implicitly reinforces gender equity and service provision rather than 
specifying which reproductive health services should be provided. 
Following the implementation of the male involvement approaches, different terms 
were used to describe men’s involvement in reproductive health such as men’s participation, 
men’s responsibility, male motivation, male involvement, men as partners, and men and 
reproductive health (Helzner, 1996b; Verme et al., 1996; Danforth and Jezowski, 1997; Finger 
et al., 1998). A number of researchers have noted that there is no consensus on which term best 
describes this perspective on men, what these terms mean, and how men can best be involved 
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in reproductive health activities (Danforth et al., 1994; Verme et al., 1996; Danforth and 
Roberts, 1997). 
The definition of male involvement is considered as an ambiguous term; lacking a 
universal and operational definition (Helzner, 1996; Greene et al., 2006 Aluisio et al., 2011). 
Although male involvement has been widely used in fertility research, there is no generally 
accepted understanding of the meaning of male involvement because “it hides a variety of 
meanings and philosophies” (Helzner, 1996). In the absence of a general meaning of what male 
participation constitutes, the term is used interchangeably with male support. Some researchers 
have suggested that the concept of male involvement is broad and encompasses several 
elements (Khalifa, 1988; Adamchak and Mbizvo, 1991).  
Other researchers have proposed a definition of male involvement to mean: men’s 
reproductive health and contraceptive/family planning knowledge; attitudes towards 
contraceptive use; spousal communication on family planning; choices or preference for 
contraceptive methods, and emotional and behavioural involvement in a woman’s 
contraceptive use (Clark, Yount and Rochat, 2008). In their study of male involvement in 
women and children’s HIV prevention, the authors measured male involvement in two ways: 
men’s physical presence in the antenatal clinic, and women’s self-report of men’s previous 
HIV testing. Essentially, regardless of the ambiguity surrounding the concept of male 
involvement, its purpose is to describe a complex process of social and behavioural change that 
is needed for men to play more responsible roles in reproductive health. “Men’s participation 
can be seen as a means to an end, rather than as a goal in itself” (Greene et al., 2006). 
 
2.3 Men’s role in reproduction, maternal health and family planning  
Literature on men and reproduction in Africa, including sub-Saharan Africa (SSA) consistently 
show that men play significant roles in women’s reproductive decisions, such as childbearing, 
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determination of family size, number of children ever born, use of maternal and antenatal health 
care services, and family planning (Bankole, 1995; Dodoo, 1993, 1995, 1998; Ezeh, 1993; 
Mbizvo and Adamchak, 1991; Brunson, 2010; Kwambai et al., 2013; Nyondo et al., 2015; 
Ganle et al., 2016; Wigginton et al., 2018). There is substantial evidence that involving men in 
women’s reproductive issues is beneficial and results in positive health outcomes for both 
mothers and children. For instance, a meta-analysis on male involvement and maternal health 
outcomes conducted by Yargawa and Leonardi-Bee (2015) showed that male involvement 
during pregnancy and at postpartum resulted in greater benefits for women by reducing 
postpartum depression and improved utilisation of maternal health services. 
Furthermore, in Malawi and Uganda, men’s inclusion in maternal health services is 
seen as a strategy for accessing quick service for women during antenatal visits, labour and 
delivery (Kululanga et al., 2011; Byamugisha et al., 2010). Pal (2000) found that when Indian 
men were involved in their partners’ pregnancy, they were more likely to have their deliveries 
in health facilities or in the presence of skilled health professionals compared to women whose 
husbands were not involved. Other studies conducted elsewhere similarly report positive 
benefits of male involvement in maternal health which include: increased maternal access to 
antenatal and postnatal services (Redshaw and Henderson, 2013); discouragement of unhealthy 
maternal practices such as smoking (Martin et al., 2007); improved maternal mental health 
(Stapleton et al., 2012; Plantin and Olukoya, 2011); increased likelihood of contraception usage 
(Mekonnen and Worku, 2011; Yue, O’Donnell and Sparks, 2010) and allayment of stress, pain 
and anxiety during delivery (D’Aliesio et al., 2009). 
While there is substantial evidence that demonstrates the significant benefits of men’s 
involvement in maternal and reproductive issues, contrary studies have found the negative 
impact of male involvement in maternal health. For example, Ganle et al. (2016) explored the 
perspectives of childbearing women on their partner’s involvement in maternal and childcare 
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in Northern Ghana. Their results showed that majority of the women had negative attitudes and 
opinions of their men’s involvement. Brunson’s (2010) research conducted in Nepal showed 
that men’s roles in their women’s pregnancy resulted in delays in transfer of pregnant women 
from home to health facilities during obstetric emergencies. 
While evidence from several anthropological and demographic studies maintain that 
couple decision-making on reproduction issues differs under strong patriarchal conditions 
(Beckman, 1983; Oppong, 1987; Blumberg, 1988), men are still dominant decision makers in 
fertility issues (Fayorsey, 1989; Mbizvo and Adamchak, 1999; Dodoo and Frost, 2008). 
However, these studies also point out that sexual and fertility decision-making involves couple 
negotiations with each partner having different fertility goals (Dodoo and Seal, 1994; Thomson 
and Hoem, 1998). According to some researchers, more responsibility rests on women when it 
is related to abortion than on determination of family size (Kabagenyi et al., 2014).  
 
2.4 Male involvement in abortion 
The disclosure of an unintended or unplanned pregnancy may most likely predict male 
participation, support, or non-involvement in the pregnancy resolution. Disclosure of the 
pregnancy may, however, vary according to multiple issues surrounding the dyadic 
relationship, social and cultural norms, and contextual issues. The duration and quality of the 
relationship, commitment to the relationship, and presence of intimate partner violence may 
affect pregnancy disclosure and subsequent male participation in the abortion (Jones, Moore 
and Frohwirth, 2011). 
 
In some societies, the decision to have an abortion depends on the nature of relationship 
between the couple or partners other than on social and cultural norms. For instance, Gursoy 
(1996) asserts that in some countries (like Turkey), women need their husband’s permission to 
have an abortion. However, in other contexts, a man might encourage his female partner to 
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terminate a pregnancy because social sanctions might apply to them for having a child out of 
wedlock (Rausch and Lyaruu, 2005). This suggests that the social context is crucial in 
regulating and defining how male partners are involved in pregnancy termination, and their 
respective roles in reproductive decision-making which is tied to the nature of the male-female 
dyadic relationship. Further, the directness of the male partners’ involvement is determined by 
the nature of the relationship between the man and the woman and socio-cultural contexts, 
whilst indirect involvement depends on social norms (Dudgeon and Inhorn, 2004). 
A review of earlier and current literature on male involvement shows that men play 
direct and indirect roles in women’s abortion. They also have limited, or sometimes no 
participation in women’s abortion experiences. In the absence of a common understanding of 
‘male involvement’, several empirical studies conducted in different contexts demonstrate the 
different forms by which men are involved in women’s abortion experiences (Leshabari et al., 
1994; Johansson et al., 1998; Abdel-Tawab et al., 1999; Kalyanwala et al., 2010; Tong et al., 
2012; Altshuler et al., 2016; Freeman, Coast and Murray, 2017; Nguyen et al., 2018). Overall, 
the body of literature on male involvement suggests that it is characterised by instrumental, 
informational, emotional and behavioural support.  
Previous research has investigated male partner accompaniment at the health facility at 
the time of an elective abortion. A study conducted by Shostak, Mclouth and Seng (1994) 
indicates that 50 percent of women receiving abortion in 30 U.S. clinics were accompanied by 
their male partners. Another study showed that minors having abortions in 46 health facilities 
were accompanied by their boyfriends (Henshaw and Kost, 1992). Studies conducted by Major 
et al. (1985), Cozzarelli et al. (1994) and others by Kalyanwala et al. (2010, 2012) conclude 
that men’s accompaniment to the hospital for their partners’ abortion is an indicator of male 
involvement during abortion care and a source of social support. 
 
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Major et al. (1985) and Cozzarelli et al. (1994) further investigated whether male 
partners’ accompaniment to the hospital/clinic was associated with women’s emotional distress 
after an abortion. Both studies, however, found no significant association between 
accompaniment and improvement in women’s psychological distress after the abortion. 
Women who were not accompanied reported similar levels of distress compared to women 
accompanied by their partners. In a similar study, Kalyanwala et al. (2012) examined the 
significance of male partners’ accompaniment to the facility for a pregnancy termination. They 
concluded that men who accompanied their female partner to the health facility served as a 
source of emotional support to them. They also found that the man responsible for the 
pregnancy was more likely to be present at the hospital with their female partner for an abortion 
than the woman’s relatives.  
Aside the physical presence of men at a health facility, evidence from other studies 
indicate that men are supportive and participate in the abortion decision-making process 
(Johansson et al., 1998; Kero et al., 1999; Puri et al., 2007; Jones, Moore and Frohwirth, 2011; 
Costescu and Lamont, 2013). For instance, Kero, Lalos and Wulff (2010) reported in their 
study that the majority of male partners supported and participated in the decision to have an 
abortion. Some studies have also found that male partners navigate the abortion-seeking 
process by collecting information on places where abortion care services are offered, provide 
transportation, and financial resources (Leshabari et al., 1994; Tong et al., 2012). Norris et al. 
(2011) concluded in their study that men contributed in the abortion-seeking process by 
alleviating cultural and social stigma’s surrounding the receipt of abortion care. Similarly, 
women attending a U.S. clinic for pre-abortion counselling reported that they received support 
from their male partners during the abortion decision-making process and this support 
contributed to a positive experience (Becker et al., 2008).  
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Another body of abortion-related studies suggests that male partners responsible for an 
abortion bear the financial expenses of the abortion after the abortion decision is made (Calves, 
2002; Henry and Faryosey, 2002; Nguyen et al., 2018). For instance, in Calves’ (2002) study 
using biographical data obtained from Cameroonian adolescents undergoing an abortion, it was 
found that male partners’ involvement in the abortion was mainly financial support. More than 
60 percent of the young women reported that their partners paid the fee for the abortion. Similar 
findings were reported by Henry and Fayorsey (2002). They found that the boyfriends of young 
adolescent girls usually supplied some funds for the pregnancy termination, especially when 
both of them participated jointly in the abortion decision-making process. Nguyen et al. (2018) 
also conducted interviews with men whose female partners were seeking abortions from two 
clinics. Their results showed that male partners provided instrumental support, mainly 
transportation and financial, and emotional support (through companionship and reassurance) 
during the abortion process. 
There is a paucity of research that investigates emotional support by male partners at the time 
of an abortion. The few studies conducted do not establish whether the presence of the male 
partner and receipt of emotional support reduce anxiety levels among their partners receiving 
an abortion (Viega et al., 2011). 
 
2.5 Impact of male involvement in abortions 
A body of research indicates that male involvement in abortion decision is associated with 
positive and negative outcomes. Male support in abortion results in improved psychosocial 
well-being (Adler et al., 1990; Major et al., 1997) as well as “confidence in pregnancy decision-
making” (Foster et al., 2012). Other studies report that male partners’ participation in the 
abortion was mainly financial (Major, 1992; Calves, 2002; Henry and Fayorsey, 2002). Some 
studies have also suggested that male partners can positively influence women’s use of female 
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contraceptive methods through consensus and effective dialogue (Blanchi-Demicheli et al., 
2003). Abdel-Tawab et al. (1999) found that husbands’ emotional support during the abortion 
was positively associated with their wives’ emotional recovery. Furthermore, there is evidence 
that the inclusion of male partners in family planning education and services increases 
utilisation of family planning methods in several contexts (Piotrow et al., 1992; Terefe and 
Larson, 1993; Becker, 1996; Soliman, 1999). Positive consequences that result from men’s 
involvement in family planning extends to continuous use of family planning methods by 
improving spousal communication and reduced male opposition (Bawah, 2002; Sternberg and 
Hubley, 2004; Hartman et al., 2012). 
Conversely, poor partner support during abortion decision-making is associated with poor 
long-term emotional outcomes for women (Kimport, Foster and Weitz, 2011) and likelihood 
for repeated abortions (Beenhakker et al., 2004).  Reich and Brindis (2006) have argued that 
whilst little partner support during the abortion decision making can reinforce a woman’s self-
autonomy, but it can at the same time place additional emotional or psychological burden on 
her.   
 
2.6 Predictors of Post-abortion Contraceptive use 
The WHO (2003) handbook on safe abortion, technical and policy guidance recommends that 
women undergoing an elective abortion should be offered non-judgmental counselling about 
contraceptives as part of post-abortion care (PAC). Women should also be offered a range of 
contraceptive options to choose from, expressed in a language which is comprehensible to 
them. Post-abortion contraception is an essential component of comprehensive abortion care 
(CAC) and PAC (WHO, 2012). Post-abortion contraception involves the provision of 
comprehensive contraceptive counselling and services immediately at the time of, and after an 
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induced abortion. Also, it takes into account women’s health needs, personal circumstances 
and ability to obtain services (Hyman and Kumar, 2004). 
Evidence from several abortion-related studies suggest that factors other than male 
partners’ involvement influence post-abortion contraception use. For example, Banerjee et al. 
(2015), in their study found that post-abortion contraception uptake and acceptance by women 
were not associated with the male partners’ involvement in abortion. Rather, reasons for post-
abortion family planning adoption and acceptance depended on woman’s age, type of health 
facility, gestational age of the pregnancy, abortion method, and post-training mentoring support 
by trained doctors. Keene et al.’s (2015) retrospective study that investigated the effect of 
previous induced abortions on post-abortion contraception selection also showed that women 
with a history of abortion, and women having living children were more likely to use highly 
effective contraceptive methods after the abortion. Other studies have reported that facility 
level factors, socio-cultural and individual factors impact on post-abortion contraceptive use 
(Wang et al., 2016). The availability of on-site family planning supplies, adequate 
infrastructure, well-trained and committed staff influence women’s initiation and acceptance 
of contraception. 
However, there are a number of studies which provide evidence to demonstrate that 
male partners influence post-abortion contraceptive use. Esber et al. (2014) examined the effect 
of male partners’ approval of post- abortion contraceptive use among women in Tanzania. 
Their results from a survey showed a strong association between partner approval of 
contraceptive use and intention to use post- abortion contraception. Another study conducted 
in Egypt to examine the effect of husband’s involvement in post-abortion recovery and use of 
contraception found that husband support for family planning predicted contraceptive use or 
intention to use contraception (Abdel-Tawab et al., 1999). Kero and Lalos (2005) also provide 
empirical evidence on the impact of male partner involvement in post-abortion contraception 
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use. They found that when male partners were involved in post-abortion counselling, their 
women continued to use contraception after one year.  
 
2.7 Barriers to male participation in sexual and reproduction issues  
Substantial scholarly work specifically in sub-Saharan Africa, on fertility and reproductive 
health issues largely demonstrate that while male involvement in family planning programmes 
and other reproductive health issues can significantly increase women’s contraceptive use and 
reduce unmet contraceptive need, there are still prevailing barriers which discourage male 
participation in reproductive health matters. 
The extant literature is conclusive on multiple factors which directly and indirectly impede 
men’s full (and somewhat partial) participation in family planning use. These identified factors 
range from predominantly intrapersonal level factors, to interpersonal, socio-cultural or 
community-level characteristics, organisational and policy level variables. Interpersonal 
factors mainly relate to partners’ attitude and behaviour which may inhibit contraceptive use. 
For example, some studies have found that men’s disapproval of contraceptive use and lack of 
participation in family planning account for low contraceptive prevalence (Dudgeon and 
Inhorn, 2004; Tubro et al., 2009; Yue, O’Donnel and Sparks, 2010).  
Other studies have found that women’s secret and latent use of family planning was 
due to their male partners’ resistance to birth control methods (Bankole and Singh, 1998; 
Miller, Severy and Pasta, 2004). Kabagenyi et al. (2014) and Adanikin, McGrath and Padmadas 
(2017) found in their studies that men expressed fears that their female partners’ use of 
contraception would encourage extramarital affairs, hence their lack of participation in fertility 
control methods. In addition, fear of spousal retaliation arising from a lack of consensus has 
been shown to impede women’s use of family planning (Biddlecom and Fapohunda, 1998).  
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In most patriarchal settings such as in sub-Saharan Africa, Asia and Latin America, 
socio-cultural norms, beliefs and practices prevent fertility control mechanisms intended to 
regulate family size as high fertility is encouraged. Early and contemporary studies which have 
examined male non-involvement in contraception uptake indicate that traditional male role 
preference for large family size for security purposes presents a strong resistance for 
contraception adoption (Ezeh, 1993; Bankole and Singh, 1998). Further, gendered norms and 
relationship power dynamics prescribe reproduction and contraception to be the domain of men 
with women having limited participation (Wambui, Ek and Alehagen, 2009; Kabagenyi et al., 
2014). 
 
2.8 Legal context of Induced abortion in Ghana  
Before the amendment of the law permitting legal abortion in Ghana in 1985, it was a criminal 
offence for women to have an abortion either by themselves or by other individuals, including 
health providers. Abortion was a criminal offence regulated by Act 29, Section 58 of the 
Criminal code of 1960, amended by PNDCL 102 of 1985.  
The conditions or circumstances under which abortion was illegal prior to the amendment of 
the law was: (i) any woman with the intention to terminate a pregnancy or consents for an 
abortion to be done by someone else through the ingestion of any chemical substance or 
through surgical means; (ii) when an individual induces or attempts, or consents to cause 
abortion, or conspires to terminate a consenting woman’s pregnancy surgically or through the 
administration of a chemical substance; (iii) when an individual purchases chemicals or 
surgical equipment with the intention to terminate a pregnancy, or aids or abets a woman to 
terminate a pregnancy. Under these circumstances, an individual or a woman was guilty with 
an imprisonment term of not more than five years.   
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However, abortion is legal and permissible in the cases of rape, incest or defilement, health risk 
to the woman or the unborn child (whether psychological, or physical), and if the pregnancy is 
terminated by a registered health facility approved under the Private Hospital and Maternity 
Home Act, 1958 (No. 9). 
 
2.9 The Context of Safe Abortion or Comprehensive Abortion Care (CAC) in Ghana 
The 1997 Reproductive Health Policy which was implemented by the Ministry of Health made 
provisions for the management of unsafe abortions and post-abortion care (PAC), but not safe 
induced abortions. In 2003, this policy was revised in response to the high mortality rates due 
to unsafe abortions, and also to address gender based violence and sexual health issues.  The 
current 2003 National Reproductive Health Policy from the Ministry of Health was amended 
to address the high maternal mortality rates for which provisions were not made in the 1997 
Reproductive Health Policy. The Ghana Health Service developed a strategic plan to reduce 
the high levels of unsafe abortion by adopting the following strategies:  
a. Dissemination of the law on abortion to health workers, the general public and health 
partners 
b. Training of health professionals (specifically, doctors and midwives) on performance 
of safe abortion and PAC 
c. Nationwide research on abortion 
d. Development of appropriate information, education, and communication materials and 
e. Promotion of family planning (FP) 
 
The policy also includes a section on the guidelines for the provision of CAC within the limits 
of the law (GHS, 2005). 
In line with efforts to ensure the full implementation of this policy, the Ministry of 
Health in collaboration with a consortium of six international health organizations and partners 
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launched the programme ‘Reducing Maternal Mortality and Morbidity’ (R3M) in September, 
2006. The core objective of the programme was to reduce morbidity and mortality due to unsafe 
abortion and increase access to CAC, and to widen access to FP services in order to minimize 
unwanted pregnancies that result in abortions (Aboagye et al., 2007).   
Since then, CAC services were integrated into Ghana’s reproductive health policy. 
From that time, it became one of the five components of the key objective “reduce maternal 
morbidity and mortality” of the 2007-2011 Ghana Reproductive Health Strategic Plan (Ghana 
Statistical Service (GSS), Ghana Health Service (GHS) and Macro International, 2009). In line 
with this policy, new standards and protocols for safe abortion services that include direction 
for interpreting Ghana’s abortion law were released. These standards were developed in 
collaboration with IPAS, WHO, and other stakeholders (Aboagye et al., 2007). 
The R3M programme was initiated in three regions: Greater Accra, Ashanti and 
Eastern. A total of seven districts were chosen in each region. One of the main objectives was 
targeted at health care providers by providing training in abortion techniques and contraceptive 
services. The consortium also provides technical advice, and assistance to health facilities, as 
well as provision of products and equipment to communities. Health providers are sensitized 
on abortion-related services (Sundaram et al., 2014).  
An evaluation of the R3M programme was conducted in the pilot regions with the aim 
of examining the programme’s impact on the provision of safe abortion services and PAC. 
Primary data for the programme assessment were obtained using a quasi-experimental design. 
The sample comprised of a treatment group (districts/regions where R3M intervention had been 
implemented) and two control groups (districts in Greater Accra Region, Ashanti and Eastern); 
and districts from Brong-Ahafo. Analysis was conducted using propensity score weighting. 
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The results showed that health care providers in the treatment groups were six times likely to 
provide safe abortion compared to the control groups (Sundaram et al., 2014). 
However, in many cases few researchers suggest that the law still tends to be interpreted 
as prohibiting abortion, and availability of abortion is limited in the public sector. A recent 
survey of health care facilities in ten districts found that less than one in every seven public 
health facilities reported offering legal abortion services; only 21 percent of providers knew all 
the legal indications for abortion; 23 percent of providers incorrectly reported that the abortion 
law requires written consent from the woman’s partner; and around half of providers reported 
having concerns about providing abortion services because of their religious beliefs (Aboagye 
et al., 2007). 
 
2.9.1 Incidence of abortion in Ghana 
According to the 2007 Ghana Maternal Health Survey (GMHS), seven percent of all 
pregnancies end in abortion and about 15 abortions are performed for every 1,000 women of 
reproductive age (15-44) annually. (GSS, GHS and Macro International, 2007). In a study 
conducted by Ahiadeke (2001) in southern Ghana, 17 abortions were observed for every 1,000 
women of reproductive age. Comparing Ghana’s abortion rates to Western Africa, it is 
apparently clear that the level of abortion in Ghana is lower than in Western Africa as a whole, 
where the rate stands at 28 procedures per 1,000 women (WHO, 2007).  
While it is noteworthy to state that the incidence of induced abortion and corresponding 
estimates may be compromised by underreporting, the evidence is lucid that 37 percent of 
births in the country are unplanned; 23 percent is mistimed and 14 percent is unwanted (GSS, 
GHS and ICF Macro, 2009). By implication, this stands to imply that more than 300,000 infants 
are born as a result of unintended pregnancies each year. 
 
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2.9.2 Characteristics of women having an Induced abortion in Ghana 
Studies have found that several social and demographic variables such as age, educational 
attainment, socio-economic status, religious affiliation, employment status, and number of 
living children are important in influencing decisions on abortion (Ahiadeke, 2001; Bankole, 
Singh and Haas, 1999; Jones, Finer and Singh, 2010; Tong et al., 2015). 
Previous scholarly work conducted by Ahiadeke (2001) to investigate the incidence of 
induced abortion in Southern Ghana showed that most Ghanaian women living in urbanized 
areas, working outside their homes, self-employed, and were in their 20s were more likely to 
have an abortion compared to unemployed women and women in rural areas. He also found 
that women undergoing abortions had already a previous abortion, were unmarried, had some 
secondary or higher education and were Christians. Similar results were also found in a recent 
study by Adjei et al. (2015) using the Kintampo Health and Demographic Surveillance System, 
among a representative sample of females aged 15-49. Compared to 20-29 year-old women, 
women aged 13-19 years were more likely to have an abortion. Wealthier women were three 
times more likely to receive an abortion than poor women.  
 
2.10 Summary of reviewed studies and identified gaps  
The reviewed literature in this chapter shows that research on the ‘male role’ in reproduction 
has been extensive and spanned across several decades. Most of the studies reviewed for this 
study are context-specific, mostly in sub-Saharan African countries. The majority of these 
studies utilised secondary data while a few focused on qualitative approaches. The results from 
these studies demonstrate that in most patrilineal contexts, the male figurehead is the primary 
decision-maker in reproductive and sexually-related health matters. The male partner controls 
the reproductive rights of his female partner by virtue of marriage and bride wealth payments. 
Thus, women have limited decision-making power in the reproductive dyad. 
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 The importance of the male partner in fertility issues is significant for improving 
maternal and child health outcomes, and even men's sexual health. The literature on male 
participation in women's abortion experiences suggest that men play direct and indirect roles. 
Mixed results have been reported in studies which investigated men's involvement in abortion 
and family planning. Whilst existing evidence in some contexts show that men provide 
supportive roles during pregnancy termination, women are viewed as having primary 
responsibility in abortion.  
Despite the scholarly work on the male role in fertility matters, a few fundamental research 
gaps are worth noting. First, few studies have employed qualitative methodologies to 
understand male involvement in abortion while majority focus on quantitative survey data. 
Apart from few recent studies employing mixed methods in studying male partners’ 
participation in abortion, this methodological gap limits a comprehensive exploration on the 
diverse ways by which men are involved in women's abortion experiences.  
Second, data is, however, limited for examining how the constructs of the Health Belief Model 
(HBM) and Theory of Planned Behaviour (TPB) explain the relationship between male 
partners’ participation in abortion and post-abortion family planning uptake. Third, the 
reviewed studies show that the link between male partners’ in abortion and post-abortion family 
planning use is under-researched. These are the research gaps that this study sought to fill.   
 
 
 
2.11 Theoretical framework 
Considering the extensive fertility research conducted in several contexts, different theoretical 
models have been posited to explain and predict individual’s behaviour specifically, in 
adopting healthy promotive behaviours. 
  
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2.11.1 Theory of Planned Behaviour 
The Theory of Planned Behaviour (TPB) was developed by Icek Ajzen as an attempt to predict 
human behaviour (Ajzen, 1991). The planned behaviour theory consists of four constructs 
which provide explanation of the likelihood of engaging in or performing a specific behaviour 
or not. These constructs are; attitude toward the behaviour, subjective norm, perceived 
behavioural control and behavioural intention. 
The first construct is behavioural intention, which consists of motivational factors that 
influence behaviour (Ajzen, 1991). The stronger the intention to engage in a given behaviour, 
the more likely that the behaviour will be performed. The second construct is attitude towards 
the behaviour which is the extent to which a person has a favourable or unfavourable appraisal 
of a specific behaviour. Attitude consists of behavioural beliefs and outcome evaluations. 
Subjective norm is the third construct and it involves social pressure to perform or not to 
perform a particular behaviour. A combination of normative beliefs and motivation to comply 
constitute subjective norm. Perceived behavioural control which is the fourth construct also 
plays a key role in the TPB and it refers to individuals’ perception of the ease or difficulty of 
performing specific behaviours. 
 
2.11.2 Health Belief Model (HBM) 
The health belief model (HBM) was developed by Rosenstock (1966) and it specifies that 
individual perceptions of four variables, namely; susceptibility, severity, benefits, and barriers 
predict and explain behaviour. The model argues that if individuals perceive a negative health 
outcome to be severe; perceive themselves to be susceptible to it, perceive the benefits to those 
behaviours that reduce the likelihood of that outcome to be high, and perceive the barriers to 
adopting those behaviours to be low, then performance of the specific behaviour is likely for 
those individuals (Carpenter, 2010). 
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The model’s ability to explain and predict a variety of behaviours (including health 
behaviours) associated with positive health outcomes (for example, contraceptive use) has been 
replicated severally (Janz and Becker, 1984; Brown, Ottney and Nguyen, 2011; Yue et al., 
2015). However, variations have been found to exist in the ability of each individual component 
or variable of the model to predict health behaviour (Harrison, Mullen and Green, 1992). For 
instance, Carpenter (2010) did a meta-analysis of 18 studies and found that perceived benefits 
and barriers were consistently the strongest predictors out of the four variables.  
Besides the four variables proposed in the original model by Rosenstock, two other 
variables, cues to action and self-efficacy, were later added to expand and provide further 
explanations to the model. However, some studies have reportedly found these variables to be 
underdeveloped and rarely measured or researched (Janz and Becker, 1984; Rosenstock, 1974; 
Zimmerman and Vernberg, 1994). 
The HBM states that individuals will be more motivated to act in healthy ways if they 
believe they are susceptible to a particular negative health outcome (Rosenstock, 1996). 
Second, the model predicts that the stronger individual’s perceive the severity of a negative 
health outcome, the more they will be motivated to engage in positive behaviours in order to 
avoid that outcome. Rosenstock argues that if the undesirable health outcome will not have a 
large impact on an individual’s life, the individual will not be motivated to act to avoid it. The 
susceptibility and severity variables thus, deal with perception of a negative health outcome.  
The third and fourth constructs, benefits and barriers are concerned with the perception 
of engaging in specific behaviours that are likely to reduce or prevent negative health outcomes.  
A person must perceive that a specific behaviour will provide strong positive benefits that will 
prevent the negative health outcome. Finally, the model posits that a person’s perception of 
strong barriers to the adoption of preventative behaviour will result in non-performance of the 
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behaviour. Cues to action involve the situation where individuals are spurred to adopt a 
preventive behaviour by some additional or external element or cues. Self-efficacy was 
proposed for inclusion in the model to account for the overall motivation to pursue healthy 
behaviour (Becker, 1974; Rosenstock, Strecher and Becker, 1988).  
 
2.11.3 Male role theory  
Decades of scholarly work largely in sub-Saharan Africa have shown that in patriarchal 
societies, men are dominant decision-makers in the sexual and reproductive matters of their 
wives by virtue of cultural norms, traditional gender roles and power, and bride wealth 
payments (Ezeh, 1993; Bankole, 1995; Mbizvo and Adamchak, 1995; Dodoo and Tempenis, 
2002). Quite apart from sub-Saharan Africa, there is substantial evidence from other patriarchal 
contexts (such as Asia and North-America) which buttresses male authority and influence in 
maternal and reproductive health decisions of women, largely a consequence of social 
structures and gender power dynamics (Brunson, 2010; Thapa and Niehof, 2013). Men, 
therefore, have full control and authority over their female partners’ reproductive decisions and 
choices including contraceptive use.   
 
2.11.4 Applicability of theories  
Ajzen’s (1991) theory of planned behaviour has been verified for its efficiency in explaining 
and predicting health behavior (Godin and Kok, 1995; Albarracin et al., 2001). Godin and Kok 
(1995) found that the TPB explains behaviour intention significantly. Attitude toward the 
action and perceived behavioural control were most often the significant variables which 
explained variation in intention. Intention remained the most important predictor, but perceived 
behavioural control contributed to the prediction. Albarracin et al. (2001) also performed a 
meta-analysis to determine how well the Ajzen’s (1991) theory predicted and explained 
contraceptive use (for example, condom use). They found that consistent with the theory, 
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perceived behavioural control was related to contraceptive use intentions. However, it did not 
contribute significantly to contraceptive use. 
The male role theory, HBM and TPB theories offer logical explanations and 
applicability for this study, as well as the possible associations or relationships between the 
explanatory variable (male partners’ involvement in abortion) and outcome variable (PAFP 
uptake or non-uptake). In applying these theories to this study, substantial evidence indicates 
that women’s socio-demographic and reproductive characteristics influence contraceptive 
initiation and post-abortion contraceptive uptake (Bankole, Singh and Haas, 1999; Rose et al., 
2012; Keene et al., 2015). For instance, some studies have shown that factors that significantly 
correlate with post-abortion contraception uptake include marital status (unmarried versus 
married), residential dwelling (rural versus urban), educational status, and employment status 
(Keene et al., 2015). Other factors that are likely to influence post-abortion contraceptive use 
relate to previous contraceptive use, previous history of abortion, and knowledge of 
contraception (Keene et al., 2015). 
The constructs in Ajzen’s planned behaviour theory also provide explanations for 
women’s likelihood of using contraception after an abortion. For instance, post-abortion 
women with positive attitudes towards using family planning (FP) or contraception to avoid 
future unintended pregnancies and abortions may be more willing to initiate contraception 
immediately after an abortion compared to women with negative attitudes about FP. Also, 
women who perceive a relative ease in adopting a contraceptive method after having an 
abortion to prevent repeat unintended pregnancies are more likely to uptake post-abortion 
family planning than women who perceive strong difficulties in using contraception. The 
perception of difficulty in FP initiation and use may stem from their male partners’ 
characteristics, lack of self-confidence, negative beliefs about contraceptive use, and socio-
cultural factors such as myths, misperceptions, and norms.   
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The HBM lists six perceptual constructs to explain and predict the probability of 
engaging in positive health behaviours to prevent negative health outcomes. Of these variables, 
which relate to this study variables, the perception of serious negative health outcomes after an 
induced abortion, and significant benefits associated with using contraception to reduce future 
unintended pregnancies and abortions are likely to result in contraception use after abortion. 
Furthermore, there is a higher likelihood of post-abortion contraception uptake among women 
who have a high self-efficacy, and who are autonomous in making reproductive decisions 
compared to women with a lower self-efficacy and who depend on their partners for 
contraceptive decision-making.  
Conversely, the perception of side-effects and negative health outcomes associated with 
contraceptive use might prevent and serve as barriers to PAFP uptake among women. The 
‘male involvement factor’ has potential to influence use or non-use of post-abortion 
contraception especially when male partners play important roles in contraceptive decision-
making, decision-making surrounding the abortion, desire to limit fertility and unintended 
pregnancies. Male partners who are knowledgeable about contraceptives are also more likely 
to offer support for continued use of post-abortion contraception for their women than those 
who are opposed to contraceptive use. Additionally, male partners who are ultimately 
responsible for bearing the financial costs of health care of their partners may be motivated to 
encourage their female partners to adopt protective measures to prevent future abortions. 
In summary, all the three theories proffer potential factors and possible explanations which 
provide a logical basis to hypothesize an association between male partners’ involvement in 
abortion and post-abortion family planning uptake. There is evidence to demonstrate that the 
HBM and TPB models are applicable in studying positive health behaviours (including sexual 
and contraceptive behaviours). Since contraception behaviour is a healthy preventative action 
engaged in by individuals to avoid unintended pregnancies and abortions, the variables 
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extracted from these models apply to the variables in this thesis. These socio-psychological 
theoretical frameworks were used to examine the association between male partners’ 
involvement in women’s abortion, and post-abortion contraception uptake. 
 
2.12 Conceptual Framework 
The conceptual framework adopted for this study was informed by empirical research, the 
HBM, and the theory of planned behaviour. The framework illustrates the interconnections and 
relationships with respect to partner involvement and post-abortion contraceptive use. The 
framework also considers post-abortion contraceptive uptake to be predicated on several 
factors which are explained in the ensuing paragraphs. In the framework shown in Figure 2.1, 
partner involvement in abortion is the main explanatory (independent) variable which directly 
influences post-abortion family planning (PAFP) uptake (dependent variable). The 
intermediate (psychosocial factors) and control variables (socio-demographics) are also 
depicted in the diagram. 
In this thesis, partner involvement is conceptualized as any form of support which is 
expressed and provided by the male partner either through actions or inactions (for example, a 
kind empathetic word), tangible and intangible, from the time of pregnancy knowledge and 
disclosure up until post-abortion contraception uptake or non-uptake. Four types of male 
partner involvement factors were identified in the literature and from the results of the 
qualitative interviews made up of instrumental (including financial, accompaniment by male 
partner), emotional, informational and communicative factors.     
The socio-demographic characteristics of a woman and her male partner are important 
factors determining post-abortion contraceptive use. As indicated in the literature, woman’s 
age, education, employment, marital status and number of surviving children account for 
contraceptive use (Frost and Lindberg, 2013; Eliason et al., 2014; Solanke, 2017). Therefore, 
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this study has included these variables. Similarly, partner socio-demographic characteristics 
may affect decisions on contraceptive use. For instance, some studies have demonstrated that 
young women with older sexual partners are less likely to use hormonal contraceptives because 
such young women tend to have less power within the relationship and lower self-efficacy 
(Zabin et al., 2000; Ford, Sohn and Lepkowski, 2001; DiClemente et al., 2002). This is, 
however, different in relationships where the age difference between the male partner and the 
woman is small.  
In this study, the woman and male partner’s socio-demographic characteristics include 
age, employment status, occupation, educational status, ethnicity, religious affiliation and 
marital status. Number of living children was included for the woman but not her partner.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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FIGURE 2. 1 CONCEPTUAL FRAMEWORK TO UNDERSTAND MALE PARTNER INVOLVEMENT 
AND SUPPORT IN WOMEN’S ABORTION, AND LIKELIHOOD OF POST-ABORTION FAMILY 
PLANNING USE. 
 
Partner involvement in abortion 
          - Instrumental  
 
          - Emotional 
          - Informational       
 
          - Communicative  
  
CONTROL VARIABLES  
 
Socio-demographic 
charac teristics of woman 
INTERMEDIATE VARIABLES 
and Male partner   Psychosocial and behavioural 
- Age  factors Post-abortion 
- Educational level 
- Emplo yment status - Attitudes towards FP 
family planning 
- Ethnicity - Level of knowledge on FP - Uptake 
- Religi ous affiliation - Perceived benefits of FP - Non-uptake 
- Marital status - Perceived barriers of FP 
- Numb er of surviving children - Perceived severity of abortion 
 - Self- efficacy in contraceptive use 
Partne rship dimensions  
- Duration of relationship Reproductive variables 
 
- Marital status - Number of previous abortions 
- Relationship stability - Contraceptive use at index 
 
Other factors pregnancy 
Socio-c ultural norms 
 
Health provider attributes  
Health  facility variables 
 
Source: Author’s construct, 2017 
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 Additionally, partnership dimensions were included in the framework to be controlled 
for as they could potentially influence a woman’s uptake of FP after the abortion. Few studies 
have found that the duration of an intimate relationship inhibits contraceptive use and vice 
versa (Osei et al., 2014; Manlove et al., 2014). There are also studies which lend support that 
the quality of relationship or partnership affects contraceptive use (Osei et al., 2014; Wildsmith, 
Manlove and Steward-Streng, 2015). For instance, relationships with partner conflicts, less 
commitment, lower stability, and intimate partner violence report lower contraceptive use 
compared to stable and committed relationships with no partner conflicts.  
A woman’s decision to initiate and use post-abortion contraception may be influenced 
by psychosocial and behavioural variables which could eventually modify or mask the direct 
influence and relationship between male partner involvement and PAFP uptake. These 
intermediate/modifying factors include: attitudes towards FP; level of knowledge on FP; 
perceived benefits and barriers of contraception; perceived severity of abortion and negative 
health outcomes, number of previous abortions, and contraceptive use at index pregnancy and 
self-efficacy.  
The self-perception variables were adopted from the HBM. The constructs in the HBM 
have been used in earlier researches to explain contraceptive use (Moos, Bartholomew and 
Lohr, 2003; Gaudet, Hahn and Reid, 2004; Lopez et al., 2009; Brown, Ottney and Nguyen, 
2011). When a woman perceives negative health outcomes (such as infertility) as a result of 
abortion, there is a high likelihood of post-abortion contraception uptake to avert the possibility 
of future infertility and complications. However, contraceptive resistance may persist if the 
perception of negative side-effects of contraception is weighed more strongly than the health 
effects of having an abortion. Similarly, the perception and knowledge of a repeat unwanted 
pregnancy immediately after an abortion is likely to influence post-abortion contraceptive 
uptake. Self-efficacy is explained as an individuals’ confidence in the ability to successfully 
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perform an action. Self-autonomous women with a high self-efficacy and lower dependency 
on their male partners have a higher chance to be autonomous in initiating contraception after 
an abortion compared to women with a lower self-confidence. 
From the TPB, four main constructs are posited to influence an individual’s positive 
behaviour change: behavioural intention, perceived behavioural control, subjective norm and 
attitude. A plethora of studies report that community beliefs and perceptions strongly influence 
and regulate a woman’s or couple’s contraceptive use (Castle, 2003; Hall et al., 2008; Ankomah 
et al., 2011; Sedgh and Hussain, 2014). So it is possible that, women who desire to or have the 
intention to prevent an unplanned pregnancy in future may be limited in initiating a 
contraceptive method out of fear of these community beliefs and myths surrounding 
contraception. 
Favourable and positive attitudes towards FP to prevent an unintended pregnancy will 
encourage and influence contraception use after abortion. Assuming a less effective 
contraceptive method was earlier used and which resulted in method failure, or was used 
inconsistently, there is a higher likelihood for the adoption of a more effective method in future.  
This study acknowledges that multiple factors at the individual, interpersonal, societal 
and health facility level may influence women’s contraceptive use after having an abortion. 
Health facility level factors such as post-abortion FP counselling, provider-controlled FP 
methods, and availability of FP at the health facility were, however not controlled for in this 
study though they have the tendency to directly or indirectly influence post-abortion 
contraception uptake. The difficulty in controlling these facility level factors was due to the 
lack of procedural uniformity in offering abortion services in each hospital, as well as the 
differences in the nature of abortion-related care services. 
 
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2.13 Hypotheses 
Two hypotheses were formulated on the basis of the potential influence of partner involvement 
factors on women’s post-abortion contraception uptake. It is hypothesized that:  
i. Women who receive communicative support from their partners during an abortion 
are more likely to use post-abortion contraception than women who do not receive 
any communicative support from their partners.  
ii. Women who are supported financially by their partners for the abortion costs are 
more likely to adopt a contraceptive method after the abortion than women who are 
not financially supported.  
 
 
 
 
 
 
 
 
 
 
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CHAPTER THREE 
METHODOLOGY 
3.1 Introduction 
This chapter presents the methodology of the study which is on male partners’ involvement in 
abortion and post-abortion family planning uptake. The chapter begins with the study design 
and its justification. This is followed by the purpose of conducting the qualitative phase of the 
study before proceeding with the quantitative phase of data collection.  
 
3.2 Study strategy   
This study adopted the sequential exploratory mixed methods research strategy. In-depth 
interviews were first used to explore and generate themes on male partners’ involvement in 
abortion and post-abortion contraception uptake. Based on these themes, a survey instrument 
was designed to examine post-abortion women’s views on their partners’ involvement in 
induced abortion and family planning uptake. Male partners who were available during data 
collection were included in the study to obtain their perspectives.  
The rationale for using the sequential exploratory mixed method design was for the purposes 
of cross validating and complementing findings from both qualitative and quantitative methods 
(Creswell, 2009). Using both methods also provided a more detailed exploration and 
understanding of partner involvement and support during abortions and post-abortion 
contraception uptake. Hence, the weaknesses inherent in each method (qualitative and 
quantitative) were compensated for.  
 
 
 
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3.3 Qualitative Data 
3.3.1 Purpose of conducting qualitative phase 
The qualitative phase of the sequential exploratory mixed method study was conducted first 
using in-depth interviews and participant observations. Generally, the aim was to explore into 
detail, contextual issues surrounding male partners’ involvement in induced abortion from both 
male and female partners’ perspectives in order to fully explore, understand, situate, and 
generate an analytical framework of how male partners are involved in their partners’ abortion. 
Another reason for the qualitative component of the study was to gain a thorough understanding 
of the underlying dimensions and factors in the dyadic relationship which might possibly help 
to understand male involvement and further support in the abortion and uptake of post-abortion 
contraception. Also, results from the qualitative analysis were used to identify variables and 
generate themes that were used in developing the survey instrument.  
  
3.3.2 Selection of study site  
The study site for the in-depth interviews was Ga West Municipal Hospital. The participating 
hospital was selected randomly from a list of health facilities providing comprehensive 
abortion care (CAC) in the Greater Accra Region. A list of all health facilities offering CAC 
was obtained from the Ghana Health Service2 after permission was granted from the 
appropriate offices. The selection process began with a determination of a cut-off number for 
elective and induced abortion statistics for the period January to December 2015. The cut-off 
was determined by computing the mean number of elective/induced abortion cases across all 
the facilities. The resulting figure (>100) was used as a criterion to select the health facilities. 
All the names of health facilities who met this selection criterion were then written on pieces 
                                                          
2 The Ghana Health Service (GHS) is a nationally recognized institution which provides published data and 
figures on health indicators in the country by region and facility basis.  
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of papers, folded and placed into a bowl. After this, a field assistant of the researcher randomly 
picked one of the folded papers from the bowl. The randomly selected paper picked was Ga 
West Municipal Hospital.  
 
3.3.3 Description of Study Site 
The study site was Ga West Municipal Hospital located at Amasaman in the Greater Accra 
Region. The hospital is centrally located between Achimota and Nsawam making it a highly 
accessible and a preferred location to individuals living within its environs. The hospital began 
its operations as a health centre within the catchment area until 2008 when it was converted to 
the status of a Municipal hospital. Available information from the hospital’s annual reports 
indicate that its conversion to a Municipal hospital was necessitated by an increased demand 
for other health services such as maternal and ante-natal health care services. As a major public 
hospital in the area, it provides an extensive range of in-patient and out-patient services to 
clients within the entire municipality and beyond. 
 
3.3.4 Sample design  
This study employed the cross-sectional design to explore male partners’ involvement in 
women’s abortion experiences at a point in time. Primary data was collected using in-depth 
interviews, participant observations and survey.  
 
3.3.5 Methods of data collection 
3.3.5.1 In-depth interviews 
In-depth interviews and participant observation were used in primary data collection. In-depth 
interviews provided a means of obtaining a detailed exploration of the ‘personal worldview’ 
(Gaskell, 2000) of study participants. Gaskell (2000) notes that in-depth interviews place 
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respondents at ‘centre stage’, and allow respondents time and space to engage in reflections 
and narrative construction of past events. The in-depth interviews were most appropriate and 
useful technique for collecting detailed information from participants on a sensitive and 
contentious topic like ‘abortion’ in the Ghanaian social and cultural milieu. The 
appropriateness of the in-depth interviews was because it provided a conducive ‘anonymity 
environment’ for study participants to feel at ease, recount, and share their experiences (both 
past and present) in the decisions leading to the abortion, and their partners’ roles and 
participation in the abortion process. 
It also ensured privacy and confidential revelation of responses, and a channel for the 
researcher to share useful sexual and reproductive health information to clients who needed 
guidance3. There was an opportunity for the researcher to familiarize herself with the study 
participants, and counsel them with important information on their sexuality. 
 
3.3.5.2 Participant observation 
Participant observation was used to capture overt behaviours and non-verbal cues which could 
not be obtained directly from the in-depth interviews. The observations provided additional 
descriptive information on events that could not be recorded with the audio-tapes such as the 
study participant’s experience of anxiety, pain before and after the abortion procedure, 
emotional expressions like weeping, and support from individuals who accompanied them to 
the hospital for the abortion.  
 
 
 
                                                          
3 Prior to data collection, the researcher had received some training on the various methods of family planning 
at a non-governmental institution offering family planning services during her internship. 
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3.3.6 Inclusion Criteria 
The inclusion criteria was all females receiving an induced or elective abortion, post- abortion 
care, and PAFP at the health facility. In addition, male partners who accompanied women for 
an abortion and were at the same time responsible for the woman’s pregnancy qualified to 
participate in the study.  
 
3.3.7 Exclusion Criteria 
All other women visiting the hospital with spontaneous or missed abortion were excluded from 
the study. Men who accompanied women for an abortion at the hospital but were not the 
partners responsible for the pregnancy were also excluded. Other individuals such as siblings, 
parents and friends who accompanied women for an abortion did not participate in the study. 
Their responses (where necessary), however, provided descriptive accounts for the field 
observations. 
 
3.3.8 Study Participants 
Study participants comprised of women in all age categories who had had an induced/elective 
abortion at the hospital, and couples (irrespective of their marital status) visiting the hospital 
for a safe induced abortion. Also, male partners who accompanied their female partners to 
terminate a pregnancy were recruited and interviewed to provide insights on the extent of their 
involvement in the abortion process before and during the abortion.  The purpose of the male 
perspective was to examine how their opinions and positions differed from their female 
counterparts with the aim of understanding the gendered nuances in abortion decision-making. 
Women seeking post-abortion care (PAC) also formed part of the study participants. This 
category of women reported at the health facility with bleeding, incomplete abortion4 or missed 
                                                          
4 Incomplete abortion is when pregnancy has ended and the product of conception is partially expelled.  
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abortion5 and severe abdominal pain. Other women who qualified to participate in the study 
were women seeking to adopt a family planning or contraceptive method after CAC. Last but 
not the least was healthcare provider(s) delivering CAC services at the facility as they could 
provide information on how CAC services were organised and delivered notwithstanding 
challenges associated in service provision. Apart from being interviewed, the provider and her 
assistant were needed to assist in recruiting and selecting potential clients for the study.  
 
3.3.9 Participant recruitment and selection 
Participants who met the eligibility criteria were invited to be interviewed by the provider6. 
The provider afterwards introduced the researcher to the potential interviewee. Prior to the data 
collection, the purpose and nature of the study was described to the provider and her assistant 
to solicit their assistance in recruiting potential study participants. This invitation of participant 
recruitment was important in getting access to potential respondents due to the sensitive nature 
of abortion, and the ‘clandestine manner’ in which some people sought abortion-related care at 
the facility. This strategy also facilitated an increase in the response rate and minimized the 
number of missing cases. In addition, this approach made potential study participants feel at 
ease to be interviewed and increased their level of trust and confidence in the researcher as the 
interview proceeded. Participants were interviewed after detailed description of the study was 
provided and informed consent was obtained.  
  
 
 
                                                          
5 Missed abortion refers to women whose pregnancies got terminated as a result of unexplained or natural 
causes without any deliberate action.  
6 The main provider of CAC at Ga West Municipal hospital was a trained professional midwife and nurse. She 
also d oubled as the main scan provider. 
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3.3.10 Sample size  
The initial plan was to interview 60 people (young women and couples included). However, 
by the 39th interview, no new responses were forthcoming; meaning that saturation had been 
achieved so the interviews had to end. Further interviews were stopped because similar 
patterns, connections, and themes were observed during interview discussions and no new 
responses were generated to answer the research questions.  
 
3.3.11 Research Instrument 
Three semi-structured interview guides were designed prior to fieldwork for the male and 
female partners, and the healthcare providers. The interview guides were informed by the 
literature reviewed and the research questions of the study. The guides were further refined 
through two processes. First, pilot interviews helped to rephrase a few questions on the guide 
and provided insights into the appropriate choice of words to elicit precise responses with the 
aim of minimizing ambiguity. Question sequence in the guide was corrected after the first three 
interviews were conducted. Second, because of language barriers to non-English speaking 
participants, the interview guides for the male and female partners were translated into two 
local languages (“Twi” and “Ga”). This helped to choose the most appropriate words that 
reflect the meaning of the English guide. These two local languages are the most commonly 
spoken languages in Ghana according to the 2010 Population and Housing Census.  
In designing the guides, questions were segmented into distinct thematic areas/sections 
based on the research objectives to be addressed. For all the three guides, the first section 
focused on respondents’ socio-demographic characteristics: age, educational level attained, 
employment status, occupation, number of surviving children, religious affiliation, marital 
status, duration of union/relationship, ethnicity, living arrangement with partner responsible 
for pregnancy, and place of residence. The other sections focused on dimensions of the sexual 
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relationship, contraceptive knowledge, reproductive history (pregnancy and abortion history), 
pregnancy wantedness, disclosure and intention, abortion decision-making, reasons for 
pregnancy termination, expectations of male partner support in abortion, and finally, post-
abortion family planning uptake. The detailed study instrument is presented in Appendices 1 
and 2.  
The interview guides for the abortion care providers was to obtain their perspectives on 
how elective abortions were conducted in their health facility, issues in the provision of 
abortion care, and post-abortion contraception uptake by women who undergo an elective 
abortion. A summary of the guide is presented in Box 1.   
 Box 1: Summary of Interview topics for Health Providers 
 Background characteristics 
  Meaning of CAC and PAC 
 Procedure for elective abortion-related care 
  Issues discussed during counselling 
 Post abortion contraception uptake 
 Challenges encountered in delivery of CAC 
 
3.3.12 Pre-testing of interview guide  
Pretesting of the interview guides was conducted from 28th April to 13th May, 2016 at La 
General Hospital, precisely at the R3M7 building. The aim was twofold: to ensure whether the 
questionnaires captured the relevant areas and exhausted all the research questions, and to 
cross-check if the guides reliably measured all the relevant variables of interest gleaned from 
the literature in order to minimize any omissions.  
                                                          
7 R3M is an acronym for Reducing Maternal Mortality and Morbidity. R3M is a popularly known term at the 
hospital. A variety of services are provided in the building. These include CAC, family planning services, 
adolescent health services, HIV/AIDS counselling, screening and testing and other procedure rooms for cervical 
cancer screening, and two administrative offices. 
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Before the interviews commenced, a recruitment strategy was adopted to increase the 
chances of enrolling a large number of participants in the study. It involved the invitation of 
potential respondents by the abortion care provider to be interviewed by the researcher. 
Interviews were conducted either before pre-abortion or after post-abortion counselling for 
women opting for medication or medical abortion (MA). On the other hand, women undergoing 
surgical abortion were interviewed thirty minutes after the procedure. Interviews were 
conducted in English, ‘Ga’ and ‘Twi’. Informed consent was sought for the interview and audio 
recordings. The duration of each interview was between 30 and 45 minutes. A total of 10 
females participated in the pre-test interviews. During the interviews, ambiguous meanings to 
some questions were rephrased, flexibility in asking and probing questions was maintained, 
and strict adherence to the guide was discouraged.  
 
3.3.13 Data collection procedure  
Data collection began from 31st May to 6th September, 2016 at Ga West Municipal Hospital, 
Amasaman. Institutional and ethical approval prior to the initiation of the study was obtained 
from the Ghana Health Service Ethical Review Committee (GHS-ERC) and the Regional 
Director of Health Services. An introductory letter from the University of Ghana was also 
obtained and presented at the health facility as part of procedures in conducting research 
projects at the health facility. Access to commence field work at the hospital was granted after 
approval by the Medical Superintendent and hospital administrator. An interactive session was 
conducted by the in-service coordinator for the purpose of understanding the nature of the 
study, potential harm to respondents, benefits, and ethical issues to be adhered to by the 
researcher. After providing satisfactory explanations, the researcher was introduced to the 
unit/departmental heads at the family planning clinic, and the CAC provider.  
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The CAC provider8 during an informal interaction reported that elective abortion 
services at the hospital were not structured/organised. Induced abortions were carried out at 
four different facilities in the hospital. These were: the scan room, gynaecology ward (also 
maternity ward), family planning unit, and labour wards. MA was offered in the scan room 
after the gestational age of the pregnancy had been ascertained by the CAC provider. 
Afterwards, the woman was made to orally ingest the pill and later instructed on the mode of 
drug administration for the remaining tablets9. On the other hand, women who chose surgical 
abortion (MVA) had the procedure performed at the gynaecology ward, or labour ward. At the 
gynaecology ward, two separate rooms were reserved for MVA: a counselling room, and a 
procedure room. After the pregnancy termination was completed, the women moved to the FP 
unit. Sometimes, an FP nurse was invited to perform an Intrauterine device (IUD) insertion if 
the client preferred the IUD as her post-abortion method choice. 
Following the recruitment strategy and suggestion from the provider, the in-depth 
interviews were conducted at the FP Clinic where post-abortion women took up FP after the 
abortion. So after the surgical abortion, the provider’s assistant brought the post-abortion 
women to the FP Unit for an FP method. She introduced the post-abortion women to interact 
with the researcher. On occasions when post-abortion women were unaccompanied to the FP 
Clinic, the researcher liaised with the FP nurses to identify and introduce any post-abortion 
woman for an interview.  
After ten days of less than 15 interviews conducted, the strategy for recruiting 
respondents was changed in light of some observations noticed during data collection: first, 
potential respondents who objected to adopt a PAFP method were missed as they did not come 
                                                          
8 A professional trained midwife and nurse, and also mainly responsible for providing scanning services to 
clients. 
9 Tablets or pills for MA comprised of five tablets (Mifepristone 200mg to be orally ingested; Misoprostol 
800mcg to inserted vaginally or buccal) 
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to the FP Clinic at all. Second, when the abortion provider’s assistant did not accompany post-
abortion women to the FP Clinic, they declined to be interviewed when approached by the 
researcher. At other times, the FP nurses forgot to introduce post-abortion women to the 
researcher for the interview resulting in missing cases. Third, some women complained of time 
constraints and a reluctance to spend more waiting time at the hospital. This problem was 
compounded on occasions when the caseload of induced abortions was high.  
The new recruitment strategy was to conduct the interviews before the abortion 
procedure in order to minimize missing potential respondents. This strategy meant that the 
researcher had to be seated in the counselling room where pre-abortion counselling was 
provided before the MVA was performed. This strategy was effective because it increased the 
sample size and minimized loses. Additionally, it provided an opportunity to interact and 
observe participants’ reactions, and expectations prior to the surgical procedure. The rapport 
established with respondents before and during the interview also made them receptive, and 
willing to be followed-up on a post-abortion contraceptive method. On many occasions, the 
abortion provider and her assistant had to be prompted to invite and introduce clients to have a 
discussion with the researcher. All the ethical procedures (voluntary participation, informed 
consent, withdrawal from the study, benefits and risks) were observed. 
To supplement the recruitment strategy, permission was sought from the provider to 
grant the researcher access to sit in the scanning room to identify women coming for MA. The 
reason for the additional plan was because no participant opting for MA had been interviewed 
yet by the 20th interview. Women who preferred MA were missed due to the following reasons: 
(i) provider’s forgetfulness to invite potential respondents to be interviewed (ii) women 
choosing MA arrived earlier before the researcher did (iii) sometimes, the researcher was in 
the middle of an ongoing interview which was difficult to end.  
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Recruitment of study participants began from the scan room with permission from the 
health provider. Her assistance was still sought in introducing potential respondents to be 
interviewed. From the observations, when women came for a pregnancy scan, they told the 
nurse about their intention to terminate the pregnancy. Of these, nearly all of them requested 
the health provider’s assistance to abort the pregnancy. Depending on the gestational age of 
the pregnancy, for example, if less than nine weeks, the woman was counselled on medication 
abortion unless she preferred MVA. The cost of abortion was then negotiated before the 
abortion was carried out.  
Couples in the study were interviewed separately to avoid the risk of response bias; 
allow free articulation of opinions without fear of harassment or threats or arguments, and to 
prevent potential relationship conflicts that may be generated during the interviews upon 
disclosure of a past incident. However, one couple was interviewed together due to data storage 
challenges with the audio recorder. It was realized after two minutes into the interview that the 
audio recorder was ‘full’ so no further recording was possible. Responses were, therefore, 
hand-written. The couple were also interviewed together.    
The average length of interviews was 40 minutes, and incomplete interviews lasted for 10-15 
minutes. Written consent was obtained for almost all respondents, and 15 women verbally 
consented. Parental assent was obtained from two parents who brought their children less than 
18 years for an abortion. Only one interview was not audio-recorded due to data storage issues. 
Nine (9) interviews were conducted in ‘Twi’, three (3) were in ‘Ga’ and the remaining one was 
in English.     
 
3.3.14 Participant observations 
A checklist was developed to guide fieldwork observations and included the following areas: 
process of procuring an abortion, accompaniment to the hospital, participants’ experiences after 
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the abortion, and uptake of post-abortion FP. The field observations were accompanied with 
informal conversations. 
 
3.3.15 Data management and analysis 
3.3.15.1 Data storage 
All but one interview responses were recorded with an audio-tape after obtaining respondents’ 
consent. At the end of each day’s interviews, recordings were stored on a laptop, with unique 
identifiers for client data protection purposes. The laptop was only accessible by the researcher 
with a safely protected password. 
 
3.3.15.2 Data analysis 
The Framework Method analysis was adopted and utilized in the management, organisation 
and analysis of the qualitative interviews. This method of analysis has been used since the 
1980s for managing and analysing qualitative data (Ritchie and Lewis, 2003). This analytic 
method was chosen because it is conflated with a deductive approach to qualitative analysis 
(Pope, Ziebland and Mays, 2000; Pope and Mays, 2009). Since a more deductive approach was 
utilized in the instrument development and data collection, its sequential and methodical 
framework suited the approach to data organisation and analysis. Additionally, the semi-
structured interview guides used during the data collection produced semi-structured 
transcripts that allowed flexibility in generating new thematic areas. The Framework Method 
analysis as noted by qualitative researchers, sits within the family of thematic analysis or 
qualitative content analysis (Gale et al., 2013). In sum, the stepwise systematic approach to 
qualitative data analysis of the Framework Method was adaptable and suitable for this study. 
 
 
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3.3.15.3 Stages in the analytic process  
Many of the English and Ga interviews were transcribed by the researcher. Transcription and 
translation of the interviews conducted in Ga was relatively less cumbersome due to the 
researcher’s fluency and mastery of the language. However, to ensure a high degree of validity 
and credibility, the transcripts were given to an independent adept research assistant specialised 
in conducting interviews in local languages (specifically, Ga) to validate the translated version 
against the Ga responses. Two research assistants fluent in the Akan language assisted with 
transcription and translation of all Akan interviews.   
Prior to coding, reading the transcripts and listening to audio recordings was done thoroughly 
and concurrently to increase familiarity with all the interview responses by study participants. 
Both activities were repeated twice to see whether it compared and matched with the translated 
English transcripts.  
Coding was manually done on hard copies of transcripts. At the initial stage of coding, a coding 
frame was developed. During the development of the coding frame, themes and sub-themes 
were inductively and deductively generated. The coding process began with identification of 
deductive codes which were pre-selected and derived from the specific research questions. The 
deductive structure and format of the guides made it easier for further generation of new codes. 
This was followed by generating inductive codes, informed by empirical data. Attention was 
given to areas of consensus and conflict in study participants’ narratives.   
An analytical framework was developed to highlight the pathways leading to male partners’ 
involvement in the abortion process. The analytical framework also sheds insights on important 
predictors which are likely to predict male participation in the abortion, likelihood of support 
during the time of abortion, and possible uptake of post-abortion contraception. The framework 
was adapted from WHO (2007).  
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The conceptual model by WHO (as depicted in Figure 3.1) was developed to help in the study 
of women’s trajectories to seeking an induced abortion or abortion-related care (Coast et al., 
2014). It provides a wider lens than previous models in understanding key issues and 
relationships between variables and elements in trajectories of abortion-related behaviour and 
care. The framework considers a diverse range of social and legal contexts, and has three 
components: (1) international, national and sub-national contexts (2) individual contexts and 
(3) an individual’s pregnancy termination-related experiences, ordered as a time sequence from 
sex to abortion sequelae. 
FIGURE 3. 1 TRAJECTORY TO ABORTION AND ABORTION-RELATED CARE: INDIVIDUAL’S 
TERMINATION OF PREGNANCY (TOP) RELATED EXPERIENCES 
 
Nature of Contraception Awareness of Disclosure of pregnancy 
sex act and use/non-use pregnancy and negotiation around 
 relationship termination of pregnancy 
(ToP) 
 
 Sequelae from Attempted (ToP) Emotions of 
attempted ToP pregnancy/child/ 
ToP 
  
For the purposes of this study, the third component of the conceptual model which focuses on 
individual’s pregnancy termination experiences was adapted and modified. The model was re-
formulated with the addition of new variables derived from the qualitative analysis results to 
produce an analytical framework for this study.  
   
3.4 Quantitative phase 
3.4.1 Study design  
The quantitative phase of the research design was the second part of the study. It involved the 
survey design as the method of data collection after qualitative data analysis was completed. 
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The essence of the survey was to investigate whether a relationship exists between male 
partners’ support in abortion and uptake of post-abortion contraception. Variables which were 
included in the survey questionnaire were generated and derived from the themes in the 
qualitative analysis. The qualitative phase, therefore, formed the basis for the implementation 
of the second phase of the study.  
The rationale behind using the survey design to conduct the second phase of this study was to 
maximize the value in obtaining data from a large number of responses for the purpose of 
conducting a robust statistical analysis. Using the survey strategy is also economical and 
facilitates identification and reporting on a large population (Babbie, 2007; Fowler, 2009).  
 
3.4.2 Study sites 
Five government hospitals located in the GAR were sampled purposively from a sample frame 
of hospitals providing comprehensive abortion care (CAC). The sample frame was obtained 
from the GHS. Out of the sample frame, hospitals reporting induced and elective abortions 
with a caseload of 100 and above were selected. Five hospitals that met the selection criteria 
became the study sites. The participating health facilities were Korle-Bu Teaching Hospital 
(KBTH), Tema General Hospital (TGH), Ga West Municipal and Maamobi General Hospitals. 
Data were not collected from the fifth hospital, namely Ada East District Hospital because of 
the difficulty in obtaining usable data10  within the study period.  
 
3.4.2.1 Korle-Bu Teaching hospital (KBTH) 
Korle-Bu Teaching Hospital is a tertiary health facility that primarily provides a wide range of 
medical services to the health insured and uninsured population. It was formerly the regional 
                                                          
10 Usable data in this context refers to meaningful data obtained from the survey questionnaires and can be 
used for statistical analysis to address the study objectives.   
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hospital in the nation’s capital until its status was ceded to Ridge Hospital. The hospital is also 
a major referral facility, and a teaching hospital for training medical health professionals. 
Korle-Bu Teaching Hospital houses a wide range of special clinics and centres for specific 
medical conditions. One of such facilities is the Reproductive Health Centre (RHC). The RHC 
was commissioned in 2008 to provide sexual and reproductive health care services such as 
family planning, comprehensive abortion care, cervical cancer screening and other services to 
the general population.  
 
3.4.2.2 Tema General hospital 
Tema General Hospital (TGH) is the biggest public health institution located in the Light 
Industrial Area of the Tema Metropolis. Tema is one of the sixteen districts in the GAR and 
located eastwards, about 30km from Accra. The TGH was established in 1954 to provide health 
care services to staff of the Tema Port. Now, the hospital offers a 24-hour general and specialist 
services to the entire populace of Tema and surrounding communities. The hospital is also the 
main referral health facility for all other clinics/hospitals in the Metropolis. Apart from the 24- 
hour general medical services, a variety of health services are provided and available: in-patient 
and out-patient departments, internal medicine, obstetrics and gynaecology, as well as 
specialist and support services.   
 
3.4.2.3 Ga West Municipal hospital 
Ga West Municipal Hospital (GWMH) was established as a health centre in 1984 to provide 
health services to the inhabitants in that area. However, its status was converted to a Municipal 
hospital in 2008 to serve the high level of health care demands of the growing population in 
that catchment area. Ga West Municipal Hospital is the only public health facility located 
between Nsawam Government Hospital and Achimota Hospital.  
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The hospital offers a number of out-patient and in-patient services. The out-patient services 
include emergency recovery, dental, ear, nose and throat (ENT), reproductive and child health, 
laboratory, pharmacy, obstetrics and gynaecology, and eye care. The in-patient services 
provided include medical and emergency care, and gynaecological care. A number of private 
maternity clinics within the Municipality are affiliated with the Ga West Municipal Hospital. 
It also monitors and supervises some Community-based Health Planning and services (CHPS) 
compounds under its jurisdiction.                                                                                               
 
3.4.2.4 Maamobi General hospital 
Maamobi General Hospital, formerly Maamobi Polyclinic is a secondary level medical care 
facility located in the Ayawaso Sub-Metro of the Greater Accra Region. It is the biggest 
publicly owned health institution in the Sub-Metro. The hospital was upgraded from a 
polyclinic to a general hospital in 2011 in response to the high demand for services and 
increasing population in the Sub-Metro. A wide variety of health services are offered in the 
hospital: obstetrics and gynaecology, internal medicine, reproductive and child health services, 
dental, disease control, pharmacy, and laboratory services. Specialist Clinics including chest 
clinic, ENT and ultra-scan services are part of the range of services provided. 
 
3.4.3 Study population 
All women visiting the health facility for an elective/induced abortion, post-abortion care, post-
abortion follow-up, and post-abortion contraception uptake were eligible to participate in the 
study. Potential study participants were identified with assistance from the CAC provider who 
usually directed this category of women to the researcher and research assistants. Women 
visiting the health facility for a post-abortion family planning method were also identified with 
the assistance of the family planning providers. The health care providers in both instances 
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were very instrumental in recognizing, identifying, and recruiting the study participants. 
However, women visiting the hospital with a spontaneous or missed abortion, rape victims, 
and adolescents below age 15 were not eligible to participate in the study. 
  
3.4.4 Sample size determination 
A sample size estimation technique was used to estimate the sample size in this study due to 
the absence of finite figures for the target population in all the study sites. Although few 
abortion-related studies conducted in other contexts have used the sample size determination 
technique proposed by Lwanga and Lemeshow (1991) and Fisher et al. (1991, 1998) where N= 
(the proportion of the target population estimated to have a particular characteristic is 
unknown), this study adopted and utilized a different formula as N was already known. The 
formula for determining the sample size was: n= N/1+N (e)2                                                                                                                                        
Where n = the desired sample size; N= population size of elective/induced abortions in all 
hospitals for 2015; e = 0.05  
Substituting N into the equation, the desired sample size yielded:  
                                          n = 1,598/1+1,598 (0.05)2 = 319.9 (rounded to 320) 
A ten percent non-response rate was calculated on the final value (10/100 *320) to yield 350. 
The desired sample size for the study was 350. From this value, the sample size estimations for 
the five hospitals were computed.  
 
3.4.5 Sampling technique 
A two-stage approach was used in selecting the study facilities in the study. First, a list of health 
facilities providing CAC services in the Greater Accra Region was obtained from the Ghana 
Health Service (GHS). Within the list, health facilities which recorded a high number of 
elective/induced abortions (above 100 cases) during 2015 were selected.  
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Second, the selected health facilities were placed into their respective district zones to 
which they belonged. The zonal placement was to avoid overlapping of facilities located within 
the same zone and providing similar services. It was also to ensure that the high patient caseload 
being recorded was a reflection of patronage of CAC services at that specific facility and not a 
result of other similar competing medical facilities providing the same level of abortion-related 
care. In a few cases where two hospitals were located in the same zone, simple randomization 
was done. Selection was irrespective of the type of health facility, or level of care, or whether 
it is publicly or privately owned.  
The selection criteria (described in the preceding paragraph) was important for two 
main reasons: first, to increase the probability of obtaining large data across the selected 
facilities within the data collection period and second, to generate large sample size estimates 
in each of the selected health facility. After these two procedures were completed, the final list 
of facilities represented the chosen study facilities.  
 
3.4.6 Data collection instrument  
An eight-page questionnaire in English was developed from the themes derived from the 
qualitative data analysis (Appendix 3). Additional statements were included in the instrument 
to measure variables in the conceptual framework. The questions were mostly closed-ended.  
The first section covered participants’ socio-demographic characteristics. It included 
age, highest educational attainment, current schooling status, employment status, occupation, 
religious affiliation, ethnicity, place of residence, living arrangement, current marital status, 
duration of union, and number of living or surviving children.  
The second section focused on participants’ contraceptive practices in their lifetime. 
Questions were asked on level of knowledge of FP/contraceptives, attitude towards 
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FP/contraceptive use, contraceptive use before index pregnancy, and duration of contraceptive 
use prior to index pregnancy. Statements on the perception of benefits and barriers of 
contraceptive use were also included in this section. Statements were measured on a five-point 
Likert scale and participants were requested to strongly disagree (SD), disagree (D), neutral 
(N), agree (A), or strongly agree (SA) with these statements. 
In the third section, questions on participants’ reproductive history were captured. The 
reproductive health questions comprised of the following: pregnancy history, for instance, the 
number of pregnancies in their lifetime (including index pregnancy), number of induced 
abortions in lifetime (including index abortion), children ever born and children dead, 
stillbirths, number of miscarriages or spontaneous abortion, and gestational age of the index 
pregnancy. Additional questions included pregnancy intention and reasons for pregnancy 
termination.  
Section four comprised of partnership characteristics which were segmented into two 
parts. The first part focussed on the socio-demographic characteristics of the male partner 
responsible for the pregnancy. The questions included age, educational level, current schooling, 
employment status, occupation, religious affiliation, ethnicity, marital status, duration of union, 
number of living/surviving children and living arrangement. The second part pertained to the 
nature of relationship between the couple. The various relationship dynamics consisted of: 
relationship stability, duration and type of relationship, current relationship status, partner’s 
level of knowledge about contraceptives/FP, attitude towards contraceptive use, 
communication with partner on contraceptive use, and finally, male partner’s knowledge of the 
pregnancy. 
In the fifth section, study participants were asked to provide information on their 
partners’ involvement in the abortion. The questions related to the partners’ knowledge about 
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the abortion, the decision-maker on abortion, partners’ support for the abortion and attitude 
toward the abortion. In addition, the partners’ provision of various forms of support, and 
whether the partners’ support in the abortion will influence uptake of an FP method after the 
abortion were included.  
Perception statements concerning the severity of abortion and negative health 
outcomes, and self-efficacy of post-abortion contraceptive use were contained in the sixth 
section of the questionnaire. Participants were requested to strongly disagree (SD), disagree 
(D), neutral (N), agree (A), or strongly agree (SA) on these statements.   
The final part of the questionnaire was on post-abortion contraception uptake. This 
section aimed to examine study participants’ adoption of an FP method immediately after the 
abortion, and/or future intentions to use post-abortion contraception. Also, reasons for 
immediate FP uptake, type of FP method chosen and reasons for choice of method, and the 
decision-maker on post-abortion contraception initiation were explored. Other questions 
included whether the male partners’ involvement in the abortion will influence post-abortion 
FP uptake.  
 
3.4.6.1 Data collection procedure  
Primary data collection began concurrently in two hospitals, KBTH and TGH from January 
30th, to March 30th, 2017. This was after approval from the hospital’s management. Prior to the 
data collection, a reconnaissance survey was undertaken in each hospital in order to develop a 
recruitment strategy to collect data, establish rapport with the main abortion service providers, 
and determine the feasibility and duration of accessing data. 
Three research assistants were trained to administer the questionnaires in three 
hospitals. The research assistants were three female health workers: a nurse assistant, 
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laboratory technologist and a research field assistant. They were all less than 27 years with 
tertiary education except the nurse assistant who had secondary level of education. She had, 
however, previously worked in a hospital for two years as a nurse assistant and attended short 
courses in health management. The three research assistants were fluent in English, Akan and 
Ga except one. Training was organised on one-to-one basis and lasted for three days. It focused 
on: (i) the ethics of the study (with emphasis on voluntary participation, informed consent, risk, 
confidential and privacy of interview, and freedom to withdraw from study); (ii) familiarity 
with the questionnaire (iii) knowledge of subject matter (iv) pre-test session with researcher 
and (v) translation of questionnaires into Akan and ‘Ga’ to ensure familiarity and clarity of the 
questions with the aim of obtaining accurate responses from study participants. The 
questionnaires were pre-tested in the presence of the researcher.  
The strategy or approach for questionnaire administration differed in each hospital 
according to how CAC services were organized and provided in the facility. For instance, in 
KBTH, and TGH, abortion-related care was more structured and organized compared to 
GWMH and Maamobi Hospital. At KBTH, elective abortions were carried out at the 
Reproductive Health Centre (RHC), and post-abortion care for incomplete abortions was 
performed at a different ward (CHENARD). In both TGH and Maamobi, pregnancy 
terminations were done at the obstetrics and gynaecology11 wards; and in GWMH, abortions 
were done in three places: scan room, labour ward, and maternity ward/unit.     
Elective abortions were also performed by different medical health professionals in 
each facility. For example, whilst professionally trained midwives performed abortions in 
GWMH and Maamobi, only gynaecologists and medical doctors performed the procedure in 
KBTH and TGH. At TGH, clients undergoing an evacuation of uterus (EOU)12 had a reserved 
                                                          
11 Used interchangeably with maternity ward.  
12 Also synonymous with manual vacuum aspiration for pregnancy termination 
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seating area. The nurses usually informed and introduced clients waiting at the reserved seating 
area to interact with the female research assistant. At other times, the research assistant was 
ushered into the ward at the bedside of a woman who had undergone an abortion. Screening 
questions were used to confirm whether it was an elective abortion, or miscarriage before the 
interview started. Arrival at the facility was 9 am from Monday to Friday in order to avoid 
missing out on women who came for an abortion very early in the morning. Data collection 
lasted for a period of 37 days. The average number of interviews conducted daily was two (2). 
Comprehensive abortion care at KBTH was provided at the RHC. The centre offers 
other reproductive health services like cervical cancer screening, family planning services, and 
pelvic scan services. The building has three private counselling rooms, two procedure rooms, 
a conference room and offices, a store room, a kitchenette and washrooms. The centre has 
professionally trained three abortion care providers (all females) and a male gynaecologist. On 
entry at the centre, clients are asked the reason for their visit. They are then ushered into a 
waiting room area to have their vital statistics checked. Thereafter, they are directed into one 
of the private counselling rooms for a more detailed assessment and purpose of their visit and 
also, for further counselling. Women visiting the centre for an elective abortion are offered pre-
abortion counselling by one of three nurses who offer abortion care services.  
Potential participants were introduced to the researcher immediately after the end of 
pre-abortion counselling, and consenting participants were ushered into a private seating area 
to be interviewed. Sometimes, interviews were interrupted on the arrival of the gynaecologist. 
On few occasions, the nurse requested an exemption of some women undergoing an abortion 
due to circumstances surrounding the abortion, and on psychological grounds. An average of 
three (3) interviews were conducted within the first week.      
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Questionnaire administration at Maamobi General Hospital began in mid-February, 
2017. The head of nursing services and in-service coordinator enquired about the objective of 
the study, respondents involved, and procedure for administering questionnaires. The CAC 
provider was later introduced to the researcher and research assistant. Two midwives 
performed induced/elective abortions to women on request at the maternity unit. After being 
informed about the procedure for accessing abortion care services, it was agreed that 
recruitment of potential participants and administration of questionnaires would be done at the 
gynaecology unit. The research assistant was to log in and sign in a book which was in the 
custody of the nurse in-charge. She was also to report at 9 am from Monday to Friday.  
The total number of questionnaires administered after the first 25 days spent at 
Maamobi Hospital was six (6). During this period, one health worker revealed to the research 
assistant that some women visiting the hospital for elective abortions were redirected to another 
private hospital which was a few meters from the study site. Further explanation for this low 
response rate was sought from the CAC providers who reported that the number of women 
reporting for elective abortion was very low at that time of the year, and high numbers were 
recorded from June through September. In view of the low response rate obtained and little 
usable data within that period, data collection was abrogated.  
Fieldwork at GWMH began on March 14th and ended on September, 6th 2017. Since 
prior in-depth interviews had already been conducted at the site, navigating the questionnaire 
administration was flexible, except when client attendance or caseload was high (five or six at 
a time), and when the procedure was performed in succession. Other exceptions were when the 
abortion care provider performed the abortions very early in the mornings before 9 am, and at 
the labour ward without the researcher’s knowledge. Four (4) questionnaires were administered 
daily.  
 
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3.4.7 Measures  
3.4.7.1 Independent variable  
The key independent variable in the study was male partners’ involvement in abortion. Twelve 
types of partner involvement components were measured (Table 3.1). The dimensions which 
measured partner involvement were extracted from the qualitative results and from similar 
studies (Clark et al., 2008).  
The internal consistency for the 12 male involvement measures was done using Cronbach alpha 
(α). This yielded an alpha value of 0.87. The internal consistency for communication, 
emotional and instrumental support were separately done and the alpha values obtained were 
0.94, 0.80 and 0.69. No internal consistency analysis was performed for informational support 
because it had only one component.  
A simple linear regression was computed to determine the degree of relationship 
between the predictor and outcome variables to measure if the data was a good fit for the 
statistical modelling. A correlation coefficient value of 0.24 was obtained which indicated a 
weak relationship between the variables. The test of multicollinearity based on variance 
inflation score (VIF) was computed for the explanatory variables. High VIF scores (3.6-6.2) 
were obtained for all communicative support items and one item on emotional support. The 
high VIF scores indicated multicollinearity between communicative support variables. The 
KMO coefficient of sampling adequacy was computed and a value of 0.8 was obtained. This 
value indicated that the sampling is adequate for factor analysis. However, factor analysis was 
not done because the variable components were already too few to be reduced.  
A composite categorisation measure of male partner involvement was developed as: 
‘No involvement’, ‘Partial involvement’ and ‘High involvement’. No involvement indicated 
no receipt of support from the male partner and was scored “0”. Partial involvement indicated 
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the receipt of some support (either 1 or 2) on a partner involvement dimension; and high 
involvement indicated the receipt of all support (either 3 or 4). A composite categorisation of 
the male partner involvement measure was developed. This approach has been used in similar 
studies (Kavanaugh et al., 2012). 
TABLE 3. 1 SUMMARY MEASURES OF PARTNERS’ INVOLVEMENT IN ABORTION AND 
CORRESPONDING DIMENSIONS 
Instrumental   
Payment of abortion fee 
Purchased drugs for home abortion 
Provided money for transportation to hospital for abortion 
Partner accompanied woman to hospital for abortion 
 
Informational  
Partner provided information on place for abortion 
 
Emotional 
Partner encouragement not to be worried about abortion 
Partner expressed concern about abortion 
Partner expressed concern about health prior to abortion 
Partner expressed concern about sexual abstinence after abortion 
 
Communication  
Partner discussed post-abortion FP uptake  
Partner agreed on post-abortion FP uptake  
Partner approved post-abortion FP initiation  
 
  
3.4.7.2 Dependent variable 
The dependent variable of interest was post-abortion family planning uptake or non-uptake. It 
was measured as: “Yes”=1 (immediate adoption or uptake of a FP method at the health facility); 
“No”=2 (non-uptake of a post-abortion FP method immediately). These were dichotomized as 
(Yes=1, No=0) during the analysis.  
 
3.5 Data management 
All the survey questionnaires were sorted by checking for their completeness. Incompletely 
answered questionnaires were discarded while completed questionnaires were organised and 
entered into SPSS version 20. Only the researcher had access to the questionnaires. Data entry 
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and cleaning lasted for five weeks. Recoding of variables was done iteratively and was based 
on statistical reasons.  
 
3.5.1 Coding and recoding of variables 
The intermediate and control variables used in the regression analysis and corresponding 
coding are described in Table 3.2. Recoding of response categories for the socio-demographic 
and psychosocial variables was done prior to their inclusion in the models for analysis. 
Variables which were recoded were premised on statistical reasons with consideration on the 
counts in each category. In some instances, the response categories were condensed or 
collapsed into new response categories due to the few counts reported. Other response 
categories were merged and recoded.  
The self-perception statements were checked for unidimensionality and reverse coding was 
done where necessary. Reliability analysis was done using Cronbach’s alpha to check the 
internal consistency of the items prior to analysis. The statements on the perceived benefits of 
contraception yielded an alpha value of 0.8. Statements on the perceived barriers of 
contraceptives and perceived severity of abortion also yielded alpha values of 0.8 and 0.7 
respectively. With the statements on self-efficacy, an alpha value of 0.6 was obtained. 
All the self-perception statements were treated as continuous variables and scoring ranged from 
1 to the highest score of 30 and above.  
 
 
 
 
 
 
 
 
 
 
 
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TABLE 3. 2 CODED AND RECODED VARIABLES 
Variables  Measurement  Recoded categories 
 
Age  Age was treated as a continuous -- 
variable  
Highest 1= No Education, 2= Preschool,     1= Other13 education; 2= Primary, 
educational 3= Primary, 4= Middle/JHS      3= Middle/JHS; 4= 
level 5= Secondary/SHS, 6= Higher/ Secondary/SHS/Higher  
Tertiary, 7= Vocational,                 
8= Other (Specify) 
Occupation/ 1= No Occupation/Not Working     1= Unemployed  2= Employed 
Employment 2=Clerical, 3= Sales, 4= Self-
Employed, 5= Unskilled Manual, 
6= Managerial, 7= Household and 
Domestic, 8= Skilled Manual                                  
9= Other [Specify] 
Religious 1= No Religion, 2= Catholic       1= No Religion; 2= Orthodox;    
affiliation 3= Presbyterian, 4= Methodist, 5= 3= Pentecostal/ Charismatic;                
Pentecost/ Charismatic,                 4= Muslim 
6= Traditional/Spiritualist,          
7= Muslim, 8= Deeper Life                    
9= SDA, 10= Jehovah Witness                         
11= Anglican, 12= Other [Specify] 
Ethnicity  1= Akan,  2= Ga-Dangme,               1= Akan;  2= Ga-Dangme;               
3= Ewe, 4= Grusi, 5= Guan, 6= 3= Ewe; 4= Northern ethnic groups 
Gruma, 7= Mole-Dagbani,              
8= Hausa, 9= Other [Specify] 
Marital status 1= Never Married, 2= Currently 1= Never Married; 2= Currently 
Married, 3= Cohabiting, 4= Married; 3= Cohabiting; 
Divorced, 5=                                      4  =  Formerly married  
Widowed, 6= Separated 
Contraceptive 1= Very Knowledgeable,              1= Knowledgeable; 2= Somewhat 
knowledge 2= Knowledgeable, 3= Somewhat Knowledgeable; 3= Don’t care; 4= 
Knowledgeable, 4= Don’t care, Not Knowledgeable 
5= Not Knowledgeable, 6= Not 
Knowledgeable at all 
Attitudes 1= Very Favourable, 2= 1= Favourable; 2= Somewhat 
towards Favourable, 3= Somewhat Favourable; 3= Don’t care; 4= Not 
contraceptive Favourable, 4= Don’t care, 5= Not Favourable 
use Favourable, 6= Not Favourable at 
all 
 
 
 
 
                                                          
13 The ‘Other education’ category comprised of pre-school, primary, no education and ‘Don’t know’. These 
categories were merged because of the few counts in each category.  
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3.6 Data Analysis 
Analysis of data was performed at the univariate, bivariate, and multivariate levels. Univariate 
analysis was mainly descriptive statistics and expressed in frequencies, percentages and mean 
distribution. Bivariate analysis with cross-tabulations and chi-square tests were used to 
examine the association between the socio-demographic variables, reproductive and attitudinal 
factors with the outcome variable (uptake or non-uptake of PAFP). Binary logistic regression 
analysis was performed to determine the relationship between the predictor variables and 
outcome variable. Since the predictor variables was a mixed set of continuous and categorical 
variables whilst the outcome variable was dichotomous (either yes or no), the binary logistic 
model suited the analysis.  
Five regression models were computed in this study to determine interactive and joint 
effects between the independent and dependent variables. In the first model, the four 
dimensions of partner involvement in abortion (instrumental, informational, emotional, 
communication) were regressed on the outcome variable controlling for all other variables in 
the study. The second model comprised of the dependent variable, women’s socio-
demographic characteristics, and partner involvement variables. Model three examined the 
dependent variable, male partner socio-demographic characteristics and partner involvement 
variables. The fourth model examined the joint effects of all the socio-demographic 
characteristics and partner involvement variables on the outcome variable. The net model was 
the final regression modelling which included all the variables in the study.  
 
3.7 Ethical consideration 
Ethical clearance was obtained from the Ghana Health Service Ethical Review Committee 
(GHS-ERC) on 12th April, 2016 with GHS-ERC number GM 02/02/16 (Appendix 4). The 
GHS-ERC is an institutional body which provides ethical approval for all social science 
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research that are conducted in all Ghana Health Service facilities. Ethical approval ensures 
respect for the rights of all voluntary participants in the study; access to information from health 
facilities, and adherence to standard ethical guidelines and regulations in the conduct of 
scientific research. 
Permission was also sought from the Regional Director of Health Services within the 
Greater Accra Region since the selected health facilities were located in the region. An 
introductory letter from the researcher’s institute (Regional Institute for Population Studies) 
included as part of administrative procedures. Written informed consent of all study 
participants was obtained prior to commencing each interview (Appendix 5). Study participants 
either appended their signature or thumbprinted as proof of consent. Some ethical issues 
encountered during the qualitative interview phase revolved around emotional discomfort, 
informed consent and willingness to participate in the study, confidentiality, anonymity, and 
detailed or full disclosure of the study and benefits.  
No study participant was coerced to participate in the study. Unique identification 
numbers to conceal participants’ names and identity were also provided. In addition, study 
participants were assured that their responses to questions as well as their names will not be 
disclosed to the public or any other third party. An information sheet detailing participants’ 
rights was explained comprehensively and made available to them to keep (where necessary). 
Study respondents were informed on their rights to choose whether to respond to some 
questions or not and leave the interview without any reason.  
The nature of research questions caused emotional discomfort to a few study 
participants especially when participants had to recount past experiences and events that led to 
the decision-making process prior to the abortion, and also as they managed to balance their 
personal views on abortions, religious and social beliefs. In order to minimize respondents’ 
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emotional discomfort, questions were asked in soft low tone; ‘abortion’ was exchanged with 
‘pregnancy termination’, ‘get rid of it’, ‘remove it’ or ‘take it out’. Empathetic words were 
proffered (where necessary) to encourage responsiveness to the questions.  
In two separate situations where respondents’ emotional discomfort yielded no response after 
five minutes, the interview was discontinued.  
3.8 Study limitations  
Some limitations were encountered during the study which are worth stating. First, results of 
the study cannot be generalised to the entire population due to unrepresentativeness of the 
sample and non-random selection of the study sites. Second, the cross-sectional focus of the 
study prevents causality inferences to be made and inability to follow-up on women who had 
future intentions of using PAFP. Third, only individual-level factors from the Theory of 
Planned Behaviour and Health Belief Models were included in the regression modelling. 
Fourth, although participants were interviewed following the cessation of pain from the 
abortion procedure, their responses could potentially affect the validity of data. Thus, 
influencing the quality of data collected. 
 
  
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CHAPTER FOUR 
SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS 
4.1 Introduction  
The socio-demographic characteristics of women and their partners have been found to be 
associated with contraceptive use. This chapter presents the socio-demographic characteristics 
of all respondents who participated in both phases of the study. The results from the data 
collection are also featured in this section.   
 
4.2 Results from data collection 
A total of thirty-eight (38) women and three (3) male partners participated in the in-depth 
interviews during the qualitative phase of the study whilst three hundred and fifty-six (356) 
questionnaires were obtained during the survey data collection during the quantitative stage. 
Out of the 356 questionnaires, twenty-nine (29), representing eight percent were excluded due 
to incomplete demographic data (about themselves and/or their partners), and ineligibility of 
some participants. The remaining questionnaires, numbering 327 (92 percent) were included 
in the analysis. Table 4.1 depicts the sample size distribution in each hospital. The results in 
the table indicate that most (64 percent) questionnaires were administered at Ga West 
Municipal Hospital, followed by KBTH, TGH and Maamobi hospitals respectively.  
TABLE 4. 1 PERCENTAGE DISTRIBUTION OF SAMPLE SIZES ACROSS STUDY FACILITIES 
Hospital  N=327 Percentage  
KBTH 65 19.9 
TGH 47 14.4 
Ga West Municipal  209 63.9 
Maamobi  6 1.8 
Total  327 100.0 
Source: Field data, 2017 
 
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4.3 Incomplete interviews and refusals  
There were incomplete interviews during both phases of the data collection process. For 
instance, some respondents became unresponsive to the questions a few minutes into the 
interview without any reason. After successive questions yielded no response, the researcher 
ended the conversation. Possible reasons for this non-response could be due to anxiety, lack of 
trust, contextual factors, or whether the line of questioning provoked guilt or regret for their 
actions. Others refused participation after a detailed description of the study was provided. 
Also, the interviews ended when some respondents complained of mild abdominal pains 
midway during the interview. In addition, others declined participation on grounds of attending 
to their personal business, family matters, exhaustion, pain, time constraints and to avoid 
further exposure to ‘strangers’.  
Furthermore, five respondents refused participation in the interviews after the provider 
introduced the researcher. These women on observation were between ages 20 and 29. Last but 
not the least, a woman who was accompanied by her partner declined consent and participation 
in the study when approached directly by the researcher. She wished to be left alone.  
 
4.4 Socio-demographic characteristics of study participants  
4.4.1 Age distribution of respondents 
Of the total number of respondents who participated in the interviews, thirty-eight (38) were 
females and three (3) were male partners of three female participants. A little more than half 
of respondents were aged between 21 and 29 years. Twenty-four percent of respondents were 
less than 20 years and the youngest was 13 years. The proportion of participants between ages 
30 and 39 years was 18 percent.  
The age distribution of participants in the in-depth interviews and survey were comparable. 
The results in Figure 4.1 show that slightly more than half (53 percent) were between ages 20 
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and 29 years. The least age group of participants who reported for an abortion during the study 
were between 40 and 44 years old. The mean age of survey respondents was 27 years. The 
findings indicate that the incidence of abortion is highest for women aged 20 to 29 years 
compared to women in other age groups. The results also suggest that many women in their 
reproductive age are likely to consider pregnancy termination at a point in their lives 
irrespective of their age.  
FIGURE 4. 1 AGE DISTRIBUTION OF STUDY RESPONDENTS 
 
Age distribution of Age distribution of survey participants
35
 participants in the in-depth 
30
interviews
25
 15
20
10 15
 
10
5
5
 
0 0
15-19 20-24 25-29 30-34 35-39 40-44
 <15 15-19 20-24 25-29 30-34 35-39 40-44  
 
 
4.4.2 Educational status of respondents  
Figure 4.2 illustrates the educational status of respondents in the study. The findings show that 
a greater proportion of respondents in the study had received some formal education. For 
instance, among those interviewed during the IDIs, 34 percent had completed primary school, 
37 percent had had a secondary education and only 11 percent had completed tertiary 
education. Only eight percent had never attended school. For the surveyed respondents, 
however, the proportion of participants with no formal education was six percent; 21 percent 
had completed primary school, 35 percent had completed Junior High School (JHS) whilst 26 
percent had completed secondary education. Twelve percent had completed a tertiary 
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education.  In sum, the results indicate that education is nearly universal with at least, every 
study participant having some level of formal education.   
FIGURE 4. 2 EDUCATIONAL LEVEL OF RESPONDENTS 
 
Educational level of participants in In-
Ed
depth interviews Educautcioantiaoln laelv leelv oefl  souf rSvueryv ey 
resppaorntdiceinp  t
asnts 
 
35
 30
25
 20
15
10
 5
0
No Primary JHS SHS Tertiary
 education
  
 
 
4.4.3 Marital status of respondents 
Table 4.2 shows the current marital status of study respondents. Of the participants in the 
qualitative interview, majority (76 percent) were not married but were currently ‘dating’ or in 
intimate sexual relationships, and twenty-four percent were married. Slightly similar results 
were observed for the marital status of the survey respondents. The data presented in Table 4.2 
show that 51 percent of the surveyed respondents were never married; 30 percent were 
currently married; 17 percent were cohabiting and three percent had ever been married. The 
ever married respondents were either divorced, separated or widowed.  
These findings indicate that many pregnancies and subsequent abortions occur outside of 
formalised unions. When unintended pregnancies occur outside marital unions, the tendency is 
that it exposes unmarried and young women to a high risk of future unplanned births and 
possible abortions increasing the lifetime pregnancies. 
 
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TABLE 4. 2 MARITAL STATUS OF RESPONDENTS 
 In-depth interviews Survey 
Number  Percentage Number  Percentage  
Never married 29  76.3 165 50.5 
Currently married  9  23.7 98 29.9 
Cohabiting  -- -- 55 16.8 
Formerly married (Divorced/ -- -- 9 2.7 
separated or widowed) 
Total  38  100.0 327 100.0 
Source: Field data (2016-2017) 
 
4.4.4 Employment and type of occupation 
One-third of the participants in the in-depth interviews (Table 4.3) were not employed whilst 
the remaining were actively engaged in different income generating activities. Of the currently 
employed respondents, their occupations varied from sales, services, administrative/clerical 
and managerial, and domestic services. For instance, participants were traders, food vendors, 
and hairdressers. Thirteen percent were currently under apprenticeship.  
On the other hand, the results from the survey showed that the leading occupation were 
sales (27 percent) and services (26 percent). One-third of participants were however, 
unemployed. Other occupations in which participants were engaged in included unskilled 
manual jobs, managerial and administrative work, and household/domestic work. Employment 
status and the type of work indicate that at least many respondents are economically 
empowered, and therefore, have the ability to purchase and access less expensive family 
planning methods. The type of occupation respondents are also engaged in may influence their 
choice of contraceptive method because of cost implications.  
 
 
 
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TABLE 4. 3 OCCUPATION TYPE OF RESPONDENTS 
 In-depth interviews Survey  
Number  Percentage  Number  Percentage  
No occupation  12  31.6 98 29.9 
Sales 12  31.6 87 26.6 
Services  4  10.5 85 25.9 
Unskilled manual --- -- 15 4.6 
Managerial/Clerical/Administrative 3  7.9 6 1.8 
Household/domestic services 1  2.6 5 1.5 
Other  --- --- 31 9.5 
Apprenticeship  5  13.2 -- -- 
Not stated 1 2.6 -- -- 
Total  38  100.0 327 100.0 
Source: Field data (2016-2017) 
 
4.4.5 Religious affiliation of respondents 
The religious denominations which the study participants belonged to differed, but most 
belonged to the Christian Charismatic Faith. The data in Table 4.4 show that a greater 
proportion of respondents were Pentecostals or Charismatics compared to the Catholics, 
Anglican, Methodists, other Christians and Muslims.   
TABLE 4. 4 RELIGIOUS AFFILIATION OF RESPONDENTS   
 In-depth interviews Survey  
Number  Percentage  Number  Percentage  
Catholic  1  2.6 10 3.1 
Anglican/Methodist/Presbyterian 4  10.5 60 18.3 
Pentecostal/Charismatic 18  47.4 214 65.5 
Muslim 5  13.2 17 5.2 
Other Christian 4  10.5 25 7.7 
No religion -- -- 1 0.3 
Not stated 6 15.7 -- -- 
Total  32  100.0 327 100.0 
Source: Field data (2016-2017) 
Other Christian include Jehovah Witness, Deeper life, and Seventh Day Adventists. 
 
4.4.6 Ethnicity  
With regard to the ethnic groups of respondents in the study, results in Table 4.5 show that the 
highest percentage of respondents belong to the Akan ethnic group. This is followed by Ewe, 
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Ga-Dangme, and other ethnic groups. The ethnic variation in the study is characteristic of the 
ethnic composition in Ghana as evidenced from the 2014 Demographic Health Survey.  
TABLE 4. 5 ETHNICITY OF RESPONDENTS 
 In-depth interviews Survey  
Number  Percentage  Number  Percentage  
Akan 19  50.0 136 41.6 
Ga-Dangme 5  13.2 61 18.7 
Ewe 9  23.7 76 23.2 
Other northern ethnic groups 2  5.2 -- -- 
Other ethnic groups 1  2.6 54 16.6 
Not stated 2 5.2   
Total 38 100.0 327 100.0 
Source: Field data (2016-2017) 
 
4.4.7 Number of living children  
The number of living children that a couple has may influence their pregnancy intention, 
fertility desires, contraceptive behaviour and practice. Results from the study indicate that a 
high proportion of respondents have at least two children (Figure 4.3). Less than one-third of 
respondents had more than five children.  
FIGURE 4. 3 NUMBER OF LIVING CHILDREN OF RESPONDENTS 
 
Parity of participants in In-depth interviews Parity 
Parity of interviewees Parity of
o Sf uSurvrveeyy  rpeasrptiocinpdanetnst s
 5%
3%
 13% 25% 37%
0
45% 1--2
 3--5
39% 5+
33%
 
0 1--2 3--4 5+
  
 
4.4.8 Residential places of respondents 
Nearly all study participants resided in the Greater Accra Region, precisely within close 
geographical proximity to the health facility. Few women, however, stayed outside the 
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catchment area of the health facilities and they accessed health care at the facility through 
recommendation from friends and family members. Some women were residents from an 
adjoining town in the Eastern Region. Respondents remarked that their decision to access 
health care at the participating health facility was on referral from a health provider, or 
recommendation from close neighbours, friends, family members and staff of the hospital. 
Some reported that fear of being stigmatized by neighbours in their place of residence 
prevented them from accessing health care in their locality. The detailed sample characteristics 
of the In-depth interviewees are presented in Appendix 6. 
 
4.5 Socio- demographic characteristics of male partners 
With respect to the age distribution of respondents’ male partners, five percent reported having 
no knowledge of their partners’ age. The results showed that a greater proportion of male 
partners were between age 30 and 39 years (Table 4.6). The mean age was 33 years.  
TABLE 4. 6 AGE DISTRIBUTION OF MALE PARTNERS 
Characteristic  Number  Percentage 
Age    
18-24 39 11.9 
25-29 69 21.1 
30-34 64 19.6 
35-39 65 19.9 
40-44 44 13.5 
45+ 31 9.5 
*Not stated  15 4.6 
Total  327 100.0 
Source: Field data 2017 
There were slight variations in the educational status of male partners. For instance, a 
third had completed secondary school, whilst 24 and 25 percent had completed Middle/Junior 
High School (JHS) and tertiary education respectively. However, 11 percent of the respondents 
reported that they had no knowledge of the educational status of their partners.   
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Participants reported that nearly all (92 percent) of their partners were currently 
employed and engaged in different types of occupation. Twenty-two percent were employed 
in the service sector, whilst 39 percent were employed in skilled manual jobs such as drivers, 
painters, and construction workers. Less than 20 percent were working as professional and 
administrative personnel. Eight percent were, however, not working at the time of the study.  
The ethnic groups to which the male partners belonged to was almost similar to their 
female partners. Similar to the female respondents, a little less than half (47 percent) of male 
partners were Akan. This was followed by the Ewes, Ga-Dangme and other ethnic groups. The 
other ethnic groups consisted of Dagomba, Gruma, Kotokoli, Guan and Hausa. 
With respect to the religious denominations, most male partners belonged to the Pentecostal or 
Charismatic religious denomination. Sixteen percent were other Christians like Deeper Life, 
Jehovah Witness, and SDA, and only seven percent were Muslims. Study participants reported 
that 43 percent of their partners had never been married compared to 39 percent of respondents 
whose partners were married. Other respondents had male partners who had ever married and 
14 percent were cohabiting. Only one percent reported not knowing the marital status of their 
partners. The detailed socio-demographic characteristics are shown in Appendix 7. 
In summary, the sociodemographic characteristics of both female and male partners 
show a similar pattern except for slight variations in the age distribution. A high proportion of 
all the study respondents had received some basic formal education and higher, and more than 
half were currently engaged in some income generating activity. The proportion of unmarried 
male partners and female respondents are quite similar.  
Similar results regarding respondents’ ethnicity and religious affiliation compares favourably 
with the 2014 Demographic and Health Survey report. Compared to the male partners, the onset 
of sexual activity which resulted in the abortion begins early for the female partners. The results 
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also show that, for females, the onset of sexual activity begins early from age 20-29 and 
gradually reduces from age 30 to 39. In sum, the slight differentials in the age distribution of 
these female respondents with their male partners in informal unions is suggestive of the risky 
sexual practices of this group of women which raises concern about the likelihood of 
subsequent future pregnancies that may lead to abortions. 
 
 
    
 
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CHAPTER FIVE 
SEXUAL AND REPRODUCTIVE HEALTH BEHAVIOUR AND 
PARTNERSHIP CHARACTERISTICS OF RESPONDENTS 
5.1 Introduction  
This chapter presents the sexual and reproductive health behaviour and partnership 
characteristics of study respondents. The sexual and reproductive health profile which was 
examined in the study were reproductive history, contraceptive practices and pregnancy 
intention. The partnership characteristics focused on the nature of sexual relationship, 
relationship stability, and level of commitment to the relationship. 
 
5.2 Sexual and reproductive health behaviour  
5.2.1 Reproductive history 
The reproductive history of participants examined in the study include pregnancy history, 
abortion history, birth history and gestational age of pregnancy.  
 
5.2.1.1 Pregnancy history 
Participants were asked to report on all the pregnancies they had had in their lifetime since 
becoming sexually active including the current or index pregnancy. From Table 5.1, the results 
indicate that a greater proportion of study participants had more than two children compared 
to less than one-third of all participants who reported the pregnancy as the first.  
    TABLE 5. 1 PREGNANCY HISTORY OF RESPONDENTS 
Number of lifetime In-depth interviews Survey  
pregnancies N % N  % 
1 11  28.9 89 27.2 
2-3 17  44.7 98 30.0 
4-5 8  21.1 75 23.0 
6+ 2  5.3 65 19.8 
Total 38  100.0 327 100.0 
  Source: Field data, 2016-2017 
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5.2.1.2 Abortion history of respondents 
Figure 5.1 shows the abortion history of participants in the study. Respondents were asked to 
report the number of pregnancies they had terminated in their lifetime by themselves at home 
or elsewhere, or by someone else since they became sexually active. From Figure 5.1, the 
proportion of respondents having their index abortion was higher (71 percent) among the in-
depth interviewees compared to the survey respondents (62 percent). It was the first time of 
terminating a pregnancy in their lifetime.  
FIGURE 5. 1 ABORTION HISTORY OF PARTICIPANTS  
 
Number of lifetime abortions of Number of lifetime abortions of 
In-depth interviewees Survey respondents
 
 
13%
 3%
26%
1 1
 25%
2
71% 2 62%
 3+ 3+
 
 
  
 
 
The number of pregnancies and induced abortions is an important reproductive feature of 
women in their reproductive age. These results suggest that at least, every sexually active 
woman is potentially at risk of having an intended or unintended pregnancy in her lifetime. 
Unintended pregnancies are likely to end in an abortion than planned pregnancies. Several 
possible explanations ranging from personal and non-personal factors may account for having 
an abortion. For instance, the narratives confirmed that some participants terminated the 
pregnancy because of lack of readiness for the pregnancy, educational aspirations, financial 
constraints, young age and partner-related problems. In addition, poor contraceptive behaviour, 
lack of contraceptive knowledge and practice, lack of contraceptive use, inconsistent 
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contraceptive use, and using traditional methods of pregnancy prevention may have resulted in 
the pregnancies and subsequent abortion. 
  
5.2.1.3 Gestational age of pregnancy 
Table 5.2 presents the gestational age of pregnancy of study participants. The data presented 
in the table indicate that nearly all the pregnancies reported by participants were first trimester 
pregnancies. This means that most respondents visited the hospital to terminate their 
pregnancies within twelve weeks of the pregnancy. Compared to second trimester abortions, 
the proportion of participants whose pregnancies were terminated during the second trimester 
was small.  
        TABLE 5. 2 GESTATIONAL AGE OF PREGNANCY OF PARTICIPANTS 
Number of weeks of In-depth interviews Survey  
pregnancy N  % N  % 
4 weeks -- -- 71 21.7 
5-8 weeks 30  78.9 178 54.4 
9- 12 weeks 5  13.2 49 15.0 
>12 weeks 1  2.6 24 7.3 
Not stated 2 5.3 5 1.5 
Total 38 100.0 327 100.0 
     Source: Field data, 2016-2017  
 
The results suggest that a large number of abortions are done within the first trimester, 
specifically, eight weeks of pregnancy. A possible explanation could be that the timing and 
receipt of the abortion-related care coincide with the end of the abortion decision-making 
process. The findings suggest that there is no limit to having an induced abortion irrespective 
of the gestational age of the pregnancy. 
 
5.3 Contraceptive practices before abortion 
A combination of modern family planning, natural family planning methods, alternative herbal 
medicines and emergency contraceptive pills were used by participants to prevent pregnancy 
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in the study. The types of contraception used by respondents are discussed in the subsequent 
paragraphs. 
 
5.3.1 Use of emergency contraceptive pills 
Results from the study indicate that almost all the participants were using a contraceptive 
method prior to the abortion. The analysis showed that 36 percent of the survey respondents 
were using emergency contraceptive (EC) pills, while almost one-third of the in-depth 
interviewees were also currently using emergency contraceptives as their main method of 
pregnancy prevention. Respondents were asked to mention the name of the EC pills they 
ingested as a way to assess their knowledge of these pills14. The branded types of EC reportedly 
used by participants were ‘Postinor 2’, ‘Leno’, ‘N-tablet’, ‘Lydia’ and ‘Potex’. The mode of 
contraceptive administration and timing of contraceptive use differed among respondents. One 
respondent reported in the following words:  
“Yes I took medicine but still got pregnant. I took an antibiotic which had only one 
tablet. The only one I know is what I have told you and I have forgotten the name. It is 
only one tablet in a small box. When you take it this week you take another one the 
following week” (27 year-old woman with one child).  
 
Some respondents experienced contraceptive failure after ingesting the emergency 
contraceptive pills before 72 hours after sexual intercourse whilst others took it prior to sex. 
Two participants narrated their past experience with the emergency pills and how it had failed 
them. They said:   
“We were using medicine called postinor 2, but it failed me; that was how I had my 
first born. I took this same postinor 2 and I got pregnant this time again. I took two 
tablets the first and second day.” (22 year-old woman with one child). 
“I was using leno. Because he is usually not around, when he comes around and we 
have sex, I use leno. I take it after sex before 72 hours. But this time, it failed me. I 
                                                          
14 Some of the respondents could not mention and remember the name of the medicines they ingested to 
prevent pregnancy. It was quite worrying to find out that they lacked knowledge of these things because it had 
been recommended to them by their peers. This has far reaching implications for their reproductive health. 
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didn’t take it on time. I took it after more than two days. We went out of town to the 
village and it was more than 48 hours. So because it was less than 72 hours I thought 
it will work” (31 year-old woman with one child). 
 
However, a few of the participants reportedly failed to take a birth control method leading to 
the pregnancy and abortion. Although participants displayed some knowledge about 
contraceptives, the reason for not using a contraceptive method was because of rumours about 
the side-effects. One participant explained as follows:  
“I didn’t take a post-pill. I have heard that taking too much of it is bad. [Pause]. When 
we had sex, I didn’t think it was going to end up this way even though I should have 
taken the necessary precaution (21 year-old girl). 
 
Another respondent also reported: 
“I know this natural method where you read your cycle to know your safe period. And 
when you have sex in your safe period, you won’t get pregnant. But I have heard of 
postinor from friends at school. I know of postinor. Sometimes friends even ask you to 
buy it for them and mostly it works out. But this time round in my case, come what may, 
I was prepared to face anything” (26 year- old girl). 
 
These contraceptive practices by respondents indicate that a greater proportion of respondents 
are aware of emergency pills. Awareness of and subsequent use of emergency pills may be due 
to its acceptability, knowledge and preference as some studies have suggested (Goulard et al., 
2006). These revelations also suggest that although measures were taken to prevent conception, 
participants’ contraception methods did not provide the maximum protection against 
unintended pregnancy. It is also plausible that respondents may not have had accurate and 
comprehensive information about emergency contraceptives and for that matter, they may have 
substituted emergency pills with oral contraceptive pills which they used regularly as birth 
prevention methods. However, regular use of emergency pills might result in failure and expose 
respondents to the risk of unintended pregnancy when the mode of prescription and 
administration is incorrect or untimely. 
 
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5.3.2 Use of modern contraceptive methods 
The oral contraceptive pills (OCP), male condoms and injectables were the only modern types 
of contraceptives being practised by participants in the study. The proportion of survey 
respondents who used oral contraceptive pills was 22 percent and two percent used injectable 
before becoming pregnant. There was no respondent who mentioned ingesting oral 
contraceptive pills and injectable during the in-depth interview. The male condom was also 
mentioned by some respondents as their method of contraception prior to conception and the 
abortion. Furthermore, the findings showed that there was a slightly high number of male 
condom users in the in-depth interviews than in the survey (18 percent versus 11 percent). 
Some in-depth interviewees reported that they experienced a burst condom during sex while 
others were inconsistent condom users. A 26 year-old woman reported that:   
 “We were using a condom and it got burst. I felt that something had gone inside of me. 
But he said it hadn’t burst but I felt that something had gone inside of me. But when we 
finished we realized it had burst”. 
 
Another participant reported that her partner preferred to use male condoms but because of the 
discomfort she experienced during sex, she suggested to the partner not to use it. She stated:  
“He uses the condom but when he uses it, then he removes it. He removes it 
himself then continues. It is because I said I don’t like it that’s why” (21 year-
old girl). 
 
Two of the male respondents who were interviewed also shared their contraceptive 
experiences. One of them reported that they used condoms inconsistently and they combined 
with the calendar/rhythm method occasionally. He narrated in the following words: 
“We use to buy a condom. Actually, we haven’t had fun all the time and it was only 
once I didn’t use a condom. She confirmed that I didn’t use a condom the last time” (23 
year-old male partner). 
 
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Another male partner also reported his dislike for using the condoms. He and his partner 
therefore switched to use emergency pills. He averred that:  
“Talking about contraceptives doesn't really come up when we chat. However, during 
intercourse, I tried using the condom but I just don't like it. I have gone to buy some 
from the drug store. I used it and removed it later on. I just don't like it. I don't feel 
anything” (23 year-old male partner). 
 
From the narratives, it appears that inconsistent condom use resulted in participants becoming 
pregnant. Other factors which can be adduced from respondents’ contraceptive behaviour relate 
to personal characteristics such as attitudes, partner influences and sexual satisfaction (Raine, 
Minnis and Padian, 2003; Sayegh et al., 2006). This finding is consistent with other studies 
which found that dislike for a particular contraceptive method was associated with condom use 
(Sayegh et al., 2006; Frost and Darroch, 2008). While sexual satisfaction is important in 
fostering sexual intimacy in a sexual dyad, the risk of unintended pregnancy is high when 
condoms are inconsistently used. Method failure could also result when condoms are 
incorrectly used, increasing the risk of unplanned pregnancy. 
 
5.3.3 Use of traditional or natural family planning method (NFP) 
The proportion of participants using traditional methods to prevent pregnancy in the study was 
nearly the same when compared to participants using all the other forms of modern 
contraception except the emergency pill. Eleven percent of all the study respondents relied on 
the rhythm or calendar method which is a natural family planning method (NFP). Participants 
who relied on the rhythm/calendar NFP method to avoid pregnancy shared their knowledge 
about their fertile and infertile days when they were asked. They reported avoiding sex during 
“fertile” or unsafe days. They reported that their choice of family planning method was based 
on previous use and knowledge. One of them said:  
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“I know this natural method where you read your cycle to know your safe period. So 
when you have sex during your safe period, you won’t become pregnant. The last time 
I had my menses was 16th of July and my menstrual cycle is 28 days. My safe period 
will start from 16th to 25th but with this very one, the day I had sex, I knew I was going 
to get pregnant” (26 year-old girl).     
 
Results from the survey showed that 22 percent of respondents practised the ‘withdrawal’ 
method compared with only eight percent of those who participated in the in-depth interviews. 
A 23 year-old woman commented:  
 “He didn’t release the sperm inside me, all came out. But I don’t know how it 
happened. A lot of sperms came out”. 
 
Furthermore, less than five percent of the participants in the study were currently using 
lactational amenorrhea method (LAM) as a birth control method. During the narratives, it was 
found that respondents did not anticipate getting pregnant because of past experience with the 
LAM method, and also because their children were very young. Joyce’s second child was less 
than eight months old when she discovered that she was pregnant. She averred that:  
“After the birth of the first born, I did not have my menses for 6 months. Then with this 
second child too, after delivery for about 6 months, I didn’t experience my menses. I 
waited but no menses came. So I went to buy pregnancy test. When I tested, I was 
pregnant” (27 year-old woman with two children). 
 
Catherine also had a one-year old child and she combined breastfeeding and withdrawal 
method. She expressed fears of adopting an intrauterine device compared to other hormonal 
family planning methods. She admitted being shocked at the news of the pregnancy. She 
narrated:  
“When we have sex, he doesn’t put the sperms inside me [laughs]. He withdraws. When 
I stopped the family planning some years ago, that was what he was doing before we 
had this child. Every day, I say I will come and do family planning but I have not been 
able to do so” (32 year old woman with three children). 
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Some respondents combined traditional methods and modern family planning methods, for 
example, withdrawal and condoms, whilst others used condoms and EC. Besides using these 
ineffective pregnancy prevention methods, respondents admitted having unprotected sex 
occasionally. Rita, an 18 year-old girl was unknowingly combining methods because of her lack 
of knowledge about conception. She said:   
“I know I don’t have much education on pregnancy but I thought everything will go on 
well. So I didn’t take anything to protect myself. 
 
In another vein, she said: 
 
 “I have been taking pills for some months when I intend to have sex. After sex, I take 
the pills for some three days’ and everything will be okay” 
 
In another situation, a respondent relied on the rhythm method and withdrawal because of her 
perceived fear of infertility which could result through using emergency pills.  
“I check my safe days and the unsafe days, but this time it failed. There are some days 
he does withdrawal” --- 21 year-old student 
 
Study participants practising NFP can be described as having an unmet need for modern 
contraception. This is because their current contraceptive practices place them at high risk for 
unintended pregnancies. It is possible that participants who practised LAM had misconceptions 
about their return to fertility after breast feeding (Kouyate et al., 2015), or they unknowingly 
delayed transitioning to adopt modern family planning methods (Bongiovanni et al., 2005). 
Furthermore, these revelations raise questions about inconsistent, and a possibly incorrect 
pattern of pregnancy preventive behaviours which might consequently lead to more unintended 
pregnancies in the future.  
5.3.4 No contraceptive use 
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Although most respondents in the study were practising some method of pregnancy prevention 
prior to the abortion, others were not practising any contraception. Of the participants who 
were surveyed, 17 percent had had unprotected sex during their last sexual encounter. 
Similarly, a few of the in-depth interviewees disclosed their lack of contraceptive use during 
their last sex. The lack of contraceptive use was due to infrequent sexual intercourse and 
irregular availability of the male partner. A 28 year-old mother of four children narrated:  
“As for me I wasn’t using anything to prevent pregnancy. I didn’t know I could become 
pregnant because he doesn’t stay here. He goes away for a long time before he 
returns”. 
 
Another respondent also mentioned her dislike for modern contraception because of the side-
effects associated with its use. In her view, she and her partner were willing to be parents if a 
pregnancy occurred. She narrated:  
“Contraception are something I have never wanted to use because of what people say 
about it especially the side effects. I had always told myself that whatever happens, I 
was going to give birth. He doesn’t like using a condom. He said [pause] he doesn’t 
like it, and we were okay because I knew I was the only lady he has, and I knew he was 
my only man. We talk about kids and marriage. So why then should we protect 
ourselves? At least, he is 32 and I’m 26 and we are old enough to give birth so there 
was no need” (26 year-old girl). 
 
Lack of contraceptive use in intimate sexual relationships most often increases a 
woman’s risk of having an unintended pregnancy. Non-contraceptive users may also be termed 
as sexual risk takers since their sexual activities are unprotected. What these results seem to 
suggest is that, contraceptive behaviours of individuals are complex and influenced by several 
factors. Consistent with the literature on determinants of contraceptive use, individual factors, 
interpersonal, socio-cultural belief systems, myths and misconception, attributes of 
contraceptive types, as well as health system factors account for contraceptive use (Madden et 
al., 2015; Sundstrom, Baker-Whitcomb and DeMaria, 2015; Pritt, Norris and Berlan, 2017).  
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The results also suggest that respondents’ contraceptive choices are motivated by their 
current partnership arrangements and coital frequency. For instance, some studies have found 
that the presence of male partners, frequency of sexual activity, personal preference for a 
specific type of contraceptive method, and knowledge of pregnancy prevention methods may 
influence contraceptive method choice and use in sexual relationships (Frost and Darroch, 
2008). In addition, the perception of potential side-effects such as infertility or delayed fertility, 
fear of partner finding out about contraceptive use, partner disapproval of contraceptive use, 
lack of economic resources to purchase contraceptives and inability to correctly use 
contraception may work as barriers to using contraception. Consequently, a high unmet need 
for modern contraception may perpetuate leading to a cycle of unintended pregnancies and 
abortion.  
These findings lend support to other studies which have found a high unmet need for 
contraception among women of reproductive ages (Sedgh and Hussain, 2014). The findings 
can also be explained in light of the theory of Planned Behaviour (TPB) and the HBM. For 
instance, the TPB posits that an individual’s attitude, subjective norm, perceived behavioural 
control and behavioural intention culminate to influence the performance of specific positive 
behaviours. In this regard, it is likely that study respondents who failed to use contraception 
prior to the abortion, as well as those who practised ineffective contraceptive methods did so 
because of their undesirable or unfavourable attitude towards modern contraception, and lack 
of personal autonomy in contraceptive decision-making. 
In the Ghanaian context where pro-natalist ideologies are upheld, individuals are likely 
to value societal misconceptions, myths and beliefs which demonize modern birth regulation 
methods. The implication is that with several of these factors regulating, shaping and 
influencing the reproductive behaviours and practices of respondents, they will begin to adopt 
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ambivalent attitudes, or negative attitudes to birth control methods which are effective in 
preventing pregnancies and abortions.  
 
5.4 Partnership characteristics 
5.4.1 Nature of relationship with sexual partner 
Pregnancy (intended or unintended) and abortion usually occur between a man and a woman 
in the context of an ongoing relationship. The quality and dimensions of the dyadic relationship 
might determine a pregnancy outcome. Relationship quality, with reference to relationship 
length, stability, commitment and satisfaction potentially increases the likelihood of male 
involvement and support during an unintended pregnancy. In this study, dimensions of the 
dyadic relationship explored were: type and duration of the relationship, relationship stability, 
and level of commitment to the relationship. The indicators which constitute the various 
dimensions of the nature of the relationship are organized and diagrammatically presented in 
the ensuing sections. 
 
5.4.1.1 Relationship type and duration of the partnership 
Two-thirds of the in-depth interviewees were in intimate sexual relationships or ‘dating’ at the 
time of the study; less than a third were married and few were cohabiting. Of the interviewees 
who were dating, they described their partners as their boyfriends, whilst others reported that 
their partners were their ‘husbands to be’ or fiancé. Three couples were interviewed during the 
in-depth interviews; one was married, while the other two were unmarried. One couple 
admitted cohabiting occasionally. The shortest duration of the relationship participants were 
involved in was three months, and the longest was 16 years.  
Compared to the survey participants, exactly half (50 percent) described their partners 
as their boyfriends; 34 percent said that their partners were their husbands and nine percent had 
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fiancés. Less than five percent described their partners as their friends, casual acquaintance, 
relative or just any other person. The results of bivariate analysis showed a high variation 
between relationship type and duration among the surveyed respondents (Table 5.3). 
From Table 5.3, type of relationship differed with the length of years in the relationship. 
For instance, a higher proportion of respondents who had boyfriends were in unions of less 
than a year compared to those who had been in a relationship for more than six years and above 
(48 percent versus 4 percent). For respondents whose partners were their husbands, a greater 
proportion of them had been in longer unions of six years and above (60 percent) than fewer 
of them. So duration of the union or relationship increases depending on whether the 
respondent had a husband compared to when respondents had boyfriends.   
TABLE 5. 3 ASSOCIATION BETWEEN TYPE OF RELATIONSHIP AND DURATION OF 
RELATIONSHIP   
 Duration of relationship 
Less than a 1- 2 years 3- 5 years 6 years and Total 
year above 
Relationship type      
                  Boyfriend  47.9% 27% 20.9% 4.3% 100% 
                  Husband  3.6% 8.9% 20.5% 60% 100% 
                  Fiancé  24.1% 41.4% 31% 3.4% 100% 
                 Others  47.8% 13% 4.3% 34.8% 100% 
Source: Field data, 2016-2017; N=327; X2 =167.340** degrees of freedom = 9; **p <0.001 
  The results in Table 5.3 indicate that many respondents in the study were unmarried 
and involved in romantic sexual relationships. The findings also reveal that heterogeneity exists 
among sexual relationships and this varies with the length or duration of the unions. A number 
of studies have found that the type, stage and duration of sexual partnerships have several 
implications for contraceptive decision-making, contraceptive method choice and pregnancy 
outcomes (Kusunoki and Upchurch, 2011; Manlove et al., 2014; Osei et al., 2014). Depending 
on the stage and duration of the relationship, the motivation to terminate an unintended 
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pregnancy may be weighed as high or low if both partners are not ready, or financially 
constrained. Partners who for example consider their relationships to be casual or transient or 
short-term or as a means to an end may be more likely to end a pregnancy than couples who 
have higher expectations of continuing their relationship. 
 
5.4.1.2 Relationship stability 
Respondents were asked to describe the stability of their relationship and whether it was stable 
or unstable. The results showed that a high proportion of those interviewed in the study reported 
that they were in what they characterised as stable relationships. On the other hand, 71 percent 
of the surveyed respondents reported that their current partnership was stable, whilst 13 percent 
said that they were in somewhat stable relationships. Sixteen percent were however not in 
stable relationships as at the time of the study. The factors or themes which constitute 
relationship stability is presented in Figure 5.2. 
FIGURE 5.2 DIAGRAM DEPICTING INDICATORS OF RELATIONSHIP STABILITY 
 
RELATIONSHIP 
 STABILITY 
 
STABLE  UNSTABLE  
 
Characteristics of stable 
Characteristics of unstable 
relationship 
 relationship - Relationship commitment 
- Negative partner attributes 
- Loving and supportive 
- Infidelity 
 partners - Partner irresponsibility 
- Promise of marriage 
- Partner deception of marital 
- Mutual understanding 
 status - Absence of relationship 
- Unsupportive partner 
conflicts 
- Partner abandonment  
- Fidelity 
   
- Partner’s awareness of 
relationship 
  
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Participants were asked the reasons for describing their relationship as stable and attributes like 
commitment, loving, understanding and supportive partners were mentioned as indicators of 
relationship stability. A 39 year-old woman simply responded that “we love each other, we 
understand each other, and we do things together”. Other respondents viewed their 
relationships as stable because of the promise of marriage. Two of them stated: 
“I say it’s stable because he told me that he will marry me. He is a Moslem and my dad 
says I should find a man who is a Moslem to marry me. So when it happened like that I 
told my parents. So my parents know about the pregnancy and my partner said he wants 
me to finish learning my trade first before giving birth so that in future when he needs 
support, I can assist him” (21 year-old girl). 
 
“It is because sometimes he says he will buy the items for the marriage that’s why I 
think he is serious” (23 year-old girl). 
 
Still on relationship stability, other respondents mentioned the absence of relationship 
conflicts, provision of financial support, and jointly engaging in activities to be primary 
indicators of their stable relationship. Some of them opined as follows:  
“Our relationship is stable. It is stable because he is not someone who is haphazard, 
he isn’t a liar, he is committed to his promise and he assists me. For instance, when I’m 
in need of finances. I also assist him” (26 year-old woman with one child). 
 
“Our relationship is stable because he doesn't quarrel with me, even if I want anything 
he gives it to me” (39 year-old woman with four children). 
 
Others commented that their partners’ fidelity to the relationship overtime was a positive 
indicator of a stable relationship. One respondent averred by saying:  
“He is not a womanizer although he travels a lot. If it were to be some other men, they 
will lose interest. But I have come to realize in so many things that he cares for me” 
(31 year-old woman with one child). 
 
In addition, some respondents including two married women found it difficult to identify 
characteristics they considered as indicators of their stable relationship. They averred that 
everything in their relationship was ‘normal’ or ‘fine’. They averred: 
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“Our relationship is stable, hmm. We don’t fight ... Nothing. I don't know what to even 
say (21 year-old girl). 
 
“Hmm, I don’t know how to describe it but then it’s stable. I don’t know how you want 
me to explain it” (29 year-old mother with two children). 
 
During the narratives, two of the three male partners interviewed stated that partner fidelity, 
and parental awareness of the relationship were fundamental attributes of their stable 
relationship. Two of them reported: 
“Our relationship is stable in the sense that talking from my perspective, I don't cheat 
on her” (23 year-old male partner). 
 
“The relationship is stable. First of all when I met her, I didn’t hesitate to go to her 
parents. I took her to my family too, my house. So in anything that we do, both families 
are aware that we are living together --- 23 year-old male partner 
 
On the other hand, nearly one-third of participants in the in-depth interviews and 16 percent of 
the respondents in the survey reported being in unstable relationships at the time of having the 
abortion. The participants narrated that their relationship became unstable from the time of 
pregnancy discovery until the abortion decision-making. Half of the in-depth interviewees in 
unstable relationships intended to end the relationship after the abortion whilst few of them 
actually mentioned that their relationship was over. Other respondents had communicated their 
intention to quit the relationship, but their partners disagreed.  
A few of these respondents in unstable relationships based their decision to end the relationship 
on partner-related grounds, specifically their partners’ negative attributes and behaviour, 
infidelity, and irresponsibility. Three respondents had this to say:  
“For now our relationship is not stable, [laughing]. He is crazy! I don’t like the way 
he behaves. I just don’t like him; the way he behaves. That is why I want to terminate 
it” (26 year-old woman with two children). 
 
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“It was stable. Actually I knew things were working, everything was going to be alright 
until the pregnancy happened. I didn’t know he had kids” (26 year-old woman).  
 
“I’m not sure the relationship is stable. I planned that after this abortion, I will stop 
the relationship because, from the beginning he did not tell me that he is married. I 
came to find out” (23 year-old woman with one child). 
  
Suzie15 (not her real name), a 19 year-old girl reported that she would end the relationship with 
her partner after the abortion because of her partner’s threat of denying responsibility for the 
pregnancy. In her frustration, she purchased some medicine for a home abortion but failed. She 
narrated saying:  
“As for me I was ready to give birth. When this pregnancy happened, he was joking 
with me that’s why I took that medicine. Sometimes, he will say that if I fool, he will 
deny responsibility of the pregnancy. So I think that he was not serious of taking 
responsibility for the pregnancy. That’s why I took the medicine” (19 year-old girl). 
Others based their decision to end the relationship on grounds of deception of their partners’ 
marital status. In their view, the ‘law of karma’ or the universal ‘neighbour’ principle16 were 
guiding principles to end the union. They further wanted to avoid the situation of becoming a 
second marriage partner, hence their decision to quit the relationship after the abortion. A 
participant explained:  
“I didn’t know at first. I came to know later that he has a wife and children, and I can’t 
have children with him. So after this abortion, I’m going to end it with him” (23 year-
old woman with one child). 
 
“I told him to end the relationship so if he gives me money now I don't take it. I told 
him that I cannot continue with him. The painful thing is that he hasn't performed her 
marriage rites but wants to perform mine. He is part of the reason why I'm terminating 
this pregnancy. He wants to have my list for the engagement. I told him that we should 
end it because my family doesn't accept second marriages. He can get another woman 
to marry if he wants one but I have stopped the relationship with him” (27 year-old 
woman with three children). 
 
                                                          
15 All names used to report the narratives are pseudonyms.  
16 ‘Do unto others what you want others to do unto you’ 
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Others reported that their partners’ sudden disappearance after the pregnancy disclosure, 
abandonment, and lack of support during the pregnancy resolution process influenced their 
decisions to terminate the pregnancy. In their view, the relationship was over. One of them 
said:  
“Right now, we are no more in a relationship. I aborted it because I don't hear from 
him, I don’t see him. I have been to his house but haven't heard from him” (27 year-old 
woman with one child).  
 
Furthermore, the narratives revealed that the male partners’ non-provision of funds for the cost 
of abortion created the condition for an unstable relationship. In two different instances, some 
respondents reported that their relationship was unstable because their partners failed to 
provide funds for the cost of the abortion. For one participant, her partners’ request for an 
abortion without her consent fuelled his decision to withhold financial support towards the 
abortion. She narrated: 
“I was expecting him to tell me something. Any time I mention this pregnancy, he won’t 
get money for me but when I stop complaining about the pregnancy, he will get money 
for me. At least if you don’t have money for the pregnancy, just find half of it and give 
it to me; but nothing at all. I was really hurt. I really don’t want him to see me. Three 
days now I have not seen him and don’t want him to see me again” (22 year-old girl). 
 
In Matilda’s case, she opposed the decision to continue the pregnancy against her partner’s 
wishes. She also had to use her personal money for the abortion without the knowledge of her 
partner since he initially refused to provide funds for the abortion. She stated:  
“When he came I told him of the problem and asked him what we are going to 
do. He told me to keep it. I said nothing. He wanted me to keep it but I didn’t 
want to keep it. So I asked him to give me money to have an abortion but he 
refused to give me money. I persisted but he refused to give me money for the 
abortion” (31 year-old with one child). 
 
The foregoing indicate that, unstable relationships contribute to pregnancy termination in 
dyadic relationships. This finding is corroborated by other studies which found that beside the 
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sexual dyad, partner characteristics were associated with intentions to end a pregnancy 
(Kusunoki and Upchurch, 2011; Manlove et al., 2014; Osei et al., 2014). From the study, 
respondents considered the undesirable attitudes of their partners, mistrust and infidelity, 
inability to obtain financial resources and support from their partner as critical to end their 
pregnancies. For such women, the desire to have a child or continue a pregnancy in unstable 
unions may impose burden of childcare, financial constraints and other hardships which is 
unplanned for. They may also consider societal normative expectations of childbearing outside 
of wedlock and decide to terminate the pregnancy.  
However, in the context of stable dyadic unions, the desire to end an unintended pregnancy 
may be ascribed to other socio-economic factors, and social desirability determinants other 
than partner attributes. Pregnancy resolutions in stable unions are more likely to have mutual 
basis and shared/joint responsibility than in unstable relationships.   
 
5.4.1.3 Level of relationship commitment  
The level of couples’ commitment in a dyadic relationship is a strong component of a stable 
relationship. Most theorists have demonstrated through several studies that relationship 
commitment is a multidimensional construct with three main components: affective, cognitive, 
and conative (Arriaga and Agnew, 2001). In this study, relationship commitment was described 
as a strong personal intention to continue a sexual relationship. The various themes which 
characterised level of commitment is diagrammatically presented in figure 5.2.  
 
 
 
 
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Figure 5.2: Figure showing thematic areas of Relationship commitment 
 
 
RELATIONSHIP Affective and 
COMMITMENT   psychological factors 
 - Love 
- Likeness/ fondness  
  
Positive personality 
attributes of male partner 
 
- Fidelity  Attributes of the 
- Attentiveness  relationship 
 - Kindness  - Perception of long-
- Provision of instrumental term orientation 
resources  - Intention to persist in 
  the relationship 
 
 
 
 
During the narratives, study participants were asked to describe factors or attributes which 
characterized relationship commitment as well as provide examples where necessary. The main 
indicator of relationship commitment reported by more than one-third of respondents was 
positive personality attributes of their male partners. Positive personality attributes included 
caring, attentiveness, kind, good, responsible, and fidelity. Some respondents reported as 
follows:  
“Both of us are committed to the relationship. He is attentive and cares about me. He 
doesn’t joke with his church. Even though I have a child which is not his, he caters for 
the child. He is good” (31 year old with one child). 
 
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Some respondents also reported that the partners’ provision of instrumental resources, 
especially financial resources indicated commitment to the relationship. Two respondents 
commented:  
“The two of us are committed. He supports me financially as I learn the trade. He was 
even the one who put me in the trade. Whenever I don’t have money, he gives me. He 
always calls me. There is no day that he doesn't call me” (21 year-old girl). 
 
“Because he looks after me. I’m jobless and I’m an apprentice so I have no money to 
look after myself so he is the one who is more committed” (25 year-old woman with 
one child). 
 
In a different circumstance, few respondents stated that performance of household duties or 
chores such as cooking, washing, and cleaning were evidence of their commitment level. A 28 
year-old woman said:  
“I am more committed in the relationship. I wash, cook and tidy up his room. I also do 
petty things for him. He even brought his child here and I was the one who took care of 
his child” (28 year-old woman with two children).  
 
In addition, less than one-third of study participants mentioned psychological attachment as 
attributes of relationship commitment. Psychological attachment related to feelings of love and 
likeness, fondness and understanding. When a 22 year-old girl was asked to provide reasons 
for why she thought both of them were committed to the relationship, she simply said: 
“because I like him, he too he likes me”. A similar response was also proffered by a 23 year-
old girl. She said: “We are both committed to the relationship because we love each other. 
He’s also gone to see my parents”. 
For some other participants, the perception of a long-term orientation regarding the relationship 
indicated the level of commitment in the relationship. These women had expectations of getting 
married to their partner in the long-term future. They viewed themselves as more committed to 
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the relationship than their partners and for that reason, felt committed to continuing the 
relationship until the pregnancy happened. One of the respondents averred:  
“As for me I thought that I would be married to him. I didn’t know he was married. I 
thought I had gotten a guy who will marry me. He also says it that he will marry me” 
(34 year-old woman with two children). 
 
The intention to persist in the relationship by two women was a sign of their commitment to 
the relationship. One of them felt morally obligated to continue the relationship because of the 
children, whilst the other said that she and her partner played their respective roles to continue 
with the relationship. She reported:  
“I am the more committed one in the relationship because of the kids I have with him” 
(25 year-old woman, 2 children) 
 
In two separate accounts, two women mentioned that their partners’ personal devotion or 
dedication to the family showed commitment to their marital union, and long-term relationship. 
In their view, however, they considered themselves to be more committed to the relationship 
than their partners. Two of them reported:  
“Both of us are committed. You know, women are more committed than men. He’s been 
kind to the family and caring. When he goes to work, he comes home on time and 
wherever he is, he ensures that I know. He lets me know his whereabouts every time. 
He sends and picks his children from school. Now that I am not in Accra, he takes care 
of the children until I come during the weekends” (29 year-old woman with two 
children). 
 
“The two of us can sit down and chat. When I'm cooking and he is around, he will sit 
with me. If I say I want to wash and he is in the house, he will help me” (39 year-old 
woman with four children). 
 
Contrary to the level of commitment characteristics reported by participants, other participants 
could neither explain nor describe what it meant to be in a committed relationship although 
they could tell who was more committed in the relationship. They had difficulties in describing 
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what constituted as marks of commitment in the relationship. Two of their responses are 
captured in the following statements: 
“He is more committed to the relationship. I can’t tell but he is more committed. He 
wants the relationship to go on” (18 year-old girl). 
 
A 21 year-old student also reported saying:  
“Both of us are committed to the relationship. For me I see myself to be committed 
and if he were to be the one, he would have said the same thing. [Laughs]. I don’t 
even know what indicators to give. It should be like that”. 
  
The level of commitment as a relationship component has been viewed as an important 
determinant in the overall quality of a relationship. The multidimensionality of commitment 
level is also evident in the results of the study. The affective component which focuses on 
psychological attachment to the relationship was mentioned by some respondents; whilst the 
intention to persist in the relationship equates with the conative component. The cognitive 
component emphasizes long-term orientation regarding the relationship (Arriaga and Agnew, 
2001). These subjective understandings and interpretations reflect the current experiences of 
participants’ dyad.  
Beside the three level of commitment components reported differently by participants, other 
respondents reported that provision of financial resources and performance of household duties 
was a function of their commitment to the relationship. It is possible that respondents 
considered these to be normative expectations in partnership arrangements where the male 
partner assumes financial obligation whilst the woman performs household tasks. So whilst 
some women perceive that commitment is tied to or dependent on ability to maintain and 
perform household chores, a lack of it may suggest otherwise.   
In summary, the results from the sexual and reproductive behaviour of study 
participants has implications for their future fertility goals, reproductive behaviour and 
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contraction of sexually transmitted infections. The results of the study suggest that this group 
of women are potentially at risk of future unintended pregnancies sometime in their lifetime. 
The likelihood of multiple abortions among this sub-population of women during their lifetime 
is also high because of their poor contraceptive behaviour and practices. The study found that 
a majority of the participants practised contraception ineffectively and inconsistently while 
others used natural FP methods which failed them. By far, the nature of the sexual dyad, partner 
characteristics, partner’s preference for contraceptive type, knowledge and attitude towards 
contraception, and fear of the side-effects of FP dictated contraceptive use and non-use prior 
to the unintended pregnancy and subsequent abortion. 
The partnership characteristics that was examined in this study pertained to the 
relationship type, duration of the partnership, relationship stability and level of commitment. 
The results showed that more than half of the respondents were unmarried but involved in 
intimate sexual partnerships whilst few were in marital unions. This suggests that sexual 
activity is prevalent in male-female dyads and not only confined to legalized partnership 
arrangements. It is plausible, therefore, to assume that sexual debut may begin early for young 
women who indulge in sexual intimate relationships with their male counterparts.  
Furthermore, respondents ascribed the level of commitment to the relationship to 
positive personality attributes of their male partners, psychological attachment, perception of 
long term attachment to the relationship and supportive partners. The results imply that, such 
attributes are important in sustaining the sexual relationship especially, being in stable unions 
where male partners are committed is vital in facilitating fertility and reproductive decision-
making, as well as improving communication for effective contraceptive use. Essentially, 
relationship stability and commitment are important determinants of the quality of relationships 
which may underpin male support and involvement in reproductive decisions. 
 
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CHAPTER 6 
MALE PARTNERS’ INVOLVEMENT IN ABORTION AND POST-
ABORTION FAMILY PLANNING (PAFP) UPTAKE 
6.1 Introduction  
This chapter presents the findings from women’s narratives about their partners’ involvement 
in abortion and family planning methods adopted thereafter. Narratives from male partners who 
were interviewed are also included in the results. Three main themes characterised male 
partners’ involvement in women’s abortion experiences. These are: partners’ knowledge of 
abortion; role of male partners in the abortion decision-making process, and male partners’ 
support in the abortion. The sub-themes under these core themes are presented in the ensuing 
sections with accompanying diagrammatic presentations.  
 
6.2. Male partners’ knowledge of abortion  
This theme describes male partners’ knowledge of their female partners’ abortion. Under this 
broad theme, five sub-themes emerged: awareness of abortion, communication with partner 
about abortion, knowledge of health-seeking behaviour for abortion, knowledge of abortion 
methods, and non-awareness of the abortion. Figure 5.1 illustrates the thematic areas under this 
theme.   
 
 
 
 
 
 
 
 
 
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FIGURE 6. 1 DIAGRAM DEPICTING MALE PARTNERS’ KNOWLEDGE OF ABORTION AND 
ASSOCIATED SUB-THEMES 
  
 
 
 
 
 
 Male partners’ Communication with 
 Awareness of knowledge of partner about 
 abortion abortion abortion 
 
 
 
  
Non-awareness of Knowledge of 
  abortion abortion methods 
  Knowledge of health-
seeking behaviour for 
 
abortion 
 Knowledge of 
places for 
 
abortion 
 Knowledge of health 
 professionals for abortion 
 
 
 
6.2.1 Awareness of abortion 
Most women informed their male partners about the abortion and decision to terminate the 
pregnancy. Disclosure of the pregnancy termination was preceded by confirmation of the 
pregnancy. In few instances, pregnancy test kits were purchased by the couple, or woman alone 
or man alone to confirm the pregnancy before decision-making. A 27 year-old woman reported 
her partner’s knowledge of the pregnancy and his enquiry about the status of her condition. She 
reported: 
“Yes, he knows I’m coming to terminate the pregnancy. He even called just a while 
ago and asked whether I’m finished. I told him that I’m now going to do family 
planning”.  
 
 
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Two other participants reported about their partners’ knowledge of the pregnancy termination. 
From their narration, it appeared that their partners were disinterested about the abortion 
decision. One of them, a 25 year-old woman said: “I told him before about the abortion and he 
said he doesn’t care if I do that”. Another respondent also remarked:  
  
“He didn’t say anything about the abortion. He said I can remove it. He said there 
may be nothing so I should go to the hospital and check again. It is poverty that 
makes us reject child birth” (36 year-old woman with six children). 
 
From the interviews, it was found that, the timing of abortion was not immediately performed 
after pregnancy confirmation. A period from three days to two weeks elapsed before abortion-
related care was sought. Results of the analysis of data from the survey also showed similar 
results whereby an overwhelming majority (94 percent) of women informed their partners 
about the abortion. Only six percent said that their partners were not aware of the pregnancy. 
 
6.2.2 Communication with male partner about abortion 
From the women’s self-reports, their partners were the first to be informed about the pregnancy 
because they had had sexual relations with them and were responsible. Discussions on whether 
to continue or terminate the pregnancy followed pregnancy disclosure until a consensus was 
reached between the couple. During the interviews, many of the women stated that after talking 
with their partners concerning the pregnancy, both agreed to terminate it. Communication 
between the couple on the abortion decision was iterative. It usually involved negotiations and 
rationalisation and was initiated by either the man or woman. Three respondents shared their 
experiences in the following words: 
“I only told my partner. He said if it’s not because of something, he should 
have made me give birth but I don't want to. He asked me about my plan and I 
told him that I don't want to give birth with somebody who is married. Then he 
said he will give me money to terminate the pregnancy”--- (23 year-old 
woman with one child). 
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“I told him first. Initially, he said I should give birth but later on, he was 
scared because he is now schooling and we have no money” (25 year-old 
woman with one child). 
 
 
 “He asked me what I will do; whether to give birth or terminate it. I told him 
that I don’t want to give birth” (26 year old woman with two children). 
 
In contrast, some women reported that their partners refused their personal decision to end the 
pregnancy after disclosing it to them. One-third of the participants provided valid reasons to 
have the abortion. Some valid reasons included; financial constraints, desire to continue 
education or schooling, not ready for a pregnancy, partner infidelity, fear of disrupting work 
and life trajectory, partner-related behaviour and to avoid giving birth to a child with foetal 
abnormalities. On the other hand, very few offered intangible explanations to keep the 
pregnancy without their partner’s support. The intangible reason pertained to the fact that 
females under 18 years in the community had a child. One respondent stated: 
“He said I should keep the pregnancy. But keeping the pregnancy will also create 
some problems for me at home. So I told him that, I am not ready and I don’t want to 
have any problems at home with my parents, especially, my dad. So I begged him to 
consider this pregnancy as a mistake and allow me to terminate it so that, next time I 
will take precaution in order that it doesn’t become a problem again” (21 year-old 
woman). 
 
“I was very determined to give birth because when you come to my home, even 16 
year-old girls have a child how much more 22. I can give birth you see. So I told him I 
want to give birth and he didn’t bother about it” (22 year-old woman)  
 
In Miriam’s case, her partner requested for an abortion on the promise of providing some 
material gifts. She lamented her partner’s irresponsiveness about her decision to keep the 
pregnancy. She said:  
 
“He said I should abort it so that he can build a house for me. So I told him that I 
won’t” (22 year-old woman).  
 
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On the other hand, some participants were not able to communicate the news of the abortion to 
their partners because they had no knowledge about the whereabouts of their partners. A 
participant narrated that:  
“When I told him about the pregnancy, I didn't hear from him. So I even went to his 
house. When I went, I didn't find anyone there. That is why I have come to abort it. He 
doesn’t know I am coming to terminate the pregnancy, because I don't see him or hear 
from him” (27 year-old woman with one child). 
 
6.2.3 Knowledge of health-seeking behaviour 
This theme describes male partners’ knowledge of places and people to contact for an abortion. 
Two sub-themes emerged from the analysis:  knowledge of health professionals required to 
perform the abortion, and places for abortion care services. 
The narratives indicate that, only one woman reported that her partner knew of a medical 
professional who could provide abortion care services. Her partner therefore obtained 
medication abortion (MA), prescribed by the doctor and guided her on how to administer the 
medication at home. However, after an unsuccessful home abortion with the medication, he 
brought her to the hospital for post-abortion care. The respondent, a 21 year-old woman said:  
“When he bought the pills for me, I told him that the pregnancy didn’t terminate and 
he said it’s because I didn't take the pills well. He said that he bought the pills from a 
medical doctor. He asked me to take the pills but if I take it and the pregnancy doesn’t 
terminate, we will go to the doctor. I told him I don’t want to go to a doctor around 
our area”. 
 
Another theme that emerged from the narratives was related to male partners’ knowledge of 
abortion places. The narratives showed that five respondents’ partners had prior knowledge of 
where to have an abortion. Two of these interviewees had their partners fully responsible for 
seeking abortion care. They mentioned that their partners knew that abortion services could be 
obtained from the hospital. In that vein, they were directed and accompanied to the hospital. 
One participant reported:  
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“We have a friend at the hospital administration. So yesterday, my husband came to 
him and he introduced the health provider to him. The health provider asked us to 
come today” (32 year-old woman with 3 children). 
 
Another respondent commented: 
“There is a hospital where I stay but I don't like it. My partner stays around this place 
[Amasaman] and he said he will bring me to Amasaman” (21 year-old girl). 
 
In the case of three other participants, their partners instructed and directed them to visit the 
pharmacy, drug store or hospital for an abortion. They were not accompanied by their partners 
during the time of seeking abortion care. For instance, two participants reported that, after 
discussing the pregnancy outcome and decision to have an abortion with their partners, their 
partners explicitly instructed them to go to the hospital. They narrated in the following words:  
“He told me not to do anything to terminate the pregnancy but I should come to the 
hospital. He showed me that the abortion can be done here. He said that they had to 
terminate the wife’s pregnancy in order to save her life, so they came here” (23 year-
old woman). 
 
“My husband told me to come to this place where pregnant women are looked after but 
they will attend to me. And so I came to this hospital” (27 year-old woman with two 
children). 
 
The rest of the respondents revealed that they were directed to the hospital by their peers, 
siblings, and relations. On the other hand, 60 percent of the surveyed respondents reported that 
other people other than their partners gave them information on where to go for the abortion. 
 
6.2.4 Knowledge of abortion methods 
Knowledge of abortion methods was the fourth theme that emerged from the narratives. 
Participants’ reports showed that although male partners knew that abortions could be 
terminated in a hospital, they had little knowledge of the procedure by which the pregnancies 
could be terminated. One out of the three men interviewed had foreknowledge about how the 
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pregnancy could be terminated, both surgically and with medication. He knew of both methods 
of abortion based on prior experience. He reported that it was the second time he and the partner 
were having an abortion from the same provider and health facility. During the first home 
abortion, he directed his girlfriend to purchase a medication drug called ‘cytotec’ which he had 
heard about from a friend. Unfortunately, it ended in an incomplete abortion which compelled 
them to seek post-abortion care at the hospital. With this background knowledge and 
experience, it wasn’t difficult seeking abortion care from the hospital again. He narrated in 
these words:  
“She was mounting pressure on me so I had to give her money to terminate the 
pregnancy. Initially, I told her to go to the hospital but from the way she was 
speaking, I could tell that she didn't go. She was still disturbing me so I gave her 
money to go to the hospital. I asked her if there was a good pharmacy around to buy 
the cytotec which I had heard off.” (23 year-old male partner). 
 
On the other hand, the other two men obtained knowledge of the abortion method from health 
providers at a health facility. Whilst one came directly to the hospital to seek information on 
the abortion from a FP health provider, the other was referred from another health facility 
following his partner’s desire for antenatal health services. According to one male partner, he 
and the girlfriend went to a nearby clinic to access maternal health care services. They were, 
however, redirected to another health facility for further maternal health care services and any 
other information pertaining to safe abortion. He said:   
“Earlier this morning, she told me that she is not feeling fine. So I told her to go to 
ante-natal clinic. So when we got there, the lady said it was a new place so they don’t 
provide maternal care. So the woman told her that if she wants ante-natal services, 
then she should come to Amasaman hospital” (23 year-old male partner). 
 
During the interview, it also emerged that some respondents’ partners knew that an abortion 
could be done biomedically and surgically at the hospital. Respondents had the option to decide 
on the abortion method before the actual care was sought. One of them asserted: 
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“Hmmm, he asked me what I will do, either take medicine or go to the hospital. I told 
him I will go to the hospital” (26 year-old woman with two children). 
 
 
6.2.5 Non-awareness of the abortion 
This theme describes male partners’ lack of awareness and knowledge of the abortion. Almost 
one-third of the female respondents mentioned several reasons for not disclosing the abortion 
to their partners. In addition, the circumstances under which the abortion occurred varied, 
causing some of these women to withhold the news of the abortion from their partners. One 
woman narrated that her partner disappeared after she informed him about the pregnancy and 
had no opportunity to inform him of the abortion. According to her, his absence made her 
ambivalent, causing delay in seeking abortion care. She said: 
“Since I got pregnant I have not heard from him. Although I decided to give birth, I 
have not heard from him since then. Even when I call, I don’t hear from him. When I 
told him about the pregnancy, I didn't hear from him. So I even went to his house but I 
didn't find anyone there. That is why I have come to abort it (27 year-old with one 
child). 
 
Of these respondents, four mentioned that despite their partners’ knowledge of the pregnancy, 
they had no intention of ever disclosing the abortion to them because of infidelity, negative 
partner attributes, and poor quality of the relationship. All of them expressed their intention to 
discontinue the relationship after the abortion. Annie, a 27 year-old woman of three recounted:   
“I told him my menses has come again so I am not pregnant, otherwise, he will tell 
his friends that I was pregnant and I have come to remove it. I decided to give birth 
but I changed my mind because the man already has a wife and children. The woman 
can even go and do something to you. So I will come and abort. I will never tell him of 
the abortion”. 
 
Another woman reported that she would not disclose the abortion to her partner because his 
knowledge of it would create family conflicts. She admitted though that he knew of the 
pregnancy and wished to have a child. She averred:  
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“I told him I can’t keep the pregnancy. He just doesn’t understand. If he finds out that 
I had this abortion, it will be a whole thing. I’m not going to tell him. He doesn’t 
agree and there is no way he’s going to agree with me and he is going to make a big 
deal about it” (21 year-old woman). 
 
In two other distinct cases, the abortion decision was made by parents and caregivers. One 
respondent said that her partner was ambivalent about the pregnancy, so this forced her 
caregivers to terminate the pregnancy without her consent. She remarked: 
 “My aunty asked me to tell the guy that I was pregnant. But when I called him, he 
didn’t pick my call. I went to his house and told him of the pregnancy and he said he 
doesn’t know what to do now because of my current work. So he asked me whether I 
want to terminate the pregnancy or keep it. I also don’t know what to do and my sister 
brought me here” (19 year-old woman). 
 
In a similar vein, parents brought their 14 year-old daughter to the CAC provider for an 
abortion. They were directed by a staff in the same facility. During the interview, the young 
girl reported being oblivious of her pregnancy after being questioned by her parents severally. 
She mentioned that her boyfriend was not aware of the pregnancy and the abortion. She also 
had no knowledge about what it meant to have an abortion. She narrated: 
“I didn't do anything about the pregnancy. My mother asked me and I said I am not 
pregnant. I haven’t menstruated this month and she said I'm pregnant and I said no. I 
disagreed with her that I'm not pregnant but she said I'm lying. My parents went to 
buy pregnancy test and showed it to me before I knew that I was pregnant. I will call 
and tell the boy about what has happened”. 
 
Another young girl who visited the facility for post-abortion care reported that the pregnancy 
was unknown to her and the boyfriend. Neither did they decide nor intend to terminate it. She 
narrated ingesting some herbal mixtures to cure stomach pains but started experiencing 
abdominal pains and bleeding a few hours later. It was at the health facility that the pregnancy 
was detected and upon further interrogation, the health personnel confirmed an incomplete 
abortion as a result of a self-induced abortion. She recounted in the following words: 
“I didn’t know that I was pregnant. If I had known, I would have told my partner and 
he would have accepted it. The nurses asked me whether I had taken any medicine and 
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I said no I hadn’t. I don’t know the type of medicines. But if my partner knew of the 
pregnancy, he wouldn’t have told me to abort it. He has ever asked me that if I get 
pregnant, will I abort it. I said no, I won’t abort it. My partner asked me how the 
pregnancy got spoilt. I told him it started on Saturday. It was really worrying me. So 
my brother’s wife gave me medicine and I don’t know whether that spoilt the pregnancy. 
That was what I told him” (18 year-old girl). 
 
From these narrative accounts, it can be deduced that respondents were determined at all cost 
to end the pregnancy, although a few were ambivalent about the pregnancy decision. It is also 
evident from their responses that the pregnancy was unintended or unplanned, hence the desire 
to terminate it with or without their partners’ consent or approval. These accounts reflect a 
strong sense of self-determination and confidence in seeking abortion care with the goal of 
avoiding any possible disruptions in their life trajectory.  
 
6.3 Role of male partners in abortion decision-making 
This theme describes the various roles played by male partners during the abortion decision-
making process. The sub-themes that emerged portray that the pregnancy resolution process is 
complex and involves multifaceted factors prior to the final decision to have an abortion. Three 
sub-themes emerged from the analysis of transcripts and include the following: male partners’ 
approval of the abortion, disapproval or opposition to the abortion, and lack of partners’ 
participation in the abortion decision-making process. A graphical presentation of the thematic 
areas and sub-themes is shown in Figure 6.2. 
 
 
 
 
 
 
 
 
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FIGURE 6. 2 GRAPHICAL PRESENTATION OF THE ROLE OF MALE PARTNERS IN ABORTION 
DECISION-MAKING 
 
 
Role of male partners 
 in abortion-decision 
making 
 
No role by male Disapproval/ 
 partner in abortion- opposition to 
decision making 
 abortion 
Approval of 
 abortion 
Joint decision 
 
 Male-led pregnancy 
Woman-led pregnancy 
resolution 
 resolution 
 
   Source: Author’s construct 
 
6.3.1 Approval of abortion 
The results from the study showed that majority of the female’s partners approved of the 
abortion and were involved in decisions leading to the abortion by initiating the pregnancy 
resolution process. Approval for the abortion was initiated through direct requests, orders, 
negotiations, and discussions. Indirect approval was given after seeking the woman’s opinion 
about the pregnancy before the final decision was made jointly, or by the male partner. From 
the narrative accounts, the male partners played active roles in seeking abortion care. Two sub-
themes emerged from the analysis of the responses. These were the male partners as initiators 
of the abortion decision and the woman-led pregnancy resolution. 
 
6.3.1.1 Male partner as initiator of abortion decision 
When the women were asked to describe who initiated the discussion on ending the pregnancy 
as well as their partners’ reaction to the pregnancy disclosure, seven of them reported saying: 
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“he said I should abort it”. From the women’s accounts, male partners approved of and 
supported the decision to end the pregnancy. They were usually the first to initiate the decision 
to abort the pregnancy through direct orders and requests. Further, pregnancy negotiation was 
directed by the men and involved suggestions, discussions, rationalisation, questioning, costs 
of childbearing and child care, and financial burden. The negotiations were underpinned by 
two main considerations: first, on current circumstances within the relationship context; and 
second, on possible disruption in their life trajectory. 
For instance, one male partner reported that he was very influential in the decision-
making process. According to him, he was the first to initiate a discussion surrounding the 
pregnancy because of the negative consequences that might affect his partner (i.e. dropping out 
of school). He subtly rationalised the situation and decided to discuss with the girlfriend to 
have the pregnancy terminated. After discussing with his girlfriend about the need to complete 
her education, she agreed to have the abortion before they finally sought abortion care at the 
hospital. He reported: 
“I suggested in the first place that the pregnancy should be terminated. I told her about 
her education. I was very concerned about her school. I know that if the pregnancy is 
developing, school authorities will not allow her so I told her about it and she 
understood that we have to terminate it. I don't like a situation where I will be an 
obstacle to her education. Also, because of the pregnancy, I told her that we have to 
terminate it and she agreed. I didn't force her. I had to speak to her. We talk together. 
So we decided that we have to terminate it” (23 year-old male partner). 
 
Another finding that emerged was that only one male partner who directly requested an end to 
the pregnancy attached conditional clauses to the abortion decision. The respondent narrated 
that her partner out-rightly demanded an abortion on hearing of the pregnancy so he could 
assist her to complete her building. However, when she refused his request for an abortion, he 
withheld all financial support and failed to pay any expenses related to the abortion. She 
asserted:  
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“I became pregnant and when I told him, he said I should abort it. Yeah, I should 
abort it so that he can build a house for me. He asked me to abort it and I said no 
because I was very determined to give birth. I told him I want to give birth and he 
didn’t bother about it. It came to a time that even when I ask for money, he doesn’t 
want to give me. But I know that when he has, he will give me. But now when I ask 
him for money, he doesn’t have money. So I decided to abort it” (22 year-old woman). 
 
Further analysis of the transcripts showed that indirect requests by male partners for an 
abortion were often made through negotiations, suggestions, rationalisation, and cost-benefit 
analysis. Whilst some men resorted to providing realistic justifications for the woman to 
rationalise with, others suggested an abortion without plausible reasons. In most of these cases, 
the woman’s consent was sought first before the process of seeking abortion-related care began. 
For instance, one woman stated that she wished to keep the pregnancy although her partner 
was not in support of that. They dialogued about the need for the termination and he offered 
reasonable justifications especially, completing her apprenticeship, and to bring honour to 
herself by not having a child out of wedlock. She narrated:  
“He enquired whether I will give birth or terminate the pregnancy. I told him that I 
wish to keep the pregnancy. His reason for not wanting me to give birth is to allow me 
concentrate on learning the trade. He said: “if you impregnate a woman, you have to 
take her to your house. She doesn’t have to continue staying in her mother’s house”. 
So he asked me that when I give birth, would I still stay with my mum? I said no. Then 
he said he will bring me to come and terminate it” (21 year-old woman). 
 
According to another respondent, her partner proposed that the pregnancy should be terminated 
without tangible reasons. However, the decision was arrived at after she also expressed no 
interest to continue with the pregnancy because she wasn’t ready to cater for a child with a 
married man. She commented:  
“He said if it’s not because of something, he should have made me give birth but I 
don't want to. I did not say anything. He asked me of my plan and I said I don't want 
to give birth with somebody who is married and he said then he will give me money” 
(23 year-old woman with one child). 
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The circumstances for two other women differed as their partners neither requested for an 
abortion nor proposed it, but their actions implied or was suggestive of pregnancy 
unwantedness. Judging by their partners’ behaviour at the time of pregnancy disclosure, they 
decided to seek abortion care. Their partners’ roles in the decision-making process was limited 
because of their non-committal behaviour. The participants averred: 
“As for my partner, he hasn’t made up his mind to have children and I am also not 
married. I can’t do that while I am at the mission house. He is not ready to have a 
child. So I told him I was pregnant. The first time, he gave me money to buy a drug 
and I inserted it, but it didn’t work” (23 year-old woman). 
 
“He said he is not aware that he is responsible, so I have to do something about it 
because I don't want to end my marriage. So yesterday when he returned from work, 
he told me that he cannot take care of the pregnancy. So I have to do something. I 
have to come to the hospital” (39 year-old woman with four children). 
 
6.3.1.2 Woman-led pregnancy resolution  
From the narratives, 10 women reported that they initiated the decision to end the pregnancy 
and were more influential in the abortion decision-making process compared to their partners. 
They stated substantive reasons to justify their decisions for an abortion. Consequently, their 
partners who hitherto disapproved of the abortion, now supported them. The reasons the 
women gave for wanting to terminate their pregnancy were mainly health-related reasons, and 
financial/ economic constraints. What was also evident from these narratives was that these 
women autonomously decided on the abortion before asking for their partners’ views. Only 
two study respondents made the decision to terminate the pregnancy for health-related reasons. 
They mentioned ingesting some drugs prior to detecting the pregnancy, hence the fear of giving 
birth to an abnormal child made them decide to abort the pregnancy. Two of them remarked:  
 “Actually, I never knew I was pregnant. I was taking this 442 medicine and I have 
heard that it is not good for pregnancy. I have taken this medicine thrice already. 
Considering the way my stomach is and the pains I’m experiencing, I told my partner 
that I cannot have a baby because I have already ingested this medicine and I don’t 
know what will happen.” (39 year-old woman with two children). 
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“The reason for terminating the pregnancy is because it will worry me. If I don’t 
terminate it, it will worry me because I have already taken a drug. I don’t want to 
deliver something” (31 year-old woman with one child). 
 
Some other four participants had the final say as to whether to keep the pregnancy or terminate 
it. The decision-making power rested on them even after communicating with their partners on 
the outcome of the pregnancy. They asserted:  
“When I found out about the pregnancy, I didn’t know what to do. I was thinking 
whether to keep it and I remembered what I will go through with this pregnancy and 
this baby. So even before I told my husband, I had doubts whether to keep it or remove 
it, I don’t know. So when I told him, he told me, when I’m pregnant I know what I go 
through and this baby is small. So what are we going to do? So I told him I’ve been 
thinking about it and I don’t want to keep it” (32 year-old woman with children). 
 
“He asked me what I will do, whether to give birth or not. I told him that I don’t want 
to give birth. He asked me if I will take medicine or go to the hospital. I told him I will 
go to the hospital” (26 year-old woman with two children). 
 
6.3.1.3 Joint abortion decision 
Another theme derived from the narratives was joint decision-making on the pregnancy. One 
couple said that they both agreed to terminate the pregnancy. When they were asked separately, 
each stated that the decision was jointly made because of their young child. When the male 
partner was asked to report on who decided to terminate the pregnancy, he said: “the two of 
us”. The woman also similarly reported that: “the two of us decided because the child we have 
now is young”. 
 
6.3.2 Disapproval of abortion 
The second theme which emerged from the narratives was disapproval of the pregnancy 
termination. Seven women stated that their partners disapproved of the abortion and wished to 
keep the pregnancy. For the most part, they significantly influenced their partners to consent 
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with the decision for an abortion and navigated the decision-making process by offering 
tangible reasons to justify their demand. The responses showed a strong insistence to terminate 
the pregnancy at all cost with or without their partners’ support. Two participants narrated how 
insistent they had to be in order to convince their partners to agree with their decision. One of 
them said:  
“When he came I told him of the problem and asked him what we are going to do. He 
told me to keep it. I said nothing. He wanted me to keep it but I didn’t want to keep it. 
So I asked him to give me money to do abortion but he refused to give me money. I 
persisted but he refused to give me money for the abortion. So since I had already 
decided not to keep it, I won’t let it keep long at all. When I realized I was pregnant on 
Wednesday, he said we shouldn’t abort it but I insisted and he said okay he will give 
me money to take it out. So I thought of it though I was very afraid” (32 year-old woman 
with one child). 
 
The other respondent also narrated: 
 
“He is a student. He was a little bit scared because maybe he will stop schooling 
that’s why I said we should abort it. At first, he said I should give birth but later on, 
he was scared because he is now schooling and we have no money. Hmm, I think I 
was the one pressuring him to do the abortion” (25 year-old woman with one child). 
 
In another case, a participant stated her partner’s readiness to have a child but she decided to 
terminate the pregnancy without his knowledge in order to avoid family problems with her 
parents. She narrated saying: 
 “He doesn’t know about the abortion. I am not going to tell him. He doesn’t agree 
and there is no way he’s going to agree with me and he is going to make a big deal 
about it. He was threatening to call my daddy about the whole thing and I tried to 
calm him by telling him that I will be busy this week so that, by next week, I will find 
time so that we can go together to do a blood test to see whether its positive. I don’t 
trust the urine test” (21 year-old woman). 
 
 
For another woman, the fear of psychological disruption, work-related reasons and future 
schooling aspirations motivated her to terminate the pregnancy despite her partner’s decision 
to keep the pregnancy. She averred:  
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“He said I should give birth and I said no. He wasn’t happy with it. I told him that I 
will be going to school and because of my work it will worry me” (26 year-old woman 
with one child). 
 
The reasons some other women gave for wanting to terminate the pregnancy were made in the 
context of avoiding disruptions to their current life trajectory. Two respondents remarked in 
the following words:  
“The guy who made me pregnant told me to deliver the baby, but I said no because 
when I signed the contract, we were told that when you get pregnant, all your money 
will be wasted, about 7 million. I will be done next year February. So I told him that 
he should give me money to do it and I told him that it will never happen again” (23 
year-old woman). 
 
“He says I should give birth with him, but I said I can’t. No I won’t. I want to travel 
and my time is nearly up, next month I will be leaving”. He told me that as for him, he 
doesn’t do those things but I should give birth. And I told him I cannot give birth. It 
will prevent me from doing something. And if I’m unable to do what I want to do, you 
and your children will enjoy, and I will be disgraced” (34 year-old woman with two 
children). 
 
 
6.3.4 Lack of male partners’ role in abortion decision-making 
Male partners’ lack of participation in the abortion decision-making was the final theme which 
emerged during the interviews. Of the total number of thirty-eight (38) female participants 
interviewed, nearly one-third did not have their partners playing any role in the abortion 
decision-making process. The main reason for male partners’ non-involvement in the abortion 
decision was because the women chose not to disclose the abortion to their partners. Although 
few women disclosed their pregnancy status to their partners, they terminated the pregnancy 
without their partners’ knowledge, approval and support. They independently made the 
decision and were not expectant of any support during the abortion decision-making process. 
One of the participants simply reported that: “I won’t tell him about the abortion. I just want 
him to bring his family”.  
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Another participant, a 40 year-old woman lamented about her partner’s irresponsible behaviour 
towards the family and her firm resolution to prevent anymore unintended pregnancies. She 
commented:  
“As for me, I just want the pregnancy to be terminated so that I will be free of any 
worries/problems and run my business. The children I had in this latter part, can you 
imagine that I pay their school fees and everything they need. He doesn’t look after the 
two children I had after he told me not to give birth again. Bearing in mind that he 
doesn’t want any more children, I cannot have this child because it will worry me. So I 
have to do something to terminate this pregnancy. I haven’t even told him about the 
pregnancy because he won’t do anything about it”. 
 
Also, the circumstances under which the pregnancy termination occurred were without the 
knowledge of the man responsible for the pregnancy; especially when the decision was made 
by parents and guardians. In one case of abandonment of the woman by the male partner, the 
respondent had expected her partner to participate in the pregnancy decision-making. She 
independently decided to keep the pregnancy. However, when she realized she had been 
abandoned after several weeks passed, she made the decision to terminate the pregnancy. She 
stated that:  
“When I told him about the pregnancy, I didn't hear from him. So I even went to his 
house. When I went there, I didn’t find anyone there. That is why I have come to abort 
it” (27 year-old woman with one child). 
 
6.4 Male partners’ support in abortion 
Partners’ support during the abortion was the third broad theme that emerged from the results 
of the analysis. This theme sheds insights on the different dimensions of support received by 
participants from their male partners prior to and at the time of the abortion. Three types of 
partner support emerged from the analysis. These are: instrumental, informational, and 
emotional. Figure 6.3 shows a graphical presentation of the themes and sub-themes derived 
from this broad theme.  
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     FIGURE 6. 3 DIAGRAMMATIC PRESENTATION OF MALE PARTNERS’ SUPPORT IN ABORTION 
  
 
 
Instrumental Physical support 
 support 
MALE 
 PARTNERS’ 
SUPPORT IN Financial support 
 
ABORTION 
Emotional and 
 behavioural support 
 
 
 Informational 
support 
 
 
Lack of partner 
 support 
 
 
   Source: Author’s construct 
 
6.4.1 Instrumental support 
Instrumental support is used in this context to make reference to tangible and intangible aid 
and service. For example, aid in labour, for instance, housekeeping or childcare; provision of 
transportation or financial assistance, and time provided by an individual.  
 
6.4.1.1 Payment for abortion  
From the interviews, instrumental support was mainly characterized by the provision of funds 
and other expenses related to the abortion care. Out of the 38 women interviewed, nearly half 
of them reported that they received financial support from their male partners to pay for the 
cost of the abortion whilst a greater proportion (77 percent) of the surveyed respondents 
reportedly received funds from their male partners for the same purpose. Besides receiving 
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funds to cover the entire costs of the abortion, other participants reported receiving only part 
of the money for the abortion. Three women, during the in-depth interviews, reported that the 
cost of abortion was shared with their partners. They received insufficient money to cover the 
expenses of the abortion so they supplemented with their personal funds. A 39 year-old woman 
commented that: “My husband gave me some and I also added mine”. Another participant also 
reported that: 
 
“He gave me GH150 but I was told to have GH200. So I added my own GH30 to 
become GH180” (23 year-old woman).  
 
However, eleven women personally paid the cost of the abortion without any financial aid or 
support from their partners. The circumstances under which the women paid for the abortion 
expenses themselves varied. Whilst some paid because their partners were not around to 
provide the money, others wanted to avoid delay in seeking abortion care. One woman for 
instance, paid herself because her partner had absconded and she was ambivalent about the 
pregnancy outcome. She said: 
“I used my money for this abortion. I have been to his home several times and I don’t 
meet him. I don’t hear from him too and there is no one in his house. The main reason 
I came to terminate this pregnancy is because I don’t hear from him” (27 year-old girl 
with one child). 
 
Another woman also used her personal finances as she didn’t want the pregnancy to be detected 
early by her older siblings and house owner. Although her partner had initially provided money 
for a home abortion, she urgently decided to seek abortion care from the hospital following a 
failed home abortion. She reported that her partner was not aware of this second abortion at the 
hospital. She narrated:  
“I used my money for this abortion. I was going to buy something with it but I will 
collect it from him. The first time I did the abortion, he gave me money to buy a drug 
and I inserted it, but it didn’t work. I don’t know the name of the first drug I bought. 
Then I took money again and I went to buy cytotec. With the second attempt, I took 
cytotec but it didn’t also come” (23 year-old woman). 
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Only one participant said that her partner refused to give her money for the abortion when she 
asked him. She, therefore, used her personal funds but planned to recoup the money from him 
afterwards. She explained:  
“Seriously, he said he doesn’t have money. I know when he has, he will give me. But 
now when I ask him money he doesn’t have. Oh so I was there and I was thinking, it 
became a burden, seriously. He didn’t pay but I know he will pay because he was having 
money. I know that he will and he is going to pay the money” (22 year-old woman). 
 
6.4.1.2. Accompaniment to the hospital  
Being accompanied by the male partner to the hospital for the abortion was the second 
instrumental support mentioned by respondents. From the observations and narratives, 14 
women were accompanied by either their husbands or boyfriends, whilst 33 percent of the 
survey respondents were also accompanied by their partners. Of this, only three male partners 
were interviewed. During the interviews, the male partners were not in close proximity to the 
women. Instead, they were somewhere within the precincts of the hospital.  
For instance, during the in-depth interview, one participant said that she and her partner thought 
men were not allowed in the counselling room and family planning clinic. For that reason, he 
decided to wait for her outside the hospital. The following observation (Box 1) was made:  
 Box 1: Field extract, DAY 16, 07/07/2016 
I introduce myself to a second young girl seated at the family planning unit. She reveals 
 during the interview that she is a Moslem accompanied by the man who impregnated her. 
She reports that her partner is sitting outside. Asked why he didn’t join her inside the 
 family planning unit, she says it appears men are not allowed inside. In the middle of the 
interview, a ward assistant comes to call her that the healthcare provider is waiting to do 
the procedure. I observe that she proceeds towards the entrance of the hospital gate. When I 
 ask, she said she’s going to collect money from the man to pay the health provider before 
the procedure. I miss out on speaking to her partner.// 
 
 
 
 
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Two out of the three male partners sat closely to where the abortion procedure was being 
performed. In one instance, the husband accompanied his wife to the family planning room for 
post-abortion family planning counselling. The observation accompanying the interview is 
provided below in Box 2: 
B ox 2: Field extract, DAY 19, 15/07/2016 
I see a woman and her husband being accompanied by a ward assistant of the abortion provider 
 
going to the family planning Unit. I enquire from the abortion provider whether the couple 
c ame for an abortion. She responds in the affirmative. I follow-up to the family planning unit. 
The couple enter the family planning Unit and sit together while the man carries their young 
c hild. I ask the nurse to direct them to speak with me. I introduce myself and the man asks me 
to speak to his wife but I tell him that I need his responses as well. Woman says she isn’t well 
so  is unable to chat with me but the family planning nurse encourages her to speak with me. 
A few minutes into the interview, I realize that my recorder is full so I proceed to interview 
the couple together. // 
 
 
In the second instance, the male partner waited outside the procedure room and after the 
procedure, accompanied his partner to the family planning unit. He sat in the FP Unit while his 
partner was counselled. The observation following the interview is provided in the extract in 
Box 3. 
Box 3: Field extract, DAY 27, 06/9/2016 
 
While waiting at the counselling room beside the abortion procedure room, the ward 
assistant informs me about a young girl coming for abortion. I seek her consent in the 
 
counselling room. I enquire whether she came alone but she tells me that her boyfriend is 
around. She is shy at first; sometimes, not willing to talk. After the abortion procedure, 
 her partner emerges from the waiting area outside the abortion procedure room and walks 
with her towards the family planning Unit. We sit at the Family Planning clinic not far 
 from her boyfriend. She gives short brief answers and looks away the whole time of the 
interview. The nurse interrupts and calls the respondent for counselling. I approach her 
partner and tell him about my study. He is receptive and gives his consent to be 
 interviewed.// 
 
 
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However, with the third couple, the male partner was not beside his partner. He was waiting 
outside at the patient waiting area. The woman mentioned that he was shy and wouldn’t want 
to be interviewed. But upon invitation to be interviewed, he consented.  
The three male partners were asked to state the reasons for accompanying their partners to the 
hospital for the abortion. The reasons given pertained to psychological attachment especially 
of love, emotional support, sense of obligation, and concern for satisfaction of service delivery. 
One of them stated: “She’s my wife and I love her that’s why”. The other two also reported: 
“Oh I couldn’t allow her to come alone, because I told her in every circumstance I’m 
behind her so that it will even boost her. At first I wasn’t in support, I didn’t agree 
with her to come and abort. But she sat with me and explained to me that we have to 
do it for the mean time. So I decided to come with her” (23 year-old male partner). 
 
“Oh, I came just to be sure that everything is well done for her. I just have to get 
involved because leaving her alone is not the best. I came with her the first time. I also 
prefer to come with her. I can't leave her to come alone. I would have, I insisted to 
come” (23 year-old male partner). 
 
Eleven women mentioned that their partners wished to accompany them to the hospital but 
could not do so because of work demands and change in plans. The frequently stated reason 
for the male partners’ absence at the hospital was mainly work-related. A 26 year-old woman 
said: “I wanted him to come and escort me but he said he will not be able to come because of 
work”. 
Some respondents narrated that personal commitments unrelated to work prevented their 
partners from being present at the hospital at the time of the abortion. A 28 year-old mother 
with four children explained: “he knows I have come to the hospital and he also left for town”. 
Only one woman reported that her partner had travelled. She said “he is my fiancé’; he has 
gone to Italy”. On the contrary, one woman reported that the fear of abortion deterred her 
partner from accompanying her to the health facility for the abortion. She narrated:  
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“When I told him to bring me here, he told me that he’s going to work. He is very 
scared. Even when I got pregnant and I was coming to deliver, he didn’t come along. 
It was his sister and mother. He was afraid. He is always calling me to find out if it 
has been done for me, and I told him to wait but not yet. But after it’s done, I will call 
him. As for him, he is afraid” (27 year-old woman with two children). 
 
Two others did not want to be accompanied by their partners to the hospital at the time of 
seeking abortion care without any reason. One of them stated:  
“He is a steel bender so he was going to work for someone. But he made up his mind 
to accompany me but I told him its nothing, but I will come alone. I don’t want it” (23 
year-old woman).  
 
 
6.4.2 Informational support 
Informational support relates to the acquisition and provision of relevant information pertaining 
to where the pregnancy can be terminated, by whom, and how it can be terminated. During the 
narratives, respondents revealed that some of their partners were knowledgeable of where an 
abortion could be performed and they facilitated the process of seeking abortion-care. For the 
survey respondents, 40 percent of them reported that their partners provided information on 
where to go for the pregnancy to be terminated. Those who reported that their partners knew 
of the places for the abortion stated:  
“The man [referring to partner] showed me this place that it can be done. He is 
around. He is the one who brought me here” (21 year-old girl). 
 
“You see, we have a friend at the administration. So yesterday my husband came to 
see him and he introduced us to the lady. So he came here yesterday around 4:30 so 
she asked that we come today” (32 year-old woman with three children). 
 
One male partner had previously accompanied his partner to the same health facility for an 
abortion so it was easy for him to navigate the process of seeking abortion care. He also 
mentioned that he directed his partner to purchase a medication pill for a home abortion but 
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she was reluctant. Hence, his decision to accompany her to the hospital for the termination to 
be done.  
“We terminated it the first time here in this hospital. For that one it was very young 
by then. We came here. We went to the scan room then just like the same procedure. 
Initially, I told her to go to the hospital but from the way she was speaking I, could 
see that she didn't go.” (23 year-old male partner). 
 
Two women were also directed by their partners to seek abortion-care from the hospital but 
they were unaccompanied. A 27 year-old woman commented:  
“My husband told me to come to this place where pregnant women are looked after, 
but they will attend to me and so I came here”.      
 
Another respondent also mentioned that “he told me not to do anything to terminate it but I 
should come to the hospital”. 
In another vein, a 19 year-old girl reported that her partner brought her to the hospital on the 
behest of her mother for the abortion. But at the time of the interview, her partner had returned 
home. She explained: “It is the boy who brought me here. My mother told him to bring me here 
[to the hospital]”. 
 
6.4.3 Emotional or behavioural support 
Emotional/behavioural support is used in this context to describe the care, concern, and 
expressions of empathy and encouragement expressed by the male partner before and after the 
abortion. Participants were asked to describe and report on the verbal, and non-verbal 
emotional and affective acts expressed by their male partners which helped to alleviate distress 
at the time of having the abortion. When asked, most of them could not explicitly describe how 
affectionate their partners had been towards the pregnancy termination.  
From the narratives, it was evident that emotional and behavioural support was 
expressed in different ways, especially through concern about the health of the woman. Three 
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women stated that their partners showed concern for them prior to the abortion by advising 
them to seek abortion care from the hospital since they didn’t want any complications, and also 
because it was safer. A 23 year-old woman simply said: “He told me not to do anything to 
terminate it but I should come to the hospital”. 
Emotional support for the abortion was also expressed through concern for the welfare of the 
woman after the abortion through phone calls. It was observed during the interviews that some 
respondents received phone calls intermittently from their partners. Whilst some women’s 
partners called to enquire about the procedure, others enquired whether the procedure had 
ended, and had set off home, whether they were in good health and other issues. One woman 
commented:  
“He even called just a while ago and asked whether I’m finished. I told him that I’m 
now going to do family planning. He is always calling me to find out if it has been 
done for me, and I told him to wait but not yet. But after it’s done, I will call him” (27 
year-old woman with two children). 
 
Three interviewees reported receiving encouragement from their partners to adopt a family 
planning method after the abortion. One of them narrated how insistent the partner had been 
for her to adopt a family planning method prior to the abortion. She said:  
“He has told me to go and do family planning but I told him that I’m afraid. It’s about 
5 months now when he told me to go and do family planning. But I’m also afraid 
because I was told that it kills people. And I was also there the whole time and now 
I’m pregnant again” (27 year-old woman with two children). 
 
On the other hand, 44 percent of the survey respondents reported that their partners expressed 
concern about their health, whilst 50 percent said their partners were concerned about the 
abortion. 
 
 
 
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6.5 Lack of partner support for the abortion 
Eleven (11) women did not receive any form of support from their male partners when they 
sought abortion care. The context under which these participants did not receive support from 
their partners at the time of having the abortion varied. Abandonment, partner-related 
problems, relationship-related conflicts, and parental responsibility were reported as grounds 
for non-involvement of partners. However, the main reason stemmed from the male partners’ 
lack of knowledge of their female partners’ personal decision to end the pregnancy, although a 
few of them were aware of the pregnancy. Thus, lack of partner support directly resulted in or 
contributed to partners’ non-involvement during the abortion. In one circumstance, an 
interviewee mentioned that she chose to keep the pregnancy a secret because her partner 
wouldn’t provide any financial support. She simply retorted: “I haven’t even told him about 
the pregnancy because he won’t do anything about it”. 
For some others, the abortion decision was made by their parents and guardians without 
recourse to the man responsible for the pregnancy. Hence, there was no anticipation of 
involvement of the partner. For instance, a young girl narrated that her eldest sister was the 
final decision maker on the abortion. Her sister accompanied her to the health facility, and 
made all payments and other expenses for the abortion. She averred:  
“My sister paid for the abortion. We were asked to pay 200 cedis, then it was reduced 
to 150 but she said she couldn’t pay for it. She had only 80 cedis so that is what we 
paid” (19 year-old girl). 
 
6.7 Male partners’ involvement in post-abortion family planning uptake 
The results from the study showed that nearly two-thirds of the in-depth interview participants 
and 72 percent of the survey respondents adopted a family planning method immediately after 
the abortion and even before leaving the health facility. Compared to the in-depth interviewees, 
the proportion of survey respondents who had future intentions of using post-abortion family 
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planning was slightly higher (24% and 28%). Fewer than 15 percent of all study respondents 
had no future intentions of adopting a contraceptive method after the abortion. However, for 
three participants in the in-depth interviews, it was not clear whether they adopted a family 
planning method after the abortion because of their sudden ‘disappearance’ immediately after 
the abortion procedure.  
A greater proportion of the study respondents took up long-acting reversible 
contraception (LARC) immediately post-abortion. Among those interviewed during the in-
depth interviews, for example, 15 of them chose a LARC, specifically implants. Similarly, 
majority (72%) of the survey respondents also preferred LARC, mainly implants (38%) and 
intrauterine device (9%). The remaining respondents opted for short-term contraception with 
the injectable, oral contraceptive pills and male condoms. For the interviewees, less than one-
third preferred the injectable compared to 17 percent of the surveyed respondents. Six percent 
opted for the oral contraceptive pills and two percent chose the male condoms.  
From the narratives, immediate post-abortion contraception uptake was not a result of male 
partners’ involvement. Multiple reasons were provided for the immediate adoption of the 
contraceptive method after the abortion including: healthcare provider’s counselling and 
suggestion, and sometimes ‘indirect compulsion’; availability of contraceptive method upon 
request; and low cost of family planning. One participant reported that:  
“The family planning nurse asked me which one I preferred. Then I told her I wanted 
the five year type. The abortion care provider said I should use the 5 year type. I would 
have chosen the 3-year family planning type but because of what she [referring to 
abortion provider] said that’s why. She called the family planning nurses to tell them” 
(27 year-old woman with one child). 
 
Another respondent also narrated that her preference for a particular family planning method 
was influenced by the health provider. She said:  
“The nurse counselled me a lot on family planning. She said, there is one month, three 
months and three years, and one year. And after she finished speaking, I told her that I 
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will do the 3 months type. And she said as for that one, I can easily get pregnant again. 
So I should do the 3 years type because that one has a longer duration before I get 
pregnant. And I thought about it and made up my mind to do the three years type” (27 
year-old woman with two children). 
 
Other participants also said that the decision to adopt a post-abortion family planning method 
was made by their caregivers. One of them stated:  
 “I was given the five year family planning type. My sister asked them to do it for me. 
As for me I don’t know which types are available. My sister is the one who knows. When 
we got there, she asked them to give me the five years type” (19 year-old girl). 
 
From the observations, most women who decided to terminate the pregnancy were 
offered pre-abortion counselling by the abortion provider prior to the abortion. Sometimes, the 
abortion provider deferred post-abortion counselling to the family planning nurses. Post-
abortion counselling focused on long-term contraception.  
During post-abortion counselling, it was observed that the abortion care provider 
strongly cautioned the post-abortion women to initiate FP immediately to prevent another 
unplanned pregnancy which could occur within two-weeks after the abortion. However, FP 
uptake was met with disaffection, unwillingness and resistance by the respondents. The general 
concerns reported against FP use related to the side-effects of FP such as cessation of menses, 
dizziness, weight gain, fast heartbeat, and loss of weight. Some of the women expressed fears 
of future infertility with FP use. The respondents who mentioned negative experiences and 
side-effects with using FP were asked whether they had experienced these symptoms 
themselves, and to which they responded in the negative. Many reported knowledge of the 
experiences of FP use from friends, and relatives as well as through hearsays by other people. 
Some women who were still sceptical about the hormonal side-effects of FP, however, adopted 
an FP method for fear of a subsequent unintended pregnancy and abortion.      
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Occasionally, family planning uptake before the pregnancy termination was 
‘conditional’ particularly for those women who opposed its use but wanted a pregnancy 
termination. It was observed that though some women were reluctant to adopt a FP method, 
they had no option than to accept the conditional clause being offered by the abortion care 
provider. In a few circumstances, some women requested for a short-term FP method instead 
of a LARC which the abortion care provider proposed. Their reason was to test for 
compatibility with their body. Yet still, those women who did not desire to initiate a post-
abortion contraceptive method were not coerced. Neither were they refused abortion care. 
However, severe admonishment accompanied the performance of the abortion procedure.  
 
6.8 Discussion 
This chapter sought to explore male partners’ participation in abortion and the extent of 
participation in women’s abortion experiences and post-abortion family planning uptake. The 
study found that male partners are mostly involved in their female partners’ abortion 
experiences through three main ways: knowledge of the abortion, role in the abortion decision-
making process and provision of support. Partners’ involvement in the abortion begins from 
the time of pregnancy awareness and disclosure and trajects until the termination of pregnancy. 
This entire period can be described as a continuum of stages with the partner being involved at 
marked points in the process of the pregnancy resolution.  
Partner knowledge of the abortion is integral to the initiation of the pregnancy 
resolution process and subsequent pregnancy outcome. It also heralds a chain of other positive 
or negative outcomes. This finding is corroborated by other studies which also found that male 
partners are knowledgeable of their female partners’ abortion and play active supportive roles 
during the pregnancy resolution process (Becker, 1996; Beenhakker et al., 2004; Schwandt et 
al., 2013). The results of the study demonstrate that averagely, male partners who are informed 
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of the abortion participated fully, partially or did not participate at all during the abortion 
decision-making process. In addition, whilst some partners played active roles after being 
informed of the pregnancy, others were ambivalent, passive or indifferent.  
The knowledge factor is an important determinant of and precursor to male 
participation in the pregnancy resolution process because it admonishes the man to assume 
responsibility for the pregnancy outcome. It also enables inter-spousal or couple 
communication about the final decision to be made about the pregnancy. It is interesting to 
note from the women’s narratives that few men had limited knowledge about where to seek 
abortion care following the abortion decision, reinforcing the belief that abortion is a woman’s 
responsibility as suggested by some researchers (Papworth, 2011). Socio-culturally, because 
men are primary decision makers in sexual and reproductive health issues, most women in the 
study deferred to their partners immediately for a decision to be made. However, there are 
exceptions when the partners’ whereabouts were unknown, and where the decision was 
independently made by the woman without involvement of the partner. 
The study also found that male partners participate in women’s abortion experiences 
through their roles during the abortion decision-making process. Multiple studies lend support 
to this finding (Schwandt et al., 2013; Freeman, Coast and Murray, 2017; Nguyen et al., 2018). 
For instance, Johansson et al. (1998) report that male partners approved of the abortion and 
were actually involved in the abortion decision. Although contrary results have been found in 
other studies (Leshabari et al., 1994; Norris et al., 2011), the results of this study provide 
evidence that male partners actually participated in their female partners’ abortion decision, 
either partially or fully.  
Further, the narratives showed that male partners either act as facilitators or initiators to end 
the pregnancy. Partners’ greater influence regarding the abortion during the decision-making 
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process was tied to the provision of support for abortion-seeking care. On the other hand, 
negotiations characterised the discussions surrounding the pregnancy resolution in 
circumstances where the male partner disapproved of the pregnancy termination. These 
revelations highlight the existing knowledge that responsibility and final decision-making on 
fertility (or childbearing) lies with men.   
Because some male partners may be absent during the pregnancy resolution process, 
participation may be expressed differently through expressions of support such as: through 
presence at the health facility at the time of abortion; providing money for transportation, and 
provision of finances for the abortion expenses. From the study results, partners’ support for 
the abortion signified participation in the abortion. Provision of support ranged from payment 
for the costs of abortion, accompanying to the hospital for the abortion, provision of 
information on where to seek abortion-related care, and emotional support in terms of showing 
concern for the abortion. This finding corroborate other findings which indicate that male 
partners provided different forms of instrumental support during the time of the female 
partners’ abortion (Cozzarelli et al., 1994; Becker et al., 2008; Kero et al., 2010; Kalyanwala 
et al., 2010; Makenzius et al., 2012).  
Financial support to cover the abortion expenses was the most dominant type of partner 
support expressed by male partners. Even partners who opposed the decision to end the 
pregnancy paid the cost of abortion. However, women whose partners were not aware of and 
informed about the pregnancy termination received no support from their partners, neither did 
they receive any other material support. Perhaps, a common responsibility that men feel 
obligated to is financial responsibility for the cost of an elective abortion they are responsible 
for. This finding gives credence to the assertion that because men have control over the sexual 
rights of women, and are involved in the reproductive decision-making, the cost of reproductive 
health services must be borne by them.  
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Provision of financial support even becomes highly expectant of men if they were 
strongly influential in the abortion decision-making process and also where the pregnancy is 
considered as unwanted. Further, financial burden will lie on the male partner if the couple are 
in a stable and committed relationship. It follows that, women whose partners are supportive 
of the abortion decision are generally more likely to provide money for the abortion. 
Several plausible explanations can be advanced for male participation in women’s 
abortion experiences. Some studies have found that unstable partnerships serve as grounds for 
an abortion (Sihvo et al., 2003); which this study found in the narratives. These include 
relationship stability, commitment level of the couple, relationship satisfaction and partner 
suitability and attributes. Women in stable relationships and committed to future long-term 
partnership with their male partners are more likely to receive greater support from their 
partners during pregnancy termination than women in unstable relationships, or women with 
intentions to end their relationship. Also, women in short-term relationships may receive little 
or no support compared to women in relatively long-term relationships depending on 
circumstances surrounding the pregnancy wantedness, psychological or emotional attachment, 
and commitment to continue the relationship.  
There were some women who reported of their partners’ non-participation during the 
time of the abortion. Reasons why the male partners were not involved in the abortion pertained 
to the women’s self-autonomy and efficacy to terminate the pregnancy without their partners’ 
knowledge, abandonment by the male partner, partner infidelity, and parental/caregiver 
decision on the abortion. Women’s autonomy during the abortion decision-making without 
partner involvement has been reported elsewhere (Oduro and Otsin, 2014). These authors 
found that economically empowered women rationalized their decision to have an abortion 
because it was their “body” and could, therefore, do anything to their body as they wished.  
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Another reason underlying male non-involvement in the abortion was premised on 
participants’ reports of their unstable relationships with their partners. Succinctly put, the 
quality of their current relationship accounted for their personal decision to keep the abortion 
a secret from their partner. Some mentioned partner infidelity, negative partner behaviour and 
personality, irresponsibility, perception of partner disapproval of the abortion decision, and 
avoidance of relationship conflicts as contributing to their self-autonomous decision-making 
on the abortion. Nearly all these women considered terminating the relationship after the 
abortion. This finding corroborates other similar studies (Barnett, Freudenberg and Wille, 
1992; Rue et al., 2004) which found that the abortion indirectly contributed to the breakdown 
of the relationship by creating emotional distance or disagreements.   
 
6.8.1 Discussion of analytic framework   
An analytic framework in Figure 6.4 was developed during the qualitative analysis to 
summarise the multiple factors that depict the pathways to male partners’ involvement in the 
abortion. The framework highlights several factors as well as events preceding male partners’ 
involvement in the abortion, and uptake of post-abortion contraception. It also helps to explain 
the dynamics of male partner involvement in women’s abortion experiences and subsequent 
post-abortion contraception uptake. The components in the framework include:  
 Nature of sexual relationship 
 Contraceptive use/non-use 
 Pregnancy awareness and disclosure 
 Pregnancy intention and acceptance  
 Partner involvement and support  
 Abortion seeking-behaviour and  
 Post-abortion family planning and counselling  
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FIGURE 6. 4 AN ANALYTIC FRAMEWORK TO UNDERSTAND MALE PARTNER INVOLVEMENT 
AND SUPPORT IN WOMEN’S ABORTION, AND LIKELIHOOD OF POST-ABORTION FAMILY 
PLANNING UPTAKE
Nature of sexual relationship Contraception use/non-use 
- Relationship length, and marital status - Method of pregnancy prevention  
- Stability of relationship - Agreement, and approval of contraception 
- Commitment to relationship - Communication on contraceptive usage 
- Partner attributes - Attitudes about contraception 
 
Pregnancy intention  
- Pregnancy wantedness/ unwantedness Pregnancy awareness and disclosure 
- Ambivalence   
- Psychological responses to 
Pregnancy acceptance pregnancy (Flight/Fear) 
- Sexual exclusivity Denial  - Partner abandonment  
 - Male partner non-involvement 
in:  pregnancy outcome, 
Male involvement and support:  abortion decision, and abortion-
- Pregnancy negotiation and resolution related care 
-  Motivation for induced abortion 
- Approval / opposition to abortion 
Abortion seeking behaviour 
- Place                             - Health provider Post-abortion 
- Access                          - Resources family planning and 
- Social support           counselling 
- Past experience/exposure 
 
Non-uptake of Family planning 
Family Planning uptake - Fear of side-effects 
- Health provider factors  - Previous contraceptive failure 
- Male encouragement and support in FP use (including) practices 
- Previous contraceptive use - Male partner opposition & 
disapproval  
- Unfavourable attitude towards 
contraceptives 
Woman’s locus of control 
Source: Author’s construct, 2017  
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The sexual relationship provided the context for pregnancy to take place. It is a 
fundamental component in the framework because both partners’ perception of the relationship 
stability, level of commitment, duration of the relationship and suitability of partners set the 
precedent for decision-making on the abortion. Relationship stability and commitment was 
decisive in determining the outcome of the pregnancy. It also provided a basis to continue with 
the relationship or quit. As was found in the narratives, negative partner attributes, relationship 
dissatisfaction, low relationship commitment level, and unstable dyads contributed to the 
decision to terminate the pregnancy and which also accounted for the lack of partners’ 
involvement in the abortion.  
Evidence from the women’s narrative accounts showed that, the type of contraception 
used (or non-use) before the abortion depended on several factors: nature of the sexual 
relationship, knowledge of contraceptive, partner attitudes towards contraception, and 
agreement between the couple on the preferred method of contraception. Contraceptive use or 
non-use was dictated by the level of relationship commitment, stability and satisfaction level 
of the couple. Dyads where contraception was inconsistently practised resulted in unintended 
pregnancies leading to the abortion. Lack of contraceptive use may inversely affect the nature 
of the relationship. For instance, women in unstable and or erratic relationships may be less 
likely than others to plan sexual intimacy, resulting in unplanned pregnancy (Glei, 1999). It is 
also possible that women who decide to end the relationship prior to, or after the abortion may 
discontinue contraceptive usage since the relationship is unstable. 
Pregnancy disclosure and awareness occurred after confirmation of the pregnancy. 
Disclosure to the male partner was central to initiating negotiations leading to the abortion 
decision-making process. The disclosure of the news of the pregnancy depended on the 
presence of the male partner within the context of the ongoing sexual relationship. Male 
partners’ knowledge and awareness of an unintended pregnancy may trigger a positive or 
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negative psychological response in the form of fear, fright or flight. Negative psychological 
responses may inadvertently lead to ambivalence about the pregnancy and which may cause 
abandonment. However, disclosure to other close persons was due to the absence of the male 
partner and parental responsibility for the pregnancy. Male partners who accepted 
responsibility for the pregnancy participated actively or passively in the abortion decision 
irrespective of whether the pregnancy was intended or unintended. However, some male 
partners were ambivalent whilst others exhibited psychological responses (such as fear or 
flight, abandonment) upon hearing of the pregnancy.  
In addition, knowledge of an unintended pregnancy triggered some positive and 
negative psychological or emotional responses from the male partner leading to abandonment, 
denial, and non-involvement in the abortion decision. A positive reaction formed the basis for 
pregnancy negotiation, decision-making and resolution. It was also characterised by 
willingness and involvement to seek abortion-related care. On the other hand, a negative 
response after pregnancy disclosure was characterised by directly observable behaviours such 
as fear, anxiety, and irresponsible behaviour towards the pregnancy. A negative attitude 
exhibited after knowledge of a pregnancy was suggestive of couple discordance in the 
pregnancy negotiation process, lack of desire for the pregnancy, unwillingness to continue the 
pregnancy and ambivalence.  
Pregnancy intention influenced the women’s (or couples’) decision to keep or terminate 
the pregnancy. It also led to the occurrence of series of multiple reactions; starting off from the 
male partners’ acceptance of the pregnancy, decision-making on the pregnancy outcome, 
involvement and support in seeking abortion-related care.  
The involvement of a male partner in his female partner’s abortion was dependent on 
several factors such as: stability and commitment to the relationship, responsibility for 
contraceptive use in the relationship, knowledge and acceptance of pregnancy, and whether the 
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pregnancy was wanted or not. Negotiating or deciding on a pregnancy resolution were often 
made on the backdrop of mixed reasons, mostly personal, by the women (or couple). In other 
situations, the motivation for an abortion occurred under circumstances beyond the woman’s 
will; for example, when the woman is still under parental control. 
Abortion care is an important part of abortion-seeking behaviour. Choosing to have a 
safe induced abortion is dependent on the couple’s knowledge of place of abortion, knowledge 
of provider, access to information on how to terminate a pregnancy, availability of resources, 
access to place of abortion care, and past experience of an induced abortion. Other individuals 
like peers, family members, and close confidants and trusted persons may also be relied upon 
for information on seeking abortion.  
Depending on the place of abortion seeking care, the woman (or couple) was counselled 
to use contraception to prevent a subsequent abortion. Per the model of safe abortion practices 
in a facility, non-judgemental counselling was offered after the abortion. Women and/or their 
partners, therefore, decided to adopt a contraceptive method immediately or at another time. 
The reasons for using post-abortion contraception was based on male support and 
encouragement for contraceptive use, woman’s confidence in contraceptive decision-making, 
previous contraceptive use, positive predisposition towards contraceptive usage, availability of 
preferred contraception, health provider factors, and ability to afford contraceptive type.  
Contrary to using post-abortion contraception, the decision not to adopt post-abortion 
contraception were hinged on male partner opposition/disapproval of contraceptive use, fear of 
side-effects, unfavourable attitude, and previous contraceptive practices. Women who 
perceived that their male partners are responsible for contraceptive decision-making were 
reluctant, and not likely to use contraception compared to women who have the power to decide 
on fertility and contraceptive issues.  
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CHAPTER SEVEN 
WOMEN’S EXPECTATION OF PARTNERS’ ROLE IN ABORTION 
7.1 Introduction 
The expectation of receiving support from a partner during difficult times is relatively high for 
individuals in dyadic partnerships. Abortion can be considered as a difficult period for women 
because of the interplay of individual, interpersonal and societal characteristics involved in the 
decision-making process, and the psychological, and sociological costs associated with the 
pregnancy resolution process. This chapter explored women’s expectation of their partners’ 
roles during the abortion and whether their expectations were met. The emerging themes are 
presented and discussed in the subsequent sections.  
 
7.2 Perceived expectation of partner support pre-abortion 
The first main theme which emerged from the analysis was the women’s perceived expectation 
of receiving support from their male partners prior to the abortion decision and actual abortion. 
These women expected to receive different kinds of support from their partners prior to, and 
during the time of the abortion. Two sub-themes that emerged from the interviewees’ perceived 
expectation of support are instrumental and affective or emotional support. 
  
7.2.1 Instrumental support 
7.2.1.1 Payment of abortion expenses 
About two-thirds of those interviewed were expectant of their partners’ provision of funds for 
the cost of the abortion. Some reported that the provision of funds by their partners was not 
prompted; it was given without them not having to demand after a consensus was reached 
during the decision-making process. However, a few demanded money from their partners to 
pay the abortion expenses. Some participants said that their expectations of their partners’ 
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financial obligation towards payment of the abortion cost was met because they did not have 
to pay for the abortion services. One respondent, 39 year-old woman simply stated: “Oh yes, 
he was aware and he gave me the money”. 
Another respondent cited her partner as the ‘breadwinner’ of the house and for that matter, all 
her financial needs were dependent on him. She narrated that:  
“As for financial support, he is the one providing everything in the house because I am 
not working. So even if I have money, he is the one who will give me the money” (32 
year-old woman with three children). 
 
Another woman who was highly expectant of being financially supported by her partner during 
the abortion period did not receive any financial support for the cost of her abortion care and 
other related expenses. She felt disappointed and hurt at her partner’s failure to provide any 
money. She reported:  
“I was expecting him to bring me the money but he asked someone to bring it. 
Yesterday, I was there and he called me to let my little cousin come and take something 
for me. So I thought he was going to send me some money through my cousin to bring 
to me. My cousin returned with meat. I was expecting him to tell me something. At least 
if you don’t have money for the abortion, just find half of it and give it to me, but nothing 
at all. I was really hurt” (22 year-old woman). 
 
7.2.1.2 Accompaniment by male partner to the hospital 
Some of the interviewees were expecting to be accompanied to the health facility by their 
partners at the time of the abortion. However, they came to the health facility unaccompanied 
because their partners were absent due to work demands or travelled. They anticipated that 
after the abortion, they might not be physically strong enough to go home by themselves, hence 
the expectation of being accompanied. One interviewee, a 26 year-old woman of one child 
stated: “I wanted him to come and escort me but he said he will not be able to come”.  
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Another interviewee also commented that, the nature of her partner’s work schedule prevented 
him from accompanying her to the hospital for the abortion although he had planned to be 
present. She explained that: 
 
“He wanted to come with me and he asked for permission from the boss. The boss 
told him today is the meeting day so he can’t absent himself” (39 year-old woman 
with two children).  
 
7.2.1.3. Emotional/ affective support 
Beside the expectation of financial support and aid to the hospital for an abortion, some 
respondents also expected to receive affection and emotional support from their partners.  
Whilst the receipt of emotional support was latent for some respondents, it was highly 
anticipated and explicit for others. For instance, Abigail, did not expect her partner to be caring 
or show concern about her until after the abortion decision was made. She explained:  
“Yes that’s what I thought; that he will give me some support. But I thought maybe he 
will change his mind. I was afraid. When I told him I was pregnant, he got [more] 
closer to me than before. He called me every morning and night to ask of me” (23 year-
old woman with one child). 
 
Unlike Abigail, Sarah expressed disappointment when her hopes of receiving some affection 
from her partner did not actualise. She narrated:  
“The day my partner brought me the money for the abortion, I had already done the 
abortion. He didn’t know. After giving me the money, he didn’t even ask me how the 
abortion went and that is what annoys me most. At least, even after giving me the money 
for the abortion he didn’t call me the whole day to ask about how things went and so 
on. He didn’t call. That makes him annoying” (32 year-old woman with one child). 
 
7.3 Expectation of partner involvement in the abortion decision-making process 
The interviewees’ expectation of receiving support from their partners during the decision-
making process was the second broad theme that emerged during the narratives. A few of the 
respondents reported that their partners’ participation was decisive in determining the outcome 
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of the pregnancy. They explained that because their partners were not forthcoming with any 
conclusive directive on the pregnancy, they were psychologically restless. Their partners’ 
passivity on the pregnancy outcome resulted in delays in seeking abortion care.   
For example, Delilah expected to have her partner participate in determining the 
pregnancy outcome since she could not independently decide to continue or terminate the 
pregnancy. She was also expecting a promise of marriage, reassurance to be cared for during 
the pregnancy and affection from her partner. However, all her perceived expectations were 
not enacted as her partner abandoned her. After a long period of absence from the partner, she 
decided to have an abortion. She reported:  
“I was expecting him to say that we should have a child, I will take care of you, or I 
will marry you something like that. But none of these things happened. I didn’t see 
him nor hear from him. Like I said, I’m looking for someone who can take care of me, 
but he can’t cater for me so...” (27 year-old woman with one child). 
 
Still regarding the expectation of partner involvement in the pregnancy outcome and decision 
making process, another respondent said:   
“I was expecting him to tell me something. Yeah. Something like keep it or don’t keep 
it, get money and go to the hospital and let’s see what we can do, yeah” (39 year-old 
woman with four children). 
 
7.4 Perceived expectation of partner support post-abortion 
The third theme that characterised participants’ responses pertained to the expectation of 
support from their partners after the abortion. Three types of post-abortion support emerged 
during the analysis: emotional, instrumental and material support.  
 
7.4.1 Affective/emotional support 
One-third of the participants stated that they expected their partners to express concern for their 
health after the abortion; enquire about the abortion procedure, and be empathetic. Some said 
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their partner would ask how “everything” went at the hospital. For instance, one woman was 
confident that her partner would express concern about the pain she experienced during the 
abortion. She averred: “he is going to ask about everything that happened, like even the pain I 
went through”.  
Another woman also reported: “He will come closer to me and ask how I'm doing and things”. 
In the case of a 21 year-old woman, she expected to receive the same kind of treatment from 
her partner prior to the abortion. She stated:  
“Hmm, with that one, we will be there normally like how everything was. Everything 
will just be the same. That is it. If he used to give me money, it will continue, if he used 
to give me emotional support, it will continue. So everything will be normal”. 
 
In contrast, another participant highly expected her partner to express concern about her, 
enquire about the abortion procedure and all other things related to the abortion. However, the 
partner’s lack of emotional support and concern for her health after the abortion angered her. 
In her view, the partner’s disapproval of the abortion accounted for the lack of any emotional 
support. She narrated:  
“He didn’t ask me anything because I annoy him. Yeah, I think he doesn’t have a male 
child. The day he brought me the money for the abortion, I had done the abortion 
already. He didn’t know. After giving me the money, he didn’t even ask me how the 
abortion went. That is what annoys me most. At least, even after giving me the money 
for the abortion he didn’t call me the whole day to ask about how things went and so 
on. He didn’t call. That makes him annoying” (32 year-old woman with one child). 
 
Two of the three male partners expressed continued emotional support for their partners’ health 
after the abortion. One of them reported that he would support the partner’s decision to adopt 
a family planning method to prevent any future unintended pregnancies. He commented: 
“What things will I do for her? Just the normal chatting. How are you feeling and those 
stuff. I will ask her about her health and buy her drugs to aid her recovery. From the 
education I just received from the nurses, I will support her to use family planning. The 
final decision will come from her if she will like to do it” (23 year-old male partner). 
 
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7.4.2 Material support 
Some participants were certain of receiving some material rewards or gifts from their partners 
after the abortion. They likened the pregnancy termination to having a safe birth delivery, hence 
the expectation of a reward. Their expectations were based on past experiences. Two of them 
explained:     
“Oh yes, he is going to ask about everything that happened. Even my provisions will be 
double today and a different shopping for tomorrow. As for that one, he will do it for 
me, he will ask me what I want. It can be compared to giving birth. So today will be my 
special day” (39 year-old woman with two children). 
 
“He will do it, he will do it. If he knows that I’m ok, then he’s ok. He knows I will not 
give him any problem. For example, he will say: today, take this; tomorrow, take that, 
when I give birth he will say congratulations! He gives me money, he bought fowl for 
me, he does a lot” (39 year-old woman with four children). 
 
Two others also expected continued provision of basic needs from their partners after the 
abortion. One of them said:  
“Hmm, he will do what he used to do at first. He is the one who feeds and clothe me 
because I have no one except him. I want him to continue doing that. My dad is there 
but he is not around” (25 year-old woman with one child). 
 
7.4.3 Instrumental support 
With regard to the expectation of receiving support, some participants who paid for the abortion 
expenses themselves hoped to reclaim the money from their partners later. One of them said:  
“He didn’t pay for the abortion but I know he will pay because he had money. I know 
that he will and he is going to pay the money” (22 year-old girl). 
 
Only one participant was very certain that her partner would assist with household chores at 
home after the abortion. In her narrative, she expected this support because her partner had 
been assisting with household chores anytime she was unwell. She commented:  
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“From here, I’m going to sleep. My husband will do the cooking and everything until 
I tell him that I’m ok before he will stop doing it” (39 year-old woman with two 
children). 
 
7.5 No expectation of partner support 
No expectation of partner support was the last theme that emerged when participants were 
asked to report on their role expectations from their partners at the time of the abortion. About 
a third expressed uncertainty about receiving any support or assistance from their partners. One 
participant said: “this is my first time of doing it so I don’t know how he will help me. I can’t 
tell”. Others could not articulate what kind of roles to expect especially in circumstances where 
the partner did not participate in the decision-making and abortion care. Few respondents were 
unresponsive to the question when interviewed. 
 
7.6 Discussion  
This chapter aimed to investigate women’s expectations of their partners’ roles at the time of 
having an abortion. The results showed that women had perceived expectations of receiving 
mainly instrumental and emotional support from their partners prior to and after the abortion. 
These findings are expected and consistent with other studies which found that most women 
want their male partners to provide support when having an abortion (Major, 1992; Johansson 
et al., 1998; Evans, 2001; Becker, Bazant and Meyers, 2008; Jones, Moore and Frohwirth, 
2011). The sociocultural norms which prescribe males as breadwinners, co-creators and 
decision-makers may have reinforced the women’s expectancy of receiving instrumental 
support from their male partners. Another plausible explanation could be that these women 
wanted to avoid the negative stereotyping when accessing abortion care (Ganle et al., 2016).  
The results can also be explained in light of the theoretical perspectives of the gendered 
role expectation models of social support and social support activation model. The gendered 
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role model emphasizes the role of gendered differences on giving and receiving of social 
support in dyads (McMullen and Gross, 1983; Sarasan et al., 1985; Belle, 1987; Barbee et al., 
1993). The effect of gender is accentuated in intimate partner arrangements or relationships 
where socio-cultural norms prescribe and sanction the behaviour of males and females. For 
example, females are more likely than males to seek and receive the needed support than males 
(Belle, 1987; Shumaker and Hill, 1991). According to Sarason et al. (1985), females have 
“higher levels of perceived social support than males”. The results are therefore, corroborated, 
on the basis of these theoretical assumptions.  
Having an abortion is a difficult and emotionally distressing time for many women 
(including men) considering the dynamic interplay of personal, social (or community beliefs), 
religious doctrines, and cultural factors surrounding the decision-making process and the actual 
abortion. Under such circumstances, the tendency for women to expect emotional support 
through reassurance, care, concern, and advice from their male partners is high given the type 
of partnership arrangement. In addition, women’s anticipation of receiving instrumental and 
emotional support could be underpinned on who the main decision-maker for the abortion was. 
For instance, if the woman was pressured by her partner to terminate the pregnancy, then there 
is greater likelihood for such a woman to expect support for the abortion compared to a woman 
who had full autonomy for the abortion decision.  
Gender role expectations may also influence how women activate and seek support 
from their social networks (including sexual partners). The female role which emphasizes 
“nurturance and emotional expressiveness” allows females to activate the needed social support 
from their social network (McMullen and Gross, 1983; Belle, 1987; Shumaker and Hill, 1991; 
Barbee et al., 1993). It is not out of place then for these women to have anticipated support 
from their partners during the time of having the abortion. The results indicate that women’s 
expectation of receiving financial resources to pay the abortion expenses may be underpinned 
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by socially accepted norms and roles of men as breadwinners of the household, and as primary 
decision-makers in the sexual dyad. In this regard, financial obligation of men towards the 
pregnancy outcome is highly anticipated.    
Furthermore, participants expected their partners’ involvement during the decision-
making process. The perceived anticipation of support during the pregnancy resolution process 
has been reported in other studies (Johansson et al., 1998; Costescu and Lamont, 2013). A 
probable explanation for this result is rooted in culturally-constructed prescriptions that cede 
women’s sexual and reproductive rights to men (Ezeh, 1993; Dodoo, 1993, 1998). Such 
normative prescriptions may, therefore, make it difficult for women to independently decide to 
keep or terminate a pregnancy without the male partner’s knowledge. It is also plausible for 
women to think that the burden of pregnancy is a shared responsibility, given the type of 
partnership arrangement, and for that matter, the male partner must contribute to the pregnancy 
outcome decision. The expectation of receiving support from their partners is, therefore not 
far-fetched.  
However, the narrative accounts from the participants showed that one-third of them 
had no role expectations from their partners at the time of having the abortion. This finding is 
supported by other studies which found that women had no perception and expectation of 
support from their male partners when having an abortion (Moore et al., 2010). These women 
did not rely on their male partners nor anticipate to receive any support for possible reasons 
that their partners may prevent them from accessing abortion care, and fear of physical abuse. 
Also, avoidance of relationship conflicts, unstable union, unsuitability of the male partner and 
intention to end the relationship may have influenced nondisclosure of the abortion to the 
partner with implications for no perception of support. More so, the absence of the male partner 
participation in the abortion decision may have contributed to the women’s lack of anticipation 
of partner support.  
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This finding reveals several things about women who are capable of exercising their agency at 
the time of undergoing an abortion without the expectation of partner support. A woman’s 
desire to exercise her reproductive freedom as suggested by Mackinnon (2010), may increase 
her autonomy in reproductive decision-making and make her less dependent on her partner 
when faced with future unintended pregnancy. It also shows that such women are self-confident 
in seeking abortion-related care, thereby, exercising their reproductive choice without any 
barriers. Further, women with high self-aspirations and personal goals may have lower desire 
to burden their partners with any responsibility, especially when their partners are ambivalent 
of an unwanted pregnancy.  
Involvement of parents or care-givers in their children’s abortion experiences has been 
found in other studies (Henshaw and Kost, 1992) and this lends support to the results in this 
study. Few women reported that the decision to terminate the pregnancy was made by their 
care-givers without regard to their partners’ involvement. In a patriarchal context like Ghana, 
parents are viewed as having primary responsibility and control of the reproductive freedom 
and choices of their children who are still economically and socially dependent on them. 
Parental decisions in this regard are, therefore, paramount in order to prevent the burden of 
childcare problems and for continued parental support for the child/children. Thus, parents and 
primary care-givers have a ‘big’ say in abortion decisions without recourse to the male partner.  
  
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CHAPTER EIGHT 
RELATIONSHIP BETWEEN PARTNERS’ INVOLVEMENT IN 
ABORTION AND POST-ABORTION FAMILY PLANNING UPTAKE 
8.1 Introduction 
This chapter examines the relationship between partners’ involvement in women’s abortion 
and post-abortion family planning uptake. The data were analysed at the bivariate and 
multivariate levels. At the bivariate level of analysis, cross-tabulation and chi-square tests were 
used to determine the association between the explanatory and outcome variable of interest. 
Multiple logistic regression models were used to examine the relationship between male 
partners’ involvement in abortion and post-abortion family planning use.  
 
8.2 Results of bivariate analyses 
8.2.1 Relationship between socio-demographic characteristics and post-abortion family 
planning uptake (PAFP) 
The variables included in the analysis are socio-demographic, psychosocial variables, 
reproductive history, and partnership characteristics. The socio-demographic variables 
included are age, highest educational level attained, employment, ethnicity, number of living 
children, religious affiliation, and marital status. Table 8.1 presents the results from the chi-
square tests (X2) of association between respondents’ and male partners’ socio-demographic 
characteristics and PAFP uptake.  
The results from Table 8.1 indicate that PAFP uptake varies by women’s employment and 
number of surviving children. The data show that family planning use after an abortion is higher 
among women who were employed compared to other women who were not employed. Also, 
a higher proportion of women with two, four and five children adopted post-abortion 
contraception compared to women who had no child. The results, however, show no 
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statistically significant association between women’s age, educational level, marital status, 
ethnicity and religious affiliation and post-abortion family planning uptake. 
 TABLE 8. 1 RELATIONSHIP BETWEEN WOMEN’S AND MALE PARTNERS’ SOCIO-
 DEMOGRAPHIC CHARACTERISTICS AND PAFP UPTAKE 
 
Characteristics  Women Male partners 
 Yes  No  X2 Yes No X2 
Age    0.6   6.201 
< 20 72.1 29.9   
< 24   --   -- 64.1 35.9 
20-24 70.5 29.5 72.5 27.5 
25-29 70.6 29.4 70.3 29.7 
30-34 76.0 24.0 76.9 23.1 
35+ 70.0 30.0 79.5 20.5 
45+ 58.1 41.9 
Educational level   5.615   1.985 
No education 73.7 26.3 66.7 33.3 
Primary  80.0 20.0 -- -- 
Middle/JHS 75.2 24.8 77.2 22.8 
Secondary/Higher+ 64.5 35.5 70.7 29.3 
Employment    4.730*   0.001 
Not employed 63.3 36.7 72.0 28.0 
Employed  75.1 24.9 71.7 28.3 
Ethnicity    3.071   6.345 
Akan  68.4 31.6 65.4 34.6 
Ga-Dangme 78.7 21.3 81.8 18.2 
Ewe  68.4 31.6 74.6 25.4 
Other ethnic groups 75.9 24.1 75.0 25.0 
Religious affiliation    7.870   1.624 
No religion   --   -- 78.9 21.1 
Christians 69.7 30.3 71.2 28.8 
Other Christian  80.8 19.2 66.7 33.3 
Muslim  88.2 11.8 78.3 21.7 
Number of living   16.032*    
children    
0 64.2 35.8 
1 70.4 29.6 
2 78.2 21.8 
3 77.1 22.9 
4 81.8 18.2 
5 83.3 16.7 
6 0.00 100.0 
  
Marital status    1.823   3.007 
Never married 69.1 30.9 70.5 29.5 
Currently married 72.4 27.6 69.3 30.7 
Cohabiting  78.2 21.8 80.4 19.6 
Formerly married 66.7 33.3 69.2 30.8 
Source: Computed from survey data 2017; N=327; *p<0.05;  
(--) indicates not applicable 
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The socio-demographic factors of the male partners’ were also examined in Table 8.1 but, the 
results show that none of the variables is statistically significant in its association with PAFP 
uptake. There is also no clear pattern or variation that can be observed from the results. 
 
8.2.2 Relationship between psychosocial variables and PAFP uptake 
Three psychosocial variables were included in the analysis to determine their relatedness to 
PAFP uptake. These psychosocial variables are: (i) attitude towards contraceptive use (ii) level 
of knowledge about contraception/FP and (iii) self-perception statements on the barriers, 
benefits, self-efficacy of contraceptive use and severity of abortion.  
The results from Table 8.2 show that women’s attitude towards contraceptive use and their 
level of knowledge about FP are associated with post-abortion contraception uptake at a 
statistically significant level of p<.05. The results indicate that women with favourable attitudes 
towards using contraception were associated with PAFP use than women with unfavourable 
attitudes towards contraceptive use. A high percentage of women with favourable attitudes 
towards contraception adopted a contraceptive method after an abortion compared to women 
with moderate and unfavourable attitudes towards contraception. In addition, level of family 
planning knowledge varied with PAFP uptake at statistically significant level of p<.05. A high 
proportion of women with a moderate level of FP knowledge adopted a family planning method 
after the abortion compared to their counterparts with no knowledge of family planning. On 
the other hand, male partners’ attitude towards FP and level of FP knowledge do not appear to 
be statistically significant in relation to post-abortion contraception uptake. 
 
 
 
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  TABLE 8. 2 RELATIONSHIP BETWEEN PSYCHOSOCIAL VARIABLES AND PAFP UPTAKE 
 Women Male partner 
 
Variables Yes No X2 Yes No X2 
Attitude towards   6.062*   4.254 
contraceptive use     
Favourable  77.6 22.4 74.4 25.6 
Moderately favourable 64.5 35.5 75.9 24.1 
Not favourable  67.3 32.7 63.4 36.6 
Level of family planning   14.173*   3.776 
knowledge     
Knowledgeable  74.0 26.0 68.4 31.6 
Moderately knowledgeable 78.2 21.8 79.2 20.8 
Not knowledgeable 54.7 45.3 67.5 32.5 
Don’t know   70.4 29.6 
 
Source: Computed from survey data, 2017; *p<0.05 
Notes: ‘Don’t know’ category applies to Male partner 
 
8.2.3 Relationship between partnership dynamics and PAFP uptake 
Table 8.3 presents the results of the partnership dynamics (relationship stability, type of 
relationship, and duration of the relationship) with PAFP uptake as the outcome variable. The 
results show no statistically significant variation in PAFP uptake by relationship dynamics. All 
the three measures of the partnership dimensions are not associated with PAFP uptake. 
TABLE 8. 3 RELATIONSHIP BETWEEN PARTNERSHIP DYNAMICS AND PAFP UPTAKE  
Characteristics  Yes No X2 
 
Relationship stability   2.646 
               Stable 70.1 29.9 
               Somewhat stable 81.8 18.2 
               Not stable  69.2 30.8 
Relationship type   1.298 
               Boyfriend  70.6 29.4 
               Husband  75.0 25.0 
               Fiancé 65.5 34.5 
               Other partnership 69.6 30.4 
Duration of relationship   5.233 
               < 1 year 68.0 32.0 
               1 – 2 years 63.8 36.2 
               3 – 5 years 76.1 23.9 
               6+ 78.0 22.0 
 Source:  Computed from survey data, 2017  
 
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8.2.4 Relationship between reproductive variables and PAFP uptake   
Four reproductive variables were included as independent factors: number of lifetime 
pregnancies, number of previous abortions, contraceptive use at index pregnancy and 
pregnancy intention. The results show no statistically significant relationship between the 
reproductive variables and PAFP uptake (Table 8.4). Although there are variations with the 
outcome variable, they are not statistically significant at p<0.05.  
 
TABLE 8. 4 RELATIONSHIP BETWEEN REPRODUCTIVE VARIABLES AND PAFP UPTAKE 
Variables Yes No X2 
Number of lifetime   5.396 
pregnancies   
                 1- 3 66.8 33.2 
                 4- 6 79.8 20.2 
                 7+ 73.2 26.8 
Number of previous induced   0.407 
abortions   
                 0- 2 71.5 28.5 
                 3- 4 69.7 30.3 
                 5+ 80.0 20.0 
Contraceptive use at index   0.499 
pregnancy   
                  Yes  70.6 29.4 
                    No  74.7 25.3 
Pregnancy intention   0.391 
                  Yes  76.5 23.5 
                    No  71.4 28.6 
Source: Computed from survey data, 2017  
 
8.3 Results of multiple logistic regression analysis 
8.3.1 Model 1: Partner involvement and PAFP uptake 
Model 1 shows the relationship between the partner involvement variables and PAFP uptake 
controlling for all the other variables. The results from Table 8.5 show a statistically significant 
relationship between communicative support and uptake of post-abortion contraception.  
Women who receive a high communicative support from their partners are 2.66 times as likely 
to use contraception after the abortion as women who did not receive any communicative 
support from their partners at p<0.01. The results further indicate that women who receive 
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some (partial) communicative support from their partners are 2.52 times as likely to use PAFP 
as women who did not receive any communicative support (p<0.05). However, physical 
support, financial support and emotional support did not show any statistically significant 
relationship with PAFP uptake. The model explains seven percent of the variation of the 
outcome variable. The analysis, thus, shows that communicative support from male partners is 
an important factor affecting post-abortion contraceptive use among women. 
 
TABLE 8. 5 LOGISTIC REGRESSION BETWEEN PARTNER INVOLVEMENT AND PAFP UPTAKE 
 Post-abortion family planning uptake  
 
Characteristics Odds ratio Standard error  95% Confidence 
(OR) (S.E.) Interval (CI) 
Physical support    
               No support (RC) 1.00   
               Partial support 1.28 0.38 0.608 – 2.698 
               High support 0.76 0.38 0.362 – 1.629 
Financial support    
               No support (RC) 1.00   
               Partial support 0.97 0.36 0.484 – 1.980 
               High support 0.76 0.51 0.279 – 2.072 
Communicative support    
               No support (RC)          1.00   
               Partial support 2.52* 0.47 0.998 – 6.399 
               High support   2.66** 0.30 1.451 – 4.873 
Emotional support    
               No support (RC) 1.00   
               Partial support 0.58 0.32 0.311 – 1.112 
               High support 0.69 0.58 0.223 – 2.145 
Notes: N= 327; Adjusted R2 =0.069; X2= 16.163; Asterisks indicate significance at *p<0.05, **p<0.01; 
(RC) - Reference category 
 
 
The results indicating that communicative support from male partners at the time of an 
abortion has a statistically significant effect on women’s uptake of post-abortion contraception 
is consistent with other studies which also found that spousal communication, and/or spousal 
discussion is a strong factor influencing women’s family planning use  (Bawah et al., 1999; 
Bawah, 2002; Sharan and Valente, 2002; Kaggwa, Diop and Storey, 2008; Yue, O’Donnell 
and Sparks, 2010; Eliason et al., 2014; Ezeanolue et al., 2015). The hypothesis that women 
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who receive communicative support are more likely to use family planning after an abortion 
compared to women who do not receive any communicative support is, therefore supported by 
the findings of this study. However, the second hypothesis which stated that women who are 
financially supported by their partners are more likely to adopt a PAFP method is not supported 
by the results of the analysis at p<0.05. 
The first hypothesis which was supported is expected because, when couples discuss, 
agree and approve of FP during the abortion decision-making process, women are encouraged 
to accept and adopt a contraceptive method to prevent future unintended pregnancies. Women 
also come to believe that by communicating with their partners on ways of preventing 
unintended pregnancies, their partners become more receptive to contraceptive use, and may 
support their actions to avoid future unintended pregnancies. Discussions surrounding limiting 
childbirth tend to assume a joint character and a shared responsibility between the couple, 
thereby minimising the woman’s discreet use of contraceptives. Some studies have found that 
discussions on family planning increase contraceptive use, and corrects women’s erroneous 
perception that their partners disapprove of contraceptive use (Bongaarts and Bruce, 1995; 
Berhane et al., 2011). Through effective dialogue on family planning, couples are able to select 
appropriate birth control methods with encouragement and support from each other. Consistent 
contraceptive use, therefore, becomes possible over time. Communicative involvement from 
the male partner is, therefore, instrumental in changing attitudes on contraceptive method use 
(DeRose et al., 2004). 
8.3.2 Partner involvement, socio-demographic variables and PAFP uptake 
Table 8.6 presents the results from three Models which examined the relationship between the 
partner involvement variables, socio-demographic characteristics and PAFP uptake. Model 2 
shows the effect of women’s socio-demographic characteristics and partner involvement 
factors on PAFP uptake. In Model 3, the male partners’ socio-demographic characteristics and 
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partner involvement variables were regressed on PAFP uptake. The fourth model combined 
both the women and male partners socio-demographic factors, and partner involvement 
variables on the outcome variable. 
In Table 8.6, the results from Model 2 indicate that communicative and emotional 
support strongly influenced women’s adoption of PAFP. Similar to the results in Model 1, 
women who received a high communicative support from their male partners were 2.32 times 
as likely to use family planning after the abortion as women who did not receive any 
communicative support from their partners at p<0.05. However, emotional support was 
inversely related to PAFP uptake. Compared to women who did not receive any emotional 
support, women who received some (partial) emotional support were 0.53 times less likely to 
adopt a contraceptive method after abortion at p<0.05. There was however no observed 
statistically significant relationship between physical and financial support and PAFP uptake. 
Among the socio-demographic variables, a woman’s age, number of living children and 
employment were statistically significant factors influencing PAFP uptake (Table 8.6). The 
results show a positive relationship between number of surviving children, employment and 
PAFP uptake, but, age was inversely related with PAFP use. Women with two children were 
4.13 times as likely to uptake PAFP as women with no children. Also, employed women were 
2.17 times as likely to use post-abortion contraception as unemployed women. The results 
further indicate that women who were aged 35-39 years were 0.79 times less likely to adopt a 
family planning method after an abortion compared to women who were less than 20 years at 
p<0.05. The model explains 18 percent of the variation in the outcome variable.  
The results in Model 3 (Columns 4 and 5) indicate that women’s receipt of 
communicative support still strongly influenced their use of a PAFP method. The results show 
that compared to women who did not receive any communicative support from their partners, 
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women who received high communicative support from their partners were 2.54 times as likely 
to uptake PAFP at p<0.05. Physical, financial and emotional support, however, had no 
statistically significant effect on PAFP uptake.  
Male partners’ age and ethnicity were found to be statistically significant predictors of 
women’s use of post-abortion contraception (Model 3). Women whose partners are aged 35-
39 years, and 40-44 years were 3.44 and 4.12 times respectively as likely to uptake PAFP as 
their counterparts whose partners were below 24 years. Additionally, the results show that 
women whose partners are Ga-Dangme are 2.38 times as likely to adopt a post-abortion 
contraceptive method as those women whose partners were Akan. The model results illustrate 
that 17 percent of the variation in the model is explained by the predictor variables. 
The fourth model includes females and male partners’ socio-demographic17 
characteristics, the partner involvement variables and PAFP uptake. The results as depicted in 
Table 8.6 (Column 6 and 7) show that communicative support still significantly predicted 
women’s use of a family planning method after an abortion with significantly higher odds for 
women who received high communicative support from their partners. The woman’s 
employment and number of surviving children, and the male partners’ educational level 
showed a strong positive relationship with PAFP uptake at p<0.05. 
                                                          
17 Religious affiliation variables for both women and male partners were excluded in Model 4 because 
of the few counts in some cells which produced insignificant values and large confidence intervals. 
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TABLE 8. 6 LOGISTIC REGRESSION OF SOCIO-DEMOGRAPHIC VARIABLES AND PAFP UPTAKE 
Variables Model 2 Model 3 Model 4 
OR (s.e.) 95% CI OR (s.e.) 95% CI OR (s.e.) 95% CI 
Physical support       
     No support (RC) 1.00  1.00  1.00  
     Partial support 1.52 (.40) .687- 3.353 1.34 (.42) .595-3.0261 1.03 (.45) .699-4.133 
     High support .86 (.41) .386- 1.920 .79 (.43) .340-1.8421 1.03 (.46) .419-2.514 
Financial support       
     No support (RC) 1.00  1.00  1.00  
     Partial support 1.09 (.39) .508-2.350 1.08 (.40) .487-2.372 1.28 (.45) .527- 3.109 
     High support .68 (.55) .243-1.994 .83 (.56) .273-2.497 .82 (.60) .255 -2.660 
Communicative       
support      
     No support (RC) 1.00  1.00  1.00 
     Partial support 2.56 (.53) .908- 7.254 2.68 (.51) .982-7.296 2.52 (.54) .866-7.315 
     High support 2.32* (.34) 1.196- 4.512 2.54* (.34) 1.310-4.918 2.16*(.37) 1.052-4.429 
Emotional support       
     No support (RC) 1.00 1.00 1.00 
     Partial support 0.47* (.36) .230-.9560 .90 (.69) .231-3.488 .88 (.74) .208-3.738 
     High support 0.84 (.63) .244- 2.871 .60 (.63) .177-2.056 .47 (.66) .130-1.730 
Woman’s characteristics      
Education    
No education (RC)          1.00 1.00 
Primary  1.80 (.57) .603- 5.612   2.28 (.64) .652-7.968 
Middle/JHS 1.30 (.48) .521- 3.472   2.02 (.59) .642 -6.370 
Secondary+ .94 (.47) .374- 2.379   1.51 (.63) .437- 5.244 
Age        
< 20 years (RC) 1.00    1.00  
      20 - 24 .80 (0.46) .323 – 1.987  .73 (.65) .207-2.606 
      25 – 29 .49 (0.54) .173 – 1.440   .44 (.80) .092-2.109 
      30 – 34 .68 (0.61) .208 – 2.225   .45 (.87) .082-2.435 
      35 – 39 .21* (0.7) .055 – .832     
     40 – 44           
Employment        
No employment (RC) 1.00    1.00  
Employed 2.17* (.36) 1.080 – 4.356   2.17* (0.39) 1.022-4.621 
Religious affiliation       
Christians (RC) 1.00      
Other Christians  1.74 (0.55) .596 – 5.088     
Muslim 3.91 (0.85) .739 – 20.672 
Ethnicity        
Akan (RC) 1.00    1.00  
Ga-Dangme 1.95 (.67) .857- 4.416   1.3 (.47) .523-3.241 
Ewe  .96 (-.03) .500- 1.860    .69 (.40) .315-1.510 
Other ethnic groups 1.27 (.24) .545- 2.975  1.52 (.50) .574-4.011 
Asterisks indicate significance at *p<0.05  
Model 2:  Adjusted R2 =.175; X2 =42.067; N= 324; df= 28  
Model 3: Adjusted R2=.172, X2= 39.583; N= 309; df = 26  
Model 4:  R2 = 0.23 X2 =53.840; N= 308; df = 41 
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Table 8.6 continued 
Variables Model 2 Model 3 Model 4 
OR (s.e.) 95% CI OR (s.e.) 95% CI OR (s.e.) 95% CI 
Parity          
              0 (RC) 1.00                 1.00 
1 1.53 (.45) .638-3.690   1.15 (.50) .434-3.048 
2 4.13* (.6) 1.261-13.495   4.4* (.65) 1.236-15.692 
3 2.95 (.65) .826-10.499   3.14 (.73) .749-13.180 
4 3.26 (.69) .835-12.703   3.00 (.78) .646-13.883 
       
Male partner       
characteristics 
  Age        
      < 24 (RC)       
      25 – 29   2.37 (.51) .871-6.456 2.53 (.63) .740-8.657 
      30 – 34   2.31 (.55) .787-6.764 2.01 (.75) .465-8.716 
      35 – 39   3.44 * (.61) 1.035- 3.09 (.79) .651-14.707 
11.170 
      40 – 44   4.12* (.67) 1.12-15.275 3.25 (.9) .557-18.925 
      45+   1.18 (.65) .332-4.185 1.13 (.88) .201-6.360 
Employment        
No employment (RC)   1.00  1.00  
Employed .58 (.58) .186-1.813 .76 (.60) .233-2.491 
Religious affiliation       
No religion (RC)   1.00    
Christians    .93 (.66) .255-3.399   
Muslim   2.23 (.99) .322-15.493   
Other Christians   .77 (.72) .190 -3.153   
Ethnicity        
Akan (RC) 
Ga-Dangme   2.38* (.42) 1.043-5.449 2.1 (.46) .858-5.146 
Ewe    1.48 (.37) .711-3.067 1.6 (.43) .694-3.668 
Other ethnic groups   1.64 (.50) .615-4.369 2.44 (.51) .894-6.635 
Education        
Other education (RC)          1.00 1.00 
Middle/JHS   1.95 (.45) .803-4.752 2.22 (.49) .856-5.804 
Secondary   2.21 (.44) .940-5.214 3.0 (.49) 1.144-7.794 
Higher/tertiary     .90 (.45) .371-2.173 2.99*(.49) 1.144-7.794 
       
Marital Status       
Never married (RC) 
Currently married    .74 (.39) .340-1.589 .48 (.57) .158-1.474 
Formerly married   .68 (.73) .164-2.859 .49 (.83) .097-2.516 
Cohabiting   1.2 (.48) .464-3.098 .99 (.70) .249-3.901 
Asterisks indicate significance at *p<0.05 
 
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 Women who were employed were 2.17 times as likely to use post-abortion contraception as 
unemployed women. Compared to women without a child (or children), women with two 
children were 4.13 times more likely to use post-abortion contraception. The results further 
indicate that women were more likely to adopt a PAFP method if their partners had a secondary 
or higher education compared to their counterparts whose partners had ‘Other’ education. 
Model 4 explains 23 percent of the variation in PAFP uptake. 
The results from Models 2, 3 and 4 show that communicative support provided by male 
partners at the time of an abortion significantly influences women’s uptake of post-abortion 
contraception. These findings are consistent with earlier studies conducted in Ghana and other 
settings which found that spousal discussion, and/or communication about contraception 
influenced women’s use of a modern family planning method (Bawah, 2002; Kaggwa, Diop 
and Storey, 2008; Yue, O’Donnell and Sparks, 2010; Mekonnen and Worku, 2011; Eliason et 
al., 2014; Ezeanolue et al., 2015). The results suggest that male partners are central to 
contraceptive decision-making and contribute to women’s acceptance, adoption and initiation 
of contraception after an abortion. Male partners who desire to limit their family size are more 
likely to be supportive of their female partners’ decision to adopt a modern FP method after an 
abortion to reduce future unintended pregnancies. On the other hand, women who perceive that 
their partners want no more children may be encouraged to implement their fertility goals with 
their partners’ implied consent.  
In furtherance to the results from Model 2, women who received some emotional 
support from their partners at the time of the abortion were less likely to adopt a contraceptive 
method after the abortion compared to women who did not receive any emotional support. A 
plausible explanation for this unexpected finding could be that, the lack of affection, 
reassurance and concern for the abortion from the male partner may be negatively reinforcing 
for these women, hence, their decision to protect themselves from another future abortion. 
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Women who do not receive any emotional support from their sexual partners tend to bear the 
burden of the psychological pain and distress alone and this can intrinsically be a ‘push factor’ 
for some of them to avoid a future unplanned pregnancy. It is possible that adopting a post-
abortion contraception may be a coping mechanism to dealing with the loss of pregnancy.  
Additionally, the results from Models 2 and 4 also found that women’s age, number of 
surviving children and employment status had a significant effect on the uptake of a PAFP 
method although age was negatively correlated with PAFP uptake. These findings corroborate 
other studies conducted by Adanu et al. (2009), Bbaale and Mpuga (2011), Jabeen et al. (2011), 
Sharma et al. (2012) and Buyinza and Hisali (2014). These studies found that women’s socio-
demographic characteristics such as age, educational status, and parity influence contraceptive 
use. However, studies with contrasting results have been reported elsewhere where women 
with no child (or children) reported higher likelihood of contraceptive use (Frost and Lindberg, 
2013). 
Couples or women with at least two surviving children who do not intend to continue 
childbearing or who want to space childbearing have a higher likelihood of using birth control 
to regulate their desired family size than other women without any children. The motivation 
may be dependent on financial constraints, changing nature of the family system and a desire 
to avoid disruption in life goals which may compel women or couples to limit their family size. 
These reasons may account for why the results showed that women with no children were less 
likely to adopt a family planning method after the abortion compared to women with two 
surviving children.  
Among women who do not have a child, plausible explanations for non-use of a PAFP 
method may stem from the fear of side-effects of modern family planning methods especially, 
concerns about infertility as some studies have found (Ross and Agwanda, 2012; Ochako et 
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al., 2015). Thus, for this group of women, the tendency to accept or initiate a modern family 
planning method even after the abortion will be low. It is also possible that women whose 
relationships ended prior to the abortion may be unwilling to initiate a contraceptive method 
immediately after the abortion since they are no longer in sexual partnerships.   
Consistent with other studies in the literature, women with a high socio-economic 
status, and/or women with a higher wealth quintile are more likely to use contraception than 
women with lower socio-economic status (Jabeen et al., 2011; Lakew et al., 2013). Women 
who are economically empowered are more likely to use family planning because they have 
financial power to access and purchase contraceptive methods which are available to them. It 
is also plausible that women’s greater autonomy in economic matters gives them a say in 
contraceptive decision-making with or without their partners’ consent for contraceptive use 
after an abortion. 
The results from Model 3 showed that women whose male partners were Ga-Dangme 
were more likely to use PAFP compared to women whose partners were Akan. This finding is 
inconsistent with earlier studies conducted by Dodoo and Takyi (2005), Addai (1999a, 1999b), 
Addai and Trovato (1999). They found that ethnic and kinship identity regulates the fertility 
goals of women in patrilineal arrangements. For instance, among the Akan, women enjoy 
autonomy in childbearing and reproductive decision-making than non-Akan women. So, whilst 
Akan women may enjoy the freedom to use modern contraception to reduce unintended 
pregnancies, non-Akan women, like the Ewe and Ga-Dangme, may be unable to implement 
their reproductive goals.  
Several plausible reasons can be adduced for this unexpected result which found that 
women with Ga-Dangme partners are more likely to adopt a post-abortion contraception. 
According to Fayorsey and Fayorsey (1992, 1993), the commoditization of childbirth is one of 
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the several factors that affect fertility. Among the Ga people who live in Central Accra, 
pregnancy, childbirth and marriage are commoditized. In Fayorsey and Fayorsey’s study 
among the Ga people, commoditization is an economic strategy employed by women to obtain 
capital from their Ga male partners from conception until childbirth. It is a socially accepted 
custom for Ga men to provide for their female partners pregnancy until childbirth. Ga men take 
pride in their paternal responsibility from conception until birth and a woman’s matrikin is 
likely to approve such partnership arrangements. However, a woman will be more likely to 
adopt post-abortion contraception on realizing that her Ga male partner is financially incapable 
of providing her needs during pregnancy. Also, such women may wish to regulate the 
pregnancies they want, avoid the liability of unwanted children, and the associated economic 
burden of childcare. In addition, women in partnership arrangements with Ga partners are likely 
to initiate contraception after an abortion if the economic burden of large family affects their 
economic activity.      
Another explanation which can be proffered for this finding can be linked to women’s 
economic autonomy in the household, shifting gender power relations in sexual dyads in 
response to normative expectations, and women’s ability to negotiate reproductive and fertility 
choices. Considering the growing awareness and availability of maternal healthcare services, 
it is possible that women who wield large economic resources in the household may discreetly 
decide to implement their fertility preferences so as to be able to continue with their work. It is 
likely that economically empowered women with Ga partners may have strong negotiating 
skills and power to influence their partners to accept their decision to regulate their fertility if 
their financial support to the household is significant. An evaluation of the trade-offs between 
expected benefits of large number of children and costs associated with high parity may compel 
latent use of contraception without their partners’ knowledge. Consequentially, women in such 
patrilineal heterosexual relationships may be motivated to use post-abortion contraception if 
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they perceive significant costs of pregnancy, their health, and employment especially in 
informal unions.  
Furthermore, the decision regarding post-abortion contraception uptake among this 
category of women may be reinforced by the availability of contraceptive services at the time 
of the abortion as some studies have found (Goodman et al., 2008; McDougall et al., 2009; Zhu 
et al., 2009). Some studies have found that women in patrilineal contexts are able to stop 
childbearing only if their partners wish to stop childbearing (DeRose, Dodoo and Patil, 2002). 
Thus, in such circumstances, women who perceive that their partners wish to control their 
fertility will be more likely to implement their partners’ reproductive intentions with that 
perceived support.  
 
8.3.3 Partner involvement, socio-demographics, intermediate variables and PAFP uptake 
In Model 5, all the variables in the study were introduced into the model and regressed on 
PAFP uptake. However, marital status variables (for both partners) were excluded from the 
model due to multicollinearity. The results in Table 8.7 are only shown for the characteristics 
which were statistically significant at p<0.05.  
From Table 8.7, women’s employment, level of family planning knowledge, and self-efficacy 
positively predicted use of post-abortion contraception at p<0.05. Compared to unemployed 
women, employed women were 3.23 times as likely to use a PAFP method. With reference to 
level of FP knowledge, women who were not knowledgeable about family planning were 
significantly less likely (0.78 times) to use a PAFP method compared to women who were 
knowledgeable about FP at p<0.05. Self-efficacy significantly predicted women’s initiation 
and use of post-abortion contraception at p<0.05. The results show that an increase in self-
efficacy is associated with an increased likelihood of PAFP use.  
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The male partners’ characteristics which showed a statistically significant relationship 
with PAFP uptake include ethnicity, educational level and level of FP knowledge. All the other 
socio-demographic factors were not significantly related to PAFP uptake. As it was found in 
the results, women with Ga-Dangme partners were 3.38 times as likely to adopt post-abortion 
contraception as women whose partners were Akan. Women whose partners have 
Middle/Junior High School and secondary education were also respectively 3.21 times and 
4.26 times as likely to use PAFP as women whose partners had ‘Other’ education. The results 
further showed that, women who reported their partners to have ‘moderate knowledge’ of 
family planning were 4.21 times more likely to use a post-abortion contraceptive method than 
women who reported their partners to have knowledge of family planning. Communicative 
support, physical, emotional and financial support, however, did not predict PAFP use. 
Compared to Models 1, 2, 3 and 4, model 5 explains 38 percent variation in the outcome 
variable.  
 
 
 
 
 
 
 
 
 
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TABLE 8. 7 LOGISTIC REGRESSION RESULTS OF ALL STUDY VARIABLES AND PAFP UPTAKE 
Variables OR (s.e.) 95%CI 
Woman   
Employment    
     Unemployed (RC) 1.00  
     Employed  3.23*(.45) 1.342-7.819 
Level of family planning knowledge   
     Knowledgeable (RC) 1.00  
     Moderately knowledgeable .92 (.44) .391-2.183 
     Not knowledgeable  0.22*(.56) .072- 0.654 
 
Self-efficacy  1.10 1.008-1.210 
   
Male partner characteristics 
Ethnicity    
     Akan (RC) 1.00  
     Ga-Dangme 3.38* (.53) 1.199- 9.551 
     Ewe  1.66 (.47) .655-4.216 
     Other Northern groups 2.10 (.61) .637-6.870 
Educational level   
     Other education (RC) 1.00  
     Middle/JHS 3.21*(.56) 1.062- 9.668 
     Secondary  4.26*(.56) 1.412-12.849 
     Higher  1.87 (.63) 0.543-6.424 
Level of family planning knowledge    
    Knowledgeable (RC) 1.00  
    Moderately knowledgeable 4.21*(.47) 1.689- 10.485 
    Not knowledgeable 1.55(.55) 0.522-4.572 
    Don’t know .98 (.58) 3.16 
Asterisks indicate significance at *p<0.05; Model 5: X2 =94.916; Adjusted R2 = 0.383;  
df= 54; N= 307
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The results from Models 2 to 5 consistently showed that woman’s employment still remained 
statistically significant in predicting PAFP uptake. The level of contraception knowledge was 
a significant correlate of post-abortion contraception use. Whilst women who were not 
knowledgeable about family planning had reduced odds of PAFP use, women whose partners 
had a moderate knowledge of contraception had higher odds of using PAFP. This finding is 
consistent with Biney’s (2011) study which showed that among women receiving abortion in 
some hospitals, they had no knowledge of contraceptive methods prior to the abortion. Beside 
this finding, scholars have attributed a high unmet need for contraception as a function of the 
lack of effective contraception knowledge (Casterline and Sinding, 2000) and poor uptake 
(Wafula, Obare and Bellows, 2014). Although contraceptive knowledge is universal in Ghana, 
the result suggests that knowledge on birth control alone may not translate into attitudes, 
practice and behaviour.  
Additionally, the study found that post-abortion family planning uptake was influenced 
by women’s self-efficacy. This finding is congruent with previous research which found 
perceived self-efficacy to be strongly associated with contraceptive use and intentions to use 
contraception (Peyman and Oakley, 2009; Peyman et al., 2009; Kahsay et al., 2018). Among 
the six constructs of the HBM, various studies have demonstrated that self-efficacy is the single 
strongest predictor of contraceptive use than the other constructs (Terry and O'Leary, 1995; 
Babalola, John and Ajao, 2015; Muhindo et al., 2015). Self-efficacy to use post-abortion 
contraception as demonstrated by the results reflect women's strong desire to prevent future 
unintended pregnancies. It is also suggestive of a strong sense of personal responsibility, self-
dependency or autonomy which is pivotal in explaining intentions for engaging in health 
promotive behaviours. By far, contraceptive self-efficacy indicates women's agentic freedom 
in contraceptive decision-making. 
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CHAPTER 9 
SUMMARY, CONCLUSION AND RECOMMENDATION 
9.1 Introduction 
Increasing men’s involvement in sexual and reproductive issues is instrumental to reducing 
unintended pregnancies and unmet need for contraception which may result in induced 
abortions. Considerable evidence from various settings indicate that male participation in 
women’s reproduction (specifically, contraceptive use) is linked to contraceptive continuity 
and consistency. Limited data, however, exist on whether male partners’ involvement in 
abortion can influence women’s use of post-abortion contraception. Although few studies have 
investigated male partners’ roles in abortion in Ghana, there is scarce literature examining the 
link between male involvement in women’s abortion experiences and post-abortion 
contraception uptake. 
This thesis examined the relationship between male partners’ involvement in abortion 
and post-abortion family planning (PAFP) uptake in the Greater Accra Region. Specifically, 
this study explored the extent of male partners’ involvement in their female partners’ abortion 
and use of PAFP; women’s expectations of their partners’ roles in abortion and identified the 
barriers to partners’ inclusion and participation in the abortion process. The mixed methods 
approach guided the collection of primary data through in-depth interviews, participant 
observations and survey. The data were obtained from four purposively selected health 
facilities within the Greater Accra Region. Forty-one interviewees participated in the in-depth 
interviews and 356 women participated in the survey. Coding and thematic analysis of 
qualitative data were done with the Nvivo software and multiple logistic regression analysis 
were done with the SPSS to examine the relationship between partner involvement and PAFP 
uptake in respect of the quantitative data.  
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The main findings of the study, theoretical implications and recommendations for future 
research are presented in the subsequent sections. 
 
9.2 Summary of findings 
The study found that the male partners are involved in women’s abortion experiences in three 
main ways: through their knowledge of the abortion, role in the abortion decision-making 
process, and provision of support for the abortion. Male partners’ knowledge of the abortion 
pertained to their awareness of abortion, communication with partners about the abortion, 
knowledge of health-seeking behaviour for abortion-related care; knowledge of abortion 
methods, and non-awareness of abortion.  
The male partners’ roles in the decision-making process was three-fold: they were 
either active facilitators or initiators in the abortion decision-making process, passive actors 
during the pregnancy resolution process, or played no role during the abortion decision. 
Regarding male partners’ support for the abortion, different types were identified. These 
include: instrumental support (mainly payment of abortion expenses and accompaniment to the 
hospital); emotional support (expressions of empathy, and concern for female partners’ health 
after the abortion); informational support (relevant direction and guidance on place of abortion-
seeking care); and communicative support (discussions and negotiation surrounding the 
abortion decision).     
The results also showed that nearly all the study participants initiated and adopted a 
contraceptive method, mainly, long-acting reversible contraception (LARC) such as implants 
immediately after the abortion without the involvement of their partners. The narratives 
indicated that immediate post-abortion family planning uptake was influenced by the abortion 
provider’s characteristics, access to and availability of family planning consumables.  
 
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Results from the study further showed that women’s expectation of receiving financial 
support for the abortion was mostly anticipated and prioritised over the expectation of partner 
participation in the pregnancy resolution process, and perceived support after the abortion. 
Some of the women had no expectations of their partners’ support at the time of the abortion. 
Lack of male partners’ awareness and knowledge of the pregnancy and abortion mainly 
inhibited their inclusion and participation in the abortion. Other factors that served as barriers 
to involvement in the abortion related to secrecy surrounding the abortion, partner 
abandonment, work-related demands, ambivalence about the pregnancy outcome, and parental 
responsibility for the pregnancy. 
The results from the multiple logistic regression analysis showed that communicative 
support provided by the male partners has a statistically significant positive effect on the 
women’s use of post-abortion family planning. Women’s receipt of emotional support from 
their male partners was, however, not predictive of PAFP uptake. The hypothesis that women 
who received high communicative support from their male partners were more likely to use 
post-abortion contraception than women who did not receive any communicative support from 
their partners was supported. The second hypothesis that women who are financially supported 
by their partners during the abortion are more likely to use a PAFP method was, however, not 
supported by the results from the study.   
The study also found that women who were knowledgeable of family planning, were 
employed, and had a high self-efficacy in using contraception were more likely to adopt a post-
abortion contraceptive method compared to women who had no knowledge of FP, or who were 
unemployed or had a low self-efficacy. The male partner characteristics which predicted 
women’s PAFP uptake were educational level, ethnicity and level of FP knowledge. Women 
were significantly more likely to adopt a post-abortion family planning method if their partners 
had a Middle/JHS and secondary level of education, and if the partner was Ga-Dangme. 
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Furthermore, women were more likely to use PAFP if their partners had a ‘moderate’ level of 
knowledge of family planning.  
 
9.3 Conclusion  
The male partners’ are involved in women’s abortion experiences in different ways. The study 
has established that communicative support from male partners during an abortion is crucial in 
positively reinforcing women’s adoption and initiation of a family planning method after an 
abortion. This finding corroborates earlier studies conducted in other settings. However, male 
partners’ lack of involvement during the abortion was a result of the secrecy and partners’ lack 
of knowledge surrounding the pregnancy and abortion, work-related demands, parental 
responsibility and partner unavailability. Furthermore, self-efficacy remained the only 
significant predictor of PAFP use compared to the other HBM constructs. This result shows 
that women are capable of exercising autonomy over their reproductive choices and goals in 
preventing pregnancies either with or without their partners’ participation in the abortion, and 
irrespective of socio-cultural myths, beliefs and perceptions regarding contraception.  
In sum, the women’s use of post-abortion contraception is a net result from individual factors 
(of both partners), partner involvement in abortion variables (communicative and emotional 
support), and HBM factors (self-efficacy). Generalizability of the results is limited to 
participating health facilities and sample characteristics. Caution should be exercised in 
extrapolating the study findings to other contexts although replication may yield additional 
interesting revelations. 
 
9.4 Recommendations  
The results obtained in this study reveal relevant issues which have implications for improving 
CAC and post-abortion family planning services. The study recommends intensive 
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comprehensive contraceptive counselling for women and couples during abortion care 
delivery. The goal of contraceptive counselling should aim at improving women’s self-efficacy 
in contraceptive decision-making, and encourage continuous and sustained contraceptive 
adherence. Comprehensive investigations into couples’ (or the woman’s) contraceptive history 
prior to the abortion will serve as a pedestal for the acceptance and uptake of effective 
contraceptive methods after the abortion. 
From a programmatic perspective, sexual and reproductive health practitioners should design 
strategies that promote men’s sexual health by emphasizing on the use of male contraceptive 
methods to prevented unintended pregnancies, sexually transmitted infections and abortion. 
Public health interventions should also apply social media communication strategies to 
advocate men’s important role in improving the sexual health of their female partners.  
   
9.5 Theoretical implications of study findings 
In this thesis, the Theory of Planned Behaviour (TPB) and Health Belief Models (HBM) were 
applied to explain and possibly predict women’s use of PAFP. The results indicate to an extent, 
the utility of these theories in predicting PAFP use. The study found that self-efficacy was the 
only significant predictor of PAFP uptake compared to the other HBM constructs. Other studies 
lend support to this finding (Peyman and Oakley, 2009; Peyman et al., 2009) where self-
efficacy influenced women’s contraceptive use. This result suggests that women are capable 
of exercising autonomy over their reproductive choices and goals when it comes to preventing 
pregnancies either with or without their partners’ participation in the abortion, and irrespective 
of socio-cultural myths, beliefs and perceptions regarding contraception. The ability of women 
to determine what happens to their ‘body’ is also indicative that women value their confidence 
to prevent future unintended pregnancies. In effect, even with male partners’ participation in 
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abortion, women with a high self-efficacy are more likely to adopt post-abortion contraception 
than women with a low self-efficacy.  
With Ajzen’s theory of Planned Behaviour (TPB), it is predicted that individual 
behavioural intention(s) are influenced by the individual’s attitude, perceived behavioural 
control and subjective norms. Linked to self-efficacy, women with a high self-efficacy have a 
relatively higher chance of exercising control of and making decisions on specific behaviours 
to engage in to prevent future unintended pregnancies and abortions compared to women with 
a low self-efficacy. The joint effect of perceived behavioural control and behavioural intention 
potentially reinforces an individual’s confidence to use contraception discounting the negative 
attitude towards FP. Though subjective norm may negatively affect women’s post-abortion 
contraceptive use, the results indicate that the intention and actual performance of a behaviour 
(uptake of PAFP) are strongly hinged on a strong sense of agency and self-determination 
discounting all other factors.    
9.6 Future research 
This study provides first-hand exploratory results which provide opportunities for further 
research agenda. First, future researchers may consider expanding the scope of this study to 
include private health facilities in other regions of the country since this study was limited to 
only public health facilities within the Greater Accra Region of Ghana. Interesting results may 
be found in these settings owing to the diversity of facility-level and provider characteristics 
which might influence or inhibit the delivery of post-abortion family planning services.  
Another area for future research relates to the research design modification. Future 
studies can consider undertaking longitudinal investigation instead of a cross-sectional one. 
This will enable causality inferences and assumptions to be drawn and follow-ups on post-
abortion contraception use can be investigated. Also, other researchers may wish to replicate 
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this topic in the wider community context as the present study was hospital-based. As the 
research was limited to only women who visited the participating hospitals, the perspectives of 
other women who might have had an abortion elsewhere were missed. There is a possibility 
that their abortion trajectories, and abortion-seeking behaviour experiences would differ from 
the current study respondents.  
This study has shown that male partners participate in women’s abortions in different 
ways. In future research endeavours, researchers may wish to collect primary data directly from 
male partners who accompany their female partners to the hospital for an abortion in order to 
obtain detailed insights into the social and psychological experiences of male involvement in 
women’s abortion experiences. Couple studies to investigate the patterns of communication on 
post-abortion contraceptive use can be worth investigating. It will be insightful and interesting 
to tap into the worldview and perspectives of male partners who are involved in women’s 
abortion experiences as this would enrich the paucity of abortion data from men, while 
contributing to a broader understanding of male involvement in abortion. 
In the current study, individual-level characteristics of the Health Belief Model and 
Theory of Planned Behaviour were factored into the conceptual model to examine its effect on 
PAFP uptake. There is existing literature which suggest that health facility variables account 
for increased post-abortion contraceptive acceptance and prevalence (Banerjee et al., 2009; 
Navin et al., 2011b). In this regard, it will be useful for future studies to explore these health 
facility characteristics, and community-level factors which might moderate the relationship 
between male involvement and PAFP uptake.   
Furthermore, although the study specifically sought to investigate male partners’ 
involvement in pregnancy termination and PAFP uptake, the available literature demonstrates 
that social networks influence post-abortion contraception use. Since such studies are 
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understudied in the Ghanaian context, researchers may wish to consider conducting exploratory 
studies to examine the influence of social networks in alleviating women’s emotional distress 
and coping mechanisms after an abortion.  
  
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APPENDICES 
Appendix 1: Interview Guide for Women 
Title of study: Male Partners’ Involvement in Abortion and Uptake of Post-abortion 
Family Planning Services. 
 Section A: Socio-demographic data 
1. Age: 
2. Highest educational level (in completed years):  
3. Present occupation:  
4. Employment status:  
5. Religious affiliation: 
6. Number of living children: 
7. Living arrangement with partner: 
8. Number of months/years living with partner: 
9. Place of residence 
 
Section B: Relationship Characteristics 
i. How are you involved with the man responsible for your pregnancy?  
Probe: - Duration of relationship/union, Relationship stability/instability; indicators of 
stable/unstable relationship, Status of relationship at time of pregnancy, Status of relationship 
at time of abortion 
                  - Level of commitment to relationship/union; and indicators of commitment   
  
Section C: Pregnancy History 
i. In your lifetime, how many pregnancies have you had?  
Probe: Age of sexual activity; sexual debut, outcome of pregnancies (birth, deaths, 
miscarriage, abortion); reasons for previous abortion (if any); pre-and post-abortion 
counselling during previous abortion 
   
Section D: Contraceptive use before abortion 
i. Before the abortion, were you or your partner doing something to prevent pregnancy?   
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Probe: - Method used to prevent pregnancy, and reason for method  
  - Duration of protection against pregnancy 
  - Partner approval/agreement of using contraceptive method, and Reasons 
  - Discussion with partner to use contraception 
 
ii. How will you describe your attitude towards contraception? 
(Favourable/Unfavourable/Neutral) 
iii. How will you describe your partner’s attitude towards contraception? 
 
Section E: Pregnancy disclosure and Intention 
i. How did you come to know/find out that you were pregnant? 
 Probe: - When did you find out about the pregnancy? 
                         - Gestational age of pregnancy when first discovered 
 
ii. Who was the first person you told when you discovered you were pregnant? 
            Probe: If partner first, or others first, give reasons. 
 - Partner’s immediate reaction to news of pregnancy. Describe 
 - Partner’s acceptance/denial of pregnancy. Describe things he did to suggest denial 
   - Awareness of partner’s pregnancy intention 
iii. How did you feel about the pregnancy when you found out? Give reasons 
iv. What was your immediate reaction to the pregnancy?  
v. Has this pregnancy come too soon, right time, later in future, or you didn’t care? Why? 
vi. Did you want/desire to become pregnant? Why? (Pregnancy wantedness)   
vii. Did you think you could become pregnant? Why? (Perceived risk of pregnancy) 
 
Section F: Abortion history  
i. Before the last time (at the clinic), have you ever terminated a pregnancy in your lifetime?  
Probe: Number of times aborted pregnancy 
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 Age of pregnancy (months/weeks) at time of abortion  
First thing to end pregnancy (whether self-induced); and Reasons 
 Person who terminated pregnancy (if not self-induced) 
Knowledge of where to seek help for pregnancy termination 
 Procedure for abortion; Reason for abortion procedure; Health complications after 
abortion; describe the kind of complication [bleeding, pain, fever, etc.]; Place of treatment for 
complication of abortion 
ii. Who paid for the abortion? Give reasons  
iii. How much was paid for the cost of abortion? 
 
Section G: Abortion decision 
i. What decision did you make independently when you discovered you were pregnant? 
ii. Who made the decision to terminate the pregnancy? 
Probe: Was your partner involved in the decision to terminate the pregnancy? Give 
reasons; Involvement of other people; Partner’s reaction to abortion; First person to 
suggest/demand for abortion; most influential in decision to terminate pregnancy 
 
iii. Before you became pregnant, did you ever discuss with your partner what you will do in 
the event of a pregnancy? 
iv. In your view, who do you think has the right to decide on abortion or not? State reasons 
Probe: - Final decision maker. Give reasons 
 
Reasons for pregnancy termination: 
i. What were the main reasons that influenced your decision to terminate the pregnancy? 
Probe: - Other factors that influenced decision to terminate pregnancy 
  - Health grounds, Partner attributes, actual time abortion was performed after  
  first discovered 
 
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Section H: Expectations of Male partner support in abortion 
i. Did you think that you could depend on your partner for any form of support when you found 
out about the pregnancy? 
ii. Did you think that you could depend on your partner for any form of support when you 
decided to have an abortion? 
iv. When u decided to terminate the pregnancy, did you expect your partner to provide some 
support for you? 
Probe: Describe various ways in which your partner provided some form of support to  
you before the abortion (financial, emotional, instrumental, family   
planning/contraception) 
      - Whether expectations were met 
      - Reasons that accounted for unmet expectations 
 
v. After the abortion, do you expect to receive support from your partner? Give examples & 
reasons 
Probe: [financially, emotionally, materially/instrumentally, & informationally] 
       **What are some of the things you expect your partner to do for you after the abortion? 
- Reasons for male partner non-support in the abortion 
     
Section K: Post-abortion Family Planning/Contraception 
i. Are you using a contraceptive method now after the abortion? Give reasons 
Probe: If Yes,- Reasons for type of contraceptive method 
- Whether contraceptive type chosen depended on partner’s preference; partner’s influence; & 
partner’s involvement/support  
- Time of contraceptive uptake 
- Whose responsibility for use of contraception in relationship  
 
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ii. Will your partner’s support for the abortion influence you to use a family planning method 
after the abortion?  
iii. If No, was there anything to prevent you from using contraception after the abortion? Give 
reasons 
Probe:  - Partner disapproval, Contraception issues (side- effects, cost, and access) 
 - Future intentions to use contraception 
iv. Were you (and your partner) encouraged to use contraception by health professional before 
or after the abortion? 
Probe: - Describe events before and after abortion procedure  
                   - Contraception/FP methods discussed 
                         - Whether felt pressured to accept a contraceptive method  
             - Partner knowledge of contraception use 
                  iii. What roles and responsibilities were you expecting from your partner from the 
time of the pregnancy until the abortion? 
 
 
 
 
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Appendix 2: Interview guide for Male Partner  
Title of study: Male partner involvement in abortion and uptake of post-abortion family 
planning (PAFP) services. 
 Section A: Socio-demographic data 
1. Age 
2. Highest educational level  
3. Present occupation 
4. Employment status 
5. Religious affiliation 
6. Number of living children 
7. Living arrangement with partner 
8. Place of residence 
 
Section A1: Relationship Characteristics 
i. Can you describe the nature of the relationship between you and the woman who got 
pregnant for you and which you assisted to terminate?  
 Probe: - Duration of relationship/union  
- **Relationship stability/instability, and reasons 
  - Level of commitment to relationship/union, and reasons 
  - Level of communication on sexual matters  
 
Section B: Abortion history  
i. In the past, have you and your partner terminated a pregnancy for which you were 
responsible for?  
Probe: Number of times pregnancy has been terminated 
 Age of pregnancy (months/weeks) at time of termination  
First thing to end pregnancy (whether self-induced); and Reasons 
 Person who terminated pregnancy (if not self-induced) 
Knowledge of where to seek help for pregnancy termination 
 Procedure for pregnancy termination 
  Health complications after pregnancy termination 
Probe: Describe the kind of complication [bleeding, pain, fever, etc.] 
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      Place of treatment for complication of abortion 
ii. Who paid for the abortion? Give reasons  
iii. How much was paid for the cost of abortion? 
  
Section C: Pre-abortion stage 
Contraceptive use before abortion 
i. Were you or your partner doing something to avoid pregnancy? Reasons if Yes/No. 
Probe: - Method used to prevent pregnancy, and Reason for method  
  - Duration of protection against pregnancy 
  - Partner approval/agreement of using contraceptive method, and Reasons 
  - Discussion with partner to use contraception 
 
ii. Can you describe your attitude towards contraception? (Favourable/Unfavourable/Neutral) 
iii. How will you describe your partner’s attitude towards contraception? 
 
Pregnancy disclosure and Intention: 
i. How did you come to know that your partner was pregnant?   
 Probe: Gestational age of pregnancy  
ii. Can you describe your immediate reaction when you found out about the pregnancy? 
 Probe:  - Describe feeling about pregnancy  
  - Timing of pregnancy (too soon, later [future], didn’t care). Reasons 
  - Responsibility for pregnancy. Reasons 
 
Abortion decision 
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i. What did you plan to do when your partner informed you about the pregnancy? 
ii. Who made the decision to terminate the pregnancy?  
Probe:  - Woman’s decision, joint decision, decision of other people 
  - First person to demand for abortion 
- Most influential in decision to terminate pregnancy 
  - Attitude of woman to abortion 
  - Intentions to provide support after abortion decision 
 
iii. Before the pregnancy, had you previously discussed what you will do in the event of a 
pregnancy?  
iv. In your view, who do you think has the right to decide on abortion or not? State reasons 
Probe: - Final decision maker. Give reasons 
Reasons for pregnancy termination: 
i. What were the main reasons that influenced your decision to terminate the pregnancy? 
Probe: - Other factors that influenced decision to terminate pregnancy 
  ** Actual time abortion was performed after first discovered 
Section D: Involvement and support in abortion 
i. Can you describe the ways in which you supported your partner at the time of abortion?   
Probe: - Reasons for non-support in the abortion   
Financial support: – Payment of cost of abortion 
       - Payments for other expenses related to abortion 
                  - Payment of transportation cost 
Physical/material/instrumental support 
- Accompany woman to facility. Give reasons. 
- Seek information on place to have the abortion performed. Give reasons. 
- Encourage rest/sleep after abortion. 
- Purchase nutritious food/drinks/drugs to aid recovery after abortion 
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- Perform any house chores/cater for the children after abortion 
Emotional support 
- Empathetic, - Reassurance about health  
- Concern to accompany woman to facility or stay home with her after the termination 
- Encourage follow-up visit to the health facility after abortion 
- Concern about postponing sexual intercourse after the abortion 
Family Planning/Contraception support 
- Encourage/Influence contraceptive use after the abortion   
- Discuss contraceptive use  
- Approved of/agreed to contraception use after the abortion 
 
ii. What things or factors prevent men from involving and supporting themselves in their 
partner’s abortion? 
Section D1: Post-abortion decision stage 
i. After the abortion, did you and your partner adopt a contraceptive method? 
Probe: If Yes,  
- Reasons for type of contraceptive method 
-Whether contraceptive type chosen depended on your preference; influence; & 
involvement/support 
- Time of contraceptive uptake  
- Future fertility intentions 
ii. If NO, was there anything to prevent you and your partner from using contraception after 
the abortion? Give reasons 
Probe:  - Contraception issues (side- effects, cost, and access); other issues (religion) 
 - Future intentions to use contraception 
 
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iii. Were you (and your partner) encouraged to use contraception by a health professional 
before or after the abortion? 
Probe: - Narrate events before and after abortion procedure  
                   - Contraception/FP methods discussed 
                         - Whether felt pressured to accept a contraceptive method  
             - Partner knowledge of contraception use 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDIX 3: QUESTIONNAIRE 
Location of Interview:  Respondent Unique ID:  
Date of interview:   
Start time:  
                           SECTION 1: RESPONDENT BACKGROUND INFORMATION  
 I would like to ask you some information about yourself.  
Q NO QUESTION  
1. How old were you on your last birthday?   
                                                                                    __ __ 
2. On what day, month and year were you born?   
                                   DAY __ __          MONTH _____                 YEAR__ __ __ __ 
3. What is the highest level of school you have attended and completed?   
     1= NO EDUCATION            2= PRE-SCHOOL                    3= PRIMARY    
     4= MIDDLE/JHS    5= SECONDARY/SHS    6= HIGHER/TERTIARY 
     7= VOCATIONAL                     8= OTHER (SPECIFY)  
4. Are you currently attending school?            
                                  1= YES                   2= NO 
5. What work are you currently engaged in for money/income for the past 6 months?   
      1= NO OCCUPATION/NOT WORKING     2=CLERICAL          3= SALES          4= SELF-EMPLOYED  
      5= UNSKILLED MANUAL                          6= MANAGERIAL       7= HOUSEHOLD AND DOMESTIC 
      8= SKILLED MANUAL                                  9= OTHER [SPECIFY] 
6. What is your religion?  
  1= NO RELIGION      2= CATHOLIC       3= PRESBYTARIAN                        4= METHODIST 
  5= PENTECOST/ CHARISMATIC                   6= TRADITIONAL/SPIRITUALIST                7= MUSLIM/ISLAM 
  8= DEEPER LIFE                    9= SDA                10= JEHOVAH WITNESS                         11= ANGLICAN 
  12= OTHER [SPECIFY] 
7. What is your ethnic group?    
          1= AKAN  2= GA-DANGME               3= EWE                                  4= GRUSI 
           5= GUAN   6= GRUMA     7= MOLE-DAGBANI             8= HAUSA 
           9= OTHER [SPECIFY]  
8. Where is your usual place of residence (for the last six months)?   
 
9. Who are you currently living with?  
       1= LIVING ALONE    2= PARTNER/SPOUSE                                   3= BOTH PARENTS                                  
        4= ONE PARENT                         5= SIBLINGS [SISTERS/BROTHERS]             6= FRIEND                       
        7= GRANDPARENTS                  8= GUARDIAN/CARE-GIVER                                                                    
        9=OTHER [SPECIFY] 
10. What is your marital status now?  
          1= SINGLE (NEVER MARRIED)             2= CURRENTLY MARRIED            3= COHABITING   
           4= DIVORCED                                         5= WIDOWED                                6= SEPARATED 
11. If currently married or Cohabiting, for how long?  
     _________ 
12. How many children do you have?    
                      
 SECTION 2a: CONTRACEPTIVE KNOWLEDGE  
 Now I would like to ask you some questions about the various ways or methods that men and  
women use to delay or avoid pregnancy. 
13. Which family planning methods or contraceptive methods have you EVER heard of? ALLOW 
1= EMERGENCY PILLS [E.G. POSTINOR, N-TABLET, PROTEX] respondent to 
2= ORAL CONTRACEPTIVE PILLS [E.G. SECURE] mention 
3= INJECTABLES  spontaneously.  
4= MALE CONDOM  
5= FEMALE CONDOM Circle as many 
6= WITHDRAWAL options 
7= IMPLANTS mentioned. 
8= IUD  
9= LACTATIONAL AMENORRHOEA METHOD [LAM] 
10= FEMALE STERILIZATION (TUBAL LIGATION) 
11= MALE STERILIZATION (VASECTOMY) 
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12= DIAPHRAGM 
13= FOAM/JELLY 
14= RHYTHM/CALENDAR  
15= OTHER METHOD [specify] 
14. Which contraceptive methods do you know of? (Probe: allow respondent to describe Circle as many 
how contraceptive is used, past experience) options 
1= EMERGENCY PILLS [E.G. POSTINOR, N-TABLET, PROTEX] described by 
2= ORAL CONTRACEPTIVE PILLS [E.G. SECURE] Respondent. 
3= INJECTABLES  
4= MALE CONDOM 
5= FEMALE CONDOM 
6= WITHDRAWAL 
7= IMPLANTS 
8= IUD  
9= LACTATIONAL AMENORRHEA METHOD [LAM] 
10= FEMALE STERILIZATION (TUBAL LIGATION) 
11= MALE STERILIZATION (VASECTOMY) 
12= DIAPHRAGM 
13= FOAM/JELLY 
14= RHYTHM/CALENDAR  
15= OTHER METHOD [specify] 
15. How will you describe your level of knowledge about family planning/contraceptives?  
     1= VERY KNOWLEDGEABLE              2= KNOWLEDGEABLE               3= SOMEWHAT KNOWLEDGEABLE 
     4= NOT KNOWLEDGEABLE              5= NOT KNOWLEDGEABLE AT ALL 
     6= DON’T CARE 
16. What is your attitude towards contraceptive use?  
        1= VERY FAVOURABLE            2= FAVOURABLE                              3= SOMEWHAT FAVOURABLE  
       4= NOT FAVOURABLE             5= NOT FAVOURABLE AT ALL         6= DON’T CARE           
   
 Instructions: In this section, I will read some statements to you. FOR EACH STATEMENT, TELL ME 5- DON’T 
WHETHER YOU: 1-STRONGLY DISAGREE    2- DISAGREE       3- AGREE             4- STRONGLY AGREE KNOW 
 Perceived Benefits Of Contraceptives SD D A SA 
a. Using contraceptives would help me avoid unwanted or unexpected pregnancy  1 2 3 4 
b. I would have saved the money I used to pay for the abortion if I used contraceptives 1 2 3 4 
c. Using contraceptives is effective and easy to use 1 2 3 4 
d. I do not have to worry about becoming pregnant when I use contraceptives 1 2 3 4 
e. I am not ready to have children now so I have to protect myself with contraceptives 1 2 3 4 
f. Using contraceptives will prevent me from having an abortion 1 2 3 4 
g. The cost of abortion is more expensive than the cost of contraceptives 1 2 3 4 
      
 PERCEIVED BARRIERS TO CONTRACEPTIVE USE     
a. I know that using contraceptives might cause side-effects  1 2 3 4 
b. I believe when I use contraceptives, I might not be able to have children in future 1 2 3 4 
c. I think that when I use contraceptives, it might cause health problems in future 1 2 3 4 
d. I am too young to use contraceptives to protect against pregnancy 1 2 3 4 
e. My partner does not agree that I use contraceptives 1 2 3 4 
f. It will be difficult to go to a hospital/clinic for a contraceptive/family planning 1 2 3 4 
g. It is an inconvenience to use contraceptives/family planning 1 2 3 4 
h. Buying contraceptives is expensive 1 2 3 4 
j. The side-effects that people have said about contraceptives prevents me from using 1 2 3 4 
it. 
   
17. Before you became pregnant, were you and/ OR your partner doing something to prevent yourself IF NO, Skip 
from becoming pregnant?           to Q19 
1= YES, WE WERE USING EMERGENCY CONTRACEPTIVE PILLS 
2= YES, WE WERE USING ORAL CONTRACEPTIVE PILLS 
3= YES, WE WERE USING MALE CONDOMS 
4= YES, WE WERE USING FEMALE CONDOMS 
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5= YES, I WAS USING WITHDRAWAL  
6= YES, WE WERE USING IMPLANTS 
7= YES, I WAS USING IUD 
8= YES, I WAS USING INJECTABLES 
9= YES, I WAS USING MY SAFE PERIOD/CALENDAR METHOD/ RHYTHM METHOD 
10= YES, I WAS BREASTFEEDING (LACTATIONAL AMENORRHEA [LAM] 
11= NO, WE WERE NOT DOING ANYTHING TO PREVENT PREGNANCY 
12= OTHER (SPECIFY) 
18. How long have you been using this method to prevent pregnancy from occurring?   
         1= LESS THAN SIX MONTHS AGO               2= ONE YEAR AGO                  3= TWO YEARS AGO 
        4= MORE THAN TWO YEARS AGO 
19. In your whole lifetime, which contraceptives /family planning types have you ever used before?  
a. NO METHOD 
b. EMERGENCY PILLS [E.G. POSTINOR, N-TABLET, PROTEX] 
c. ORAL CONTRACEPTIVE PILLS [E.G. SECURE] 
d. INJECTABLES  
e. MALE CONDOM 
f. FEMALE CONDOM 
g. WITHDRAWAL 
h. IMPLANTS 
j. IUD  
k. LACTATIONAL AMENORRHEA METHOD 
l. DIAPHRAGM 
m. FOAM/JELLY 
n. RHYTHM/CALENDAR  
O. OTHER METHOD [specify] 
 PREGNANCY HISTORY SECTION  
20.  In your whole lifetime, how many times have you become pregnant (including this last pregnancy)?  
_____ 
21. Out of this (these) pregnancy/pregnancies, how many ended in live births? _________  
 
22. How many ended in stillbirths?   
 
22a. How many ended in deaths? ____________  
 
23. How many ended in induced abortion? _______  
 
23a. So how many of the pregnancies were miscarriages/spontaneous abortions?  
 
23b. So how many months/weeks are you pregnant?  
 
24. Before this current pregnancy, did you want/wish to become pregnant?  
                1= YES                                   2= NO                      3= DIDN’T CARE                                     
25. So how would you consider the timing of your pregnancy?  
                1= TOO SOON (UNEXPECTED)                              2= AT THE RIGHT TIME                   
              3= LATER (IN FUTURE)                                           4= DIDN’T CARE 
26. If LATER (IN FUTURE), when did you want to become pregnant?  
             1= IN 12MONTHS TIME         2= IN 2YEARS TIME                        3= IN 3YEARS TIME                     
            4= IN 4YEARS TIME                         5= IN 5YEARS TIME                     
            6= OTHER [SPECIFY] 
27. Which of the following best describes how you felt when you found out you were pregnant.  
                1= VERY UNHAPPY                  2= UNHAPPY            3= NORMAL (NEITHER HAPPY OR UNHAPPY)                                   
                4= HAPPY                                  5= VERY HAPPY  
28.  What are the main reasons why you don’t want to have a child now or keep this pregnancy?  
  
 
 
 
 
 
 
 
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SECTION 3: MALE PARTNER BACKGROUND INFORMATION  
 In this section, I would like to ask you a few questions about your male partner who is responsible for  
your pregnancy. 
29. How old is your male partner (age as at last birthday)? ____  
 
30. What is the highest level of education your partner has completed?  
     1= NO EDUCATION                 2= PRE-SCHOOL                       3= PRIMARY  
     4= MIDDLE/JHS                  5= SECONDARY/SHS                       6= HIGHER/TERTIARY   
     7= DON’T KNOW                                 8= OTHER (SPECIFY) 
31. What kind of work/job is your partner currently engaged in or doing for income/money?  
  1= NOT WORKING/NO OCCUPATION              2= CLERICAL              3= SALES   
  4= SELF-EMPLOYED                                              5= UNSKILLED MANUAL          6= MANAGERIAL   
  7= HOUSEHOLD AND DOMESTIC                       8= OTHER [SPECIFY] 
31a. Is your partner currently attending school?  
          1= YES                         2= NO 
32. What religion does your partner belong to?  
    1= NO RELIGION                                    2= CATHOLIC  3= PRESBYTARIAN               4=METHODIST    
    5= PENTECOST/CHARISMATIC            6=TRADITIONAL/SPIRITUALIST                              7= MUSLIM/ISLAM                          
    8= DEEPER LIFE                                      9= SDA          10= JEHOVAH WITNESS                   11= ANGLICAN               
    12= OTHER [SPECIFY] 
33. What is your partners’ ethnic group?    
       1= AKAN   2= GA-DANGME                    3= EWE   4= GUAN 
        5= GRUMA  6= MOLE-DAGBANI               7= GRUSI                       8= HAUSA 
       9=OTHER [SPECIFY] 
34. What is your partner’s current marital status?   
             1= SINGLE (NEVER MARRIED) 2= CURRENTLY MARRIED        3= DIVORCED 
            4= WIDOWED 5= SEPARATED 6= DON’T KNOW 
           7= OTHER [SPECIFY]   
35. Who is your partner currently living/ staying with?  
   1= ALONE                  2= ME/SPOUSE         3= ANOTHER WOMAN                            4= BOTH PARENTS          
   5= ONE PARENT       6= FRIEND                 7= SIBLINGS [SISTERS/BROTHERS]           8= GRANDPARENTS                                                          
   9= OTHER [SPECIFY] 
 SECTION 3b: NATURE OF RELATIONSHIP WITH MALE PARTNER  
 
36. What is your relationship with the man who is responsible for your pregnancy?  
      1= BOYFRIEND                    2= HUSBAND                                       3= FIANCÉ                   4= RELATIVE 
      5= FRIEND                             6= CASUAL ACQUAINTANCE            7= RELIGIOUS LEADER/PASTOR 
      8= OTHER [SPECIFY] 
37. How long have you been in a relationship with the man responsible for the pregnancy?  
     1=LESS THAN 6MONTHS 2= 6 MONTHS TO 1 YEAR                  3= 1-2YEARS            4= 3-5YEARS 
     5= 6YEARS- 11YEARS  6= MORE THAN 11YEARS 
 
38. How stable is your relationship with the man responsible for the pregnancy?  
      1= VERY STABLE                   2= STABLE                                      3= SOMEWHAT STABLE   
      4= NOT STABLE                    5= NOT STABLE AT ALL 
39. Right now, are you in a relationship with this man?  IF YES, go to 
      1= YES                            2= NO                   3= NOT SURE             4= I INTEND TO END THE RELATIONSHIP WITH HIM Q41 
40. If NOT SURE, OR INTEND TO END THE RELATIONSHIP, what are the reasons?  
 
 
41. How will you describe your partner’s level of knowledge about family planning/ contraceptives?  
      1= VERY KNOWLEDGEABLE            2= KNOWLEDGEABLE             3= SOMEWHAT KNOWLEDGEABLE 
      4= NOT KNOWLEDGEABLE             5= NOT KNOWLEDGEABLE AT ALL 
      6= DON’T KNOW 
42. Have you and your partner ever talked about or discussed using contraceptives in your relationship?  
                 1= YES, VERY OFTEN           2= YES, SOMETIMES                3= NEVER 
 
43. Before this pregnancy, did your partner agree that you will use contraceptives in your relationship?  
                                  1= YES                     2= NO 
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44. If NO, why didn’t your partner agree to using contraceptives?  
 
 
 
45. What is your partner’s attitude towards contraceptive use?  
          1= VERY FAVOURABLE                    2= FAVOURABLE                              3= NOT FAVOURABLE  
         4= NOT FAVOURABLE AT ALL         5= HE DOESN’T CARE  
          
46. Before this pregnancy, did you know when your partner wanted to have a child?  If NOT SURE 
         1= YES, HE WANTED A CHILD NOW/IMMEDIATELY or DON’T 
         2= YES, HE WANTED A CHILD LATER (IN THE FUTURE)  KNOW, go to 
         3= NOT SURE WHEN HE WANTED A CHILD Q48 
         4= NO, I DON’T KNOW 
         5= HE DOES NOT WANT ANY MORE CHILDREN 
47. If YES, how many children does your partner want to have in future?   
        ___________ 
48. If NO, why don’t you know when your partner wants to have children?  
        1= WE HAVE NEVER TALKED ABOUT IT                  2= ITS NOT IMPORTANT  
        3= HE HAS NEVER TOLD ME ABOUT WHEN HE WANTS TO HAVE CHILDREN 
        4= I HAVE NEVER ASKED HIM WHEN HE WANTS TO HAVE CHILDREN 
        5= OTHER [SPECIFY] 
49. Does your partner know that you are pregnant for him? If YES, 
                      1= YES                        2= NO                      continue at 
Q50 
 If NO, why doesn’t your partner know of the pregnancy?  
  
 
 
 SECTION 5a: MALE PARTNER INVOLVEMENT IN ABORTION   
I am going to ask you a few questions about how your partner is involved in the decision to have an 
abortion. 
50. Before you became pregnant, did you discuss or talk with your partner about what you will do in IF NO, go to 
the event of an unintended pregnancy?            Q52 
                         1=YES                                 2=NO 
51. If YES, what did the two of you decide to do in the event of an unintended pregnancy?  
         1= TO GIVE BIRTH/KEEP THE PREGNANCY          2= TO TERMINATE THE PREGNANCY 
        3= UNDECIDED/ NOT SURE 
        4= OTHER [specify] 
52. If NO, why did you not discuss with your partner what you will do during an unintended pregnancy  
earlier before the pregnancy? 
   1. WE DIDN’T THINK THE PREGNANCY COULD HAPPEN  
   2. NOT NECESSARY OR IMPORTANT 
   3. I WAS USING CONTRACEPTION [PILLS] 
   4.WE WERE DOING SOMETHING TO PREVENT PREGNANCY [E.G. USING WITHDRAWAL, SAFE PERIOD, LAM] 
   5. NO REASON 
   6. OTHER [SPECIFY] 
53. Does the man who got you pregnant know that you are choosing to have an abortion? IF YES, go to 
                         1= YES                         2= NO  Q55 
54. If NO, why doesn’t he know that you are terminating the pregnancy or choosing to have an  
abortion? 
a. HE IS NOT AROUND/TRAVELLED 
b. I DON’T KNOW HIS WHEREABOUTS 
c. I DON’T WANT TO TELL HIM 
d. HE IS NOT FAITHFUL 
e. WE ARE NO LONGER IN A RELATIONSHIP  
f. I WANT IT TO BE A SECRET 
g. I WANT TO AVOID CONFLICTS OR PROBLEMS 
h. AFRAID HE WILL DISCLOSE IT TO HIS FAMILY OR FRIENDS OR CHURCH MEMBERS 
j. OTHER [SPECIFY] 
 
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55. Who made the decision to terminate the pregnancy? If MY 
         1= MYSELF                             2= MY PARTNER                                  3= BOTH OF US PARTNER=2co
        4= MY PARENTS [MOTHER, FATHER, OR MOTHER ALONE, OR FATHER ALONE] ntinue at Q57. 
        5= MY OLDER SIBLING [SISTER, OR BROTHER]                              6= MY GUARDIAN/CAREGIVER 
        7= OTHER [SPECIFY] 
56. If YOU (woman) made the decision, is your partner supportive of your decision to have the abortion?  
         1= YES, HE IS SUPPORTIVE                    2= NO, HE IS NOT SUPPORTIVE   
        3= OTHER [SPECIFY] 
57. How supportive or to what extent is your partner of your decision to have the abortion?  
      1= VERY SUPPORTIVE                 2= SUPPORTIVE                               3= SOMEWHAT SUPPORTIVE 
      4= NOT SUPPORTIVE                  5= NOT SUPPORTIVE AT ALL 
58. How will you describe your partner’s attitude toward the abortion?  
       1= FAVOURABLE                           2= NOT FAVOURABLE AT ALL                 3= DOESN’T CARE 
     4= NOT AWARE OF ABORTION   
59. Between you and your partner, who was the FIRST person to initiate or suggest the abortion?  
         1= MY PARTNER                  2= MYSELF                                     3= BOTH OF US       
          
60. Who was the MOST INFLUENTIAL person in the decision to terminate the pregnancy?  
           1= MY PARTNER                       2= MYSELF                                      3= BOTH OF US 
          4= MY PARENTS                       5= MY OLDER SIBLINGS                6= GUARDIAN/CARE-GIVER                    
          7= MEDICAL DOCTOR             8=  QUALIFIED NURSE            
          9= OTHER [SPECIFY] 
 
 SECTION 5b: MALE PARTNER SUPPORT IN THE ABORTION  
In the following questions, I will like to know how your partner provided some support for you 
before and during the time of the abortion.  
                                                Please tick YES [√] or NO [X]. 
 What are some of the things your partner did for you when you or (both of you) decided to terminate the Y N   
pregnancy?  
a. Pay for the abortion     
b. Bought me some drugs to terminate the pregnancy before I came to the hospital     
c. Accompanied me to the clinic/hospital     
d. Provided me with information on where I could go for the abortion      
e. Gave me money for transportation to the hospital     
f. Encouraged me not to be worried about the abortion     
g. Expressed concern about the abortion     
h. Expressed concern about my health      
j. Talked to me about using contraceptives/family planning after the abortion     
k. He agreed that we will use contraceptives to prevent another pregnancy     
l. Expressed concern that we should abstain from sexual intercourse after the abortion     
m. Approved that we will use contraceptives after the abortion     
n. OTHER [Specify]     
61. Will your partner’s support in the abortion influence you to use family planning after the  
abortion?                        1= YES                      2= NO                      3= I DON’T KNOW 
62. To what extent will your partner’s support during the abortion influence you to use contraception  
after the abortion?  
 
        1= VERY MUCH/GREATLY                             2= MUCH/ GREATLY               3= LITTLE                                     
      4= VERY LITTLE                                               5= NEVER/NOT AT ALL 
 SECTION 6: SELF-PERCEIVED QUESTIONS  
 I am going to ask you the following questions about your perceptions of severity of abortion. I will also ask you  
about whether you have the ability to prevent another pregnancy and abortion from occurring in future. FOR 
EACH STATEMENT, TELL ME WHETHER YOU: 
 1-STRONGLY DISAGREE    2- DISAGREE       3- AGREE             4- STRONGLY AGREE 
 Perceived Severity Of Abortion And Negative Health Outcomes SD D A SA 
      1. It is possible for some people to die as a result of abortion 1 2 3 4 
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      2. The thought of having an abortion again in my life scares me 1 2 3 4 
      3. Having an abortion is a painful experience so I will not want to have another abortion 1 2 3 4 
      4. I will not want another abortion in my life because I might not be able to bear children in future 1 2 3 4 
      5. This abortion might cause some complications for me in future  1 2 3 4 
      6. I will never have my peace of mind because of this abortion 1 2 3 4 
      7. It is expensive to have an abortion than to buy contraceptives 1 2 3 4 
      
 SELF-EFFICACY     
     1. I am confident that I can use FP to protect myself from becoming pregnant 1 2 3 4 
     2.  I can confidently go to a nurse or hospital for family planning 1 2 3 4 
     3. I don’t need to depend on anyone to use FP after the abortion 1 2 3 4 
     4. On my own, I can make a decision to use family planning 1 2 3 4 
     5. I have to take responsibility for using contraception/family planning after the abortion 1 2 3 4 
     6. My partner doesn’t need to be involved in the contraception/family planning I use after 1 2 3 4 
the abortion 
     7. It is the responsibility of men to use contraceptives in a relationship 1 2 3 4 
     8. My partner does not need to know about the family planning method I use after the 1 2 3 4 
abortion 
     9. I am confident that I have enough knowledge on how I can prevent an unwanted 1 2 3 4 
pregnancy 
    10. I am sure that I can protect myself from having an unwanted pregnancy even if I don’t use 1 2 3 4 
contraceptives/ family planning 
      
 SECTION 7: POST-ABORTION FAMILY PLANNING/ CONTRACEPTION UPTAKE  
***** What will influence you to use FP/contraception after this abortion?  
 
 
 
63. Will your partner’s involvement in the abortion influence you to use FP after this abortion?  
                             1= YES                              2= NO                              3= I DON’T KNOW 
64. How likely or to what extent will your partner’s involvement in the abortion influence your  
decision to use contraception/FP after the abortion? 
          1= VERY MUCH/GREATLY      2= MUCH/ GREATLY                        3= LITTLE                      
         4= VERY LITTLE                                 5= NEVER/ NOT AT ALL 
65. If NEVER, why won’t your partner’s involvement in the abortion influence your decision to use  
contraception/FP after the abortion?  
            1= BECAUSE HE WASN’T INVOLVED IN THE ABORTION                                         
            2= NO REASON 
            3= OTHER [SPECIFY] 
 
 66. Have you adopted any family planning method after the abortion?   IF NO, SKIP TO 
                             1= YES                2= NO  Q71 
 67. If YES, what is (are) the reasons for your choice of FP method now after the abortion?  
1. TO PREVENT UNWANTED PREGNANCY 
2. TO PREVENT ANOTHER ABORTION 
3. BECAUSE I HAVE EVER USED IT BEFORE 
4. BECAUSE OF ENCOURAGEMENT/COUNSELLING/SUGGESTION FROM NURSE/ DOCTOR 
5. BECAUSE OF PARTNERS’ APPROVAL TO USE FP/CONTRACEPTION   
6. BECAUSE OF PARTNERS’ ENCOURAGEMENT & SUPPORT TO USE CONTRACEPTIVE/FP 
7. BECAUSE MY PARTNER AND I DECIDED TO USE A MORE EFFECTIVE CONTRACEPTION/FP METHOD 
8. BECAUSE MY PARTNER SUPPORTS MY DECISION TO USE CONTRACEPTION/FP 
9. BECAUSE MY PARTNER WAS INVOLVED IN THE DECISION TO TERMINATE THE PREGNANCY  
10. OTHER [SPECIFY] 
68. What FP method are you using now after the abortion?  
               1= IMPLANTS                                                 2= IUD                                  3= INJECTABLES                                                
             4= ORAL CONTRACEPTIVE PILLS                 5= MALE CONDOMS          6= FEMALE CONDOMS 
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             7= OTHER [SPECIFY] 
69. Why did you choose to use this type of FP type? (Multiple Choice)  
1. BECAUSE OF MY KNOWLEDGE ABOUT IT 
2. I HAVE USED IT BEFORE   
3. PARTNER’S PREFERENCE FOR CONTRACEPTIVE TYPE 
4. BECAUSE MY FRIENDS HAVE ENCOURAGED ME TO USE IT 
5. BECAUSE THE NURSE SUGGESTED AND COUNSELLED ME TO USE IT 
6. OTHER [SPECIFY] 
70.  Who made the decision to use the FP after the abortion?  
    1= MY PARTNER                2= MYSELF                           3= NURSE  
    4= MEDICAL DOCTOR            5= PARENTS                         6= OLDER SIBLING [SISTER/BROTHER] 
    7= OTHER [SPECIFY] 
71. Before you came for the abortion, had you already made up your mind to use FP after the abortion  
is done? 
 1= YES                                2= NO  3= I DON’T KNOW 
72. If NO, what contraceptive method/FP method do you intend to use after the abortion?  
      1= IMPLANT                                           2=IUD                                                       3= INJECTABLES 
      4= PERIODIC ABSTINENCE                   5=ORAL CONTRACEPTIVE PILLS          6= RHYTHM/CALENDAR METHOD                  
      7= NO METHOD                                    8= UNDECIDED                9= OTHER (SPECIFY) 
73. What will be your reason/reasons for choosing to use this type of FP in future?  
1. TO PREVENT UNWANTED PREGNANCY 
2. TO PREVENT ANOTHER ABORTION 
3. BECAUSE OF ENCOURAGEMENT FROM NURSE/DOCTOR 
4. BECAUSE OF PARTNER’S APPROVAL TO USE FP/CONTRACEPTION   
5. BECAUSE OF PARTNER’S ENCOURAGEMENT AND ADVICE TO USE CONTRACEPTION/FP 
6. BECAUSE MY PARTNER AND I DECIDED TO USE A MORE EFFECTIVE CONTRACEPTION/FP METHOD 
7. BECAUSE PARTNER SUPPORTS MY DECISION TO USE CONTRACEPTION/FP 
8. BECAUSE MY PARTNER WAS INVOLVED IN THE DECISION TO TERMINATE THE PREGNANCY  
9. OTHER [SPECIFY] 
 
74. What is preventing you from using a FP method immediately after the abortion?  
1. MALE PARTNER DISAPPROVAL TO USE CONTRACEPTIVE/FP 
2. FEAR OF SIDE EFFECTS OF CONTRACEPTIVES 
3. NEGATIVE PERCEPTION ABOUT USING CONTRACEPTIVES/FP 
4. I WANT TO HAVE MY MENSES FIRST BEFORE I USE CONTRACEPTION 
5. I WILL BE CAREFUL NEXT TIME SO THAT I DON’T GET PREGNANT  
6. I HAVEN’T PLANNED OR DECIDED TO USE CONTRACEPTION/FP AFTER THE ABORTION 
7. OTHER [SPECIFY] 
75. What is/are the main reasons why you do not intend to use a contraceptive method at any time in  
the future? 
 
 
 
 
THANK YOU VERY MUCH FOR PARTICIPATING IN THIS SURVEY. 
I will like to get in touch with you between two to 6 weeks just to find out whether you have decided to use a family planning 
method.   IF YOU AGREE, KINDLY GIVE ME YOUR CONTACT NUMBER: _____________________________ 
 
 
 
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Appendix 4: Ethical Approval Letter 
 
 
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Appendix 5: Consent Form 
INFORMED CONSENT FORM 
Principal Investigator: Esinam Afi Kayi  
Regional Institute for Population Studies. University of Ghana, Legon 
 
My name is _____________________. I am conducting a survey on ‘Male partners’ involvement 
in abortion and uptake of post-abortion family planning services’ in selected hospitals in Accra. 
I will ask you questions about you and your partner’s background, contraceptive knowledge, 
involvement of your male partner during your pregnancy and abortion. The information you provide 
is solely for academic purposes. It will help me fulfil the requirements for the award of my academic 
degree.  
There are no risks associated with participating in this study. You are free to decide if you want to be 
in this research. Your decision will not affect any service and benefits you would normally receive. 
Your participation is entirely voluntary. 
All the information you provide in this interview is confidential and anonymous. Your name will not 
be linked to any responses. Neither will your name be mentioned in any report. No one will know 
that you participated in this study. Your information will be protected, and it will not be released to 
anyone. Only the researcher will have access to your information. If you agree to be interviewed, it 
will take 30-40minutes.  
This study has been reviewed and approved by the Ghana Health Service Ethical Review Committee 
(GHS-ERC). After the interview, you may be contacted for some follow-up questions. If you have any 
concerns regarding the study, you may contact me on these numbers: 0543-567448/0265039701. If 
you have any questions about your rights as a research participant, you may contact [Hannah Frimpong, 
GHS-ERC Administrator on this number, 050-7041223].  
 
CONSENT TO PARTICIPATE IN THE SURVEY 
Please sign or thumbprint below if you agree to participate in the study. 
I certify that I voluntarily agree to participate in the interviews. The nature of the research 
describing its benefits, risks, and procedures has been explained to me. I understand that my 
participation in this research is voluntary and I am free to withdraw from the study whenever 
I wish. All my questions have been answered satisfactorily. I agree to participate as a 
volunteer. 
Respondent’s Unique ID code:   ______________ 
 
Respondent’s Signature/thumbprint                                                          Date: ____________                                                                             
 
Interviewer Signature __________________                                                  Date:  _____________ 
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Appendix 6: Sample Characteristics of In-depth interviewees 
Unique  Age  Educational status  Occupation  Employment Religious Parity  Living 
ID status affiliation  arrangement  
F1 27 Some primary school  Sells cooked Not working Moslem 1 Stays alone 
food 
F2 27 No school Sells Employed  Baptist 2 Stays with partner 
doughnut for 4yrs, married 
F3 26 Completed Senior Teacher  Employed  Charismatic  1 Stay with parents  
high school 
F4 19 Completed JSS Apprentice Unemployed  Pentecost  0 Stays with sister 
seamstress 
F5 18 Currently in Senior Not working Unemployed   0 Stays with mum 
high school (student) 
F6 31  Sells Employed   1 Stays with partner  
foodstuffs 
F7 32 Completed JSS Hairdresser  Employed  Catholic  1 Stays alone 
F8 23 Completed JSS Apprentice Employed Charismatic  0 Stays alone 
hairdresser  
F9 18 Currently in JSS 2 Not working Unemployed  Charismatic  0 Stays with parents 
(student)  
F10 22 Completed SSS House help Employed  Pentecost  1 Stays with mother 
F11 39 Completed SSS Fashion Employed  Charismatic  2 Stays with partner, 
designer married  
F12 13 Currently in class 6 Not working Unemployed  0 Resides with parents 
(student)  
F13 19 Currently in SS2 Not working Unemployed   0 Stays with parents 
(student) 
F14 28 No school  Sells Employed  Moslem  4 Stays with partner, 
charcoal married 
F15 18 Completed SSS Not working Unemployed  Presby  0 Stays with parents  
 
F16 21 Currently in tertiary Not working Unemployed  Charismatic  0 Stays with parents  
institution  (student) 
F17 21 Completed JSS Not working Unemployed  Moslem  0 Stays with parents 
[apprentice 
seamstress] 
F18 22 Completed SSS  Secretary  Employed  Charismatic 0 Stays with mother 
  
F19 32 Completed SSS Not working Unemployed  Charismatic  3 Stays with partner, 
(house wife) married for 7years 
F20 29 Completed tertiary  Assistant Employed  Pentecost  2 Stay with partner, 
Budget married for 7years 
analyst 
F21 23 No school Apprentice  Unemployed  Methodist  1 Stays with extended 
family 
F22 29 Completed SSS Not working  Unemployed  Charismatic 1 Stays with partner 
church for 1 and half years, 
married 
F23 34  Hairdresser  Employed  Moslem  2 Stays alone 
F24 21 Completed SSS Sells food Unemployed  Charismatic 0 Cohabiting  
  
F25 26 Tertiary  Accounts Employed  Pentecost  0 Stays with parents 
officer  
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F26 36 Didn’t complete SSS Trader  Unemployed  Deeper life 6 Stays with partner 
for 6years, married 
F27 23 Completed JSS Shop keeper Employed  Church of 0 Stays with sibling 
Christ  
F28 26 Completed JSS Hairdresser  Employed  Christ 2 Stays alone 
apostolic 
church  
F29 39 No response Fried fish Employed  Baptist  4 Stays with partner 
seller for 14years since 
married, 
F30 25 Completed JSS Apprentice Unemployed  Pentecost  1 Stays with partner 
hairdresser  occasionally 
F31 27 Did not complete Fried fish Employed  Pentecost  3 Stays with partner 
seller  
F32 26 Completed SSS Shop Employed  Pentecost  1 Stays alone 
assistant 
F33 21 Tertiary  Not working Unemployed Charismatic  0 Stays with parents 
[student] 
F34 25 Completed SSS Trader  Employed  Action faith 2 Stays with mother 
  
F35 40  Trader  Employed  Moslem  4 Stays with partner, 
married  
F36 19 Completed JSS Not working  Unemployed   0 Stays with mother 
 
F37 18 Currently in SSS Not working Not employed Christ 0 Stays with parents 
[student] Apostolic 
Church 
F38 14 Currently in JSS Not working Not employed  0 Stays with parents 
[student] 
 
 
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Appendix 7: Socio-demographic Characteristics of Male Partners 
Characteristics  Number  Percentage  
 
Employment status   
         Unemployed  25 7.6 
         Employed  300 91.7 
         Missing  2 0.6 
Educational status   
         No education 6 1.8 
         Preschool 2 .6 
         Primary 9 2.8 
         Middle/JHS          79 24.2 
         Secondary 110 33.6 
         Tertiary  81 24.8 
         Don’t know 36 11.0 
         Other 4 1.2 
Ethnicity    
         Akan  153 46.8 
         Ga-Dangme 55 16.8 
         Ewe  71 21.7 
         Other  47 14.3 
         Don’t know 1 .3 
Religion   
         No religion  19 5.8 
         Catholic  14 4.3 
         Presbyterian  31 9.5 
         Methodist 14 4.3 
         Pentecostal/ Charismatic 171 52.2 
         Muslim  23 7.0 
         Anglican  3 .9 
         Other Christian (SDA, 14 4.3 
Deeper life, Jehovah’s witness)   
         Other  21 6.4 
         Don’t know 16 4.9 
         Missing  1 .3 
Marital status   
         Never married  139 42.5 
         Currently married 127 38.8 
         Formerly married 13 4.0 
         Cohabiting  46 14.1 
         Don’t know 2 .6 
 
 
 
 
 
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