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 

 



i 
 

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 

 

 

 

 

 



ii 
 

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 

 

 

 

 

 

 

 

 

 



iii 
 

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.  



iv 
 

DEDICATION 

This work is dedicated to all the women who participated in this study. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



v 
 

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!



vi 
 

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 



vii 
 

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 



viii 
 

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 



ix 
 

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 



x 
 

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 



xi 
 

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 

 

 

 

  

 

 

 

 

 

 

 

  

 



xii 
 

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 

 

file:///C:/Users/KAFUI/Documents/PH%20Thesis%202018/CHAPTER%20WRITE-ups/FINAL%20WORK%2009%20AUG18.docx%23_Toc521589309
file:///C:/Users/KAFUI/Documents/PH%20Thesis%202018/CHAPTER%20WRITE-ups/FINAL%20WORK%2009%20AUG18.docx%23_Toc521589309
file:///C:/Users/KAFUI/Documents/PH%20Thesis%202018/CHAPTER%20WRITE-ups/FINAL%20WORK%2009%20AUG18.docx%23_Toc521589312
file:///C:/Users/KAFUI/Documents/PH%20Thesis%202018/CHAPTER%20WRITE-ups/FINAL%20WORK%2009%20AUG18.docx%23_Toc521589312


xiii 
 

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 



xiv 
 

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 

 

 



1 
 

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 



2 
 

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. 

 

 



3 
 

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. 



4 
 

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 



5 
 

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-



6 
 

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’. 



7 
 

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. 



8 
 

 

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 



9 
 

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 



10 
 

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. 



11 
 

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). 

 



12 
 

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 



13 
 

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, 



14 
 

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 



15 
 

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 



16 
 

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. 

 



17 
 

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).  



18 
 

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 



19 
 

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 



20 
 

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 



21 
 

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).  



22 
 

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.   



23 
 

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 



24 
 

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. 



25 
 

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. 

 



26 
 

 
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. 



27 
 

 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, 



31 
 

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 eviden