Background: Making the final decision to terminate a pregnancy can be influenced by different circumstances involving various individuals. This paper describes the key players involved in the decision-making process regarding abortions among women who elected to undergo an induced abortion in a cosmopolitan urban setting in Ghana. Methods: A retrospective cross-sectional mixed method study was conducted between January and December 2011. A total of 401 women with records in abortion logbooks were selected for an interviewer-administered questionnaire and an in-depth interview. Descriptive and multinomial logistic regression analyses were used to assess the quantitative data, and a thematic analysis was applied to the qualitative data. Results: The findings of the study reveal that pregnant individuals, mothers of abortion-seekers, male partners, and “Others” (for example, friends, employers) were instrumental in making a decision to terminate unplanned/unwanted pregnancies. Several key factors influenced the decision-making processes, including aversion from the men responsible for the pregnancy, concerns about abnormalities/deformities in future births due to unprofessionally conducted abortions, and economic considerations. Conclusion: A number of individuals, such as friends, mothers, and male partners, influence the decision-making process regarding abortion among the participants of the study. Various targeted messages are needed for the various participants in the decision.
This study was conducted in the Accra Metropolis, which has an estimated population of 2,242,505, of which 841,533 are within reproductive age [18]. As of 2010, there were 481 health facilities in the metropolis, consisting of four government hospitals, seven polyclinics, four quasi-government hospitals, 49 private hospitals, 270 clinics, 39 company clinics, 79 private maternity homes and 29 NGO/Mission hospitals. In 2008, approximately 17% (range: 8.1%-22.4%) of women (15–49 years) throughout the country reported a terminated pregnancy in the preceding five years. Disaggregated by region, 22.4% of women in the Greater Accra Region, where this study was conducted, had undergone an abortion [19], making it the region with the highest incidence of abortion in the country. In 2006, the Ghana Health Service, in collaboration with a consortium of five multinational organizations (EngenderHealth, Ipas, Marie Stopes International, Population Council, and the Willows Foundation) initiated the Reducing Maternal Mortality and Morbidity (R3M) project in the Greater Accra, Eastern and Ashanti regions following initial piloting in 17 districts in 2007. The R3M provides financial and technical assistance to enable the government to significantly expand access to modern family planning (FP) and comprehensive abortion care (CAC). The Accra Metropolis, a municipality within the Greater Accra that was involved in the pilot project, was purposively selected because of its cosmopolitan nature. Three accredited R3M health facilities, consisting of one private-not-for profit and two publicly owned and managed, were purposively selected. These were Marie Stopes International Ghana, BlueStar HealthCare Network, La and Ridge Hospitals. They were selected because of the high number of abortion cases registered in the metropolis in addition to the fact that they were the largest health facilities accredited to perform abortions under the R3M project. This context provides ‘friendly’ conditions for a safe abortion. This study employed a retrospective cross-sectional approach. Both qualitative and quantitative data were collected. This was done to complement the strengths and mitigate the limitations of the respective paradigms by using both questionnaires and in-depth interview (IDI) guides [20]. Neither the quantitative nor the qualitative data were given more weight [21], and the findings are presented concurrently. The questionnaire [22] and IDI guides [23, 24] were adapted from prior studies on abortion in Ghana. The questionnaire was structured around induced abortion decision-making processes, key individuals whose counsel was sought in the decision-making process, factors influencing choice of place for abortion and familiarity with the policy and legal frameworks, which influence induced abortion procedures in Ghana. The IDI guide, which was unstructured, focused on the following: pregnancy characteristics (e.g., person responsible), decision on whether to terminate, place of abortion, and choice of method, among others. Both questionnaires and interview guides were available in English but were translated into local languages for respondents who could not speak English. On average, each interview lasted approximately 60 min. At the first stage of the sampling, a purposive method was used to select three abortion service providers accredited by R3M. The total number of women who had undergone an abortion between January and December 2010 was collated, resulting in an overall total of 9,494. This served as the sampling frame for the study, and individual women with a record of abortion served as the unit of analysis. With this, a sample size of 370 was drawn based on OpenEpi [25]. An additional 10% upward adjustment was made to correct for non-response. The sample was distributed among the facilities based on population (share of abortion cases) proportional to size (PPS). Thus, the proportions of the 9,494 women were allocated as follows: Marie Stopes (61), BlueStar (217), Ridge (53) and La (39) hospitals. Respondents were then selected randomly to respond to the interviewer-administered questionnaires. Another 35 respondents consisting of five previously married women, 10 unmarried women and 20 married women were selected to further explore the reasons for involving other individuals in abortion decision-making. Ten trained nurses served as research assistants. The fieldwork was conducted between June and December 2011. The Ghana Health Service Ethics Review Committee reviewed and approved the study. All research subjects provided verbal and written informed consent. Four main groups of role-players were derived from the data: abortion seekers (self/personal autonomy), parents/mothers of abortion seekers, male partners, and less frequently mentioned role-players categorized as “Others”. Descriptive statistics with corresponding Chi-Square values were derived, followed by multinomial regression. Multinomial regression was used for inferential analysis because the dependent variable (role-players) has more than two outcomes, which makes it the most appropriate statistical tool for isolating the independent effects of the various categories of the background factors of abortion-seekers in abortion decision-making. The background factors captured in the quantitative data were occupation, age, marital status, religion, ethnicity, parity and number of previous abortions. These variables were entered concurrently because there was no intention to determine the impact of any single explanatory factor on the role-players. The qualitative data were analysed inductively by identifying main themes. FYG first undertook preliminary coding of the data. AKK and JAA independently reviewed all codes, followed by identification, discussion and resolution of the inconsistencies in the themes by all of the authors. All three authors had to agree upon a particular theme before it was included in the codebook. Finally, a colleague with expertise in qualitative analysis reviewed our codes, comparing these to the transcripts, field notes and tape recordings. STATA version 12 (College Station, Texas 77845 USA) was used to analyse the quantitative data, while the qualitative data were analysed manually.
N/A