Pregnancy options counselling in Ghana: A case study of women with unintended pregnancies in Kumasi metropolis, Ghana

  • BMC Pregnancy and Childbirth, Volume 19, No. 1, Year 2019

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Study Justification:
– Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana.
– Absence/inadequate pregnancy options counselling for clients to make informed decisions.
– This study examines options counselling for abortion seekers in health facilities in Ghana.
Highlights:
– Majority of respondents had been pregnant more than twice, but about 53% had no biological children.
– Induced abortion and parenting were mentioned as the only available options to unintended pregnancy in hospitals.
– Exposure to options counselling was significantly associated with parity, gestational age, previous induced abortions, perception of pregnancy at conception, and level of education.
– Majority of respondents were not aware that giving a child up for adoption is an option to abortion in Ghana.
– Pregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana.
– Higher educational attainments significantly expose women to options counselling for informed decisions.
Recommendations:
– Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.
Key Role Players:
– Health facility administrators and managers
– Health workers and counselors
– Government officials and policymakers
– Non-governmental organizations (NGOs) involved in reproductive health
Cost Items:
– Training and capacity building for health workers and counselors
– Development and implementation of comprehensive options counselling programs
– Awareness campaigns and educational materials
– Monitoring and evaluation of counselling services
– Research funding for further studies on counselling services
Please note that the cost items provided are general suggestions and may vary depending on the specific context and requirements of the recommendations.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is analytical cross-sectional, which allows for the collection of data at a specific point in time. The sample size calculation and sampling method are clearly described. The data analysis methods are appropriate for the research objectives. However, the abstract lacks information on the specific findings and their significance. To improve the evidence, the abstract should include a summary of the key findings and their implications for pregnancy options counselling in Ghana.

Background: Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions. This study examines options counselling for abortion seekers in health facilities in Ghana. Methods: Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study. Results: Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P = < 0.001), gestational age (P = < 0.001), previous induced abortions (P = < 0.001), perception of pregnancy at conception (P = < 0.001) and level of education (P = 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P = < 0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to abortion in Ghana. Conclusions: Pregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana. Although higher educational attainments significantly exposes women to options counselling for informed decisions, the less educated are disadvantaged in this regard. Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.

This is an analytical cross-sectional study involving first time female visitors with unintended pregnancies seeking pregnancy related healthcare services from the identified health facilities. The use of first time visitors was to help avoid contamination so that no single participant would be recruited more than once. The sample size (462) was calculated using the formula n = pqz2/d2, where n = sample size, z = level of confidence at 95% =1.96; d = allowable error = 0.05; p = proportion of unintended pregnancies and q = 1-p; p = proportion of unintended pregnancies in Ghana [15] obtained from the 2008 GDHS = 0.4, and thus q = 1–0.4 which translated into 0.6.n = 368.7986 which was approximated to 369 plus 25% non-response (the 25% non-response rate was assumed because of the sensitive nature of the subject and the probability of the respondents opting out in the course of the interview as observed during the pretesting). Purposive sampling method was used to select the health facilities for data collection because they are both situated in the central business area of the city and are well known to provide pregnancy related services in Kumasi. All consenting clients with unintended pregnancy patronising these health facilities were invited into the study until the desired numbers were obtained. In terms of proportions of respondents obtained from the health facilities. This study was conducted in two health facilities [Non-Governmental Organization (NGO) reproductive health center and Public hospital] within the Kumasi Metropolis in Ghana. Kumasi is Ghana’s second biggest city situated about 300 km from the national capital, Accra. The city is 150sq Km in size. Politically, Kumasi is divided into ten sub metropolitan areas namely: Manhyia, Tafo, Suame, Asokwa, Oforikrom, Asawase, Bantama, Kwadaso, Nhyiaeso and Subin. It has been a busy market center and attracts people of varied social background. Most of the people in Kumasi patronize the Adum market and thus facilities in this vicinity are opened to a good mix of clientele involving the Kumasi populace. The NGO reproductive health center is operated by an international NGO established in 2006 in response to a need for more organizations to deliver sexual and reproductive healthcare in Ghana. The organisation has 2 main health care centres in Kumasi (Adum and Alabar) and also offers reproductive health services through the Blue Star franchise scheme in several private health facilities in Kumasi. The Blue Star is to widen access to safe abortion services while using existing providers to give quality sexual and reproductive health services to clients by strategically selecting shops located in underserved areas in an attempt to reach people who otherwise would not have access to family planning counselling, commodities, and services. One of their main groups of clients is women with unintended pregnancy crisis situation needing help to resolve it. The Public facility is a Government owned Maternal and Child Health Hospital (MCHH) also located in Adum (the central business district of Kumasi). According to the 2013 Mid-Year Report (unpublished), it has an average of 200 antenatal care new entrants per month. Among these are those with unintended pregnancies requiring professional help for resolution. Its unique location exposes it to a good mix of people from all walks of life. The data collection started from 1st January-30th April, 2014. Data was collected from consented clients using authors developed structured questionnaire (open and close-ended) after permission was granted by participating facilities. The questionnaire was developed based on information from relevant literature and took a maximum of 15 min to administer. The variables or domains that were collected via the questionnaire include pregnant women’s choice of unintended pregnancy options (independent variable) and exposure to options counselling (dependent variable). Pretesting of the questionnaire was done at a different facility with similar characteristic to ensure validity and reliability of the instrument. Two female research assistants proficient in Ashanti Twi and English were trained and used for data collection. Recruitment of respondents was facilitated by health workers at the respective facilities via clients’ information about the study during the routine general interactions on arrival in the health facilities. Clients were also informed that their participation in the study was voluntary and refusal to take part in the study would not affect the quality of care to be provided. Only clients who voluntarily consented to be part of the study were interviewed using the questionnaires. The questions were read in the language in which a client is most fluent (i.e Twi or English) to ensure clear understanding of what is required. The recruitment of respondents for the interviews were done on a daily basis until the desired numbers were obtained. The study protocol was registered with the Kwame Nkrumah University of Science and Technology Research and Development Unit to ensure its relevance to the research objectives of the University. The study approval was given by the Committee of Human Research, Publications and Ethics, Kwame Nkrumah University of Science and Technology. Written permissions were sought from the management of facilities in which data was collected. Informed consent and permission to participate in the study were obtained from each respondent. Permission was also sought to have participants’ phone numbers for any follow issues relating to the study. Data analysis started with coding, cleaning and entering the data into Epi Info 7 (7.1.1.14). The double entry technique was employed in order to improve the accuracy of the data entry. To ensure confidentiality, questionnaires were put under lock and key and the electronic data was password protected by the principal investigator. In line with the study objectives, data was summarized using frequency distribution and simple proportions for the discrete variables while mean, standard deviation, median, range were used for continuous quantitative variables. Pearson’s chi-square analyses were carried out to test the association between the pregnant women’s choice of unintended pregnancy options (independent variable) and exposure to options counselling (dependent variable). Logistic regressions were also done to observe the relationships between these variables. All computations were done at 95% confidence interval and 5% level of significance (p < 0.05).

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Implement comprehensive pregnancy options counseling: This study highlights the need for improved pregnancy options counseling for women with unintended pregnancies. Health facilities could develop comprehensive counseling programs that provide information on all available options, including abortion, parenting, and adoption. This would ensure that women are able to make informed decisions about their pregnancies.

2. Increase awareness of adoption as an option: The study found that the majority of respondents were not aware that giving a child up for adoption is an option to abortion in Ghana. Health facilities could work on increasing awareness about adoption as a viable option for women with unintended pregnancies. This could be done through educational campaigns, informational materials, and training for healthcare providers.

3. Targeted counseling for specific populations: The study found that higher education was significantly associated with being exposed to options counseling. To address the disparity in access to counseling, health facilities could develop targeted counseling programs for less educated women. These programs could be tailored to meet the specific needs and preferences of different populations, ensuring that all women have access to comprehensive counseling services.

4. Integration of counseling services into existing healthcare systems: To improve access to counseling, health facilities could integrate counseling services into existing maternal health programs. This would ensure that counseling is readily available to women seeking pregnancy-related healthcare services. By integrating counseling services, women would have easier access to information and support throughout their pregnancy journey.

5. Use of technology for counseling: Technology could be utilized to improve access to counseling services. Health facilities could develop mobile applications or online platforms that provide information and support for women with unintended pregnancies. These platforms could offer resources, counseling sessions, and access to healthcare providers, making counseling more accessible and convenient for women.

It is important to note that these recommendations are based on the specific context and findings of the study mentioned. Further research and evaluation would be needed to determine the feasibility and effectiveness of these innovations in improving access to maternal health.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to prioritize and strengthen pregnancy options counseling services in health facilities in Ghana. This can be achieved through the following steps:

1. Training and capacity building: Health care providers should receive comprehensive training on pregnancy options counseling, including information on abortion, parenting, and adoption. This will enable them to provide accurate and unbiased information to women with unintended pregnancies.

2. Standardized counseling protocols: Develop standardized protocols and guidelines for pregnancy options counseling to ensure consistency and quality of care across health facilities. These protocols should include information on all available options, their risks and benefits, and support services available to women.

3. Awareness and education: Conduct awareness campaigns to educate women and communities about the availability and importance of pregnancy options counseling. This can be done through community outreach programs, media campaigns, and collaboration with local organizations and community leaders.

4. Integration of services: Integrate pregnancy options counseling services into existing maternal health programs and services. This will ensure that women have access to counseling at the same time they seek other maternal health services, such as antenatal care or postpartum care.

5. Collaboration and partnerships: Foster collaboration between health facilities, NGOs, and other stakeholders to strengthen the provision of pregnancy options counseling services. This can include partnerships with organizations specializing in reproductive health and family planning, as well as collaborations with community-based organizations to reach women in underserved areas.

6. Research and evaluation: Conduct further research to assess the effectiveness of pregnancy options counseling services and identify areas for improvement. This can include evaluating the impact of counseling on women’s decision-making process, their satisfaction with the services received, and the long-term outcomes of their choices.

By implementing these recommendations, access to maternal health can be improved by ensuring that women with unintended pregnancies have the information and support they need to make informed decisions about their reproductive health.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase awareness: Develop and implement public health campaigns to raise awareness about the importance of maternal health and the available options for unintended pregnancies. This can be done through various channels such as television, radio, social media, and community outreach programs.

2. Strengthen healthcare infrastructure: Invest in improving healthcare facilities, especially in underserved areas, to ensure that pregnant women have access to quality maternal healthcare services. This includes providing necessary equipment, trained healthcare professionals, and adequate resources for prenatal care, delivery, and postnatal care.

3. Expand access to options counseling: Establish and promote pregnancy options counseling services in health facilities across the country. This counseling should provide unbiased information about all available options, including abortion, adoption, and parenting, to help women make informed decisions about their pregnancies.

4. Improve education and training: Enhance the education and training of healthcare professionals, particularly in the area of maternal health and counseling. This will ensure that healthcare providers have the knowledge and skills to provide comprehensive and non-judgmental care to pregnant women, including options counseling.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the percentage of pregnant women who receive options counseling, the percentage of women who are aware of all available options, and the percentage of women who have access to quality maternal healthcare services.

2. Collect baseline data: Conduct a survey or gather existing data to establish a baseline for the identified indicators. This will provide a starting point for measuring the impact of the recommendations.

3. Implement interventions: Implement the recommended interventions, such as awareness campaigns, infrastructure improvements, and training programs for healthcare professionals.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the interventions. Collect data on the identified indicators at regular intervals to assess the progress and impact of the recommendations.

5. Analyze data: Analyze the collected data using statistical methods to determine the changes in the identified indicators over time. Compare the data to the baseline to measure the impact of the recommendations on improving access to maternal health.

6. Adjust interventions: Based on the analysis of the data, make any necessary adjustments to the interventions to further improve access to maternal health. This could include refining awareness campaigns, targeting specific areas with additional resources, or providing further training to healthcare professionals.

7. Repeat the process: Continuously repeat the monitoring, evaluation, and adjustment process to ensure ongoing improvement in access to maternal health. This will help to identify any new challenges or opportunities and adapt the interventions accordingly.


Statistics:
Citations: 1
Identifiers:
DOI: 10.1186/s12884-019-2598-7
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations
Study Countries:
Ghana
Study Design:
Case Study, Cross Sectional Study, Grounded Theory
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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