Predictors of pregnancy termination among young women in ghana: Empirical evidence from the 2014 demographic and health survey data

  • Healthcare (Switzerland), Volume 9, No. 6, Year 2021

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Study Justification:
– The study addresses the issue of pregnancy termination among young women in Ghana, which is a delicate and contentious reproductive health issue.
– It examines the associations between demographic and socio-economic factors and pregnancy termination, providing empirical evidence to inform policy and interventions.
– The study contributes to the achievement of Sustainable Development Goal 3.1, which aims to reduce maternal mortality.
Highlights:
– Young women aged 20-24 are more likely to have a pregnancy terminated compared to those aged 15-19.
– Working young women have a higher likelihood of pregnancy termination compared to those who are not working.
– Young women who had their first sex at the age of 20-24 and those whose first sex occurred at first union have lower odds of pregnancy termination compared to those who had their first sex at a younger age.
– Young women with parity of three or more have the lowest odds of pregnancy termination compared to those with no births.
– Pregnancy termination is less likely among young women living in rural areas and the Upper East region of Ghana.
Recommendations for Lay Reader and Policy Maker:
– Develop programs and strategies, such as sexuality education and regular sensitization programs, to reduce unintended pregnancies that often result in pregnancy termination.
– Ensure easy access to contraceptives and comprehensive sexual and reproductive health education.
– Design interventions considering the socio-demographic characteristics of young women.
Key Role Players:
– Government of Ghana
– Non-governmental organizations (NGOs)
– Ministry of Health
– Ministry of Education
– Ministry of Gender, Children, and Social Protection
– Health professionals and educators
– Community leaders and influencers
Cost Items for Planning Recommendations:
– Development and implementation of sexuality education programs
– Organization of regular sensitization programs
– Provision of contraceptives and family planning services
– Training of health professionals and educators
– Production and dissemination of educational materials
– Monitoring and evaluation of interventions
– Research and data collection on reproductive health indicators
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on the specific context and scope of the interventions.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on a large sample size (2114 young women) and utilizes both descriptive and inferential analyses (frequency, percentages, chi-square tests, and binary logistic regression). The statistical significance was set at p < 0.05. The study also provides adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI) to demonstrate the precision and significance of the reported odds ratio values. To improve the evidence, the study could have included more information on the methodology, such as the specific variables used in the logistic regression models and any potential limitations of the study. Additionally, providing more context on the demographic and health survey data used, such as the representativeness of the sample and the data collection methods, would enhance the evidence.

Pregnancy termination remains a delicate and contentious reproductive health issue because of a variety of political, economic, religious, and social reasons. The present study examined the associations between demographic and socio-economic factors and pregnancy termination among young Ghanaian women. This study used data from the 2014 Demographic and Health Survey of Ghana. A sample size of 2114 young women (15–24 years) was considered for the study. Both descriptive (frequency, percentages, and chi-square tests) and inferential (binary logistic regression) analyses were carried out in this study. Statistical significance was pegged at p < 0.05. Young women aged 20–24 were more likely to have a pregnancy terminated compared to those aged 15–19 (AOR = 3.81, CI = 2.62–5.54). The likelihood of having a pregnancy terminated was high among young women who were working compared to those who were not working (AOR = 1.60, CI = 1.19–2.14). Young women who had their first sex at the age of 20–24 (AOR = 0.19, CI = 0.10–0.39) and those whose first sex occurred at first union (AOR = 0.57, CI = 0.34–0.96) had lower odds of having a pregnancy terminated compared to those whose first sex happened when they were less than 15 years. Young women with parity of three or more had the lowest odds of having a pregnancy terminated compared to those with no births (AOR = 0.39, CI = 0.21–0.75). The likelihood of pregnancy termination was lower among young women who lived in rural areas (AOR = 0.65, CI = 0.46–0.92) and those in the Upper East region (AOR = 0.18, CI = 0.08–0.39). The findings indicate the importance of socio-demographic factors in pregnancy termination among young women in Ghana. Government and non-governmental organizations in Ghana should help develop programs (e.g., sexuality education) and strategies (e.g., regular sensitization programs) that reduce unintended pregnancies which often result in pregnancy termination. These programs and strategies should include easy access to contraceptives and comprehensive sexual and reproductive health education. These interventions should be designed considering the socio-demographic characteristics of young women. Such interventions will help to achieve Sustainable Development Goal 3.1 that seeks to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030.

Data from Ghana’s 2014 Demographic and Health Survey (DHS) were used for this study. The DHS is conducted in about 85 low- and middle-income countries around the world. Unintended pregnancy, contraception use, qualified birth participation, immunization of under-fives, and intimate partner abuse are among the main maternal and child health issues targeted by the survey. The survey used a stratified two-stage sampling method. The first step was to choose clusters from all over the country, in both urban and rural settings. These were used to establish the study’s enumeration areas (EAs). These clusters were chosen from the country’s ten former administrative regions, spanning urban (n = 216) and rural (n = 211) areas. The selected EAs were then subjected to a systematic household sampling. A total of 12,831 households were included in the study. A total of 9396 women were interviewed for the survey [44] from the 12,831 households (response rate of 97.3%). Only young women (15–24 years old) who had ever been pregnant and had complete cases on all of the variables studied (n = 2114) were included in this analysis. As a result, young women who had never been pregnant (n = 1211) were excluded from the study because they had no risk of terminating a pregnancy (see Figure 1). Flow chart showing how the respondents were selected. The dependent variable employed for this study was “pregnancy termination” which was derived from the question “have you ever had a terminated pregnancy?”, and the response was coded as 0 = “No” and 1 = “Yes”. Eleven variables were considered as explanatory variables. These are age, wealth quintile, occupation, educational level, religion, marital status, age at first sex, parity, media exposure, place of residence, and region. We selected these variables on the basis that previous studies have found them to have significant associations with pregnancy termination [45,46,47,48,49]. In this study, the original coding for age, wealth quintile, place of residence, and region was maintained, while the remaining six variables were recoded to make them meaningful for the analyses and interpretation of results. Age in the DHS was coded as 15–19 and 20–24 for women aged 15–24. The statistical software Stata version 13 (Stata Corporation, College Station, TX, USA) was used to process the data. All frequency distributions were weighted using the sample weight (v005/1,000,000), while the svy command was used to account for the complex survey design and generalizability of the findings. Both descriptive (frequency, percentages) and inferential (binary logistic regression) analyses were carried out in this study. Statistical significance was pegged at p < 0.05. First, frequencies and percentages were used to show the proportion of pregnancy termination across the socio-demographic characteristics of the respondents. This procedure was followed by both bivariate and multivariate binary logistic regression analyses to examine the predictors of pregnancy termination. Model 1 focused on the independent association between each of the explanatory variables and pregnancy termination, while in Model 2, we adjusted for the effect of all the explanatory variables by putting all of them in the same model with pregnancy termination. Binary logistic regression was employed because the dependent variable was measured as a binary factor. Results for the binary logistic regression analyses are presented as crude odds ratios (COR) and adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI), signifying the precision and significance of the reported odds ratio values. Since the data are available in the public domain, no additional approval was needed for this study. However, according to the DHS, ORC Macro Inc.’s Ethics Committee provided ethical clearance. Before starting interviews with each respondent, both respondents gave their informed consent. The authors requested and received permission to download and use the data from MEASURE DHS. The data are available at https://dhsprogram.com/what-we-do/survey/survey-display-437.cfm (accessed on 6 April 2021).

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Based on the research findings and recommendations from the study titled “Predictors of pregnancy termination among young women in Ghana: Empirical evidence from the 2014 demographic and health survey data,” the following innovations can be developed to improve access to maternal health:

1. Comprehensive Sexual and Reproductive Health Education Programs: Develop and implement programs that provide comprehensive sexual and reproductive health education to young women in Ghana. These programs should focus on providing accurate information about contraception, family planning, and the consequences of unintended pregnancies.

2. Increased Access to Contraceptives: Improve access to a wide range of contraceptives, including both modern and traditional methods. Strengthen the supply chain and distribution systems, ensure availability in both urban and rural areas, and reduce barriers such as cost and stigma associated with contraceptive use.

3. Regular Sensitization Programs: Conduct regular sensitization programs to raise awareness about the importance of preventing unintended pregnancies and the available resources for maternal health. Organize these programs in schools, community centers, and healthcare facilities, targeting both young women and their families.

4. Tailored Interventions: Design interventions and strategies considering the socio-demographic characteristics of young women in Ghana. Take into account factors such as age, wealth quintile, occupation, educational level, religion, marital status, and place of residence to effectively reach and support young women in accessing maternal health services.

5. Collaboration with Stakeholders: Collaborate with government agencies, non-governmental organizations, healthcare providers, and community leaders to implement and monitor the recommended interventions. Allocate resources, share best practices, and evaluate the impact of interventions to ensure a coordinated and comprehensive approach to improving access to maternal health services.

By implementing these innovations, Ghana can make significant progress in improving access to maternal health and reducing the incidence of pregnancy termination among young women.
AI Innovations Description
Based on the research findings and recommendations from the study titled “Predictors of pregnancy termination among young women in Ghana: Empirical evidence from the 2014 demographic and health survey data,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Develop comprehensive sexual and reproductive health education programs: Government and non-governmental organizations should collaborate to develop and implement programs that provide comprehensive sexual and reproductive health education to young women in Ghana. These programs should focus on providing accurate information about contraception, family planning, and the consequences of unintended pregnancies. By increasing knowledge and awareness, young women can make informed decisions about their reproductive health, reducing the likelihood of unintended pregnancies and subsequent pregnancy termination.

2. Increase access to contraceptives: Efforts should be made to improve access to a wide range of contraceptives, including both modern and traditional methods. This can be achieved by strengthening the supply chain and distribution systems, ensuring availability in both urban and rural areas, and reducing barriers such as cost and stigma associated with contraceptive use. Providing easy access to contraceptives will empower young women to take control of their reproductive health and reduce the need for pregnancy termination.

3. Regular sensitization programs: Regular sensitization programs should be conducted to raise awareness about the importance of preventing unintended pregnancies and the available resources for maternal health. These programs can be organized in schools, community centers, and healthcare facilities, targeting both young women and their families. By addressing cultural and social norms surrounding pregnancy termination and promoting positive attitudes towards reproductive health, these programs can contribute to reducing the demand for pregnancy termination.

4. Tailor interventions to socio-demographic characteristics: Interventions and strategies should be designed considering the socio-demographic characteristics of young women in Ghana. This includes taking into account factors such as age, wealth quintile, occupation, educational level, religion, marital status, and place of residence. By understanding the specific needs and challenges faced by different groups, interventions can be tailored to effectively reach and support young women in accessing maternal health services.

5. Collaborate with stakeholders: Government agencies, non-governmental organizations, healthcare providers, and community leaders should collaborate to implement and monitor the recommended interventions. This collaboration will ensure a coordinated and comprehensive approach to improving access to maternal health services. Stakeholders can work together to allocate resources, share best practices, and evaluate the impact of interventions, leading to sustainable improvements in maternal health outcomes.

By implementing these recommendations, Ghana can make significant progress in improving access to maternal health and reducing the incidence of pregnancy termination among young women. This aligns with the Sustainable Development Goal 3.1, which aims to reduce the global maternal mortality ratio by 2030.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Data collection: Collect data on the current status of access to maternal health services in Ghana, including indicators such as the number of unintended pregnancies, pregnancy termination rates, contraceptive use, and availability of sexual and reproductive health education programs.

2. Baseline assessment: Analyze the collected data to establish a baseline for access to maternal health services in Ghana. This will provide a reference point for measuring the impact of the recommendations.

3. Intervention design: Based on the recommendations, design interventions that align with each recommendation. For example, develop comprehensive sexual and reproductive health education programs, improve access to contraceptives, conduct regular sensitization programs, tailor interventions to socio-demographic characteristics, and foster collaboration among stakeholders.

4. Simulation modeling: Use simulation modeling techniques to estimate the potential impact of the interventions on improving access to maternal health services. This can involve creating a mathematical model that incorporates relevant variables and simulating different scenarios based on the interventions.

5. Data analysis: Analyze the simulated data to assess the impact of the interventions on key indicators such as the reduction in unintended pregnancies, decrease in pregnancy termination rates, increase in contraceptive use, and improvement in knowledge and awareness of sexual and reproductive health.

6. Evaluation and refinement: Evaluate the results of the simulation and refine the interventions if necessary. This may involve adjusting the parameters of the simulation model or modifying the interventions based on the observed outcomes.

7. Policy recommendations: Based on the findings of the simulation, develop policy recommendations for implementing the interventions at a larger scale. These recommendations should consider the feasibility, cost-effectiveness, and sustainability of the interventions.

8. Implementation and monitoring: Implement the recommended interventions in collaboration with relevant stakeholders, such as government agencies, non-governmental organizations, healthcare providers, and community leaders. Monitor the implementation process and regularly assess the impact of the interventions on improving access to maternal health services.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of the recommendations and make informed decisions on how to improve access to maternal health services in Ghana.


Statistics:
Citations: 1
Identifiers:
DOI: 10.3390/healthcare9060705
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ghana
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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