Abortion care in Ghana: a critical review of the literature.
Maternal mortality is a large and un-abating problem, mainly occurring in the developing world. According to the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), UNFPA and the World Bank, 287,000 women die each year worldwide from pregnancy-related causes (1). Sub-Saharan Africa has the highest maternal mortality ratio in the world of 500 per 100,000 births. WHO estimates 47,000 of these deaths per year are attributable to unsafe abortion, making abortion a leading cause of maternal mortality (2). Not all unsafe abortions result in death, disability or complications. The morbidity and mortality associated with unsafe abortion depend on the method used, the skill of the provider, the cleanliness of the instruments and environment, the stage of the woman's pregnancy and the woman's overall health (3). It is estimated that 5 million women per year from the developing world are hospitalized for complications resulting from unsafe abortions, resulting in long and short-term health problems (4). The health consequences and burdens resulting from unsafe abortion disproportionately affect women in Africa (5).
Unsafe abortion is defined by WHO as a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both (6). Approximately 21.2 million unsafe abortions occur each year in developing regions of the world (1,7). Over 99% of all abortion-related deaths occur in developing countries. In sub-Saharan Africa, one in 150 women will die from complications of this procedure (6).
Although only 24% of abortions worldwide are performed in sub-Saharan Africa, almost half of deaths related to this procedure occur in the region (4,8). In many countries in sub-Saharan Africa women's access to safe abortion and post-abortion care for complications is hampered by restrictive laws, socio-cultural barriers, and inadequate resources to provide safe abortion (4,9-12).
The UN Millennium Development Goal (MDG) number 5 aims to reduce by three quarters the number of maternal deaths in the developing world. Without tackling the problems of unsafe abortion MDG 5 will not be reached (13,14).
Ghana, a country in West Africa, has a population of approximately 24 million people. The average per capita income is approximately $1810 (15), placing Ghana in the middle income bracket. Ghana has a similar pattern of health as other countries in the region, characterized by a persistent burden of infectious disease among poor and rural populations, and growing non-communicable illness among the urban middle class. Following generalized progress in child vaccination rates through the 1980s and 1990s, and corresponding declines in infant and child mortality (from 120/1000 in 1965 to 66/1000 in 1990), progress has stalled maternal and under 5 indicators in rural areas in the past decade. The national under-five mortality rate remains at 78 deaths/1,000 live births (16). Maternal death is currently estimated at 350 per 100,000 live births (17). In Ghana, abortion complications are a large contributor to maternal morbidity and mortality. According to the Ghana Medical Association, abortion is the leading cause of maternal mortality, accounting for 15-30% of maternal deaths (18,19). Further, for every woman who dies from an unsafe abortion, it is estimated that 15 suffer short and long-term morbidities (20).
Compared to other countries in the region, the laws governing abortion in Ghana are relatively liberal. Safe abortion, performed by a qualified healthcare provider, has been part of the Reproductive Health Strategy since 2003 (19,21). When performed by well-trained providers in a clean environment, abortion is one of the safest medical procedures with complications estimated at 1 in 100,000 (8).
Currently in Ghana, abortion is a criminal offense regulated by Act 29, section 58 of the Criminal code of 1960, amended by PNDCL 102 of 198522. However, section 2 of this law states abortion may be performed by a registered medical practitioner when; the pregnancy is the result of rape or incest, to protect the mental or physical health of the mother, or when there is a malformation of the fetus. The government of Ghana has taken steps to mitigate the negative effects of unsafe abortion by developing a comprehensive reproductive health strategy that specifically addresses maternal morbidity and mortality associated with unsafe abortion (23).
Further, since midwives have been shown to safely and effectively provide post-abortion care in South Africa (24) and Ghana (19) a 1996 policy reform has allowed midlevel providers with midwifery skills to perform this service in Ghana (25). To ensure these providers have the skills necessary to perform the service, in 2009, Manual Vacuum Aspiration (MVA) was added to the national curriculum for midwifery education to train additional providers in this life-saving technique.
However, even with the liberalization of the law and the training of additional providers, abortion-related complications remain a problem. This integrated literature review aims to present findings from empirical research directly related to abortion provision, complete abortion care, or post-abortion care in Ghana and identify gaps for future research.
The Pubmed, Ovid Medline, Global Health and Popline databases were searched with the keywords "Ghana & abortion". Pubmed returned 80 articles, Ovid Medline returned 70, Global Health returned 40 articles and Popline returned 78 articles, many of which overlapped. All titles and abstracts were reviewed. Inclusion criteria were: 1) English-language research articles; 2) published in a peer-reviewed journal after 1995; and 3) directly measured abortion services or provision. Manuscripts that only briefly mentioned abortion, commentaries, and literature reviews were not included in the final sample. A total of 39 articles met inclusion criteria and are included in this review (Figure 1).
Complications and Admissions to Gynecology Ward: Abortion-related complications are repeatedly found to represent a large component of admissions to gynecological wards in hospitals in Ghana. Abortion complications resulted in 38.8%, 40.7%, 42.7% and 51%26-29 of all admissions to these wards in the articles reviewed for this paper. The majority of admissions were for the treatment of spontaneous abortion, although induced abortion is notoriously under-reported (4,12,26,30), and many women who reported spontaneous abortions had history that indicated induced abortion (31). Sundaram and colleagues (32) estimated that only 40% of abortions were reported in the 2007 Ghana Maternal Health Survey, even when participants were explicitly asked about their experiences with inducted abortions. Full results are provided in Table 1.
Demographic Factors Associated with Abortion Care
Many studies investigated demographic factors associated with abortion-care seeking with conflicting results. Several manuscripts found women of higher socioeconomic status, with more education, who are married, older, and living in urban areas to be more likely to obtain induced abortions. However, others reported younger, unmarried women were more likely to obtain induced abortions, when compared to women seeking care for spontaneous abortion (28,31,33,36).
Prevalence of Obtaining an Induced Abortion
The prevalence of obtaining an induced abortion varied greatly in the studies reported here. The highest rate reported was by Agyei and colleagues (37) who found 47% of the female respondents in their study reporting at least one pregnancy underwent an abortion sometime in her life. Morhe et al (38) found 36.7 of the adolescents in their sample outside of Kumasi had experienced an abortion. Ahiadeke (36,39) reports an abortion rate of 27 per 100 live births using data from the Maternal Survey Project. Krakowiak-Reed et al (40) found 20% of their community-based sample outside Kumasi had had at least one abortion. Oliveras et al. (34) found between 10% and 17.6% of women in their study reported their previous pregnancy ended in induced abortion. Geelhoed and colleagues (41) found a prevalence of induced abortion of 22.6%, which falls in the range reported elsewhere (42). Glover et al (43) found that 70% of ever-pregnant youth in their sample reported attempting an abortion. Sundaram et al (32) state approximately 10% of the sample for the 2007 Maternal Health Survey reported having had an abortion in the five years prior to the survey. However, the authors note that this rate is likely highly under-reported.
Abortion and Maternal Mortality
Many studies sought to estimate the proportion of maternal mortality associated with unsafe abortion. Mills and colleagues (44) found abortion-related causes to be the leading cause of maternal death in rural northern Ghana, as did Baiden and colleagues (10). Ohene et al (45) discovered that the majority of adolescent maternal deaths at Korle Bu Teaching Hospital in Accra were due to complications from unsafe abortion. Abortion complications were the leading cause of death among the youngest women in a sample of maternal deaths at Tamale Teaching Hospital, and the fourth leading cause overall (45). Abortion complications were the second leading cause of death due to maternal causes, behind post-partum hemorrhage, between 2004-2009, a period which spans the introduction of the policy changes around abortion care, in the Eastern region (47). Lee et al (48) discovered that genital tract sepsis, often as a result of an abortion, had the highest case-fatality rate of all the causes of maternal death in their study. In the Brong Ahafo region, Geelhoed et al (41) found that abortion complications were the leading cause of maternal death at the Berekum District Hospital.
Although the law governing abortion in Ghana is relatively liberal, and the 2006 policy change has made abortion services part of the national reproductive health strategy, no literature was found evaluating the impact of that policy change. The fact that admissions to the gynecological wards due to complications from abortion does not appear to have dramatically declined since the implementation of the 2006 policy suggests that women are not accessing safe abortion services, if they exist (26,49). Different cadres of health providers were found to be unsure of the law governing abortion services (50,51) and women who were interviewed were also unsure of the law (26,52). In the Brong Ahafo region, Hill and colleagues (52) found that abortion was deemed illegal, dangerous and bringing public shame, but also being perceived as common, understandable, and necessary. Although Clark et al (25) found that post-abortion care (PAC) services remain limited, despite wide-spread training in the service, while Baird et al (53) report that PAC training for midwives is an effective way to increase access to the service. Including post-abortion care as part of comprehensive family planning training for midwives has the potential to empower these providers and the women they serve to make choices about contraception (54). Graff & Amoyaw (11) identified sustainable access to MVA equipment as a major barrier to MVA services. Laar (55) found in an analysis of Ghanaian print media that less than 1% of total newspaper coverage was dedicated to family planning, abortion, and HIV, underscoring the dearth of information available to many in the Ghanaian public.
Abortion and Contraception
One of the main findings in many of the papers reviewed is the lack of modern contraception being used by the majority of Ghanaian women. Many of the papers found a high unmet need for contraception defined as currently engaging in sexual activity without using contraception but without intending to get pregnant (9,32,33,56). There is an urgent need to improve access to reliable contraception for Ghanaian women. Many Ghanaian women report being wary of using contraception for fear of side effects that may impair future fertility (9). Biney (56) noted that women in her study viewed contraception as more harmful to their health than abortion. Obed & Wilson (57) reported 81% of their sample of women being treated for abortion complications desired further children, although almost one-third had to have a hysterectomy to treat the complications from their abortion and were thus unable to have further children. Mac Domhnaill and colleagues (58) found schoolgirls in their sample were much more aware of abortion methods than of contraception and many explicitly mentioned not using contraception because they knew how to abort if necessary. Adanu and colleagues (33) reported women seeking care for induced abortion were more aware of modern contraception than their counterparts seeking care for spontaneous abortion, although this did not translate into higher usage rates.
Identified Gaps for Further Research
The biggest gaps identified through this review are the experiences of women with securing an induced abortion to end an unwanted pregnancy. Hospital-based chart reviews are important to understand the types of cases being treated. Surveys examining the reasons for securing an induced abortion shed some light on this issue. However, information regarding the process by which a woman seeks an induced abortion is still lacking. Gathering information from women regarding their experiences securing safe and legal abortions and reasons for resorting to unsafe methods will enable policy makers to pinpoint interventions to prevent life-threatening complications. Specifically, why do women resort to dangerous methods of aborting unwanted pregnancies?
Complications from unsafe abortion have been and remain a large component of maternal mortality and morbidity in Ghana. Although responding to international calls to liberalize the law governing abortion and training more providers in the service, Ghana has not yet realized a large reduction in complications from unsafe abortions. Knowledge of the law appears to remain limited, among both healthcare providers and the general population. Work to improve this is warranted.
There appears to be a robust literature around abortion in Ghana. However, this review did identify gaps in the literature and future directions for research. The heavy reliance on hospital-based retrospective chart reviews, while an important step to establish the general burden of disease attributable to abortion-related complications, needs to be expanded. The studies completed were generally of a high scientific standard, although the data were often limited by what was documented in charts or log books. The few purposefully-designed surveys elucidated interesting observations that need to be augmented by qualitative work to answer some of the deeper questions of the process by which women undertake unsafe abortions. It has been documented that many women are seeking care outside (59) the formal healthcare system in unsafe locations from unsafe providers (33), however reasons why have not been investigated. Is it a lack of awareness of the legality of this procedure? Are there not enough providers in communities close to where the women live? Is cost prohibitive? Both women seeking care for post-abortion care and providers of abortion have been shown to be unclear of the law governing abortion in Ghana. Konney et al (26) found 92% of women being treated for abortion complications at Komfo Anokye Teaching Hospital were unaware of the law and Voetagbe et al (51) noted an alarmingly high proportion of midwifery tutors were not aware of the full law governing the provision of safe abortion services. If teachers are not sure of the law, the midwives who they train will also likely be uncertain of the conditions under which they are legally allowed to provide complete abortion care.
Accessibility of abortion care was defined by Billings et al (19) as 1) distance from a woman's home; 2) cost of services and payment options; 3) waiting time for services/total length of stay; and 4) social proximity to the provider. All of these accessibility issues require further investigation, with an operations-research design that could address many of them.
The repeated finding of the high incidence of abortion complications and resulting hospitalizations in the tertiary care centers, as well as some smaller district-level hospitals in the country, highlights the need to adequately train providers to treat complications resulting from abortions, whether these abortions are spontaneous or induced. Assessing the ability of public hospitals to safely provide treatment for post-abortion complications, as well provide a safe and affordable place for women to access comprehensive abortion care, is necessary. Women in urban areas appear to have greater access to safe abortion services, although the availability country-wide has not been assessed. The government of Ghana has responded to the need to provide treatments for post-abortion complications by recently adding training in MVA to the curriculum of midwifery training colleges. An assessment to assure midwives are graduating knowing how to handle these complications will be a necessary next step to ensure the safety of Ghanaian women who suffer from post-abortion complications.
Although demographic differences were found in many of the papers, it is conceivable the differences found could be explained by selection bias, as most of the studies reporting this information are hospital-based surveys conducted at the large referral centers, either Korle Bu in Accra or Komfo Anokye Teaching Hospital in Kumasi. Women in rural areas without the means to travel to and be treated at these tertiary care centers will therefore not be included in the sample. It is unclear from these studies whether the differences reported are due to differences in sampling techniques and survey populations or to true differences in the need for abortion services. In the 2007 Maternal Health Survey, as reported by Sundaram and colleagues (32), which is nationally representative, women in their twenties who have never been married, have no children, have terminated a pregnancy before, are Protestant or Pentecostal/Charismatic, of higher SES, and know the legal status of abortion are more likely to seek an abortion. Further, they found younger women were less likely to seek a safe abortion, as were women of low SES and those in rural areas. A partner paying for the procedure was associated with seeking a safe abortion.
The repeated findings of how few women are using contraception both preceding and following an abortion are worrisome. There is an urgent need to improve access to reliable contraception for Ghanaian women. However, the results from many studies indicate simply improving access to modern contraception may not improve utilization if women are more afraid of the side effects of contraception than of complications from unsafe abortion (9,56). This fear is ironic considering the very real negative health implications that follow unsafe abortions. Those who know more about contraception were found not to be more likely to use it, suggesting that simply providing information does not seem adequate to substantially increase usage (33).
Although not directly investigated in the studies reported here, unfamiliarity with the legal status of abortion appears to be a driver of women seeking care in unsafe locations outside the formal healthcare system. Future work needs to be done to evaluate the best ways to educate health workers and the public on the law and availability of services. Qualitative work interviewing healthcare providers, policymakers, and community members to elucidate interventions to improve the provision of safe abortion services and post-abortion care is necessary. Billings and colleagues (19) note that to understand the role midwives can play in providing safe abortion, further research should be conducted at the community level. Hill and colleagues (51) suggest purposefully designing qualitative studies to assess the perceptions of healthcare workers towards providing safe abortion services, as well as asking participants to report on friends' use of abortion services to determine rates. Aniteye and Mayhew (9) recommend qualitative work with women undergoing treatment for abortion complications to elucidate reasons they are not using family planning methods.
The government of Ghana has made the important initial steps of reducing legal barriers to safe abortion services and increasing the training of qualified personnel (30) in order to reduce the burden of disease attributable to unsafe abortion. However, complications from unsafe abortion are still a large contributor to women's mortality and morbidity. Future work is needed to investigate barriers that prevent women from accessing safe abortion services and to ensure that Ghanaian women have access to safe abortion as fully allowed by the law.
Contribution of Authors
SR conceptualized the research and performed the initial searches. JR reviewed search results. SR wrote the first draft of the manuscript. JR edited the manuscript. Both authors reviewed the final version of the manuscript.
(1.) World Health Organization (WHO). 2012 Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: WHO.
(2.) Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, 3rd ed. Geneva, World Health Organization, 2011.
(3.) World Health Organization (WHO). 2004. Unsafe abortion. Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th ed. Geneva: WHO.
(4.) Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet 2006; 368(95550): 1887-1892.
(5.) Shah I, Ahman E. Unsafe abortion: global and regional incidence, trends, consequences and challenges. Journal of Obstetrics and Gynecology Canada, 2009, 31 (12): 1149-1158.
(6.) World Health Organization (WHO). 1997. Unsafe abortion. Global and regional estimates of incidence of and mortality due to unsafe abortion with a listing of available country data. 3rd ed. Geneva: WHO.
(7.) Aahman E, Shah I. Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000, 4th edition. Geneva: WHO, 2004.
(8.) World Health Organization. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003. Geneva: WHO, 2007.
(9.) Aniteye P, Mayhew S. Attitudes and experiences of women admitted to hospital with abortion complications in Ghana. Afri J Reprod Health. 2011. 15(1): 47-55
(10.) Baiden F, Amponsa-Achiano K, Oduro AR, Mehsah TA, Baiden R, Hodgson A. Unmet need for essential obstetric services in a rural district hospital in northern Ghana: complications of unsafe abortions remain a major cause of mortality. Journal of the Royal Institute of Public Health. 2006. 120(5): 421-426.
(11.) Graff M, Amoyaw DA. Barriers to sustainable MVA supply in Ghana: challenges for the low-volume, low-income providers. Afri J Reprod Health. 2009. 13(4): 73-80.
(12.) Lithur NO. Destigmatizing abortion: expanding community awareness of abortion as a reproductive health issue in Ghana. Afri J Reprod Health. 2004. 8(1): 70-74.
(13.) Hu D, Grossman D, Levin C, Blanchard K, Adanu R, Goldie SJ. Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana. Afri J Reprod Health 2010; 14(2): 85-103.
(14.) Facts on induced abortion Worldwide. World Health Organization, Department of Reproductive Health and Research. Geneva, 2012.
(15.) Global Health Observatory, 2009. Accessed from http://www.who.int/countries/gha/en/. July 23, 2013.
(16.) UNICEF Country Statistics, Ghana. Accessed from http://www.unicef.org/infobycountry/ghana_statistics. html January 9, 2014.
(17.) The State of World's Midwifery 2011: Delivering Health, Saving Lives. UNFPA, 2011
(18.) Asamoah BO, Moussa KM, Stafstrom M, Musinguzi G. Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study. BMC Public Health. 2011, 11: 159
(19.) Billings DL, Ankrah V, Baird TL, Taylor JE, Ababio KPP, Ntow S. (1999) Midwives and comprehensive postabortion care in Ghana. In Postabortion Care: Lessons from Operations Research. Huntington and Piet-Pelon (eds). New York, New York; Population Council.
(20.) Eades CA, Brace C, Osei L, LaGuardia KD Traditional birth attendants and maternal mortality in Ghana. Soc. Sci. Med. 1993;36(11):1503-1507
(21.) Sedge G, Abortion in Ghana. In Brief. New York: Guttmacher Institute, 2010, No. 2
(22.) Morhe RAS, Morhe ESK. Overview of the law and availability of abortion services in Ghana. Ghana Medical Journal. 2006; 40(1): 80-86.
(23.) Taylor J, Diop A, Blum J, Dolo O, Winikoff B. Oral misoprostol as an alternative to surgical management for incomplete abortion in Ghana. International Journal of Gynecology and Obstetrics. 2011; 112: 40-44
(24.) Sibuyi MC. Provision of safe abortion services by midwives in Limpopo Province of South Africa. Afr J Reprod Health. 2004; 8(1):75-78
(25.) Clark KA, Mitchell EhM, Aboagye PK. Return on investment for essential obstetric care training in Ghana: do trained public sector midwives deliver postabortion care? Journal of Midwifery and Women's Health. 2010; 55(2):153-161
(26.) Konney TO, Danso KA, Odoi AT, Opare-Addo HS, Morhe ESK. Attitude of women with abortion-related complications toward provision of safe abortion services in Ghana. J Womens Health. 2009;18(11):1863-6.
(27.) Srofenyoh EK, Lassey AT. Abortion care in a teaching hospital in Ghana. International Journal of Gynecology and Obstetrics. 2003. 82: 77-78.
(28.) Turpin CA, Danso KA, Odoi AT. Abortion at Komfo Anokye Teaching Hospital. Ghana Medical Journal. 2002; 36(2): 60-64.
(29.) Yeboah RwN, Kom MC. Abortion: The case of Chenard Ward, Korle Bu from 2000 to 2001. Research Review. 2003. 57-66.
(30.) Cohen SA. Access to safe abortion services in the developing world: Saving lives while advancing rights. Guttmacher Policy Review. 2012 15(4): 2-6.
(31.) Adanu RMK, Tweneboah. Reasons, fears and emotions behind induced abortions in Accra, Ghana. Research Review. 2004: 20(2): 1-9.
(32.) Sundaram A, Juarez F, Bankole A, Singh S. Factors associated with abortion-seeking and obtaining a safe abortion in Ghana. Studies in Family Planning 2012; 43(4): 273-286.
(33.) Adanu RMK, Ntumy MN, Tweneboah E. Profile of women with abortion complications in Ghana. Tropical Doctor. 2005; 35(3): 139-142.
(34.) Oliveras E, Ahiadeke C, Adanu RM, Hill AG. Clinic based surveillance of adverse pregnancy outcomes to identify induced abortions in Accra, Ghana. Studies in Family Planning. 2009; 39(2): 133-140
(35.) Schwandt HM, Creanga AA, Danso KA, Adanu RMK, Agbenyega T, Hindin MJ. A comparison of women with induced abortion, spontaneous abortion and ectopic pregnancy in Ghana. Contraception. 2011. 84(1): 87-93
(36.) Ahiadeke C. The incidence of self-induced abortion in Ghana: What are the facts? Research Review. 2002; 18(1): 33-42
(37.) Agyei WKA, Biritwum RB, Ashitey AG, Hill RB. Sexual behavior and contraception among unmarried adolescents and young adults in Greater Accra and Eastern Regions of Ghana. Journal of biosocial Science. 2000; 32(4): 495-512.
(38.) Morhe ESK, Tagbor HK, Ankobea F, Danso KA. Reproductive experiences of teenagers in the Ejisu-Juabeng district of Ghana. International Journal of Gynecology and Obstetrics. 2012; 118(2): 137-40
(39.) Ahiadeke C. Incidence of induced abortion in Southern Ghana. International Family Planning Perspectives. 2001; 27(2): 96-108.
(40.) Krakowiak-Redd D, Ansong D, Otupiri E, Tran S, Klanderud D, Boakye I, Dickerson T, Crookston B. Family planning in a sub-district near Kumasi, Ghana: Side effect fears, unintended pregnancies and misuse of medication as emergency contraception. Afri J Reprod Health. 2011; 15 (3): 121
(41.) Geelhoed DW, Nayembil D, Asare K, Schagen van Leeuwen JH, van Roosmale J. Contraception and induced abortion in rural Ghana. Tropical Medicine and International Health. 2002. 70(8): 708-716.
(42.) Mote CV, Otupiri E, Hindin M. Factors associated with induced abortion among women in Hohoe, Ghana. African Journal of Reproductive Helath. 2010; 14(4): 115-121.
(43.) Glover EK, Bannerman A, Pence BW, Jones H, Miller R, Weiss E, Nerquaye-Tetteh J. Sexual health experiences of adolescents in three Ghanaian towns. International Family Planning Perspectives. 2003; 29(1): 32-40.
(44.) Mills S, Williams JE, Wak G, Hodgson A. Maternal mortality decline in the Kassena-Nankana district of northern Ghana. Maternal and Child Health Journal. 2008; 12: 577-585.
(45.) Ohene SA, Tettey Y, Kumoji R. Cause of death among Ghanaian adolescents in Accra using autopsy data. BMC Research Notes. 2011; 12(4):353
(46.) Gumanga SK, Kolbila DZ, Gandau BBN, Munkaila A, Malechi H, Kyei-Aboagye K. Trends in maternal mortality in Tamale Teaching Hospital, Ghana. Ghana Medical Journal. 2011; 45(3); 105-110.
(47.) Ganyaglo GYK. A 6-year (2004-2009) review of maternal mortality at the Eastern Regional Hospital, Koforidua, Ghana. Seminars in Perinatology. 2012; 36(1): 79-83.
(48.) Lee QY, Odoi AT, Opare-Addo H, Dassah ET. Maternal mortality in Ghana: a hospital-based review. Acta Obstetricia et Gynecologica Scandinavica. 2012; 91(1):87-92
(49.) Henaku RO, Horiuchi S, Mori A. Review of unsafe/ induced abortions in Ghana: Development of reproductive health awareness materials to promote adolescents health. Bulletin of St. Luke's College of Nursing. 2007; 33(3): 93-102
(50.) Morhe ES, Morhe RA, Danso KA. Attitudes of doctors towards establishing safe abortion units in Ghana. International Journal of Gynecology and Obstetrics. 2007; 98(1):70-74
(51.) Voetagbe G, Yellu N, Mills J, Mitchell E, Adu Amankway A, Jehu-Appiah K, Nyante F. Midwifery tutors' capacity and willingness to teach contraception, post-abortion care, and legal pregnancy termination in Ghana. Human Resources for Health. 2010. 8(2).
(52.) Hill ZE, Tawiah-Agyemang C, Kirkwood B. The context of informal abortions in rural Ghana. Journal of Women's Health. 2009; 18(12); 2017-2022.
(53.) Baird TL, Billings DL, Demuyakor B. Community education efforts enhance postabortion care program in Ghana. American Journal of Public Health. 2000; 90(4): 631-632.
(54.) Fullerton J, Fort A, Johal K. A case/comparison study in the Eastern region of Ghana on the effects of incorporating selected reproductive health services on family planning services. Midwifery. 2002; 19: 17-26.
(55.) Laar AK. Family planning, abortion and HIV in Ghanaian print media: A 15-month content analysis of a national Ghanaian newspaper. Afri J Reprod Health. 2010; 14(1): 80.
(56.) Biney AAE. Exploring contraceptive knowledge and use among women experiencing induced abortion in the Greater Accra region, Ghana. Afri J Reprod Health. 2011; 15(1): 37-46.
(57.) Obed SA, Wilson JB. Uterine perforation from induced abortion at Korle Bu Teaching Hospital, Accra, Ghana: A five year review. West African Journal of Medicine. 1999; 18(4): 286-289.
(58.) Mac Domhnaill B, Hutchinson G, Milev A, Milev Y. The social context of schoolgirl pregnancy in Ghana. Vulnerable Children and Youth Studies. 2011; 6(3): 201-207.
(59.) Lassey AT. Complications of induced abortions and their preventions in Ghana. East African Medical Journal. 1995. 72(12): 774-777.
Sarah D Rominski  * and Jody R Lori 
 Global REACH, University of Michigan Medical School;  School of Nursing, University of Michigan.
* For Correspondence: E-mail: firstname.lastname@example.org, Phone: 001-734-717-5930.
Authors Title, Journal Findings and Year 1. Morhe ESK, Reproductive Teenagers have Tagbor HK, experiences of their sexual Ankobea F, teenagers in the Ejisu- debuts at young Danso KA. Juabeng district of ages. 36.7% of 2012 Ghana. International the females have Journal of Gynecology had at least and Obstetrics one abortion. 2. Lee QY, Maternal mortality in Genital tract Odoi AT, Ghana: a hospital- sepsis, often as Opare-Addo H, based review. Acta a result of an Dassah ET. Obstetricia et abortion, had the 2012 Gynecologica highest case-fatality Scandinavica rate of all the causes of maternal death in this study. 3. Ganyaglo A 6-year (2004-2009) Abortion complications GYK, Hill WC. review of maternal were the second 2012 mortality at the East leading cause of Regional Hospital, maternal mortality, Koforidua, Ghana. behind post-partum Seminars in hemorrhage. The Perinatology largest proportions of post-abortion deaths were due to sepsis (29 of the 37 post-abortion deaths). 4. Sundaram A, Factors associated Almost half of all Juarez F, with abortion-seeking reported abortions Bankole A, and obtaining an were conducted Singh S. 2012 unsafe abortion in unsafely. The profile Ghana. Studies in of women who seek an Family Planning abortion is: unmarried, in their 20s, have no children, have terminated a pregnancy before, are Protestant or Pentecostal/ Charismatic, of higher SES, and know the legal status of abortion. Younger women were less likely to seek a safe abortion, as were women of low SES and those in rural areas. A partner paying for the procedure was associated with seeking a safe abortion. 5. Krakowiak- Family planning in a 20% of the sample Redd D, sub-district near had had at least Ansong D, Kumasi, Ghana: Side one abortion Otupiri E, Tran effect fears, S, Klanderud unintended D, Boakye I, pregnancies and Dickerson T, misuse of medication Crookston B as emergency 2011 contraception. African Journal of Reproductive Health 6. Aniteye P, Attitudes and Great majority of Mayhew S. experiences of women women were young and 2011 admitted to hospital single. The majority with abortion of women had help complications in performing their Ghana. African abortion and most Journal of accessed post- Reproductive Health abortion care at a health facility shortly after experiencing complications. 7. Gumanga Trends in maternal The institutional SK, Kolbila mortality in Tamale maternal mortality DZ, Gandau Teaching Hospital, rate was 1018 per BBN, Munkaila Ghana. Ghana 100,000 live births A, Malechi H, Medical Journal was recorded between Kyei-Aboagye 2006 and 2010. K Complications from 2011 unsafe abortion was the leading cause of maternal death for youngest women, and the 4th leading cause overall. 8. Biney AAE Exploring Many respondents noted 2011 contraception that prior to their knowledge and use induced abortion, they among women had no knowledge about experiencing induced contraception, but abortion in the Greater since the abortion Accra region, Ghana. they had been using African Journal of it. Women also Reproductive Health mentioned feeling contraception was more dangerous to their health than was induced abortion. 9. Ohene SA, Cause of death among 20/27 maternal deaths Tettey Y, Ghanaian adolescents to adolescents were a Kumoji R. in Accra using autopsy consequence of 2011 data. BMC Research abortion. Notes 10. Mac The social context of Student's knowledge Domhnaill B, school girl pregnancy of abortive methods Hutchinson G, in Ghana. Vulnerable was considerably more Milev A, Milev Children and Youth detailed than their Y. Studies knowledge of 2011 contraception. Many explicitly mentioned not using contraception because they knew how to abort a pregnancy if necessary. Participants note local and herbal methods of abortions, although they admitted they were dangerous. Abortion is seen by these participants as an unfortunate fact of being sexually active. 11. Schwandt A comparison of N = 585. Majority HM, Creanga women with induced reported spontaneous AA, Danso KA, abortion, spontaneous abortion between June Adanu RMK, abortion and ectopic and July 2008. Those Agbenyega T, pregnancy in Ghana. with reported induced Hindin MJ abortion were more 2011 Contraception likely to have more power in their relationships and to have not disclosed the index pregnancy to their partners. 12. Mote CV, Factors associated One-fifth (21.3%) of Otupiri E, with induced abortion respondents reported Hindin MJ. among women in having had an induced 2010 Hohoe, Ghana. abortion. Most common African Journal of reasons for having an Reproductive Health. abortion: "not to disrupt education or employment" and "too young to have bear a child." 65.5% performed by a medical doctor, 31% by partners or friends. 60.9% in a hospital, 29.9% at home. 50.6% used sharps or hospital instruments, 31% used herbs. 13. Voetagbe Midwifery tutors' Only 18.9% of the G, Yellu N, capacity and tutors surveyed knew Mills J, willingness to teach all the legal Mitchell E, contraception, post- indications under Adu- abortion care, and which safe abortion Amankway A, legal pregnancy could be provided. Jehu-Appiah K, termination in Ghana. These tutors were Nyante F. Human Resources for not taught manual 2010 Health vacuum aspiration during their training. 14. Laar AK Family planning, This analysis showed 2010. abortion and HIV in that family planning, Ghanaian print media: abortion and HIV A 15-month content received less than analysis of a national 1% of total newspaper Ghanaian newspaper. coverage in one African Journal of national Ghanaian Reproductive Health newspaper. 15. Clark KA, Return on investment The availability Mitchell EHM, for essential obstetric of PAC in Ghana Aboagye PK care training in Ghana: remains limited. Far 2010 Do trained public fewer midwives than sector midwives physicians offer PAC, deliver postabortion even after having care? Journal of received PAC clinical Midwifery and training, although an Women's Health analysis of the curriculum and training was outside the scope of this study. 16. Graff M, Barriers to sustainable Sustainable access to Amoyaw DA MVA supply in MVA equipment has 2009 Ghana: Challenges for been challenging the low-volume, low- particularly for income providers. low-volume, low- African Journal of income providers. Reproductive Health. Although many of the midwives in rural areas had the skills to provide MVA, they did not have the equipment and thus continued to refer women to district or regional hospitals. 17. Hill ZE, The context of Key themes were Tawiah- informal abortions in related to the Agyemang C, rural Ghana. Journal perception of Kirkwood B. of Women's Health. abortions as illegal, 2009 dangerous, and bringing public shame and stigma but also being perceived as common, understandable, and necessary. None of the respondents knew the legal status of abortion, with most reporting that it was illegal. 18. Konney Attitudes of women Abortion-related TO, Danso KA, with abortion-related complications Odoi AT, complications toward accounted for 42.7% Opare-Addo provision of safe of admissions to the HS, Morhe abortion services in gynecological ward at ESK. Ghana. Journal of KATH, 28% of whom 2009 Women's Health indicated an induced abortion. 92% of the women interviewed were not aware of the law regarding abortion in Ghana. Most felt that there was a need to establish safe abortion services in Ghana. 19. Oliveras E, Clinic-based 1,636 women completed Ahiadeke C, surveillance of adverse the questions. Adanu RM, pregnancy outcomes Younger, better Hill AG to identify induced educated and 2008 abortion in Accra, unmarried women are Ghana. Studies in more likely to have Family Planning. had an induced abortion. Between 10-17.6% of women report having had an abortion. Women seeking care at a private facility were more than twice as likely to have ended their previous pregnancy by induced abortion. 20. Mills S, Maternal Mortality Abortion-related Williams JE, Decline in the deaths were the most Wak G, Kassena-Nankana frequent cause of Hodgson A District of Northern maternal deaths in 2008 Ghana. Maternal and this sample in the Child Health Journal Northern Region. 21. Morhe Attitudes of doctors Most physicians were ESK, Morhe toward establishing supportive of playing RAS, Danso safe abortion units in some role in KA Ghana. International developing safe 2007 Journal of Obstetrics abortion units in and Gynecology hospitals in Ghana. However, only 54% of maternal and child health-related health workers were aware of the true nature of the abortion law, with 35% believing that the law permits abortion only to save the life of the woman. More than 50% of the workers reported they would be unwilling to play a role in performing pregnancy terminations. 22. Adanu Profile of women with 31% of the study RMK, Ntumy abortion complications for complications MN, in Ghana. Tropical from induced abortion. Tweneboah E. Doctor Those seeking care for 2005 induced abortion were younger, or lower parity, more education, less likely to be engaged in income-generating activity, in less stable relationships and had more knowledge of modern contraception than those presenting for treatment from spontaneous abortion. 23. Baiden F, Unmet need for Complications from Amponsa- essential obstetric abortion were the Achiano K, services in a rural leading cause of Oduro AR, district northern maternal mortality. Mehsah TA, Ghana: Complications Although abortion is Baiden R, of unsafe abortions considered taboo Hodgson A. remain a major cause in NKD, according 2006 of mortality. Public to clinic evidence, Health there is a high incidence of backstreet and unsafe practices. The district hospital did not have any access to formal safe abortion services. 24. Adanu Reasons, fears and Women having induced RMK & emotions behind abortion were younger, Tweneboah E induced abortions in better educated, less 2004 Accra, Ghana. likely to be married. Research Review 31.3% were reported to be induced abortion. Many who reported spontaneous abortion had stories that seemed to show induced. Most induced abortions were obtained outside the formal health system. 25. Yeboah Abortion: The case of The majority of RWN & MC Chenard Ward, Korle admissions are due Kom. Bu from 2000 to 2001. to incomplete 2003 Research Review abortions, although there were not classified by spontaneous or induced. Reported cases of induced abortions are high. 26. Glover EK, Sexual health 35% of the female Bannerman A, experiences of respondents reported Pence BW, adolescents in three ever being pregnant, Jones H, Miller Ghanaian towns. and 70% of those R, Weiss E, International Family reported having had Nerquaye- Planning Perspectives. or attempted an Tetteh J. abortion. 2003 27. Srofenyoh Abortion care in a 30% of induced EK, Lassey AT teaching hospital in abortions had 2003 Ghana. International complications while Journal of 10% of spontaneous Gyneaecology and abortions had Obstetrics complications. 15% of maternal deaths over the study period were due to complications from abortion. Abortion complications were the leading cause of admission to the maternity ward (40.7% of all admissions). 28. Geelhoed Trends in maternal Institutional DW, Visser LE, mortality: a 13-year maternal mortality Asare K, hospital-based study in rate of 1077 per Schagen van rural Ghana. European 100,000 live births. Leeuwen JH, Journal of Obstetrics Abortion van Roosmalen and Gynecology. complications were J. the leading cause 2003 (43 of the 229 deaths) 29. Srofenyoh Abortion care in a 40% of EK, Lassey AT teaching hospital in admissions 2003 Ghana. International over the study Journal of Gynecology period were and Obstetrics related to abortion complications. Almost 77% were spontaneous abortions. 30% with induced abortion had serious complications while 10% of spontaneous abortion had similar complications. 30. Turpin CA, Abortion at Komfo Abortion Danso KA, Anokye Teaching complications Odoi AT Hospital. Ghana accounted for 2002 Medical Journal 38.8% of admissions to the KATH Ob-Gyn ward in 1994. Induced abortions were more common in younger, unmarried women. The majority of induced abortions occurred in the 15-19 year old group. 31. Blanc A, Greater than expected The total Grey S. 2002 fertility decline in fertility rate Ghana: Untangling a in Ghana has puzzle. Journal of declined at a Biosocial Science higher rate than would be expected by the contraception prevalence rate. The authors find evidence of widespread abortion to control fertility, although accurate rates are hard to determine. The authors also note that the gap between expected fertility given contraception utilization and actual fertility is greater in urban areas than rural areas lends support to couples using abortion to limit or space births. 32. Geelhoed Gender and unwanted Induced DW, Nayembil pregnancy: a abortions were D, Asare K, community-based reported by Schagen van study in rural Ghana. 22.6% of the Leeuwen JH, Journal of surveyed van Roosmale Psychosocial population. J. 2002 Obstetrics and Gynecology 28.2% of women reported having had an induced abortion. More women than med reported an unwanted pregnancy ending in abortion, perhaps signaling female independence in deciding on abortion care. 33. Ahiadeke C The incidence of self The rates 2002 induced abortion in identified here Ghana: What are the suggest that facts? Research over a lifetime, Review. 900 abortions per 1,000 women will be performed. The majority of women reported receiving their abortion from outside the formal healthcare system (30% from a pharmacist, 11% from self- medication, 16% from a "quack doctor" and 3% from other means). 34. Geelhoed Contraception and About 40% of D, Nayembil D, induced abortion in participants had Asare K, rural Ghana. Tropical experienced an Schagen JH, Medicine and unwanted van Roosmalen International Health. pregnancy in J. their lives. 2002 Socioeconomic reasons were the most common for why a pregnancy was unwanted 35. Ahiadeke Incidence of induced 317/1,689 women 2001 abortion in southern aborted Ghana. International pregnancies (19/ Family Planning 100, 27/100 live Perspectives births, 17/ 1,000 women of reproductive age). Majority of women were under 30, married, Christian. Abortions happened outside the formal health sector. 36. Agyei Sexual behaviour and A majority of WKA, contraception among the young adults Biritwum RB, unmarried adolescents surveyed were Ashitey AG, and young adults in sexually Hill RB Greater Accra and experienced, 2000 Eastern Regions of although few Ghana. Journal of were using Biosocial Science contraception. Approximately 47% of those adolescents who had been sexually active reporting having had an abortion. While most participants were aware of modern methods of contraception, few used them. 37. Baird TL, Community education Post-abortion Billings DL, efforts enhance care training Demuyakor B. postabortion care for midwives was 2000 program in Ghana. effective. American Journal of Community- Public Health outreach was effective at educating the public about the new services being offered by midwives. 38. Obed SA & Uterine perforation 21.1% of the Wilson JB from induced abortion 10,518 cases of 1999 at Korle Bu Teaching abortion Hospital, Accra, complication Ghana: A five year treatments for review. West African abortion were Journal of Medicine considered to be induced. 79 (3.6%) of those had uterine perforation. 40.9% (n=29) induced their abortion because they were not ready to have a baby, 36.6% (26) cited the index pregnancy being too close to previous deliver. 81% (64) reported wishing to have future children, although almost 1/3 of the patients had a hysterectomy to treat the complications. 39. Lassey AT Complications of 58% of induced 1995 induced abortion and abortions were their prevention in performed Ghana. East African outside the Medical Journal health system and about 30% were complications from self- induced abortions using sticks, needles and herbal (often corrosive) inserted into the vagina. Only 9-212 were referrals, the rest were self- referred. Authors Study Design Study Setting and Year 1. Morhe ESK, Cross-sectional survey Ejisu-Juabeng Tagbor HK, community-based district of Ghana. Ankobea F, survey. Danso KA. 2012 2. Lee QY, Secondary data analysis Komfo Anokye Odoi AT, of patient charts Teaching Hospital Opare-Addo H, Dassah ET. 2012 3. Ganyaglo Secondary analysis of Koforidua Regional GYK, Hill WC. Obstetrics and Hospital, Eastern 2012 Gynecology ward Region admission and discharge books, triangulated against minutes from maternal death audit meetings and midwifery returns. Patient folders were available for 2009 only. 4. Sundaram A, Nationally representative Maternal Juarez F, survey Health Survey Bankole A, Singh S. 2012 5. Krakowiak- Cross-sectional Barekese Redd D, community-based survey sub-district in Ansong D, the Ashanti Otupiri E, Tran Region S, Klanderud D, Boakye I, Dickerson T, Crookston B 2011 6. Aniteye P, Structured survey with Gynecology ward, Mayhew S. 131 women with Korle Bu and Ridge 2011 incomplete abortions. Hospitals. 7. Gumanga Hospital records from Tamale Teaching SK, Kolbila January 1 2006- Hospital DZ, Gandau December 2010. BBN, Munkaila A, Malechi H, Kyei-Aboagye K 2011 8. Biney AAE 24 semi-structured Gynecology wards, 2011 individual interviews Tema General were conducted with Hospital and Korle women who were being Bu Teaching treated and reported Hospital having experience with induced abortion. 9. Ohene SA, Autopsy data Korle Bu Teaching Tettey Y, Hospital Kumoji R. 2011 10. Mac Focus group discussions Ho, Ghana Domhnaill B, in both rural and Hutchinson G, periurban settings. Milev A, Milev Y. 2011 11. Schwandt Surveys administered by Gynecology HM, Creanga nursing and midwifery emergency wards, AA, Danso KA, students with women Korle Bu Adanu RMK, being treated for and KATH. Agbenyega T, abortion complications. Hindin MJ 2011 12. Mote CV, 408 community-based Hohoe, Volta Otupiri E, surveys Region Hindin MJ. 2010 13. Voetagbe 74 midwifery tutors Midwifery G, Yellu N, from all 14 public training colleges Mills J, midwifery schools were country-wide Mitchell E, surveyed. Adu- Amankway A, Jehu-Appiah K, Nyante F. 2010 14. Laar AK Content analysis of the Newspaper 2010. Daily Graphic newspaper. 15. Clark KA, Secondary data analysis Nationally- Mitchell EHM, of 2002 Ghana Service representative Aboagye PK Provision Assessment sample of health 2010 survey. 428 health facilities and facilities working in health providers 1448 health facilities were surveyed. 16. Graff M, Interviews with 24 Data gathered in Amoyaw DA midwives and 16 seven of the ten 2009 physicians regions of the country. 17. Hill ZE, Qualitative interviews in Tawiah- Kintampo, Brong-Ahafo. Agyemang C, Kirkwood B. 2009 18. Konney Interviews of women Gynecology TO, Danso KA, being treated for ward at KATH Odoi AT, abortion complications Opare-Addo at KATH between May HS, Morhe 1 and June 30, 2007. ESK. 2009 19. Oliveras E, Using previous birth Three public and Ahiadeke C, technique, during two private Adanu RM, prenatal care, nurses clinics in Accra Hill AG asked 5 questions to that provide 2008 illicit how their previous antenatal and pregnancy ended. maternity services. 20. Mills S, Family members of all Northern Region Williams JE, maternal deaths between Wak G, January 2002 and Hodgson A December 2004 were 2008 interviewed 21. Morhe Cross sectional survey of Komfo Anokye ESK, Morhe 74 physicians at KATH Teaching Hospital, RAS, Danso Kumasi. KA 2007 22. Adanu Cross-sectional survey Korle Bu Teaching RMK, Ntumy of 150 patients being Hospital MN, treated for abortion Tweneboah E. complications. 2005 23. Baiden F, Secondary data analysis Kassena-Nankana Amponsa- from chart review of all district in the Achiano K, maternal deaths from Northern Region Oduro AR, January 2001 to Mehsah TA, December 2003 at the Baiden R, district hospital in Hodgson A. Kassena-Nankana 2006 24. Adanu Interviews with 150 Gynecology ward, RMK & women experiencing Korle Bu Tweneboah E abortion complications. 2004 25. Yeboah Chart review of all Gynecology RWN & MC abortion-related emergency ward, Kom. admissions between Korle Bu Teaching 2003 January 1, 2000 and Hospital, Accra, December 31, 2001; Ghana. nurse interviews 26. Glover EK, Community-based Tamale, Takoradi Bannerman A, surveys of never-married and Sunyani Pence BW, youth about general Jones H, Miller sexual experiences. R, Weiss E, Nerquaye- Tetteh J. 2003 27. Srofenyoh Chart review of all Gynecology ward, EK, Lassey AT patients admitted to Korle Bu 2003 Korle Bu for abortion complications between January 1 and December 31, 2001. 28. Geelhoed Records from all Berekum District DW, Visser LE, maternal deaths between hospital, Brong Asare K, 1987 and 2000 were Ahafo Region Schagen van reviewed Leeuwen JH, van Roosmalen J. 2003 29. Srofenyoh Retrospective chart Korle Bu Teaching EK, Lassey AT review of all patients Hospital 2003 treated for abortion complications in 2000. 30. Turpin CA, 1,301 of 1,313 cases of Obstetrics and Danso KA, abortion admissions to Gynecology ward, Odoi AT KATH were analyzed Komfo Anokye 2002 retrospectively. Teaching Hospital 31. Blanc A, Demographic and Health Representative Grey S. 2002 Surveys from 1988, sample. 1993 and 1998. 32. Geelhoed 2137 community -based Berekum, Brong DW, Nayembil surveys Ahafo Region. D, Asare K, Schagen van Leeuwen JH, van Roosmale J. 2002 33. Ahiadeke C Data come from the 2002 cross-sectional community-based Maternal Health Survey in four regions 34. Geelhoed Community-based Berekum District, D, Nayembil D, surveys with 2137 Brong Ahafo Region Asare K, participants Schagen JH, van Roosmalen J. 2002 35. Ahiadeke As part of Maternal 4 of the country's 2001 Health Survey Project; 10 regions: 1,689 pregnant women Central, Eastern, were interviewed Volta and Greater Accra. 36. Agyei Fertility survey Greater Accra and WKA, data with 953 males Eastern regions Biritwum RB, and 829 females. Ashitey AG, Hill RB 2000 37. Baird TL, Post-abortion care Eastern Region. Billings DL, training for midwives to Demuyakor B. increase their skills, 2000 coupled with community outreach to educate women about where to access safe abortion services. 38. Obed SA & Prospective study of all Korle Bu Teaching Wilson JB patients being treated at Hospital 1999 Korle Bu for perforated uterus following an abortion (n=79) between 1990-1994. Patient interviews and chart review. 39. Lassey AT Chart review of 200 Gynecology ward, 1995 patients admitted to Korle Bu Teaching the gynecology ward Hospital at Korle Bu for abortion complications. Authors Strengths and Database and Year limitations retrieved from 1. Morhe ESK, There were no Global Tagbor HK, questions asked Health, Ankobea F, as to the Popline Danso KA. processes 2012 undertaken to obtain abortions. 2. Lee QY, Comments are Reference Odoi AT, made that are List Opare-Addo H, not supported by Dassah ET. data or 2012 references, such as, "Social stigma plays a role in preventing vulnerable women from accessing safe abortion services." Reasons behind not accessing safe abortion services need to be investigated. 3. Ganyaglo This is the Global GYK, Hill WC. first hospital- Health 2012 based study outside a major teaching hospital. 4. Sundaram A, This study uses Ovid Juarez F, nationally- Medline, Bankole A, representative Global Singh S. 2012 data to Health investigate PubMed safe and unsafe abortion seeking. However, abortion is under-reported, and there were no questions about unwanted pregnancy, or reasons for seeking safe versus unsafe abortions. 5. Krakowiak- A relatively Global Redd D, small sample Health Ansong D, size (n=85) Otupiri E, Tran of only women. S, Klanderud There was a D, Boakye I, qualitative Dickerson T, component, Crookston B but not about 2011 abortion- related issues. 6. Aniteye P, The authors Ovid Mayhew S. note a need for Medline, 2011 qualitative Global work especially Health, around the PubMed, reasons why Popline women are not using family planning as well as to discover who the unsafe providers are. 7. Gumanga Documented the Global SK, Kolbila causes of Health DZ, Gandau maternal death BBN, Munkaila in the Northern A, Malechi H, Region of Ghana. Kyei-Aboagye K 2011 8. Biney AAE This study was Ovid 2011 mainly about Medline, contraception, Global and so access Health, to abortion PubMed, services were Popline not investigated. 9. Ohene SA, Demonstrated PubMed Tettey Y, the burden of Kumoji R. disease 2011 attributable to adolescent death 10. Mac The focus-group Global Domhnaill B, methodology Health Hutchinson G, enables students Milev A, Milev to talk among Y. themselves about 2011 sexual relationships. 11. Schwandt This is one of Ovid HM, Creanga the only studies Medline, AA, Danso KA, to look at male- Global Adanu RMK, female Health, Agbenyega T, relationships PubMed Hindin MJ and how these 2011 impact reproductive health decision making. 12. Mote CV, Using community- Global Otupiri E, based surveys Health, Hindin MJ. gets a broader PubMed 2010 population than hospital-based. 13. Voetagbe 74 of 123 PubMed G, Yellu N, selected tutors Mills J, returned the Mitchell E, survey, giving a Adu- response rate of Amankway A, 60.2%. Jehu-Appiah K, Importantly Nyante F. documented the 2010 lack of complete knowledge of the law, even among midwifery tutors. 14. Laar AK This analysis Global 2010. shows that local Health, speculations PubMed that the quantity and prominence of reproductive health issues are neglected in local newspapers are warranted. 15. Clark KA, Information Ovid Mitchell EHM, about supplies Medline, Aboagye PK available at the PubMed, 2010 clinics, as well Popline as whether the providers were offering CAC services, were not available in the dataset. 16. Graff M, Interviews with Ovid Amoyaw DA a wide range of Medline, 2009 stakeholders is Global a major Health, strength. PubMed 17. Hill ZE, Ovid Tawiah- Medline, Agyemang C, Global Kirkwood B. Health, 2009 MedLine 18. Konney The first study Ovid TO, Danso KA, to investigate Medline, Odoi AT, the attitudes Global Opare-Addo of women being Health, HS, Morhe treated for PubMed, ESK. abortion Popline 2009 complications towards the provision of safe abortion services in Ghana. 19. Oliveras E, Although this Ovid Ahiadeke C, technique does Medline, Adanu RM, not measure Global Hill AG prevalence or Health, 2008 lifetime PubMed, exposure to Popline abortion, it is another way to investigate abortion. Further work to elucidate differential responses based on healthcare provider asking is important. 20. Mills S, Relying on Ovid Williams JE, verbal autopsy Medline, Wak G, requires PubMed, Hodgson A survivors to Popline 2008 know of pregnancy status. There may have been more abortion- related deaths than reported if those interviewed did not know the woman was pregnant. 21. Morhe The attitudes of Ovid ESK, Morhe health care Medline, RAS, Danso providers is an Global KA important area Health, 2007 to investigate PubMed due to the barriers these people can represent. 22. Adanu The Reference RMK, Ntumy determination of list MN, induced versus Tweneboah E. spontaneous 2005 abortion was reliant on self- report, which the authors note may be under- reported. 23. Baiden F, Established Ovid Amponsa- abortion- Medline, Achiano K, related deaths Global Oduro AR, are the leading Health, Mehsah TA, cause of PubMed, Baiden R, maternal deaths. Popline Hodgson A. Further research 2006 including all members of a woman's community needs to be conducted to fully understand the social and cultural factors associated with seeking maternal healthcare. 24. Adanu Only qualitative Reference RMK & paper list Tweneboah E investigating 2004 the reasons behind and actions taken to terminate pregnancies. 25. Yeboah No follow-up or Popline RWN & MC interviewing Kom. of patients to 2003 determine reasons for abortion. 26. Glover EK, Using a Global Bannerman A, community-based Health, Pence BW, technique PubMed, Jones H, Miller sampled Popline R, Weiss E, previously Nerquaye- under- Tetteh J. represented 2003 groups. 27. Srofenyoh Important Ovid EK, Lassey AT documentation Medline 2003 of the burden of abortion complications at Korle Bu. 28. Geelhoed Global DW, Visser LE, Health, Asare K, Popline Schagen van Leeuwen JH, van Roosmalen J. 2003 29. Srofenyoh Documents the Ovid EK, Lassey AT high level of Medline, 2003 burden Global represented by Health abortion complications at Korle Bu. 30. Turpin CA, Established the Danso KA, large proportion Odoi AT of cases of 2002 post-abortion complications treated at KATH. Purely descriptive and reliant on information included in patient charts. 31. Blanc A, As there are no Popline Grey S. 2002 reliable measures of abortion prevalence, the authors cannot rule out abortion being the reason behind the observed gap. Further, the authors note that abortion was, at the time or writing, illegal except to save the life of the mother or in the case of rape or incest. 32. Geelhoed Interviewing Ovid DW, Nayembil both men and Medline D, Asare K, women gives a Schagen van broader Leeuwen JH, perspective. van Roosmale Questions J. 2002 investigating the process to obtain an abortion were not asked. 33. Ahiadeke C These Global 2002 data come from Health before abortion policies were liberalized. 34. Geelhoed Using anonymous, Ovid D, Nayembil D, privately Medline, Asare K, administered Global Schagen JH, surveys yielded Health, van Roosmalen a high response Popline J. rate. 2002 Interviewing both men and women is a strength. 35. Ahiadeke Community-based Global 2001 survey offers a Health different perspective than hospital-based, although further questions regarding the process are still necessary. 36. Agyei Investigated the Ovid WKA, knowledge and Medline Biritwum RB, practices of Ashitey AG, adolescents Hill RB regarding their 2000 sexual health. Large community- based sample allows for generalization of findings. Due to quantitative nature, hard to establish the processes undertaken by pregnant girls to end their pregnancies or how many were safe versus unsafe. 37. Baird TL, No comprehensive Ovid Billings DL, evaluation of Medline, Demuyakor B. effectiveness Public 2000 was conducted. Health 38. Obed SA & Reference Wilson JB list 1999 39. Lassey AT Data limited by Ovid 1995 being a chart Medline review, although this early study highlighted the problem of unsafe abortion in the Greater Accra area.
|Printer friendly Cite/link Email Feedback|
|Author:||Rominski, Sarah D.; Lori, Jody R.|
|Publication:||African Journal of Reproductive Health|
|Date:||Sep 1, 2014|
|Previous Article:||Does access to antiretroviral drugs lead to an increase in high-risk sexual behaviour?|
|Next Article:||A comparative analysis of fertility differentials in Ghana and Nigeria.|