Intervention in Ghana helps increase safe abortion care

Thursday, December 18, 2014

In 2006, in response to high maternal mortality and morbidity rates driven largely by unsafe abortion, the Ghanaian government implemented R3M, “Reducing Maternal Mortality and Morbidity,” a program to train providers in abortion care, meet women’s needs and increase access to family planning services. The program was launched by the Ministry of Health, in partnership with a consortium of international health organizations, including Ipas, Engender Health, Marie Stopes International (MSI), the Population Council, and Willows Foundation, and implemented in seven districts located in three regions: Greater Accra, Ashanti and Eastern.

Researchers from the Guttmacher Institute examined the impact to the provision of safe abortion services and postabortion care (PAC) in the districts. They also examined the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision.

The study collected data from 457 ob-gyn providers in the districts where R3M had been implemented and in other districts in Greater Accra, Ashanti and Eastern, as well as in Brong Ahafo, where the program had not been implemented and found:

  • Greater proportions of providers exposed to R3M than of those not exposed provided safe abortion services (54% vs. 13%) and postabortion care (66% vs. 33%).
  • A greater proportion of exposed providers had been trained in abortion techniques (84% vs. 52%).
  • A greater proportion of exposed providers than others were confident in their ability to provide safe abortion care (77% vs. 36%); confident providers were eight times more likely to provide safe abortions, and they were also more likely to provide safe postabortion care.

In addition, the study found that R3M’s positive impact stretched beyond the implementing districts. Even in nonprogram districts located near districts where R3M had been implemented, the initiative had a positive effect on the provision of safe abortion and postabortion care.

In November, Guttmacher and the implementing partners held a workshop in Accra to discuss the impact of the intervention. Ipas Ghana Country Director Dr. Koma Jehu Appiah shared Ipas’s enthusiasm for the program and areas for continued progress: “What we know is that this program really works. It’s gratifying to see that more women can access safe abortion care now from confident, well-trained providers.” Ipas Ghana works primarily in the public sector in Ghana and has built strong ties with medical schools, midwifery schools and the Ghana Health Service. “We also know that we must continue our work with nurses and midwives to increase their knowledge and confidence in provision of safe abortion care; as they outnumber physicians in Ghana and yet are less likely to provide such care.”

“It is heartening to see this positive impact—it tells me that our years-long work with various stakeholders in Ghana, such as women leaders, lawyers and judiciary, parliamentarians, and the health system, has helped to lay the groundwork for success,” adds Dr. Jehu Appiah.