Why Women are dying from unsafe Abortion: Narratives of Ghanaian abortion providers

Carolyn M. Payne, Michelle Precourt Debbink, Ellen A. Steele, Caroline T. Buck, Lisa A. Martin, Jane A. Hassinger, Lisa H. Harris

Abstract

In Ghana, despite the availability of safe, legally permissible abortion services, high rates of morbidity and mortality from unsafe abortion persist.  Through interviews with Ghanaian physicians on the front lines of abortion provision, we begin to describe major barriers to widespread safe abortion.  Their stories illustrate the life-threatening impact that stigma, financial restraints, and confusion regarding abortion law have on the women of Ghana who seek abortion.  They posit that the vast majority of serious abortion complications arise in the setting of clandestine or self-induced second trimester attempts, suggesting that training greater numbers of physicians to perform second trimester abortion is prerequisite to reducing maternal mortality. They also recognized that an adequate supply of abortion providers alone is a necessary but insufficient step toward reducing death from unsafe abortion.  Rather, improved accessibility and cultural acceptability of abortion are integral to the actual utilization of safe services.  Their insights suggest that any comprehensive plan aimed at reducing maternal mortality must consider avenues that address the multiple dimensions which influence the practice and utilization of safe abortion, especially in the second trimester.  (Afr J Reprod Health 2013; 17[2]: 118-128).

Résumé

Au Ghana, en dépit de la disponibilité des services d'avortement sûrs et autorisées par la loi, des taux élevés de morbidité et de mortalité suite à des avortements  persistent. Grâce à des entrevues avec des médecins ghanéens qui jouent un rôle important dans la dispensation de services  d'avortement, nous commençons à décrire les principaux obstacles à l'avortement sans risque généralisé. Leurs histoires illustrent l'impact potentiellement mortel que la stigmatisation, les contraintes financières, et  la confusion en ce qui concerne la  loi sur l'avortement ont sur les femmes  ghanéennes qui recherchent l'avortement. Ils postulent que la grande majorité des complications de l'avortement graves se posent dans le cadre de tentatives clandestines ou autoinduites du deuxième trimestre, ce qui suggère que la formation de plus grand nombre de médecins pour pratiquer un avortement du second trimestre est une condition préalable à la réduction de la mortalité maternelle. Ils ont également reconnu qu'un nombre suffisant des dispensateurs de services  d'avortement autonomes est une étape nécessaire mais non suffisante à la réduction du deces occasionne  par  l’avortement dangereux.   Plus exactement, une meilleure accessibilité et acceptabilité culturelle de l'avortement font partie intégrante de l'utilisation réelle des services non dangereux.  Leurs points de vue donnent à penser que toute tentative globale visant à réduire la mortalité maternelle doit envisager des voies qui s’adressent aux multiples dimensions qui influencent la pratique et l'utilisation de l'avortement médicalisé, surtout dans le deuxième trimestre. (Afr J Reprod Health 2013; 17[2]: 118-128).

 

Keywords: Abortion, providers, law, access, reproductive health care

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