Emmanuel Morhe

Attitudes of doctors toward establishing safe abortion units in Ghana.

Objectives To assess physician knowledge of the current legal status of abortion in Ghana and determine the proportion physicians in favor of establishing units where safe abortion would be provided, and the proportion of those willing to offer such services. Methods A survey conducted at Komfo Anokye Teaching Hospital, Ghana, in August 2003. Using a self‐administered questionnaire, 74 randomly selected physicians expressed their views on whether abortion units should be established within national health facilities in Ghana, and what role they would play in them. Results Of the 59 physicians (80%) who favored the establishment of safe abortion units within national health facilities, 27 (36%) indicated a willingness to take part in counseling only, 33 (45%) were prepared to carry out abortions, and 14 (19%) said they would play no role in these units. Conclusion Most physicians participating in this study conducted in Ghana were willing to play some role in the provision of safe abortion services.

Attitude of Women with Abortion-Related Complications toward Provision of Safe Abortion Services in Ghana

OBJECTIVES To determine the attitude and perception of women with abortion-related complications toward the provision of safe abortion services, their sociodemographic characteristics, and their awareness of the law permitting abortion under certain circumstances in Ghana. METHODS A cross-sectional study using a standardized questionnaire was conducted over a 2-month period among patients admitted with abortion-related complications at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. RESULTS Abortion-related complications accounted for 42.7% of admissions to the gynecological ward. The median age of the women was 26 years. Of the 296 patients interviewed, 28% reported induced abortion in the index pregnancy, 29% were not married, 30% had no formal education, and 92% were not aware of the current legal status of abortion in Ghana. They thought there was the need to provide safe abortion services in the country, and almost all of them were willing to patronize such services. CONCLUSIONS Awareness of the current legal status of abortion was lacking among women with abortion-related complications attending a tertiary center in Kumasi. However, the provision of safe abortion services was much needed in this population.

Episiotomy in Ghana.

Trauma to the genital tract commonly occurs during childbirth and causes short- and long-term morbidity in women. Episiotomy as a small and neat incision that would facilitate delivery decrease trauma and allows the perineum to be restored to its functional condition after proper suturing has been promoted extensively. Currently however there is no evidence that routine or prophylactic episiotomy reduces the risk of severe perineal trauma improves perineal healing prevents fetal trauma or reduces the risk of urinary or anal incontinence as initially purported. A selective episiotomy policy has resulted in a worldwide downward trend of episiotomy rate. In the United States between 1983 and 2000 the overall episiotomy rate fell from 69.9% of all births to 19.4% of vaginal deliveries. Recent rates in other countries include Sweden 9%; Zimbabwe 27%; Burkina Faso 46%; and Nigeria 54.9%. (excerpt)

Health information-seeking behaviours among pregnant teenagers in Ejisu-Juaben Municipality, Ghana.

OBJECTIVE to examine health information-seeking behaviours among pregnant teenagers. DESIGN qualitative design using semi-structured interviews and focus groups. The study followed the Consolidated Criteria for Reporting Qualitative Studies (COREQ). SETTINGS/PARTICIPANTS: antenatal clinic at Ejisu Government hospital, Ghana. Twenty eight pregnant teenagers aged 15-19 and one midwife participated in the study. METHOD the participants were interviewed in person at the antenatal clinic. The individual interviews and focus groups were digitally recorded, transcribed, and then analysed using thematic framework analysis. FINDINGS three themes emerged from the analysis of the transcripts: information needs, sources of information and barriers to information seeking. Findings indicate unmet information needs among pregnant teenagers including proper understanding of pregnancy stages, infant feeding practices, nutrition, labour and birth and postnatal care. Pregnant teenagers largely relied on traditional sources for information on pregnancy as compared to official sources such as midwives, nurses or doctors. CONCLUSION/IMPLICATIONS FOR PRACTICE: given that traditional sources, such as family and neighbours were the predominant sources of information, to effectively and comprehensively address the information needs of pregnant teenagers, interventions should target both the expecting teenagers and the family and/or the community at large. The findings further point to a need for a shift in maternal health care policy through the establishment of adolescent only antenatal care day to effectively meet the heath information needs of pregnant teenagers.

Severe morbidities associated with induced abortions among misoprostol users and non-users in a tertiary public hospital in Ghana.

BackgroundMisoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.MethodsThis was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher’s exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.ResultsOverall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks’ gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).ConclusionSelf-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana.

Young women’s experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.

Maternity care provider knowledge, attitudes, and practices regarding provision of postpartum intrauterine contraceptive devices at a tertiary center in Ghana

To assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.

Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana

Objective Using our previously developed and tested Adolescent Sexual and Reproductive Health (SRH) Stigma Scale, we investigated factors associated with perceived SRH stigma among adolescent girls in Ghana. Methods We drew upon data from our survey study of 1,063 females 15-24yrs recruited from community- and clinic-based sites in two Ghanaian cities. Our Adolescent SRH Stigma Scale comprised 20 items and 3 sub-scales (Internalized, Enacted, Lay Attitudes) to measure stigma occurring with sexual activity, contraceptive use, pregnancy, abortion and family planning service use. We assessed relationships between a comprehensive set of demographic, health and social factors and SRH Stigma with multi-level multivariable linear regression models. Results In unadjusted bivariate analyses, compared to their counterparts, SRH stigma scores were higher among girls who were younger, Accra residents, Muslim, still in/dropped out of secondary school, unemployed, reporting excellent/very good health, not in a relationship, not sexually experienced, never received family planning services, never used contraception, but had been pregnant (all p-values <0.05). In multivariable models, higher SRH stigma scores were associated with history of pregnancy (β = 1.53, CI = 0.51,2.56) and excellent/very good self-rated health (β = 0.89, CI = 0.20,1.58), while lower stigma scores were associated with older age (β = -0.17, 95%CI = -0.24,-0.09), higher educational attainment (β = -1.22, CI = -1.82,-0.63), and sexual intercourse experience (β = -1.32, CI = -2.10,-0.55). Conclusions Findings provide insight into factors contributing to SRH stigma among this young Ghanaian female sample. Further research disentangling the complex interrelationships between SRH stigma, health, and social context is needed to guide multi-level interventions to address SRH stigma and its causes and consequences for adolescents worldwide.

“My friend who bought it for me, she has had an abortion before.” The influence of Ghanaian women’s social networks in determining the pathway to induced abortion

Background Even given the liberal abortion law in Ghana, abortion complications are a large contributor to maternal morbidity and mortality. This study sought to understand why young women seeking an abortion in a legally enabling environment chose to do this outside the formal healthcare system. Methods Women being treated for complications arising from a self-induced abortion as well as for elective abortions at three hospitals in Ghana were interviewed. Community-based focus groups were held with women as well as men, separately. Interviews and focus group discussions were conducted until saturation was reached. Results A total of 18 women seeking care for complications from a self-induced abortion and 11 seeking care for an elective abortion interviewed. The women ranged in age from 13 to 35 years. There were eight focus groups; two with men and six with women. The reasons women self-induce are: (1) abortion is illegal; (2) attitudes of the healthcare workers; (3) keeping the pregnancy a secret; and (4) social network influence. The meta-theme of normalisation of self-inducing’ an abortion was identified. Discussion When women are faced with an unplanned and unwanted pregnancy, they consult individuals in their social network whom they know have dealt with a similar situation. Misoprostol is widely available in Ghanaian cities and is successful at inducing an abortion for many women. In this way, self-inducing abortions using medication procured from pharmacists and chemical sellers has become normalised for women in Kumasi, Ghana.

Postpartum contraceptive choices among women attending a well‐baby clinic in Ghana

To assess postpartum contraceptive choices among women attending a well‐baby clinic in Ghana.