Incidence of induced abortion in southern Ghana

Context: In countries such as Ghana, where the law restricts elective induced abortion, data to quantify the incidence of abortion are scarce. Existing data on induced abortions in Ghana come mainly from hospital records, which are unreliable because record-keeping is poor and induced abortions often are classified inaccurately. Methods: A multistage random sampling design was used to identify 18,301 women aged 15-49 from eight communities in four of the 10 regions in Ghana between January and March 1997 Of the identified women, 1,689 were pregnant. From March 1997 to March 1998, fieldworkers living in the pregnant women's communities monitored their health and pregnancy outcomes, including self-induced abortions. Results: During the study period, the rate of abortion in the study areas was 17 induced abortions per 1,000 women of childbearing age. There were 19 abortions per 100 pregnancies (or 27 abortions for every 100 live births). The majority (60%) of women who had an abortion were younger than 30 and 36% were nulliparous. Forty-five percent had obtained their abortions before the seventh week of gestation, and 90% had done so before the 10th week. Only 12% of the women said they had obtained their abortion from a physician. Muslim women had decreased odds of obtaining an abortion. Women who lived in urban areas. who were educated or who had four or more children had increased odds of obtaining an abortion. Women who were self-employed had greater odds of obtaining an abortion than those who were employed by someone else. Conclusion: Ghana's abortion law does nothing to prevent many induced abortions from occurring. However, few Ghanaian women who seek abortions obtain them from physicians, and most appear to induce abortions themselves, often in collaboration with pharmacists.