Women’s knowledge of the legality of abortion and other determinants of abortion safety among women in Ghana: An Analysis of 2007 and 2017 Maternal Health Surveys

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Abstract Background: Regardless of the existence of legal abortion services in Ghana, unsafe abortion remains a major health issue affecting the sexual and reproductive life of women. This study therefore examines the predictors of abortion safety among women in Ghana by comparing two different rounds of surveys.Methods: The study used data from the 2007 and 2017 Ghana Maternal Health Surveys. A weighted sample of 552 (2007) and 1,880 (2017) women aged 15-49 whose activities related to their most recent induced abortion were selected. This study, however, limits the analysis to a subpopulation of women who terminated a pregnancy between 2002 and 2007 and 2012 and 2017. Binary logistic regression analysis was used to show the relationship between abortion safety and knowledge of legality of abortion. The statistical significance level was set at p < 0.05.Results: The study found that there has been an increase in the proportion of women who know about the legality of abortion under some conditions in Ghana from 6.2% in 2007 to 10.7% in 2017. Again, the likelihood of unsafe abortion practices was high among women who had knowledge of legality of abortion in 2017 (AOR=1.85, C.I:1.21-2.82) but not in 2007. Women who had secondary or higher education in 2007 (AOR=0.40, C. I: 0.19-0.84) and 2017 (AOR=0.44, C.I:0.30-0.64), who were married in 2017 (AOR=0.70, C. I: 0.51-0.97) had lower odds of engaging in unsafe abortion practices. Similarly, women residing in urban areas in 2007 (AOR=0.29, C.I: 0.19-0.44) and 2017 (AOR=0.68, C.I: 0.54-0.85) and residing in the northern zone (AOR=0.10, C.: 0.01-0.98) were less likely to practice unsafe abortion. Again, partners of women who had favourable attitudes towards abortion in 2007 (AOR=0.38, C.I:0.23-0.65) and 2017 (AOR=0.62, C.I:0.47-0.81) were less likely to have unsafe abortion.Conclusion: Increasing knowledge of legal status on abortion among women corresponded with a decrease in safe abortion practices over the decade (2007-2017), as the results suggest has implications for poor reproductive health outcomes and increased maternal mortality among women in Ghana. Factors likely to encourage unsafe abortion practices should be addressed to improve the safe sexual and reproductive health of women.

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