INDUCED ABORTION AND CONTRACEPTIVE USE IN THE HOHOE MUNICIPALITY OF GHANA

ABSTRACT

BACKROUND: Induced abortion has been reported to be the third most significant cause of maternal mortality globally. Whereas the prevalence in the developed countries is declining due to an increased use of contraceptives, the same cannot be said about developing countries. In Ghana 60% of all those who seek for abortion services are below the age of 30years. In the Hohoe municipality of Ghana, more than two-thirds of all maternal deaths recorded in 2006 were due to the complications of unsafe abortion. This study aimed at finding any correlation between induced abortion and contraceptive use in the Hohoe Municipality. The objectives that were looked at include sources of contraceptives, factors that influence contraceptive use, mode of induced abortion and reasons for induced abortion. METHOD: The study design was case-control which was conducted in the Hohoe municipality of the Volta region of Ghana. A purposeful sample of 429 women in their reproductive ages was recruited. These comprised 206 women (case group) who were admitted to the hospital for complications of induced abortion and also antenatal clients who have a history of induced abortion. These were compared with a control group comprising women who were attending antenatal or postnatal clinics and have never obtained induced abortion. Facility-based interviews were conducted using structured questionnaires. Other respondents who had been discharged were traced.

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Data Analysis The data were processed and analyzed with the statistical software stata 9. Proportions were generated for the variables under study and then compared among the cases and the controls. The mean ages were calculated using t-test. The explanatory variables and potential confounders were regressed for using logistic regression analysis. This was done to compare the effect of some baseline variables on contraceptive use and having number of children less than four. P-values were used to determine the statistical significance of the outcomes. Odd ratios were used to compare some variables on induced abortion. FINDINGS The study found that 68% of women who obtained induced abortion were above 25 years of age and that they use contraceptives mainly when their children are too young. They were also highly educated (Senior Secondary and above) and prefer getting their contraceptive services from pharmacy shops rather than Family Planning Clinics, nonetheless 74% of women use the services of the Family Planning Clinic for their contraceptive needs. Highly educated women are 2 times more likely to be among those who obtain induced abortion than those who do not (p=0.031), this is statistically significant. Contraceptives were used to avoid pregnancy more than for any other reason. Contraceptive failure rate among users was 15%, however these women have low odds for induced abortion (OR: 0.8) compared to those who did not have contraceptive failure, but also obtained induced abortion. Whereas 38% women do not use contraceptives because of the fear of side effects, 24% had no reason for not using contraceptives and 10% thought they were too young to use contraceptives.

Women who do not use contraceptives for fear of side effects were about three times more likely to have an induced abortion compared to the controls. Women with regular salary have high odds for induced abortion (OR: 2 p=0.031), this is statistically significant.

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Women who obtain induced abortion are 3.3 times more likely to be higher salary earners than those who do not (p