Objectives Attitudes and Perceptions of Family Planning Among Patients and Skilled • To determine the most common barriers for termination of pregnancy (TOP) Medical Providers at Axim • To examine the attitudes and perceptions of health care providers and patients on the topic of TOP . Government Hospital to Help • To determine the rates and types of TOPs performed at Axim Government Hospital Reduce Induced Abortions To improve availability and quality of family planning accessibility for patients both pre/post TOPs To implement a sustainable counseling sessions to Shontreal Cooper MD, MPH patients both pre/post TOPs procedures GE/NMF Program May 06, 2014 Comprehensive Reproductive Comprehensive Reproductive Health Protocol Health Protocol Prior to 1985, abortion was prohibited under ALL • circumstances. • The Ministry of Health has developed several Reproductive Health policies in In Ghana, the law provides that “ It shall not be an offence if the • abortion or miscarriage is caused in any of the following Ghana. These include: circumstances by a registered gynecologists or any other 1. The National Reproductive Health registered medial practitioner in a government hospital or in a private hospital registered under Private Clinics and Maternity Service Policy and Standards revised in 2003 to Homes Board. Since the amendment in 1985, it is now include the specific provision of safe abortion permitted legally under the following stated conditions: within the law 1. Where pregnancy occurred as a result of rape or defilement • 2. The National Reproductive Health 2. Where there is substantial risk of a physical abnormality or Service Protocol. • disease occurring in the unborn child. 3. The Adolescent Reproductive Health 3. Where continuing with the pregnancy would risk the mental Policy - October 2000. • or physical health or the life of the pregnant woman. Methods Qualitative Analysis • Attitudes and Perceptions of Abortions This qualitative, cross-sectional study involving female patients • ages 15-36 for the period of March 24, 2014to April 11, 2014 at Axim Government Hospital (AGH). “…most women who come in for abortion care are teenage girls, who will do • just about anything to get rid of the pregnancy” Midwife 2 All termination of pregnancies and indications for the • • Religion and Morals termination listed in the Maternity Ward Admission & Discharge book were documented. Of the ten health care providers, there were four midwives, four “I, myself, will not have an abortion because I am a Christian and I don’t • • nurses, one anesthetist, and one physician. believe that this is the right thing to do. But I don’t condemn patients who decide to have abortions; I just think that the routes and options they take to induce the abortion are morally wrong .” Midwife Survey conducted which included midwives, nurses, • anesthetist, and a physician who have had at least 6 months of • Contraceptive Knowledge and Use clinical training at Axim Government Hospital. Self-administered questionnaire with both closed and opened “….I didn’t know anything about family planning before today, so I never • • use it. Even if I am taken to the family planning department I will not ended questions. take birth control because it will make me become infertile.” Patient 1 Data was also collected from the Maternity Ward Admission & • Discharge Book with only recordings of correctly listed induced abortion diagnosis.
Qualitative Analysis Qualitative Analysis Variable # % Estimated age (years) ≤ 20 4 40 21-25 2 20 26-30 1 10 31-35 1 10 Attitudes of Health Care Providers on TOP at Axim Government Hospital Responses ≥ 35 2 20 Marital Status Single 6 60 Opinion Married Ye s No 4 40 Widowed Do you understand the definition of TOP? 6 4 Education Do you pre-counsel patients before TOP? No Education 5 5 0 Primary School Do you post-counsel patients after TOP? 2 20 3 7 Are you comfortable with elective TOP? Junior Secondary School 2 8 4 40 Senior Secondary School 4 40 Table 2: Displays the attitudes of health care providers that were interviewed and surveyed Work Unemployed 2 20 Trading 7 70 Teacher 1 10 Nursing 0 Table 1: Demographics of patients that were interviewed and surveyed Results Results Total # of Termination Diagnosed/Month Causes of Incomplete Termination Stratified By Age T o ta l 14 12 12 11 Unkno wn 8 6 6 6 6 6 Ma la ria 5 5 4 3 E ne ma 1 1 1 1 1 0 nc o mple te nc o mple te nc o mple te nc o mple te nc o mple te nc o mple te nc o mple te Se lf-I nduc e d Cyto te c hre a te n Misse d hre a te n Misse d hre a te n Misse d hre a te n hre a te n Misse d hre a te n Misse d hre a te n Misse d 0 5 10 15 20 25 T T T T T T T I I I I I I I >30 26-30 21-25 15-20 Se pte mb e r Oc to b e r No ve mb e rDe c e mb e r Ja nua ry F e b rua ry Ma rc h Results Results Types of Terminations Stratified by Age Risk Factors for Abortions: 40 Patients' Response Risk Factors for Abortions: 35 Providers Response L a c k o f K no wle dg e No Fa mily Pla nning Ava ila b le 30 No Co unse ling 4 3.5 25 Unwa nte d Pre g na nc y 3 2.5 20 2 1.5 19% 15 1 26% Mid wife Re spo nse 0.5 0 Re pro duc tive He a lth 10 5 23% 0 15-20 21-25 26-30 >30 32% I nc o mple te Misse d T hre a te n
Findings Recommendations • Provide condoms and education material • There is a festival that occurs in September which correlates with low rates of abortions for this month. during the festival in September as prevention of unwanted pregnancy. • Most health care providers believe that emergency TOPs were needed however, many of them personally did not • Offer contraceptive options to all patients feel comfortable doing elective TOPs if they were offered. admitted for TOPs regardless of age. • Nurses were also observed spending little time • Provide counseling to all patients by both counseling patients prior to any TOP procedure, which midwives and a reproductive health care have been a result of shortage of skilled staff and the multitasking of most midwives. provider both pre/post abortion. • Majority of the health care providers also indicated • Provide family planning sessions to all commitment and readiness to provide counseling women coming to Antenatal Clinic. services for women both pre/post TOPs. Acknowledgements Questions? I would first like to thank Dr. George Hagan for allowing me to • conduct research at Axim Government Hospital. I want to thank all the nurses, midwives, and reproductive health care team for allowing me to interview them, implement interventions to improve their services, aiding me in collecting data, and translating questions to the patients. I want to also thank Dr. Ebenezer Amekah for providing the clinical guidance and supervision at St. Luke’s Hospital. I am forever grateful. I would also like to thank GE/NMF for allowing me the opportunity to engage and learn about a different culture, while also learning different techniques and research analysis about patients at Axim Government Hospital. I am eternally grateful. Also, I’d like to thank Dr. Oduroboatey for his mentorship Lastly I’d like to thank Dr. Buckle, Kenneth, and the rest of the staff at Integrated Health Solutions for helping to make this such a memorable experience.
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