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The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care

In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve compr...

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Autores principales: Sundaram, Aparna, Juarez, Fatima, Ahiadeke, Clement, Bankole, Akinrinola, Blades, Nakeisha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559115/
https://www.ncbi.nlm.nih.gov/pubmed/25261230
http://dx.doi.org/10.1093/heapol/czu105
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author Sundaram, Aparna
Juarez, Fatima
Ahiadeke, Clement
Bankole, Akinrinola
Blades, Nakeisha
author_facet Sundaram, Aparna
Juarez, Fatima
Ahiadeke, Clement
Bankole, Akinrinola
Blades, Nakeisha
author_sort Sundaram, Aparna
collection PubMed
description In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion care services. This article examines whether this intervention made a difference to the provision of safe abortion services and postabortion care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ∼2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC.
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spelling pubmed-45591152015-09-08 The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care Sundaram, Aparna Juarez, Fatima Ahiadeke, Clement Bankole, Akinrinola Blades, Nakeisha Health Policy Plan Original Articles In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion care services. This article examines whether this intervention made a difference to the provision of safe abortion services and postabortion care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ∼2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC. Oxford University Press 2015-10 2014-09-25 /pmc/articles/PMC4559115/ /pubmed/25261230 http://dx.doi.org/10.1093/heapol/czu105 Text en Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Sundaram, Aparna
Juarez, Fatima
Ahiadeke, Clement
Bankole, Akinrinola
Blades, Nakeisha
The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title_full The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title_fullStr The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title_full_unstemmed The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title_short The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care
title_sort impact of ghana’s r3m programme on the provision of safe abortions and postabortion care
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559115/
https://www.ncbi.nlm.nih.gov/pubmed/25261230
http://dx.doi.org/10.1093/heapol/czu105
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