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Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017

INTRODUCTION: Induced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approa...

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Autores principales: Polis, Chelsea B, Castillo, Philicia W, Otupiri, Easmon, Keogh, Sarah C, Hussain, Rubina, Nakua, Emmanuel K., Larsen-Reindorf, Roderick, Bell, Suzanne O
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170428/
https://www.ncbi.nlm.nih.gov/pubmed/32337086
http://dx.doi.org/10.1136/bmjgh-2019-002130
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author Polis, Chelsea B
Castillo, Philicia W
Otupiri, Easmon
Keogh, Sarah C
Hussain, Rubina
Nakua, Emmanuel K.
Larsen-Reindorf, Roderick
Bell, Suzanne O
author_facet Polis, Chelsea B
Castillo, Philicia W
Otupiri, Easmon
Keogh, Sarah C
Hussain, Rubina
Nakua, Emmanuel K.
Larsen-Reindorf, Roderick
Bell, Suzanne O
author_sort Polis, Chelsea B
collection PubMed
description INTRODUCTION: Induced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approach: the Abortion Incidence Complications Methodology (AICM), to understand the incidence of abortion in Ghana in 2017. METHODS: We drew a nationally representative, two-stage, stratified sample of health facilities. We used information from 539 responding facilities to estimate treated complications stemming from illegal induced abortions, and to estimate the number of legal abortions provided. We used information from 146 knowledgeable informants to generate zonal multipliers representing the inverse of the proportion of illegal induced abortions treated for complications in facilities in Ghana’s three ecological zones. We applied multipliers to estimates of treated complications from illegal abortions, and added legal abortions to obtain an annual estimate of all induced abortions. RESULTS: The AICM approach suggests that approximately 200 000 abortions occurred in Ghana in 2017, corresponding to a national abortion rate of 26.8 (95% CI 21.7 to 31.9) per 1000 women 15–49. Abortion rates were lowest in the Northern zone (18.6) and highest in the Middle zone (30.4). Of all abortions, 71% were illegal. CONCLUSION: Despite Ghana’s relatively liberal abortion law and efforts to expand access to safe abortion services, illegal induced abortion appears common. A concurrently published paper compares the AICM-derived estimates presented in this paper to those from other methodological approaches.
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spelling pubmed-71704282020-04-24 Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017 Polis, Chelsea B Castillo, Philicia W Otupiri, Easmon Keogh, Sarah C Hussain, Rubina Nakua, Emmanuel K. Larsen-Reindorf, Roderick Bell, Suzanne O BMJ Glob Health Original Research INTRODUCTION: Induced abortion is legally permitted in Ghana under specific conditions, but access to services that meet guidelines approved by government is limited. As part of a larger project comparing five methodologies to estimate abortion incidence, we implemented an indirect estimation approach: the Abortion Incidence Complications Methodology (AICM), to understand the incidence of abortion in Ghana in 2017. METHODS: We drew a nationally representative, two-stage, stratified sample of health facilities. We used information from 539 responding facilities to estimate treated complications stemming from illegal induced abortions, and to estimate the number of legal abortions provided. We used information from 146 knowledgeable informants to generate zonal multipliers representing the inverse of the proportion of illegal induced abortions treated for complications in facilities in Ghana’s three ecological zones. We applied multipliers to estimates of treated complications from illegal abortions, and added legal abortions to obtain an annual estimate of all induced abortions. RESULTS: The AICM approach suggests that approximately 200 000 abortions occurred in Ghana in 2017, corresponding to a national abortion rate of 26.8 (95% CI 21.7 to 31.9) per 1000 women 15–49. Abortion rates were lowest in the Northern zone (18.6) and highest in the Middle zone (30.4). Of all abortions, 71% were illegal. CONCLUSION: Despite Ghana’s relatively liberal abortion law and efforts to expand access to safe abortion services, illegal induced abortion appears common. A concurrently published paper compares the AICM-derived estimates presented in this paper to those from other methodological approaches. BMJ Publishing Group 2020-04-09 /pmc/articles/PMC7170428/ /pubmed/32337086 http://dx.doi.org/10.1136/bmjgh-2019-002130 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Polis, Chelsea B
Castillo, Philicia W
Otupiri, Easmon
Keogh, Sarah C
Hussain, Rubina
Nakua, Emmanuel K.
Larsen-Reindorf, Roderick
Bell, Suzanne O
Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title_full Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title_fullStr Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title_full_unstemmed Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title_short Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017
title_sort estimating the incidence of abortion: using the abortion incidence complications methodology in ghana, 2017
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170428/
https://www.ncbi.nlm.nih.gov/pubmed/32337086
http://dx.doi.org/10.1136/bmjgh-2019-002130
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