Nursing and Midwifery Training College, Kumasi, Ghana
Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students’ reported likelihood to provide abortion services. Final-year students at 15 public midwifery training colleges participated in a computer-based survey. Demographic and attitudinal variables were tested against the outcome variable, likely to provide comprehensive abortion care (CAC) services, and those variables found to have a significant association in bivariate analysis were entered into a multivariate model. Marginal effects were assessed after the final logistic regression was conducted.
A total of 853 out of 929 eligible students enrolled in the 15 public midwifery schools took the survey, response rate 91.8%. The mean age of the participants was 25 years, ranging from 18 to 49. The majority of the participants were in a relationship but not married. Most of the participants did not have any children. Each school contributed between 2.5% and 11.3% of participants. Most participants had received classroom education in MVA, but many fewer had received either simulation or supervised clinical practice in the procedure.
A majority of the participants reported being either very likely (n= 420, 49.24%) or somewhat likely (n= 179, 21%) to provide CAC services once they have graduated from midwifery school. For those who reported not being likely, the main reasons were personal beliefs and religious beliefs. A large majority (97.3%, n= 830) of the participants believe unsafe abortion to be a problem in Ghana, and 68.7% (n= 586) believe that Ghanaian women are able to access safe abortion services when they need them. A majority of the participants (73.3%, n= 625) agree that it is a good thing that Ghanaian women are able to access legal abortions, and 78.2% (n= 667) think that women should not use abortion as a form of birth control. Almost one fifth of the sample has experienced an unplanned pregnancy (19.9%, n= 170), while 41% (n= 503) have experienced a pregnancy scare, defined as a time when they thought they might be pregnant but it turned out they were not.
In multivariate regression analysis, the factors significantly associated with reported likeliness to provide CAC services were having had an unplanned pregnancy, currently using contraception, feeling adequately prepared, agreeing it is a good thing women can get a legal abortion and having been exposed to multiple forms of education around surgical abortion. Ensuring that midwives-in-training are well trained in abortion services, as well as encouraging empathy in these students, may increase the number of providers of safe abortion care in Ghana.