GHANA / GABON – Three Delays Model applied to prevention of unsafe abortion in Ghana: a qualitative study

by Mercy Nana Akua Otsin, Angela J Taft, Leesa Hooker, Kirsten Black

BMJ SRH Journal  16 July 2021 (Early version / Not open access)


Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women’s experiences and access to induced abortion care.

We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.

Findings The first delay (in seeking care) occurred because of women’s poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women’s homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals’ non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.

This study has shown the value of the Three Delays Model in illustrating women’s experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.

PHOTO: Global Press Journal, 14 March 2013


Four articles on in-hospital delays in providing care leading to deaths from abortion complications in Gabon’s main maternity hospital in 2009, 2012, 2018 and changes in 2019

1. Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon

by Sosthène Mayi-Tsonga, Litochenko Oksana, Isabelle Ndombi, Thierno Diallo, Maria Helena de Sousa, Aníbal Faúndes

Reproductive Health Matters 2009;17(34)

2. The contribution of research results to dramatic improvements in post-abortion care: Centre Hospitalier de Libreville, Gabon

by Sosthène Mayi-Tsonga, Pamphile Assoumou, Boniface Sima Olé, Jacques Bang Ntamack, Jean François Mayé, Maria Helena Sousa, Aníbal Faúndes

Reproductive Health Matters 2012;20(40)

3. Transient reduction in abortion-related lethality after interventions to reduce delays in provision of care at Centre Hospitalier de Libreville, Gabon

by Ulysse Minkobame, Sosthène Mayi-Tsonga, Pamphile A Obiang, Opheelia M Komba, Justine M Ella, Jean François Mayé, Aníbal Faúndes

International Journal of Gynecology & Obstetrics 2018 Nov;143(2): 247-48

4. Midwives and post-abortion care in Gabon: “Things have really changed”

by Aimée Patricia Ndembi Ndembi, Justine Mekuí, Gail Pheterson, Marijke Alblas

Health & Human Rights 2019 Dec;21(2):145-55