Comprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-2016

Abstract

Background: Access to safe abortion services reduces incidence of unsafe abortion. However, other studies have documented negative impacts such as rise in sexually transmitted infections in jurisdictions with liberal abortion laws. Objective: We assessed the impact of Comprehensive Abortion Care (CAC) services on selected reproductive health indicators in the Tain district. Method: Aggregated service data on abortion, contraception (family planning), and delivery antenatal Human Immuno-deficiency Virus (HIV) infection status of women age 10-49 years were extracted from the District Health Information Management System version 2 (DHIMS-2) database for the period 2010 to 2016. Data were converted to rates using projected population figures from the Ghana Statistical Service and presented as tables and graph for trend analysis. Results: The proportion of unsafe abortion increased from 2010 to 2012 and declined from 2013 onwards with increasing proportions of women opting for safe induced abortions; while spontaneous abortions followed an incremental trend from 2010 to 2013; leveling out from 2014. The family planning acceptor rates stayed above 38% over the period. The total fertility rate (women age 10-14 inclusive) increased sequentially from 4.6/1000 women in 2010 to 89.4/1000 in 2016. The HIV infection prevalence were 2.2%, 3.7%, 3.4%, 3.8%, 2.5%, 2.3% and 2.7% for 2010 to 2016 respectively. Conclusion: Access to Comprehensive Abortion Care (CAC) services reduces the incidence of unsafe abortions. Improved access to contraception may not necessarily lead to a decline in abortion or fertility rates. Liberalizing abortion does lead to a rise in the prevalence of sexually transmitted infections (HIV).