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

Abstract

IntroductionInduced 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.MethodsWe 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.ResultsThe 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.ConclusionDespite 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.

Estimating the incidence of abortion: a comparison of five approaches in Ghana

“…The AICM yielded an abortion incidence rate of 27 per 1000 nationally (95% CI: 22 to 32), with zonal estimates ranging from 19 (Northern zone) to 30 (Middle zone). 2 †The 33% of respondents who reported no confidantes had different demographic characteristics and a lower abortion rate than those with at least one confidante. Assuming confidantes are similar to respondents on the aggregate, these 'missing' confidantes may have significantly different abortion behaviours than those in the data, which would affect the incidence rate.…”

“…We describe the HFS and KIS elsewhere. 2 We drew the CBS sample using a two-stage stratified cluster design with probability proportional to size sampling. First, 100 enumeration areas (EAs) were selected, stratified by urban/rural residence and region.…”

“…13 Due to the complexity of the AICM when applied to Ghana, we describe the methodology and results in a separate paper. 2 The AICM has limitations, 3 12 including reliance on expert opinion to estimate the proportion of abortions receiving treatment. To address this, we propose a modified version of the AICM (approach #3), in which we calculate the multiplier using information collected from women directly.…”

“…AICM and modified AICM Data collection for the standard AICM is described in Polis et al 2 For the modified AICM, we estimated PAC caseloads from the HFS (as in the standard AICM) but estimated the multiplier from women's self-reported abortions (instead of the KIS). We asked women who reported an abortion in the past 3 years whether they had experienced complications and if so, whether and where they had sought treatment.…”

“…1 In Ghana, although abortion is legal under several circumstances, many women are unaware of the law and obtain clandestine abortions. 2 Thus, many abortions are not…”