The impact of Ghana’s R3M programme on the provision of safe abortions and postabortion care

• Published in: Health policy and planning 2015-10, Vol.30 (8), p.1017-1031
• Main Authors: Sundaram, Aparna, Fatima, Juarez, Ahiadeke, Clement, Bankole, Akinrinola, Blades, Nakeisha
• Format: Article
• Language: English
• Subjects: Abortion; Abortion, Induced - mortality; Abortion, Induced - statistics & numerical data; Aftercare - statistics & numerical data; Attitude of Health Personnel; Control groups; Female; Ghana; Ghana - epidemiology; Government; Health administration; Health care; Health care policy; Health Personnel - psychology; Health Policy; Humans; Maternal mortality; Maternal Mortality - trends; Medical treatment; Morbidity; Mortality; Mothers; Original; Original articles; Patient Safety - statistics & numerical data; Pregnancy; Studies
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czu105

In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion care services. This article examines whether this intervention made a difference to the provision of safe abortion services and postabortion care (PAC). We also examine the role played by provider attitudes and knowledge of the abortion law, on providers with clinical training in service provision. Primary data on health care providers in Ghana, collected using a quasi-experimental design, were analysed using propensity score weighting. Apart from the treatment group, the sample included two controls: (1) Districts in Accra, Ashanti and Eastern, not exposed to the treatment; and (2) Districts from distant Brong Ahafo, also not exposed to the treatment. The findings show that providers in the treatment group are nearly 16 times as likely to provide safe abortions compared with their peers in Brong Ahafo, and ~2.5 times as likely compared with providers in the other control group. R3M providers were also different from their peers in providing PAC. Associations between provider attitudes and knowledge of the law on both outcomes were either non-significant or inconsistent including for providers with clinical knowledge of abortion provision. Provider confidence however is strongly associated with service provision. We conclude that the R3M programme is helping safe abortion provision, with the differences being greater with control groups that are geographically distant, perhaps owing to lower contamination from movement of providers between facilities. Increasing provider confidence is key to improving both safe abortion provision and PAC. En 2006, en réponse à un fort taux de mortalité maternelle dû essentiellement à des avortements faits dans de mauvaises conditions, le gouvernement du Ghana en partenariat avec d’autres organisations a lancé un programme de réduction de la mortalité maternelle (R3M) dans sept districts de la région du Grand Accra, de la région d’Ashanti et de la région Orientale afin d’y améliorer les services de soins pour les avortements. Nous examinons dans cet article si ces actions ont eu un impact sur la prestation de services d’avortement médicalisé et sur les soins après avortement. Nous avons aussi analysé le rôle jou