The Law on Defilement in Ghana and Challenges in its Implementation at the Ejisu-Juabeng Domestic Violence and Victims Support Unit of the Ghana Police Service

Ghana like other African countries has been involved in the universal effort to uphold reproductive justice for children including adolescents. The country’s efforts have been predominately geared towards legislation and prosecution of defilement cases. The Domestic Violence and Victims Support Unit of the Police Service (DOVVSU), is directly responsible for such prosecutions. The objective of this study was to assess the implementation of the law on defilement at the DOVVSU of Ejisu-Juabeng Municipality of Ashanti Region of Ghana. The study involved in-depth interview of the staff and analysis of police dockets on cases of defilement filed at the local DOVVSU office. Thematic analyses of the in-depth interviews were done. The case records were summarised using descriptive statistics. The findings revealed that Ghana has a comprehensive law on defilement. Many complaints of defilement were filed at DOVVSU during the period under review. Majority of the cases were abandoned or withdrawn for settlement out of court.  Settlement of defilement cases outside court violates the very spirit and letter of the law on defilement in Ghana. Further research is needed to establish why cases are withdrawn after complaints have been filed with DOVVSU. Keywords: Defilement, DOVVSU, Children, Access to Reproductive Justic

Increasing access to intrauterine contraceptive device uptake in Ghana: stakeholders views on task sharing service delivery with community health nurses

Introduction: Evidence supporting successful task sharing to increase Intrauterine Contraceptive Device (IUD) uptake exist in some developing countries that have challenges with availability of trained health professionals. Although Community Health Nurses (CHNs) in Ghana are trained to provide primary health care including emergency deliveries in rural communities, they are not professionally mandated to provide IUD services.Objectives: To explore stakeholders’ views on task sharing IUD services with CHNs in Ghana.Methods: This qualitative case study was conducted in Accra, Ghana between June and September 2018. Focus group discussions and in-depth interviews were used to collect data from purposively selected participants. Included in the study were policy makers, policy implementing institutions, service regulators, Non-Governmental Organisations, field providers and service end users. Interviews were recorded and transcribed verbatim. We manually performed thematic analysis of data and findings were appropriately described by paraphrasing and/or quoting relevant responses verbatim.Results: There is a general mixed feeling towards task sharing IUD services with community health nurses in Ghana. Policy makers, programmers, gynaecologists and IUD users interviewed believed that CHNs are capable of providing safe IUD services when well trained, adequately resourced and supervised. Based on some field experiences of complications associated with IUD insertions, participants who were midwives clearly indicated the need for effective training and careful implementation strategies.Conclusions: Despite concerns about user safety, respondents endorsed task-sharing IUD services with trained CHNs in Ghana. Implementation study focusing on competency-based IUD training for selected CHNs is recommended to provide empirical evidence to back policy decisions.Keywords: Task-sharing, IUD, Community Health Nurses, Policy, GhanaFunding: Marie Stopes Ghana funded the field work

Discontinuation of long‐acting reversible contraception versus short‐term hormonal methods in urban Ghana: A pilot longitudinal study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/1/ijgo12518.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/2/ijgo12518_am.pd

Maternity care provider knowledge, attitudes, and practices regarding provision of postpartum intrauterine contraceptive devices at a tertiary center in Ghana

ObjectiveTo assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.MethodsA descriptive, cross‐sectional study was conducted between June 28 and July 15, 2011. Specialists, residents, house officers, and nurse midwives who had been working in the Department of Obstetrics and Gynecology for at least 3 months were included. Self‐administered questionnaires assessed formal training, current proficiency in IUD insertion, and attitudes toward postpartum IUD provision.ResultsOf 91 providers surveyed, 70 (77%) reported previous training in contraceptive counseling. Fewer than one in three respondents had ever inserted an IUD: 17 (44%) of 39 physicians and 9 (17%) of 52 midwives reported ever having inserted an IUD. A total of 33 (36%) respondents reported that they would recommend an IUD in the immediate postpartum period.ConclusionAlthough most maternity care providers at KATH had received training in contraceptive counseling, few felt confident in their ability to insert an IUD. Further training in postpartum contraceptive management is needed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135552/1/ijgo137.pd

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women’s family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents’ use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide

Self‐managed abortions in Ghana: A health policy framework analysis

Abstract Background Self‐managed abortions (SMAs) remain a public health challenge; and are worst in deprived settings. In this policy review, we sought to analyze the legal and policy frameworks within which SMA occurs and look at how these may help improve abortion outcomes in Ghana. Methods We searched and reviewed documents on “self‐induced” or “self‐managed” abortion in Ghana from 2015 to 2022. Databases searched included Ghana Digital Attorney, PubMed Central, Google Scholar, and Repositories of Public Universities in Ghana. The key documents reviewed included the abortion law (Act 29) of Ghana, the fourth (2021) edition of the Ghana Health Services’ Comprehensive Abortion Care Standards and Protocols, and the 2017 Maternal Health Survey report. Key documents reviewed included amended Act 29, Comprehensive Abortion Care policy, and standards. We then performed policy analysis using Walt and Gilson's policy triangle framework regarding the context, practice, processes, and key players. Results After a careful review of the literature, the following key themes emerged in the framework analysis: the policy environment for SMA, the practice of SMAs, key players of SMAs, consequences of induced abortions, the abortion law, and criminal connotations of SMA. We found that SMAs remain criminalized in Ghana but the local practice persists with the use of registered and unregistered abortifacients. We also observed frequent criminal connotations of SMAs in the literature but no evidence of related prosecutions. There was limited empirical evidence on the safety and efficacy of SMAs in Ghana. Conclusion From our findings, we contend that there is an unduly high criminal connotation of SMA in Ghana. We, therefore, recommend a multilevel stakeholder engagement to decriminalize SMAs to ensure improved access to safe abortions in Ghana

Human Rights-Based Approach to Reducing Preventable Maternal Deaths in Ghana: A Six-year Review of Media Reports

This paper sought to ascertain the extent to which litigation is highlighted in reports on maternal deaths in the Ghanaian media. Using internet search we reviewed reports on maternal death in the media from January, 2013 to December, 2018. Thematic analyses of the reports that satisfied the inclusion/exclusion criteria were performed. It was established that healthcare leaders and key state personalities have through the media created good public awareness about unacceptably high maternal deaths in the country. The root causes were highlighted. Only few case reports were presented and there had been scanty emphasis on using legal means of addressing the problem of inadequate access as a human rights violation. In conclusion rights-based approach to addressing poor maternal health challenges in Ghana is grossly underutilized. Stakeholders are encouraged to include the option of using legal redress as a means of ensuring government and healthcare providers keep their promise of providing quality maternity care to reduce preventable deaths of women.Keywords: Ghana, Litigation, Rights-Based Approach, Maternal Health, Media Report

Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana.

BackgroundData pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension.MethodsAn analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant.ResultsA total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or "self-referred" from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01-1.87), preterm delivery at ConclusionWomen with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre

Give women what they want: contraceptive discontinuation and method preference in urban Ghana

Abstract Background Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. Methods Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. Results Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). Conclusions To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences