Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Center for Biomedical Research, Population Council, New York, NY, United States of America.
PLoS One. 2024 Aug 22;19(8):e0308371. doi: 10.1371/journal.pone.0308371. eCollection 2024.
Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana.
Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics.
Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman's life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only.
Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability.
自 1985 年以来，加纳已允许出于多种原因进行堕胎，并且多年来一直在努力扩大安全堕胎护理的可及性。然而，秘密进行的、可能不安全的堕胎仍然很常见，这表明仍然存在许多获取堕胎服务的障碍；一个可能的障碍是在医疗机构工作的人对堕胎法的了解不足。我们的研究旨在确定加纳医疗机构工作人员的法律知识水平。
本文的数据来自 2018 年进行的一项具有全国代表性的医疗机构横断面调查；我们的分析样本包括 340 家提供人工流产和/或流产后护理（PAC）的医疗机构。该调查收集了关于提供堕胎和 PAC 的数据，以及对堕胎合法性的认识和减少不安全堕胎的建议。我们使用描述性统计数据来检查知识和建议的水平，并使用逻辑回归评估与个人和机构特征的关联。
医疗机构工作人员对堕胎合法的综合认识程度较低；只有 6%的人能识别出所有合法的适应症，而且大多数人（83%）低估了允许堕胎的情况数量。对于更严格的适应症，如妇女的生命处于危险之中，受访者的知识程度较高，有 72%的人能识别出来，而对于更广泛的可解释的适应症，如心理健康，只有 29%的人能识别出来。提供人工流产和 PAC 的医疗机构的工作人员对几项合法适应症的了解要好于仅提供 PAC 的医疗机构的工作人员。
医疗机构工作人员对堕胎合法性的认识存在重大差距。这一人群对法律的了解对于确保堕胎护理在法律允许的最大范围内提供至关重要。需要努力提高提供者和医疗机构工作人员对法律的了解，特别是对具有广泛可解释性的适应症。
