Agula Caesar, Biney Adriana, Kyei Pearl, Bawah Ayaga A
Regional Institute for Population Studies, University of Ghana, Accra, Greater Accra, Ghana.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251347032. doi: 10.1177/17455057251347032. Epub 2025 Jun 17.
Women's decision to access medication abortion (MA) in clinics or pharmacies may be shaped by several factors, but is an area that has not been adequately researched. Little is also known about the primary predictors of choice of MA provider.
Our study examined the factors associated with choice of MA provider and identified the primary predictors.
A non-inferiority and prospective design.
We utilized data from a non-inferiority and prospective study that recruited women who had MA from selected clinics and pharmacies in Ghana. Our sample comprises 1045 and 929 women from clinics and pharmacies, respectively. We used a multivariate binary logistic model to examine the factors associated with MA providers. Following this, a decision tree model was utilized to shed light on the main predictors.
Our results show that women were more likely to spend more on accessing MA in clinics than in pharmacies (adjusted odds ratio (AOR) = 1.0, < 0.01). Notably, results from the decision tree model indicate that MA cost has the strongest effect on provider selection (χ = 937, < 0.01). Additionally, women over 24 years old (AOR = 0.7, < 0.05), those with secondary education (AOR = 0.5, < 0.01), those who learned about MA from friends or close relatives (AOR = 0.5, < 0.01), and those who previously had MA before their recent MA (AOR = 0.6, < 0.01) were less likely to access MA in clinics.
We found that cost has the strongest effect on women's choice of MA provider in Ghana. In addition, sociodemographic and abortion-related factors play a role. These factors should be considered in developing strategies to enhance equal opportunity in accessing high-quality and safe MA. For instance, developing strategies to reduce MA costs in clinical settings could reduce the burden on vulnerable women, including those younger who may prefer clinic providers.
女性决定在诊所或药店进行药物流产（MA）可能受多种因素影响，但这一领域尚未得到充分研究。对于药物流产提供者选择的主要预测因素也知之甚少。
我们的研究考察了与药物流产提供者选择相关的因素，并确定了主要预测因素。
非劣效性前瞻性设计。
我们利用了一项非劣效性前瞻性研究的数据，该研究招募了在加纳选定诊所和药店进行药物流产的女性。我们的样本分别包括来自诊所的1045名女性和来自药店的929名女性。我们使用多元二元逻辑模型来考察与药物流产提供者相关的因素。在此之后，利用决策树模型来揭示主要预测因素。
我们的结果表明，与药店相比，女性在诊所进行药物流产的花费可能更高（调整后的优势比[AOR]=1.0，<0.01）。值得注意的是，决策树模型的结果表明，药物流产费用对提供者选择的影响最大（χ=937，<0.01）。此外，24岁以上的女性（AOR=0.7，<0.05）、受过中等教育的女性（AOR=0.5，<0.01）、从朋友或近亲那里了解到药物流产的女性（AOR=0.5，<0.01）以及在最近一次药物流产之前曾有过药物流产经历的女性（AOR=0.6，<0.01）在诊所进行药物流产的可能性较小。
我们发现，费用对加纳女性选择药物流产提供者的影响最大。此外，社会人口统计学和与流产相关的因素也起作用。在制定提高获得高质量安全药物流产平等机会的策略时应考虑这些因素。例如，制定降低临床环境中药物流产费用的策略可以减轻弱势女性的负担，包括那些可能更喜欢诊所提供者的年轻女性。
