title: The context of informal abortions in rural Ghana.
abstract: OBJECTIVE
  This qualitative study explores the context of unsafe abortion in rural Ghana with the aim of identifying areas that should be considered when operationalizing abortion-related reproductive health strategies.
  
  
  METHODS
  Data come from eleven narratives about planned or attempted abortions and seven narratives of abortion-related deaths. These individual data are supplemented by data from ten focus group discussions.
  
  
  RESULTS
  Communities describe abortions as dangerous and, if they become public knowledge, shameful. Despite this, abortions were understood as necessary for some women in some situations, but secrecy was paramount. Women carefully chose their confidants based on the anticipated reaction and did so for advice about cheap and effective methods or for financial assistance. Complications were usually managed at home. When complications were taken to the health facility, the abortion was often not disclosed. Women reported trying sequential abortion methods, starting with cheaper milder methods and, if these attempts failed, resorting to harsher more expensive methods. Access to pharmaceuticals and finances also determined the method used. Financial hardship, interruption of education, and being unmarried were the most frequently cited reasons for abortions.
  
  
  CONCLUSIONS
  Unsafe abortion is an important public health issue in Ghana. Current strategies to reduce abortion-related deaths include increasing the provision of safe abortion services. For the strategy to be successful, services should be accessible, affordable, and confidential, and discourse with communities and health workers to break the public silence about abortion is needed.
authors.affiliation: Centre for International Health and Development, Institute of Child Health, and University College London, UK. zhill.ich@gmail.com
authors.forename: Zelee Elizabeth
authors.initials: ZE
authors.lastname: Hill
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah-Agyemang
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
mesh_terms: D000024:Abortion, Illegal / Q000523:psychology*; D000029:Abortion, Legal / Q000523:psychology; D000328:Adult; D000739:Anecdotes as Topic; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012424:Rural Population; D012938:Social Perception; D012945:Social Values; D011795:Surveys and Questionnaires; D016387:Women's Health; D055815:Young Adult