title: Reproductive health laws and fertility decline in Ghana.
abstract: BACKGROUND
  An unresolved debate in demography concerns the causal sequence between the supply of contraception and the demand for smaller families in fertility decline. Through a mixed-methods approach, we explored the effect of a sudden increase in access to legal abortion on subsequent fertility decline when Ghana's criminal code was amended in 1985.
  
  
  METHODS
  Using Ghana Demographic and Health Surveys, we constructed a panel of women aged 15-34 years and undertook a spline regression analysis to examine the effect of legal changes in 1985 and fertility decline controlling for social determinants of fertility. In addition, we conducted 17 key informant interviews (KIIs) to understand the reasons for the legal change and competing explanations for fertility decline.
  
  
  RESULTS
  Multivariate results indicated that the timing of the liberalization of the abortion law coincided with the onset of Ghana's fertility decline. The KIIs indicated that the reasons for the liberalization of reproductive health laws were in response to famine and physician advocacy.
  
  
  CONCLUSIONS
  While the timing of the abortion law liberalization coincided with the fertility decline in Ghana, we are unable to decouple the effect of the legal change from the effects of a severe famine that affected the region at the same time. Further research on documented and undocumented abortion in Ghana should be conducted to validate the contribution of legal abortion to fertility decline.
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, USA. Electronic address: jfinlay@hsph.harvard.edu.
authors.forename: Jocelyn E
authors.initials: JE
authors.lastname: Finlay
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Fox
mesh_terms: D000029:Abortion, Legal / Q000331:legislation & jurisprudence*; D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods; D003270:Contraceptive Agents / Q000600:supply & distribution*; D003625:Data Collection; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D005869:Ghana; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D012044:Regression Analysis; D060728:Reproductive Health / Q000331:legislation & jurisprudence*; D013217:Starvation / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents
keywords: Contraception; Fertility; Ghana; Reproductive health laws