Stigmatized by association: challenges for abortion service providers in Ghana.
Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana.



A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists.



Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association.



Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.
School of Nursing, College of Health Sciences, University of Ghana, P.O.BOX LG 43, Legon, Ghana.
Patience
P
Aniteye
Edmonton Clinic Health Academy (ECHA), Faculty of Nursing, 11405-87 Ave, 3rd Fl, Edmonton, Alberta, T6G1C9, Canada.
Beverley
B
O'Brien
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK. Susannah.Mayhew@lshtm.ac.uk.
Susannah H
0000-0002-2433-3809
SH
Mayhew
D000028:Abortion, Induced / Q000331:legislation & jurisprudence / Q000523:psychology*; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D002985:Clinical Protocols; D003695:Delivery of Health Care / Q000592:standards; D005239:Fear; D005260:Female; D005869:Ghana; D006176:Gynecology / Q000592:standards; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000592:standards; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology / Q000592:standards; D009774:Obstetrics / Q000592:standards; D061214:Patient Safety / Q000592:standards; D010595:Pharmacists / Q000523:psychology / Q000592:standards; D011247:Pregnancy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D013240:Stereotyping
Abortion; Ghana; Qualitative research; Skilled providers; Stigma