Academic journal article Asian Social Science

"Fear, Shame and Embarrassment": The Stigma Factor in Post Abortion Care at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Academic journal article Asian Social Science

"Fear, Shame and Embarrassment": The Stigma Factor in Post Abortion Care at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Article excerpt


Using qualitative data on post abortion care services at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the paper explored evidence of social stigma as a factor in post abortion care. Results from 6 focus group discussions, 10 narratives and observations identified three areas of stigma. The Patients (perspective and experience), the Providers (the medical environment and setting) and the Community (family, relations and peers). Evidence from the focus group discussions, narratives and observations suggested social stigma as a significant factor in the process of pre-marital sex, abortion and post abortion care. At the individual level there was fear, shame and embarrassment. The medical setting was judgmental, indifferent and/or showed disdain while there was moral consensus, the morality of abortion by family, peers and community. In recognition of the dangers inherent in unsafe abortion outside the medical setting and in view of the fact that death from complications of unsafe abortion is preventable, these findings have implications for intervention and policy. The paper recommended collective effort to addressing all three areas of stigma and post abortion care. Sustained education, sensitization and dissemination using all available channels including traditional teachings and practices to reduce stigma and provide safer alternatives were suggested.

Keywords: post abortion care, stigma, pre-marital sex, traditional teachings and practices, Kumasi

1. Introduction

The paper attempts to explore evidence of stigma as a factor in post abortion care (PAC) at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. The study was a follow up to findings from the baseline study, a collaborative research between Kwame Nkrumah University of Science and Technology, School of Medical Sciences and Obstetrics and Gynecology unit / JHU BSPH which examined the quality PAC at the large referral teaching hospital, KATH, in 2000. Results from the initial study indicated among others that there was unsafe abortion with complications, evidence of reporters, the use of abortion as contraceptive, lack of knowledge about abortion law and its legal status as well as lack of post abortion care.

There is increasing recognition of the dangers and long-term complications inherent in informal abortions outside the medical setting. Hospital based studies report anywhere from 25%-30% of maternal mortality as attributable to abortion related complications. In Africa 23,000 women die each year from unsafe abortion accounting for 13% of all maternal death. The practice of unsafe abortion and associated maternal mortality is very high in Ghana. Available data suggest that more than half (50%) of the Obstetrics and Gynecology admissions are due to abortion related complications including incomplete, complete, inevitable or induced (WHO, Program of Action ICPD 1994, 1999).

Baseline study in 2000 showed that quality of PAC at KATH was very poor. It was curative and not preventive. Improving overall reproductive health and PAC was not the core of obstetrics and gynecology training and residents continued traditional practice of dilatation and curettage. KATH provided treatment oriented services-curative care-for post abortion complications, not PAC as framed by the International Project Assistant Services (IPAS). Post abortion care was lacking.

A vast majority (90%) of the cases were treated by medical interns and residents. More than 50% of patients could not obtain pain medication, even when requested. Of the cases, 25% delayed seeking care. Provider-client interaction was poor. Women substituted abortion for contraceptive use and had repeated abortion. Of the cases observed, 70% never used contraceptives. Family planning counseling was not always provided. Only 7% received contraceptive counseling and referral to a family planning clinic, while only 3% requested contraceptive method.

Evidence suggested there was inadequate knowledge of the legal status of abortion among abortion seekers. …

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