Barriers to Contraceptive Use and Medication Abortion in the Ga East District of Greater Accra, Ghana

Virginia Bowen, Johns Hopkins Bloomberg School of Public Health

Ghana is one of few African nations where abortion is legal, yet most people think it is illegal. A recent DHS suggests that contraceptive prevalence declined over the past five years. We examined facility- and provider-level barriers to contraceptive use and provision of medication abortion (Cytotec) in peri-urban Accra. Using semi-structured questionnaires, we collected data on contraception and Cytotec provision from 12 clinics and 11 pharmacies. Compared with private clinics, government clinics offered a wider variety of contraceptives. Most pharmacies reported high sales of condoms and emergency contraception but failed to stock methods with slower turnover. Pharmacies reported an increasing number of Cytotec requests (2-20 per week); however, few pharmacy employees admitted to selling Cytotec. Some providers reported dissuading pregnant women from obtaining abortions. Pharmacies may be an important outlet for contraceptive supplies if method mix is improved. Providers may be a significant barrier to obtaining safe abortions in Ghana.