Ensuring Comprehensive Abortion Care Accountability In Ghana
Access to comprehensive abortion care (CAC) services has seen a gradual increase over the past years both in public and private facilities. According to Guttmacher 2021, the national abortion rate is currently set as 44%, with 22% of all health facilities in Ghana offering abortion services. Despite the increase in access, there still exist some limitations that continue to make unsafe abortion one of the leading causes of maternal mortality in Ghana. Stigma and values (religious, community, personal etc) continue to contribute immensely to the attitude of some service providers who refuse to provide CAC service despite supportive legal and policy environment.
PPAG will seek to contribute to closing this gap by holding duty barriers and key stakeholders accountable for commitments made towards improving access to CAC. The project will work with 16 CSOs to hold duty bearers accountable. Women and girls will be empowered to seek CAC service either by themselves or through peers. Reproductive health information will be disseminated and the CSOs will also continue their engagement with duty bearers on safe abortion provision through partnership. It is expected that these interventions will help reduce the high rate of unsafe abortion and maternal morbidity and mortality in the implementing locations. The MA will continue to partner Ghana Health Service, MMDAs to implement this intervention.
Reproductive Health Education and Services for Young people (RHESY)
In Ghana, 61.6% of Ghana’s population is made up of young people (10-24). According to the Ghana Maternal Health Survey (2017), contraceptives use among sexually active women is lowest among young people (9.8%); teenage pregnancy represents 11.2% of all pregnancies in Ghana, with unsafe abortion being highest among young people aged 20years and below (29.9%). There has also been a significant increase in HIV incidence among young people (NACP).
With the increasing reproductive health issues, there is a need for interventions that reinforce healthy SRHR behaviors. The Young and Wise centres therefore are safe spaces designed to facilitate young people’s access to SRHR information and services, while supporting their intellectual, cognitive and social skills development. These centres are especially critical in the Ghanaian context as traditional approaches have had serious impediments.
Currently, eight of these centres are delivering SRHR interventions. However, the lack of modern facilities to make the centres relevant and attractive has reduced their patronage in recent years.
PPAG therefore seeks to improve the centres by introducing youth centered innovation to improve patronage. Key activities will include basic renovations/rebranding, youth-led engagements, delivery of RHE (Whatsapp/in-person) mentoring sessions, edutainment events, know-your-nurse-know-your-client visits for poor and marginalized groups, teen mothers.
Glowing Maternal, Child Health and Nutrition in Ghana through PPAG Clinics (Glow Project)
Ghana is steadily progressing in achieving key reproductive health indicators, including the significant reduction of institutional maternal mortality from 151.1 in 2016 to 105.9 in 2020 (GHS/FHD, 2020). However, the country lags significantly behind concerning other reproductive health issues. In the past 5 years, uptake of antenatal care has reduced by 6.4% and post-natal care uptake also reduced by 2.3%. Similarly, the family planning acceptance rate among women has dropped by 6.3%, from 31.5% in 2018 to 29.5% in 2020. Unmet need for FP among married and sexually active unmarried women is 30% (GDHS 2014). Also, access to comprehensive abortion care has improved, but coverage is still limited. As of 2020, 71% of all abortions in Ghana were unsafe, which is slightly below the sub-Saharan regional average of 77%.
Furthermore, utilisation of reproductive services by adolescents is significantly low, compared to the older age groups. This partly contributes to reproductive health challenges among young people including increased incidence of HIV, and teenage pregnancy (GHS/UNICEF 2020). Against this background, PPAG would seek to contribute to closing these gaps through this project by rendering quality integrated SRHR services to our target groups. This would involve using a community-based reproductive health approach, expanding social franchisee for health initiatives, redefined mobile clinic strategies and digital health interventions to serve the poor, marginalized, and socially excluded groups (PMSEU). It is anticipated these tested approaches will improve reproductive health utilization across the country.
Strengthening HIV/AIDS Prevention and Care among Vulnerable Groups (SHIP) Project
Ghana’s prevalence rate of HIV is 1.7%. The estimated number of people living with HIV increased from 339,727 to 345,534 in 2020. With this prevalence, women and girls are estimated to account for 80% of HIV infections. Approximately,42,000 youth between ages 15 and 24 out of 347,000 people living with HIV/AIDS. Report indicated that the prevalence rate of FSW, MSM, STI, Pregnant women, and Inmates is 4.6%,18%,7%, 2%, and 2% respectively (GHS/NACP, 2020) which is higher than in the general population.
A report from GHS revealed that 73% of people living with HIV know their status. This was attributed to inadequacy of information and access to HIV testing and counselling, poor linkage to care and stigma and discrimination at the facility level. These contributed to the high increased in the new infection rate. The 2022 programme will use comprehensive community-based HIV prevention, elimination of mother to child transmission to reach the vulnerable group. It is expected the evidence-based approach will reduce undiagnosed HIV infection to improve the health of people living with HIV and reduce new HIV infections to reach Ghana’s 95-95-95 fast-track target.
Frontiers for SRHR – Improving women and girls’ SRHR through sustainable innovative, and client-centered approaches
According to the WHO, about 75% of all pregnancies worldwide end in induced abortion, with 45% being unsafe. In Ghana, it is estimated that 23% of all pregnancies end in induced abortion, but a vast majority of 75% are considered unsafe. The excesses in resorting to unsafe abortion is as a result of deep seated challenges with access. Some of these challenges include illegality of abortion, stigma and discrimination, high cost of services, and lack of information about abortion care and rights. However, despite the challenges, an average of 70% worldwide adopted self-managed medical abortion to discontinue their pregnancies.
This momentum has been exarcebated with the occurance of the Covid-19 pandemic, heightening the need to adopt self-care mechanisms to avoid physical contact as much as possible. Research has also indicated that, formalizing abortion self-care is a groundbreaking step to significantly improve access to safe abortion services, by eliminating the aforementioned barriers. PPAG recognizes the opportunities to improve access to abortion care and thus would adopt self-care mechanisms to reach client across women and girls across the country. This will involve the adoption of both community-based and digital health interventions to maximize impact.
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