背景:自1985年以来,在加纳,堕胎已成为多种适应症的法律,并且在此后的几年中,人们一直在努力扩大安全堕胎护理的可用性。然而秘密,潜在的不安全,堕胎仍然很常见,这表明许多障碍仍然存在;一个可能的障碍是在医疗机构工作的人对堕胎法了解不足。我们的研究旨在确定加纳各地医疗机构工作人员的法律知识水平。
方法:本文的数据来自2018年进行的具有全国代表性的横断面医疗机构调查;我们的分析样本包括340个提供人工流产和/或流产后护理(PAC)的机构。调查收集了提供堕胎和PAC的数据,以及堕胎合法性的知识和减少不安全堕胎的建议。我们使用描述性统计数据来检查知识和建议的水平,和逻辑回归来评估与个体和设施特征的关联。
结果:医疗机构工作人员对堕胎法律适应症的全面了解较低;只有6%的人确定了所有法律适应症,大多数人(83%)低估了堕胎合法的条件。更限制性适应症的知识更高,比如一个女人的生命处于危险之中,72%的受访者认为,比更广泛解释的适应症,比如心理健康,由29%确定。与仅提供PAC的设施相比,在提供人工流产和PAC的设施中的受访者对几种法律适应症有更好的了解。
结论:医疗机构工作人员在堕胎合法性知识方面存在显著差距。在这些人口中了解法律对于确保在法律的最大范围内提供堕胎护理非常重要。需要努力提高提供者和设施工作人员对法律的了解,特别是对于具有广泛可解释性的适应症。
BACKGROUND: Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana.
METHODS: Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics.
RESULTS: Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman\'s life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only.
CONCLUSIONS: Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability.