The importance of abortion training for obstetrician-gynecologists: A comparison of the United States, Sweden, and Ghana.

Since 2020, World Health Organization guidelines state that universal access to abortion care is critical for individual and community health, and for the realization of human rights. Yet the right to access safe abortion care is severely restricted in many countries. This article outlines institutional and educational systems in the USA, Sweden, and Ghana, which all require obstetrics and gynecology (ob-gyn) training to include abortion care but vary in implementation. It argues that regardless of the political environment, the specialty should protect abortion training worldwide. In Sweden and Ghana, ob-gyn residents are required to participate in abortion training, while in the USA they are permitted to opt out. In Sweden, practicing ob-gyn specialists are required to provide abortion care, whereas in Ghana and the USA, this care is optional, leading to geographic disparities in abortion care access in these two countries. In the USA, the Supreme Court's Dobbs ruling jeopardizes programs' abilities to meet the training mandate, a requirement that was insufficiently implemented even before the ruling. It is critical that all clinicians are well-equipped to provide accurate information to their patients and provide pre- and post-abortion care. For this reason, we recommend that abortion is included in all undergraduate medical education programs in accordance with the recommendations of FIGO (the International Federation of Gynecology & Obstetrics). To meet WHO guidelines that require ob-gyn specialists to provide abortion care in an emergency, we urge FIGO to create a guideline about expectations for abortion training integration in obstetrics and gynecology.

Knowledge of female genital schistosomiasis and urinary schistosomiasis among final-year midwifery students in the Volta Region of Ghana.

BACKGROUND: Female genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20-120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care. METHODS: A cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants' demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages. RESULTS: Only 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets. CONCLUSION: Awareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions.

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana.

BACKGROUND: Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa. METHOD: This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant. RESULTS: A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths. CONCLUSION: Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.

Prioritizing Workplace Health Promotion Policy to Address High Blood Pressure and Obesity in a Public University in the Northern Region of Ghana.

The International Labour Organization (ILO) recommends the engagement of the world of work in providing comprehensive and effective prevention strategy for noncommunicable diseases (NCDs). Workers are at risk of developing 1 or more cases of NCDs due to their exposure to risk factors at work. The ILO suggests that the work-related risk factors can be prevented by improving working conditions and integration of workplace health promotion programs. Workplace health promotion policies promote workers general health, improve working environment, work practices, and reduces the risks of common NCDs including hypertension (high blood pressure) and obesity among employees. A number of studies have described the increasing trends of hypertension and obesity among civil servants but are limited in assessing the availability and effectiveness of workplace health promotion policies to address them. We assessed the availability and effectiveness of workplace health promotion policy to address the prevalence of high blood pressure in a public university in the Northern Region of Ghana. Using a mixed method study design, 191 administrative staff were recruited and in-depth qualitative interviews conducted among 5 key informants. The study found significant number of participants with elevated and high blood pressure and overweight and obesity with no functional workplace health promotion at the time of the study. We therefore recommend the prioritization and development of a workplace health policy to reduce the prevalence of high blood pressure and obesity among staff of the university using the integrative workplace health promotion model.

Contraceptive counseling in 2 urban cities in Ghana and the extent of shared decision-making.

BACKGROUND: Increased use of contraception is associated with reduced maternal mortality worldwide; however, an unmet need remains high in many places, including Ghana. The quality of care provided by family planning practitioners influences contraceptive use; one way to improve the quality of care is to adopt a client-centered approach to counseling, including engaging in shared decision-making. In Ghana, little is currently known about the extent of shared decision-making between clients and providers in contraceptive counseling encounters. OBJECTIVE: The purpose of this study was to explore the extent of shared decision-making during contraceptive counseling in 2 cities in Ghana. STUDY DESIGN: This was a cross-sectional study across 6 urban family planning clinics in Accra and Kumasi, Ghana. We recorded, transcribed, and analyzed 20 family planning patient-provider interactions using the "Observing PatienT InvOlvemeNt" (OPTION) scale. This scale has 12 domains, which are scored on a 5-point scale, from 0 ("the behavior is not observed") to 4 ("the behavior is observed and executed at a high standard"); the scores of each domain are summed up for a total score ranging from 0 to 48. RESULTS: In these encounters, the mean total scores for each interaction ranged from a low of 9.25/48 to a high of 21.5/48. Although providers were thorough in sharing medical information with clients, they did not actively involve clients in the decision-making process and did not generally elicit client preferences. Across the 12 domains, the mean total score was 34.7%, which is below the 50% that would correspond with a "baseline skill level," suggesting there are very low levels of shared decision-making currently occurring. CONCLUSIONS: In these 20 patient-provider encounters, counseling was mainly a sharing of medical information from the provider with the client, without the provider eliciting information from the client about her preferences for method characteristics, side effects, or method preference. Family planning counseling in these settings would benefit from increased shared decision-making to engage patients in their contraceptive choice.

Reproductive experiences and factors influencing contraceptive use among female head-porters in Ghana: A cross-sectional study.

Background and Aims: Female head-porters are a cohort of women who have migrated from their rural communities into commercial cities in search of better economic opportunities. These young women are vulnerable to untoward reproductive experiences. The study assesses the reproductive experiences of women and the factors influencing contraceptive use among them. Methods: A cross-sectional study was conducted from January to May 2021 in the Kumasi Metropolis (n = 280). The study included 280 female head-porters within the reproductive age of 15-49 years. Convenience sampling and consecutive recruitment were used to obtain the needed sample size. All statistical significance was declared at a p-value of <0.05. Results: Forty-two percent of respondents had a history of contraceptive use (all modern or artificial contraception). The study found gravidity (p < 0.0001), parity (p < 0.0001), number of sexual partners post-migration (p = 0.008), and age of first sex (p = 0.033) to be associated with contraceptive use among female head-porters. Conclusion: Fourteen percent had experienced sexual exploitation post-migration, the first sexual encounter of one-third of participants were nonconsensual, 19% had sex at or before 16 years, and 72% were aware of contraception. Reproductive experiences such as gravidity and sexual debut (age at first sex) have a significant influence on the use of contraception.

Prolonged Duration of Air-Dry Fixation of Cervical Smears Produces Superior Cytomorphological Staining Quality over Conventional Wet-Fixed Smears.

INTRODUCTION: Immediate fixation of smears in 95% alcohol for Pap staining is commonly used for cytopathological diagnosis of cancers and other diseases. Few research studies have investigated the comparative outcomes of alcohol wet fixation and rehydration of air-dried smears, indicating that air-dried rehydrated (ARF) smears are viable alternative to wet-fixed (WF) smears. However, there are no or few investigations on the effects of long durations of air-drying fixation on cytomorphological staining quality. MATERIALS AND METHODS: 124 cervical smears were obtained from the Family Planning Unit of Komfo Anokye Teaching Hospital in Kumasi, Ghana. Quadruple smears were WF and air-dried for 2 h, 4 h, and 8 h prior to rehydration with normal saline and fixation (ARF). All the smears were stained with Papanicolaou stain, examined microscopically for their cytomorphological features, and scored. Cytomorphological scores were statistically analyzed using SPSS software. RESULTS: No significant difference in cytolysis, cell border, nuclear border, chromatin, and cellularity between WF and ARF was observed. However, significant differences in cytoplasmic staining quality (p value <0.001) and the absence of RBCs (p value <0.001) were observed in the 4-h ARF. The absence of RBCs in the ARF smears rendered a clearer background than in the wet fixation. CONCLUSIONS: ARF, Pap-stained smears showed comparably superior cytomorphological features to those of WF smears. The 8-h ARF smears produce crispy chromatin and excellent background, making them suitable for bloody cytological samples.

Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana.

BACKGROUND: We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. METHODS: A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. RESULTS: Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. CONCLUSION: Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

Give women what they want: contraceptive discontinuation and method preference in urban Ghana.

BACKGROUND: Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. METHODS: Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. RESULTS: Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). CONCLUSIONS: To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.

The parasitology of female genital schistosomiasis.

Female genital schistosomiasis (FGS) is the gynaecological presentation of Schistosoma haematobium infection, resulting from egg deposition in the female genital tract. Despite the fact that this condition has been reported in the early days of the discovery of S. haematobium in Egypt, its existence has been grossly neglected, causing many women in schistosomiasis-endemic areas to go through a preventable, debilitating, and stigmatizing presentation of FGS. To prevent this, increasing awareness of FGS is necessary for all, especially healthcare providers, to improve the diagnosis, management, and treatment. As proposed by the FAST package project, several healthcare professionals with different specializations are expected to be involved in the management of FGS. It is therefore important that basic updated knowledge on the parasitology of the disease be acquired by healthcare professionals. This review provides basic information necessary to improve the knowledge of FGS among healthcare professionals in areas endemic to schistosomiasis. Armed with these basic details, healthcare professionals can improve their confidence in the management and treatment of FGS, contributing significantly to the control and prevention of FGS in endemic areas.

Exploring Sexual and Reproductive Health Needs and Associated Barriers of Homeless Young Adults in Urban Ghana: A Qualitative Study.

Background: Homelessness has become a major global and public health challenge, especially in low- and middle-income countries. This phenomenon predisposes young adults to severe psychosocial and health challenges. Aim: To explore the sexual and reproductive health needs and behaviours of homeless young adults and challenges in accessing these services. Methods: A semi-structured interview guide was used for data collection from in-depth interviews, focus group discussions, and key informant interviews. Data were collected between 01 June and 31 July 2020 from 30 participants using in-depth interviews, two focus group discussions involving 12 participants, and one key informant interview. Thematic analysis was used to analyse transcripts from the interviews. Results: The findings show that certain behavioural patterns associated with homelessness impact the lives of homeless young adults in their sexual and reproductive health (SRH) choices, beliefs, and perspectives. This group faces several challenges in accessing sexual and reproductive health services (SRHS) such as modern contraceptives and abortion care. The high cost, and undesirable and unfriendly attitude of service providers in health facilities pose as barriers to accessing SRHS by homeless young adults. Conclusion: Sustainable and proactive measures must be put in place to address the identified barriers. Timely delivery of accurate information and educative materials, ensuring affordability, and setting up of accessible and friendly facilities could improve SRHS for this group. Social and Public Policy Implications: This study may inform and support policy guideline development to address homelessness and SRH needs of young adults in urban Ghana.

Factors associated with reproductive autonomy in Ghana.

Reproductive autonomy is essential for women to achieve reproductive rights and freedom. However, the factors associated with reproductive autonomy in various contexts have not been explored. The aim of this analysis was to understand the socio-demographic, reproductive history and social context variables associated with two validated reproductive autonomy sub-scales among 516 young Ghanaian women age 15 to 24. We used multiple linear regression modelling to test associations between covariates of interest and the communication sub-scale and decision-making sub-scale. Covariates included age, educational attainment, ethnic group, employment, religion, religious attendance, relationship type, previous pregnancy, previous abortion, social support for adolescent sexual and reproductive health, and social stigma towards adolescent sexual and reproductive health. Results from final models demonstrated that factors associated with the communication scale included education (p = 0.008), ethnic group (p = 0.039), and social support for adolescent sexual and reproductive health (B = 0.12, p = 0.003). Factors associated with the decision-making scale included ethnic group (p = 0.002), religion (p = 0.003), religious attendance (p = 0.043), and previous pregnancy (p = 0.008). Communication reproductive autonomy and decision-making reproductive autonomy were associated with different factors, providing insight into potential intervention approaches and points. Social support for adolescent sexual and reproductive health was associated with increases in young women's abilities to communicate with their partners about sexual and reproductive health issues including sex, contraceptive use and fertility.

Resolving unintended pregnancy crisis: Is adoption a viable option? A cross-sectional study in Kumasi, Ghana.

OBJECTIVES: Unintended pregnancy presents a crisis situation with limited options for resolution. Abortion appears to be a commonly chosen option but is stigmatized in many societies including Ghana. Keeping a child from an unintended pregnancy is also unsuitable for many people. Carrying through with the pregnancy and placing the child up for adoption is a potential management option but there is scanty literature on how viable this option is to women globally including Ghana. The study sought to assess acceptability of this option and its barriers and facilitators in Ghana. METHODS: This study was a part of a bigger analytical cross-sectional study on unintended pregnancy in Kumasi conducted in three centres from January to April 2014. Exit interviews were conducted for 461 consenting women to capture data on demography, reproductive profile and acceptability of giving up a child from an unintended pregnancy for adoption. Frequencies, proportions and means were computed and presented in tables. RESULTS: Over 85% of respondents would not give up their children for adoption as a way to manage their unintended pregnancy, whereas about 6% were undecided. A need for the child to grow up in a two-parent home was considered more important than the financial security of the adoptive parents while disappointment from family and friends came up as marked barrier to adoption. CONCLUSIONS: Keeping a pregnancy and placing the child up for adoption is presently not ideal for managing an unintended pregnancy crisis. More education is needed to increase awareness of adoption as an option in resolving this crisis while continued efforts are made at primary prevention through using contraceptives. The complex adoption process must be made friendly for women with unintended pregnancies who neither desire parenting nor abortion.

Soil transmitted helminth infections in Ghana: a ten year review.

For more than a decade, intervention programs have been instituted in Ghana to combat soil transmitted helminth (STHs) infections. Knowledge of the trend of the infection in the country is needed for evaluation and modification of existing control programs to achieve national targets. The objective of this review is to examine the pattern of soil transmitted infections in Ghana between 2009-2018. We searched and reviewed published literature on soil transmitted helminths in Ghana in PubMed, Medline, Google Scholar and Institutional Repositories of Kwame Nkrumah University of Science and Technology, University of Ghana, University of Cape Coast, and University for Development Studies-Tamale. We observed paucity of research work on STHs in Ghana over the period of this review. Twenty-nine studies consisting of 24 published works in peer reviewed journals and five graduate theses were included in the study. Hookworm was the most prevalent of STHs recorded followed by roundworm, threadworm, and whipworm. Pinworm was very rarely reported. These infections were reported from different regions and ecological zones of the country and among children, pregnant women, farmers, food vendors, children in orphanage home and psychiatric institution. Although there is some downward trend over the period, soil transmitted helminths are still prevalent in Ghana. This is an indication of some hope of eventual control and elimination of these diseases in the country if control measures are optimised. Further research particularly population studies into soil transmitted helminths in Ghana is needed.

Increasing access to intrauterine contraceptive device uptake in Ghana: stakeholders views on task sharing service delivery with community health nurses.

INTRODUCTION: Evidence supporting successful task sharing to increase Intrauterine Contraceptive Device (IUD) uptake exist in some developing countries that have challenges with availability of trained health professionals. Although Community Health Nurses (CHNs) in Ghana are trained to provide primary health care including emergency deliveries in rural communities, they are not professionally mandated to provide IUD services. OBJECTIVES: To explore stakeholders' views on task sharing IUD services with CHNs in Ghana. METHODS: This qualitative case study was conducted in Accra, Ghana between June and September 2018. Focus group discussions and in-depth interviews were used to collect data from purposively selected participants. Included in the study were policy makers, policy implementing institutions, service regulators, Non-Governmental Organisations, field providers and service end users. Interviews were recorded and transcribed verbatim. We manually performed thematic analysis of data and findings were appropriately described by paraphrasing and/or quoting relevant responses verbatim. RESULTS: There is a general mixed feeling towards task sharing IUD services with community health nurses in Ghana. Policy makers, programmers, gynaecologists and IUD users interviewed believed that CHNs are capable of providing safe IUD services when well trained, adequately resourced and supervised. Based on some field experiences of complications associated with IUD insertions, participants who were midwives clearly indicated the need for effective training and careful implementation strategies. CONCLUSIONS: Despite concerns about user safety, respondents endorsed task-sharing IUD services with trained CHNs in Ghana. Implementation study focusing on competency-based IUD training for selected CHNs is recommended to provide empirical evidence to back policy decisions. FUNDING: Marie Stopes Ghana funded the field work.

Reproductive autonomy and pregnancy decision-making among young Ghanaian women.

Decision-making regarding the outcome of a pregnancy may include participation of the woman herself, her sexual partner, parents, family, and/or community. This paper examines who had the most say in the outcome of young Ghanaian women's last pregnancy and whether this correlated with her level of reproductive autonomy (RA). We analysed cross-sectional data from 380 previously pregnant young women in urban Ghana. We measured communication and decision-making RA using modified scales ranging from 3 (low RA) to 12 (high RA). We tested unadjusted associations between the RA sub-scales and who made the pregnancy decision (self, partner, both together, or someone else) and used multinomial regression models to understand these associations when controlling for sociodemographic, reproductive history, and social context variables. In final models, a one-point increase in decision-making RA was associated with an adjusted relative risk ratio of 0.79 (95% CI: 0.66-0.93; p = 0.006) of partner having the most say as compared to the woman having the most say. The communication RA scale was not associated. Programmes that increase RA may be effective in increasing women's rights to execute decisions about reproductive health and outcomes. Future research should explore this notion and the role of pregnancy disclosure in this relationship.

Sexual and reproductive rights violations at sexual debut of male and female adolescents in Ghana.

OBJECTIVE: To examine the social and ethical challenges in enforcing sexual and reproductive rights of male and female adolescents abused at sexual debut in Ghana. METHODOLOGY: This was a secondary analysis of cross-sectional survey data on 278 sexually experienced male and female teenagers from 12 communities selected by cluster random sampling in the Ejisu-Juben district. We extracted relevant data from a 2009 academic thesis project involving 481 respondents. We assessed differences between sexual debut experiences of males and females using Pearson's chi-square and ANOVA tests. P-values ≤0.05 were considered significant. RESULTS: Mean ages at sexual debut for males and females were 16.05 ± 1.8 and 15.98 ± 1.47 years respectively (P=0.719). Adolescents of both sexes experienced defilement and forced sexual debut; similar proportions had early sexual debut. Females who had early sexual debut were more likely than their older counterparts to have low educational attainment and induced abortion. CONCLUSIONS: Many male and female adolescents experience sexual and reproductive rights breaches at sexual debut. Prevailing circumstances hinder optimization of sexual and reproductive rights of juveniles in Ghana. We recommend making clear provisions for young persons in the law on sexual offences in the criminal code to facilitate development of interventions to improve access to justice for offenders and victims.

Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana.

BACKGROUND: Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension. METHODS: An analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant. RESULTS: A total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or "self-referred" from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01-1.87), preterm delivery at <34 weeks' gestation (adjusted RR, 2.74; 95% CI, 1.40-5.36) and preterm delivery at <37 weeks' gestation (adjusted RR, 1.89; 95% CI, 1.25-2.85), compared to women with chronic/gestational hypertension. CONCLUSION: Women with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.

Reproductive Autonomy and Modern Contraceptive Use at Last Sex Among Young Women in Ghana.

CONTEXT: Variability in the conceptualization and measurement of women's empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy-a specific measure of empowerment-and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. METHODS: Survey data were collected from a sample of 325 urban Ghanaian women aged 15-24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales-decision making and communication-and women's use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. RESULTS: In multivariable analyses, reproductive autonomy decision making-but not reproductive autonomy communication-was positively associated with women's modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1-9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. CONCLUSIONS: The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context.

RESUMEN Contexto: La variabilidad en la conceptualización y medición del empoderamiento de las mujeres ha resultado en hallazgos inconsistentes con respecto a las relaciones entre el empoderamiento y los resultados de salud sexual y reproductiva. La autonomía reproductiva­una medida específica del empoderamiento­y su papel en el uso de anticonceptivos modernos, rara vez han sido evaluados en contextos subsaharianos. Métodos: Los datos de la encuesta se obtuvieron a partir de una muestra de 325 mujeres urbanas ghanesas de 15 a 24 años de edad, reclutadas en centros de salud y escuelas en Kumasi y Accra en marzo de 2015. Se utilizaron análisis de regresión logística bivariada y multivariada para examinar las asociaciones entre dos subescalas adaptadas de autonomía reproductiva: toma de decisiones y comunicación, así como el uso de anticonceptivos modernos en la última relación sexual por parte de las mujeres, después de controlar covariables demográficas, reproductivas y el contexto social (i.e. aprobación y el estigma relacionado con la salud sexual y reproductiva de las adolescentes). Resultados: En los análisis multivariados, la toma de decisiones sobre la autonomía reproductiva­pero no la comunicación sobre la autonomía reproductiva­se asoció positivamente con el uso de anticonceptivos modernos por parte de las mujeres en la última relación sexual (razón de probabilidades, 1.1); La edad, haber estado empleada en los últimos siete días y vivir en Kumasi también se asoció positivamente con el uso de anticonceptivos modernos (1.1-9.8), mientras que el hecho de haber tenido un embarazo previo se asoció negativamente con el resultado (0.3). La toma de decisiones sobre autonomía reproductiva se asoció positivamente con el uso de anticonceptivos en un modelo posterior que incluyó la aprobación social de la salud sexual y reproductiva de las adolescentes (1.1), pero no en los modelos que incluyeron el estigma hacia la salud sexual y reproductiva de las adolescentes. Conclusiones: La construcción teórica de la autonomía reproductiva y la subescala de toma de decisiones en particular, demostraron tener relevancia para los resultados de planificación familiar entre las mujeres jóvenes en Ghana y pueden tener utilidad en entornos globales. Las investigaciones futuras deben explorar la comunicación sobre autonomía reproductiva y los posibles efectos de confusión del contexto social.

RÉSUMÉ Contexte: La variabilité de la conceptualisation et de la mesure de l'autonomisation des femmes a produit des conclusions divergentes sur les relations entre l'autonomisation et les résultats de santé sexuelle et reproductive. L'autonomie reproductive­une mesure spécifique de l'autonomisation­et son rôle dans la pratique contraceptive moderne n'ont guère été évalués dans les contextes subsahariens. Méthodes: Les données de l'étude proviennent d'un échantillon de 325 Ghanéennes urbaines âgées de 15 à 24 ans, recrutées dans des structures sanitaires et écoles de Kumasi et d'Accra en mars 2015. Des analyses de régression logistique bi- et multivariées ont servi à l'examen des associations entre deux sous-échelles adaptées d'autonomie reproductive­ la prise de décision et la communication­et la pratique de la contraception moderne des femmes au dernier rapport sexuel, sous contrôle des covariables de contexte démographique, reproductif et social (approbation et stigmatisation à l'égard de la santé sexuelle et reproductive des adolescentes). Résultats: Dans les analyses multivariées, la prise de décision liée à l'autonomie reproductive­mais pas la communication­ s'est révélée associée positivement à la pratique contraceptive moderne des femmes au dernier rapport sexuel (RC, 1,1). L'âge, l'emploi durant les sept jours précédents et la résidence à Kumasi présentent aussi une association positive avec la pratique contraceptive moderne (1,1-9,8), tandis que l'existence d'une grossesse antérieure est en association négative avec ce résultat (0,3). L'association positive de la prise de décision en matière d'autonomie reproductive avec la pratique contraceptive se maintient dans un modèle ultérieur tenant compte de l'approbation sociale de la santé sexuelle et reproductive des adolescentes (1,1), mais pas dans ceux tenant compte de la stigmatisation à son égard. Conclusions: Le concept d'autonomie reproductive, et la sous-échelle de prise de décision en particulier, se sont avérés pertinents en termes de résultats de la planification familiale parmi les jeunes femmes du Ghana et pourraient se révéler utiles dans les contextes mondiaux. La recherche future devra étudier plus avant la communication, eu égard à l'autonomie reproductive, et les effets de confusion potentiels du contexte social.