The role of stigma in abortion care in Ghana: influences on method choice and experiences of care.

The proposed research aims to examine the role of stigma in abortion care and method choice in Ghana. Specific research questions include: i) what role (if any) does stigma play in women's choice of abortion method, and their experiences of abortion methods? ii) how do women's experiences of abortion care influence whether and how they experience stigma, and how can stigma within abortion services be measured? iii) how do providers' attitudes to abortion influence abortion method use? iv) How do interventions that aim to
influence provider attitudes and quality of counselling impact use of abortion methods? The research will employ mixed methods, using a selection of the following approaches. Qualitative research with women and providers, using in-depth interviews, focus groups and observation, will investigate how stigma and perceptions of abortion methods interact. A literature review and the
findings from qualitative research will inform the development of a scale to measure experiences of stigma in service delivery, for future validation using cognitive and expert interviews and client survey data analysis. Analysis of data from the 2017 Ghana Maternal Health Survey will assess characteristics associated with abortion method use, including socio-demographics, abortion
motivations and awareness of legal status. Record linkage of routinely-captured health service data with provider attitudinal surveys will examine associations between provider attitudes and abortion method use. Interrupted time series analysis will be used to evaluate the impact of provider behaviour interventions on abortion method use.