Comprehensive Abortion Care Services, Standards and Protocols, Ghana Health Service

86 Pages·2012·2.42 MB·English

by  Eben Tee

REPUBLIC OF GHANA
Prevention & Management
of Unsafe Abortion:
Comprehensive Abortion Care Services
Standards and Protocols
I
Third Edition April 2012
Foreword
In addressing national and international goals of to in pregnancy termination and the increasing use of
reducing unacceptably high maternal mortality medication abortion (Using “Cytotec” misoprostol) in
and morbidity, it has become necessary to urban areas.
improve all aspects of policies, standards and
protocols. In Ghana, unmet need for Family Planning is In response to the objectives of the National RH Policy
35% (GDHS 2008), prevalence of induced abortion is and Standards, there is the need to extend services
7% (GMMS 2007) and complications of unsafe beyond postabortion care, to include the provision of
abortion contribute 22 to 30 percent of all maternal quality comprehensive abortion care services to the
deaths in our leading referral hospitals. extent permitted by law including strengthened
contraceptive services. These standards and protocols
Postabortion care is an integral part of Safe provide technical and managerial guidance for the
Motherhood programmes and non-physicians, provision of quality services. It is an integral part of the
specifically midwives' use of manual vacuum Reproductive Health Protocols.
aspiration in the management of incomplete abortion
has been demonstrated, widely disseminated and This document has been put together by a team of
adopted internationally and in Ghana (more than a national experts with technical assistance from Ipas
decade ago). However the problem of unsafe abortion and WHO, Geneva. The second edition has been
continues to occur in alarming proportion and updated to among others take cognisance of the
currently is the second leading cause of maternal advances made in medication abortion, strengthen
death in Ghana. postabortion contraceptive services and make the
document more reader friendly. Ghana Health
Even though the law in Ghana permits abortion under Services is grateful to Ipas, WHO and all individuals and
certain circumstances, and the National Reproductive organizations that have contributed to its
Health Policy and Standards in the component of development
Prevention and Management of Unsafe abortion and
Post abortion Care has an additional objective “to It is my hope and desire that these will be put to use to
provide abortion care services as permitted by law”, improve reproductive health services, improve
access to safe legal abortion services are still maternal health outcomes and reduce maternal
inadequate or lacking in many settings despite the mortality and morbidity in Ghana.
advances made in the last 5 years.
Findings of a strategic assessment of abortion and
abortion care services in 2005 and subsequently the
Ghana Maternal Mortality Study of 2007, confirmed
the ”culture of silence" on abortion, the clandestine .....................................................
nature and high cost of services, the lack of knowledge DR. FRANK NYONATOR
of the law by health workers and the general public, Ag. Director General, Ghana Health Service
the many dangerous methods women and girls resort March 2012
Prevention & Management of Unsafe Abortion 03
Foreword
In addressing national and international goals of to in pregnancy termination and the increasing use of
reducing unacceptably high maternal mortality medication abortion (Using “Cytotec” misoprostol) in
and morbidity, it has become necessary to urban areas.
improve all aspects of policies, standards and
protocols. In Ghana, unmet need for Family Planning is In response to the objectives of the National RH Policy
35% (GDHS 2008), prevalence of induced abortion is and Standards, there is the need to extend services
7% (GMMS 2007) and complications of unsafe beyond postabortion care, to include the provision of
abortion contribute 22 to 30 percent of all maternal quality comprehensive abortion care services to the
deaths in our leading referral hospitals. extent permitted by law including strengthened
contraceptive services. These standards and protocols
Postabortion care is an integral part of Safe provide technical and managerial guidance for the
Motherhood programmes and non-physicians, provision of quality services. It is an integral part of the
specifically midwives' use of manual vacuum Reproductive Health Protocols.
aspiration in the management of incomplete abortion
has been demonstrated, widely disseminated and This document has been put together by a team of
adopted internationally and in Ghana (more than a national experts with technical assistance from Ipas
decade ago). However the problem of unsafe abortion and WHO, Geneva. The second edition has been
continues to occur in alarming proportion and updated to among others take cognisance of the
currently is the second leading cause of maternal advances made in medication abortion, strengthen
death in Ghana. postabortion contraceptive services and make the
document more reader friendly. Ghana Health
Even though the law in Ghana permits abortion under Services is grateful to Ipas, WHO and all individuals and
certain circumstances, and the National Reproductive organizations that have contributed to its
Health Policy and Standards in the component of development
Prevention and Management of Unsafe abortion and
Post abortion Care has an additional objective “to It is my hope and desire that these will be put to use to
provide abortion care services as permitted by law”, improve reproductive health services, improve
access to safe legal abortion services are still maternal health outcomes and reduce maternal
inadequate or lacking in many settings despite the mortality and morbidity in Ghana.
advances made in the last 5 years.
Findings of a strategic assessment of abortion and
abortion care services in 2005 and subsequently the
Ghana Maternal Mortality Study of 2007, confirmed
the ”culture of silence" on abortion, the clandestine .....................................................
nature and high cost of services, the lack of knowledge DR. FRANK NYONATOR
of the law by health workers and the general public, Ag. Director General, Ghana Health Service
the many dangerous methods women and girls resort March 2012
Prevention & Management of Unsafe Abortion 03
References Ministry of Health, Republic of Ghana. 2006. Prevention and Management of Unsafe Abortion: Comprehensive
Abortion Care Services: Standards and Protocols. Accra, Ghana.
Mueller M et al. 2011. Antibiotic prophylaxis for medical and surgical first-trimester induced abortion. Cochrane
Database of Systematic Reviews, in press.
Neilson JP et al. 2010. Medical treatments for incomplete miscarriage (less than 24 weeks). Cochrane Database of
These evidence-based protocols were developed using the following as the main reference documents:
Systematic Reviews. (1):CD007223.
Baird, Traci L., Laura D Castleman, Robert E Gringle and Paul D Blumenthal. 2007. Clinicians guide to second-trimester
Newmann SJ et al. 2010. Cervical preparation for second trimester dilation and evacuation. Cochrane Database of
abortion, Second Edition. Chapel Hill, NC, Ipas.
Systematic Reviews. (8):CD007310.
Grossman D, Grindlay K. 2011. Alternatives to ultrasound for follow-up after medication abortion: a systematic
Partnership for Maternal, Newborn & Child Health. 2011. A Global Review of the Key Interventions Related to
review. Contraception. 83(6):504–510.
Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, Switzerland: PMNCH.
Hyman, Alyson G. and Laura Castleman. 2005. Woman-centered abortion care: Reference manual. Chapel Hill,
Promsonthi P, Preechapornprasert D, Chanrachakul B. Nitric oxide donors for cervical ripening in first-trimester
NC, Ipas.
surgical abortion. Cochrane Database of Systematic Reviews, 2009, (4):CD007444.
Ipas. 2010. Safe abortion care (SAC) toolkit. Chapel Hill, NC: Ipas.
Republic of Ghana.1992. Constitution of the Republic of Ghana. Accra, Ghana.
Jackson E, Kapp N. 2011. Pain control in first-trimester and second-trimester Medical termination of pregnancy: a
systematic review. termination of pregnancy: a systematic review. Contraception. 83:116–126. Renner RM et al. 2009.Pain control in first trimester surgical abortion. Cochrane Database of Systematic Reviews.
(2):CD006712.
Lohr PA, Hayes JL, Gemzell-Danielsson K. 2008. Surgical versus medical methods for second trimester induced
abortion. Cochrane Database of Systematic Reviews. (1):CD006714. Say L et al. 2010. Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database
of Systematic Reviews. (1):CD003037.
Kapp, N. et al. 2010. Cervical preparation for first trimester surgical abortion. Cochrane Database of Systematic
Reviews. (2):CD007207. Tunçalp O, Gülmezoglu AM, Souza JP. 2010. Surgical procedures for evacuating Incomplete miscarriage. Cochrane
Database of Systematic Reviews. (9):CD001993.
Kulier R et al. 2001. Surgical methods for first trimester termination of pregnancy. Cochrane Database of Systematic
Reviews. (4):CD002900. UNICEF, UNFPA, WHO, and World Bank. 2010. Packages of interventions: Family planning, safe abortion care,
maternal, newborn and child health. Geneva, Switzerland.
Kulier R et al. 2004. Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews
(1):CD002855, updated 2010. Wildschut H et al. 2011. Medical methods for mid-trimester termination of pregnancy. Cochrane Database of
Systematic Reviews., (1):CD005216.
Kulier R, Kapp N. 2011.Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-
trimester abortion. Contraception. 83:30–33. World Health Organization. 1992. The prevention and management of unsafe abortion. Report of a Technical
Working Group. WHO/MSM/92.5. Geneva, World Health Organization.
Ministry of Health, Republic of Ghana. 1999. National Reproductive Health Service Protocols. Accra, Ghana.
World Health Organization. 2000. Managing complications in pregnancy and childbirth: A guide for midwives
Ministry of Health, Republic of Ghana. 2003. National Reproductive Health Service Policy and Standards, 2nd Edition. and doctors. Geneva, Switzerland: WHO.
Accra, Ghana. http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf
Ministry of Health, Republic of Ghana. 2008. National Safe Motherhood Protocol. Accra, Ghana. World Health Organization. 2003. Safe abortion: Technical and policy guidance for health systems. Geneva, World
Health Organization.
04 Ghana Health Service Prevention & Management of Unsafe Abortion 05
References Ministry of Health, Republic of Ghana. 2006. Prevention and Management of Unsafe Abortion: Comprehensive
Abortion Care Services: Standards and Protocols. Accra, Ghana.
Mueller M et al. 2011. Antibiotic prophylaxis for medical and surgical first-trimester induced abortion. Cochrane
Database of Systematic Reviews, in press.
Neilson JP et al. 2010. Medical treatments for incomplete miscarriage (less than 24 weeks). Cochrane Database of
These evidence-based protocols were developed using the following as the main reference documents:
Systematic Reviews. (1):CD007223.
Baird, Traci L., Laura D Castleman, Robert E Gringle and Paul D Blumenthal. 2007. Clinicians guide to second-trimester
Newmann SJ et al. 2010. Cervical preparation for second trimester dilation and evacuation. Cochrane Database of
abortion, Second Edition. Chapel Hill, NC, Ipas.
Systematic Reviews. (8):CD007310.
Grossman D, Grindlay K. 2011. Alternatives to ultrasound for follow-up after medication abortion: a systematic
Partnership for Maternal, Newborn & Child Health. 2011. A Global Review of the Key Interventions Related to
review. Contraception. 83(6):504–510.
Reproductive, Maternal, Newborn and Child Health (RMNCH). Geneva, Switzerland: PMNCH.
Hyman, Alyson G. and Laura Castleman. 2005. Woman-centered abortion care: Reference manual. Chapel Hill,
Promsonthi P, Preechapornprasert D, Chanrachakul B. Nitric oxide donors for cervical ripening in first-trimester
NC, Ipas.
surgical abortion. Cochrane Database of Systematic Reviews, 2009, (4):CD007444.
Ipas. 2010. Safe abortion care (SAC) toolkit. Chapel Hill, NC: Ipas.
Republic of Ghana.1992. Constitution of the Republic of Ghana. Accra, Ghana.
Jackson E, Kapp N. 2011. Pain control in first-trimester and second-trimester Medical termination of pregnancy: a
systematic review. termination of pregnancy: a systematic review. Contraception. 83:116–126. Renner RM et al. 2009.Pain control in first trimester surgical abortion. Cochrane Database of Systematic Reviews.
(2):CD006712.
Lohr PA, Hayes JL, Gemzell-Danielsson K. 2008. Surgical versus medical methods for second trimester induced
abortion. Cochrane Database of Systematic Reviews. (1):CD006714. Say L et al. 2010. Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database
of Systematic Reviews. (1):CD003037.
Kapp, N. et al. 2010. Cervical preparation for first trimester surgical abortion. Cochrane Database of Systematic
Reviews. (2):CD007207. Tunçalp O, Gülmezoglu AM, Souza JP. 2010. Surgical procedures for evacuating Incomplete miscarriage. Cochrane
Database of Systematic Reviews. (9):CD001993.
Kulier R et al. 2001. Surgical methods for first trimester termination of pregnancy. Cochrane Database of Systematic
Reviews. (4):CD002900. UNICEF, UNFPA, WHO, and World Bank. 2010. Packages of interventions: Family planning, safe abortion care,
maternal, newborn and child health. Geneva, Switzerland.
Kulier R et al. 2004. Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews
(1):CD002855, updated 2010. Wildschut H et al. 2011. Medical methods for mid-trimester termination of pregnancy. Cochrane Database of
Systematic Reviews., (1):CD005216.
Kulier R, Kapp N. 2011.Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-
trimester abortion. Contraception. 83:30–33. World Health Organization. 1992. The prevention and management of unsafe abortion. Report of a Technical
Working Group. WHO/MSM/92.5. Geneva, World Health Organization.
Ministry of Health, Republic of Ghana. 1999. National Reproductive Health Service Protocols. Accra, Ghana.
World Health Organization. 2000. Managing complications in pregnancy and childbirth: A guide for midwives
Ministry of Health, Republic of Ghana. 2003. National Reproductive Health Service Policy and Standards, 2nd Edition. and doctors. Geneva, Switzerland: WHO.
Accra, Ghana. http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf
Ministry of Health, Republic of Ghana. 2008. National Safe Motherhood Protocol. Accra, Ghana. World Health Organization. 2003. Safe abortion: Technical and policy guidance for health systems. Geneva, World
Health Organization.
04 Ghana Health Service Prevention & Management of Unsafe Abortion 05
World Health Organization. 2003. Maternal and Neonatal Health: A Guide for Doctors and Midwives. Geneva, World Acknowledgements
Health Organization.
World Health Organization. 2011. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion
and associated mortality in 2008, 3rd ed. Geneva, World Health Organization.
This standards and protocols document has been The Ghana Health Service would like to acknowledge
prepared jointly, and in different stages, by the Ghana the participation and valuable contributions of
Health Service/Ministry of Health and several institu- participants and resource persons at the consensus
tions and individuals with an interest and building workshop on the standards.
commitment in reducing maternal mortality.
1. Prof. Fred T. Sai Presidential Advisor on Population and HIV/AIDS
2. Dr Robert Sagoe Ghana Medical Association
3. Mrs. Cynthia Bruce-Smith Komfo Anokye Teaching Hospital
4. Ms. Kathlyn P.P Ababio Ghana Registered Midwives Association/Nurses & Midwives Council
5. Ms. Edna Kuma African Women Lawyers Association
6. Ms. Perfect Pearl Bleboo Retired Midwifery Tutor /Consultant
7. Mrs. Mary Dampson Head, Public Health Nursing School
8. Dr. T.N. Awua Siaw Director, Institutional Care Division, Ghana Health Service
9. Dr. Kofi Ahmed Chief Medical Officer, Ministry of Health
10. Dr. Caroline Jehu-Appiah Deputy Director Policy Planning Monitoring and Evaluation
Division, GHS
11. Dr. Joseph. E. Taylor Obs/ Gynaecologist, Regional Health Administration, Eastern Region
12. Dr. Ali Samba Obs/ Gynaecologist, UGMS, Korle- Bu Teaching Hospital
13. Prof P.K. Nyame Rector,Ghana College of Physicians & Surgeons/Ghana Medical &
Dental Council
14. Mrs. Gladys Kankam Retired Midwifery Tutor /Consultant
15. Dr Sylvia Deganus Obs/ Gynaecologist, Tema General Hospital, GHS
16. Dr. Sophia Winful District Director, GHS/Eastern Region
17. Dr. Richard B. Turkson Legal Consultant, Ipas
18. Lawrence Aduonum-Darko Consultant
19. Ms. Marian Amissah Health Promotion Unit, GHS
20. Mrs. Mary Arday-Kotei Deputy Director, Health Promotion Unit, GHS
21. Mrs. Mercy Offei Deputy Director of Nursing Services, Obs/Gyn Dept. KBTH
22. Mrs. Ernestina Djokotoe President, Ghana Registered Midwives Association
23. Dr. A. Arkutu Country Director, Pathfinder International
24. Mrs. Nana Oye Lithur CHRIAG/AWLA
25. Ms. Ruby Akua Aglagoh AWLA
26. Mrs. Elizabeth Obeng-Yeboah Dept. of Women (MOWAC)
27. Mr. Fred Yao Gbagbo National Population Council Secretariat
28. Dr. Charles Fleischer-Djoleto WHO, Ghana
06 Ghana Health Service Prevention & Management of Unsafe Abortion 07
World Health Organization. 2003. Maternal and Neonatal Health: A Guide for Doctors and Midwives. Geneva, World Acknowledgements
Health Organization.
World Health Organization. 2011. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion
and associated mortality in 2008, 3rd ed. Geneva, World Health Organization.
This standards and protocols document has been The Ghana Health Service would like to acknowledge
prepared jointly, and in different stages, by the Ghana the participation and valuable contributions of
Health Service/Ministry of Health and several institu- participants and resource persons at the consensus
tions and individuals with an interest and building workshop on the standards.
commitment in reducing maternal mortality.
1. Prof. Fred T. Sai Presidential Advisor on Population and HIV/AIDS
2. Dr Robert Sagoe Ghana Medical Association
3. Mrs. Cynthia Bruce-Smith Komfo Anokye Teaching Hospital
4. Ms. Kathlyn P.P Ababio Ghana Registered Midwives Association/Nurses & Midwives Council
5. Ms. Edna Kuma African Women Lawyers Association
6. Ms. Perfect Pearl Bleboo Retired Midwifery Tutor /Consultant
7. Mrs. Mary Dampson Head, Public Health Nursing School
8. Dr. T.N. Awua Siaw Director, Institutional Care Division, Ghana Health Service
9. Dr. Kofi Ahmed Chief Medical Officer, Ministry of Health
10. Dr. Caroline Jehu-Appiah Deputy Director Policy Planning Monitoring and Evaluation
Division, GHS
11. Dr. Joseph. E. Taylor Obs/ Gynaecologist, Regional Health Administration, Eastern Region
12. Dr. Ali Samba Obs/ Gynaecologist, UGMS, Korle- Bu Teaching Hospital
13. Prof P.K. Nyame Rector,Ghana College of Physicians & Surgeons/Ghana Medical &
Dental Council
14. Mrs. Gladys Kankam Retired Midwifery Tutor /Consultant
15. Dr Sylvia Deganus Obs/ Gynaecologist, Tema General Hospital, GHS
16. Dr. Sophia Winful District Director, GHS/Eastern Region
17. Dr. Richard B. Turkson Legal Consultant, Ipas
18. Lawrence Aduonum-Darko Consultant
19. Ms. Marian Amissah Health Promotion Unit, GHS
20. Mrs. Mary Arday-Kotei Deputy Director, Health Promotion Unit, GHS
21. Mrs. Mercy Offei Deputy Director of Nursing Services, Obs/Gyn Dept. KBTH
22. Mrs. Ernestina Djokotoe President, Ghana Registered Midwives Association
23. Dr. A. Arkutu Country Director, Pathfinder International
24. Mrs. Nana Oye Lithur CHRIAG/AWLA
25. Ms. Ruby Akua Aglagoh AWLA
26. Mrs. Elizabeth Obeng-Yeboah Dept. of Women (MOWAC)
27. Mr. Fred Yao Gbagbo National Population Council Secretariat
28. Dr. Charles Fleischer-Djoleto WHO, Ghana
06 Ghana Health Service Prevention & Management of Unsafe Abortion 07
29. Mrs. Mildred Ampadu-Mensah Regional Health Directorate /Greater Accra Regions We also wish to acknowledge Dr. Gloria Quansah-
30. Ms. Mary Amoateng Nurses & Midwives Council Asare and Mr. Stephen Ntsua of the Reproductive and
31. Dr. Gloria Quansah Asare Reproductive & Child Health Unit, GHS Child Health Unit of the Ghana Health Service and Mrs.
32. Mr. Stephen Ntsua Reproductive & Child Health Unit, GHS Josephine Addy of Ipas Ghana Office for coordinating
33. Mrs. Josephine Addy Ipas, Ghana the activities.
34. Mr. Kofi Asare Ipas, Ghana
35. Mrs Patience Boni Municipal Health Directorate, Tema The development of these standards and protocols
have been made possible under the leadership and
FOREIGN PARTICIPANTS support of Professor Agyeman-Badu Akosa, Director
General of the Ghana Health Service, Professor F. T. Sai
35. Mr. Fermando Diez deleon Ipas Mexico and Dr. Eunice Brookman-Amissah. Their commitment
36. Ms. Christine Kaseba University Teaching Hospital, Zambia to the cause of reducing maternal morbidity and
37. Ms. Hawa Shekararu Ipas Nigeria mortality due to complications of unsafe abortion is
38. Dr. Ronnie Jonhson World Health Organization –Headquarters Geneva commendable.
RESOURCE PERSONS/FACILITATORS
39. Ms. Mary Luke Ipas NC
40. Dr Eunice Brookman Amissah Ipas Africa Alliance
41. Ms. Patty Skuster Ipas Chapel Hill
42. Ms. KatherineTurner Ipas NC
43. Ms.Charlotte Hord Smith Ipas NC
44. Ms. Tamara Braam Ipas Africa Alliance
45. Nuniye Ortali World Health Organization –Headquarters Geneva
46. Helena von Hertzen World Health Organization –Headquarters Geneva
Second Edition Reviewed By:
Dr. Gloria Quansah Asare - Director FHD
The Ghana Health Service wishes to acknowledge the We are grateful for the technical support provided by Dr. Patrick K Aboagye - Deputy Director, FHD, in charge of RCH
invaluable efforts and commitment of the technical the resource persons from Ipas and WHO Geneva. Dr. Baffour Opoku - Dept. Obst & Gynae (KATH)
team of Ghanaian experts who drafted the initial Special thanks go to Dr. Richard B. Turkson for the legal Dr. Emmanuel Srofenyo - Dept. Obst & Gynae, Ridge Hostpital
standards and protocols document. expertise provided throughout. Special Thanks also go Dr Devine Banyubala - Medico legal Dept, GHS
to Ms. Karen Otsea for assisting with the finalization of Dr. Koma Jehu-Appiah – Ipas Ghana
They are: the document. Dr. Joseph C. Mills - Ipas Ghana
Mrs. Cynthia Bruce-Smith, Ms. Perfect Blebo, Mrs. Mrs. Josephine Addy - Ipas Ghana
Gladys Kankam, Dr. Patrick K. Aboagye, Dr. Sylvia The Ghana Health Service is sincerely grateful to Ipas Dr. Ali Samba - Dept. of Obst and Gynae, KBTH
Deganus and Dr. Joe Taylor. for funding for the development and printing of this Dr. Joseph E. Taylor - Obstetrician Gynaecologist
document. Dr. Dalia Brahmi, Ipas NC
Further reviews and finalization were conducted by Dr. Laura Castleman, Ipas NC
this team and others - Professor F.T. Sai, Dr. Robert Ms. Mary Fjerstad, Ipas NC
Sagoe, Mrs. Mary Dampson, Mrs. Mercy Offei, Ms. Dr. William Powell, Ipas NC
Kathlyn Ababio, Dr. Ali Samba, Mrs. Josephine Addy Ms. Patty Skuster, Ipas NC
and Dr. Gloria Quansah Asare. Ms. Katherine L. Turner, Ipas NC
08 Ghana Health Service Prevention & Management of Unsafe Abortion 09
29. Mrs. Mildred Ampadu-Mensah Regional Health Directorate /Greater Accra Regions We also wish to acknowledge Dr. Gloria Quansah-
30. Ms. Mary Amoateng Nurses & Midwives Council Asare and Mr. Stephen Ntsua of the Reproductive and
31. Dr. Gloria Quansah Asare Reproductive & Child Health Unit, GHS Child Health Unit of the Ghana Health Service and Mrs.
32. Mr. Stephen Ntsua Reproductive & Child Health Unit, GHS Josephine Addy of Ipas Ghana Office for coordinating
33. Mrs. Josephine Addy Ipas, Ghana the activities.
34. Mr. Kofi Asare Ipas, Ghana
35. Mrs Patience Boni Municipal Health Directorate, Tema The development of these standards and protocols
have been made possible under the leadership and
FOREIGN PARTICIPANTS support of Professor Agyeman-Badu Akosa, Director
General of the Ghana Health Service, Professor F. T. Sai
35. Mr. Fermando Diez deleon Ipas Mexico and Dr. Eunice Brookman-Amissah. Their commitment
36. Ms. Christine Kaseba University Teaching Hospital, Zambia to the cause of reducing maternal morbidity and
37. Ms. Hawa Shekararu Ipas Nigeria mortality due to complications of unsafe abortion is
38. Dr. Ronnie Jonhson World Health Organization –Headquarters Geneva commendable.
RESOURCE PERSONS/FACILITATORS
39. Ms. Mary Luke Ipas NC
40. Dr Eunice Brookman Amissah Ipas Africa Alliance
41. Ms. Patty Skuster Ipas Chapel Hill
42. Ms. KatherineTurner Ipas NC
43. Ms.Charlotte Hord Smith Ipas NC
44. Ms. Tamara Braam Ipas Africa Alliance
45. Nuniye Ortali World Health Organization –Headquarters Geneva
46. Helena von Hertzen World Health Organization –Headquarters Geneva
Second Edition Reviewed By:
Dr. Gloria Quansah Asare - Director FHD
The Ghana Health Service wishes to acknowledge the We are grateful for the technical support provided by Dr. Patrick K Aboagye - Deputy Director, FHD, in charge of RCH
invaluable efforts and commitment of the technical the resource persons from Ipas and WHO Geneva. Dr. Baffour Opoku - Dept. Obst & Gynae (KATH)
team of Ghanaian experts who drafted the initial Special thanks go to Dr. Richard B. Turkson for the legal Dr. Emmanuel Srofenyo - Dept. Obst & Gynae, Ridge Hostpital
standards and protocols document. expertise provided throughout. Special Thanks also go Dr Devine Banyubala - Medico legal Dept, GHS
to Ms. Karen Otsea for assisting with the finalization of Dr. Koma Jehu-Appiah – Ipas Ghana
They are: the document. Dr. Joseph C. Mills - Ipas Ghana
Mrs. Cynthia Bruce-Smith, Ms. Perfect Blebo, Mrs. Mrs. Josephine Addy - Ipas Ghana
Gladys Kankam, Dr. Patrick K. Aboagye, Dr. Sylvia The Ghana Health Service is sincerely grateful to Ipas Dr. Ali Samba - Dept. of Obst and Gynae, KBTH
Deganus and Dr. Joe Taylor. for funding for the development and printing of this Dr. Joseph E. Taylor - Obstetrician Gynaecologist
document. Dr. Dalia Brahmi, Ipas NC
Further reviews and finalization were conducted by Dr. Laura Castleman, Ipas NC
this team and others - Professor F.T. Sai, Dr. Robert Ms. Mary Fjerstad, Ipas NC
Sagoe, Mrs. Mary Dampson, Mrs. Mercy Offei, Ms. Dr. William Powell, Ipas NC
Kathlyn Ababio, Dr. Ali Samba, Mrs. Josephine Addy Ms. Patty Skuster, Ipas NC
and Dr. Gloria Quansah Asare. Ms. Katherine L. Turner, Ipas NC
08 Ghana Health Service Prevention & Management of Unsafe Abortion 09
Contents
Purpose Of The Document
These Standards and Protocols have been written to address the knowledge and PART I: STANDARDS 14
service gaps in Ghana. The goal of publishing this document is to facilitate the
provision of a package of services called Comprehensive Abortion Care (CAC) that SECTION ONE: INTRODUCTION 15
will reduce unwanted pregnancy and abortion-related maternal morbidity and Overview 15
mortality. This document is directed to health providers and service managers. It Objectives of Comprehensive Abortion Care (CAC) 15
contains guidance on how, by whom and in which facilities CAC services should Guiding Principles for the implementation of CAC services 16
be provided, all of which is based on sound, current evidence of safe medical
practice and the laws of Ghana. SECTION TWO: TYPES OF SERVICES AND WHERE THEY CAN BE PROVIDED 19
Uterine evacuation methods 19
Table 2.1: Methods of abortion 20
Providers and services suitable to different levels of the health care system 21
PART II: CLINICAL PROTOCOLS 22
SECTION ONE: INITIAL ASSESSMENT AND REFERRAL TO SERVICES 23
Provided at all facility levels
SECTION TWO: SAFE INDUCED ABORTION: PRE-PROCEDURE CARE 24
Provided at all Registered Health Care Facilities equipped with trained health providers and necessary
infrastructure, per Standards for Comprehensive Abortion Care (Appendix 2)
Step 1: Establish rapport with the client, determine her needs and reasons for her visit 24
Step 2: Take client history 24
Step 3: Conduct Pre-Abortion Counselling on pregnancy options 25
Step 4: Perform assessment 26
Step 5: Counselling on abortion methods/techniques 26
Table 2.1: Characteristics of abortion methods during the first 12 weeks of pregnancy 27
Step 6: Provide counselling on post-abortion contraception and method provision 28
Step 7A: Provide counselling on pain management options 29
Table 2.2: Sources of pain and pain management 30
Step 7B: Create a Personalised Pain Management Plan with client 31
Step 8: Confirm that the decision to have abortion still stands 31
Step 9: Obtain informed consent 31
Step 10: Perform laboratory and other investigations, if available and necessary 31
Step 11: Administer pre-procedure medications 31
Step 12: Prepare to perform safe abortion using recommended method 31
10 Ghana Health Service Prevention & Management of Unsafe Abortion 11