A government initiative in Ghana is helping to improve comprehensive abortion care in the country, according to a new study "The Impact of Ghana’s R3M Program on the Provision of Safe Abortion and PAC," by Aparna Sundaram, senior researcher at the Guttmacher Institute. The study found that health care providers exposed to the program were more likely than those not exposed to provide safe abortion and postabortion care.

In 2006, in response to high maternal mortality and morbidity rates driven largely by unsafe abortion, the Ghanaian government implemented R3M, a program to train providers in abortion techniques, sensitize them to client needs and help improve provision of contraceptive services in facilities. The program was implemented in seven districts located in three regions: Greater Accra, Ashanti and Eastern.

Sundaram analyzed 2011–2012 data from 457 providers of obstetric and gynecologic services in the districts where R3M had been implemented and in other districts in Greater Accra, Ashanti and Eastern, as well as in Brong Ahafo, where the program had not been implemented

The study found that:

• Greater proportions of providers exposed to R3M than of those not exposed provided safe abortion services (54% vs. 13%) and postabortion care (66% vs. 33%).
• A greater proportion of exposed providers than of others had been trained in abortion techniques (84% vs. 52%).
• A greater proportion of exposed providers than others were confident in their ability to provide safe abortion care (77% vs. 36%); confident providers had almost eight times the odds of other providers of providing safe abortions, and they were also more likely to provide safe postabortion care.

In addition, the study found that the initiative had a positive effect on the provision of safe abortion and postabortion care in nonprogram districts located near districts where R3M had been implemented. Sundaram suggests that this could be attributed to R3M-trained providers being transferred to nearby nonprogram districts.

Sundaram recommends that interventions that aim to improve comprehensive abortion care in Ghana should focus on training providers in abortion techniques, which in turn should increase their confidence in their ability to provide safe services. This is especially relevant for mid-level providers, such as nurses and midwives. The study found that mid-level providers were less likely than doctors to provide postabortion care; in Ghana, there is generally a greater availability of these providers than of doctors.

Sundaram also recommends that the R3M program be expanded to the whole country, to reduce the number of women who are injured and die from unsafe abortion.

"The Impact of Ghana’s R3M Program on the Provision of Safe Abortion and PAC," by Guttmacher senior researcher Aparna Sundaram is now available online in the journal Health Policy and Planning.