The battle of values: Health practitioners make medical decisions based on personal values

consulting room
consulting room

Women seeking legal abortion care including life-threatening complications due to abortion (post-abortion complication) or after suffering miscarriage may be denied care by some health service providers in Ghana due to their religious or moral beliefs, a research finding has revealed.

According to the study, which looked at Conscience-based Objection to abortion care or Conscientious Objection to abortion (CO) conducted in two regions in Ghana Volta and Eastern Regions by reproductive rights advocacy network, Global Doctors for Choice Ghana, a relatively high number of doctors, midwives, nurses and physician assistants who have received training in comprehensive abortion care will rather exercise their right to refuse to provide legal abortion services to women in need due to their religious or morale beliefs.

The situation leads to a conflict of values and clash of interests between patients who want a safe legal medical procedure, a provider who has religious or moral opposition to the procedure, and the government, which wants to reduce maternal morbidity and mortality.

Similar to most policies on CO around the world, Ghana’s comprehensive abortion policy and Safe Motherhood Policy mandate a health professional with requisite training to provide abortion and related services especially in life threatening emergency conditions. In the circumstances that the health service provider is unable to provide the service for whatever reason, the service provider is obliged to duly refer the patient to a facility where she can have the service.

In a religious dominated country like Ghana however, it was known that physicians and other providers make value-based judgement in the provision of services although there is no existing study on the subject except one by the same organization, which was conducted in the three regions in the northern Ghana (Northern, Upper East and Upper West regions).

The CO study by GDC Ghana in Eastern and Volta regions regarded as South Eastern Ghana, and funded by AmplifyChange of UK, was seeking to determine the prevalence of CO in this part of the country, describe the abortion-related practices of health providers, health providers knowledge on abortion law in Ghana, their beliefs and attitudes towards the abortion law in Ghana.
In all, the survey covered 421 providers comprising 136 physicians, 136 midwives, nurses and physician assistants from three types of facilities; public, private and faith-based.
Presenting the findings of the CO study, the GDC Ghana Lead Dr. Koku Awoonor said it was most revealing to note that less than one in every three doctors may provide the optimum care when it comes to abortion services.

He said it was also alarming to note that approximately 20% of providers who refused to provide abortion also failed to refer patients for abortion-related services contrary to the Comprehensive Abortion Care guidelines of Ghana Health Service. The study further showed that overall, nearly half (40.1%) of health services providers trained to provide legal and safe abortion services in the two regions are self-identified objectors (health providers who admit that despite having received the requisite training they would not provide abortion services including under the circumstances permitted by the law). In other words, they will not provide abortion services in any circumstance due to their religious and moral beliefs a tendency that puts additional pressure on clinicians who are willing to perform the procedure, increases health risks for women resorting to unsafe abortion and escalates healthcare costs due to resulting preventable complications

Commenting on the findings of the study by GDC Ghana, a public health expert and an Obstetrician/Gynaecologist Dr. Chris Opoku Fofie said “the loss of a pregnancy may be caused by many factors however; complications from abortions deteriorate rapidly requiring critical care or more resources to save life”. In this regard, he entreated health service providers to abide by the national guidelines and protocols on referral if they chose to exercise their right to conscientiously object to provide any services including legal abortion services, especially in emergency situations.

Unsafe abortion is a major cause of maternal death in Ghana contributing about 8 to 13% of maternal mortality globally and accounting for about 15% maternal mortality in Ghana.

Abortion is illegal in Ghana. However, it is permitted under the law when the pregnancy poses serious health risk to the pregnant woman, severe fetal abnormalities and in situations where the pregnancy results from rape, incest or defilement. Under the current circumstances, where there are just a few health service providers working in many remote communities, clinicians’ refusal to perform abortion on moral and religious grounds known as Conscientious Objection may restrict access to legal and safe abortion services and increase the temptation for unsafe abortion in the hands of untrained persons or quacks. This situation is a challenge to efforts to reduce maternal mortality.

Dr. Fofie said, whilst clinicians have a right to Conscientious Objection for a particular medical procedure, lack of regulations and enforcement of guidelines and protocols to exercise could deny women their right to life saving sexual and reproductive health services. It is therefore important to review current policies to regulate application of CO in the health sector.

The knowledge of providers surveyed on Ghana abortion law was found to be quite high. Almost all the respondents and in fact all the self-identified objectors knew the circumstances under which abortion is permissible under the current law.

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