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Research Article | DOI: https://doi.org/10.31579/2768-2757/170
1Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
2Department of Biostatistics and Epidemiology, University of Health and Allied Sciences, Ho, Ghana.
*Corresponding Author: Anthony Edward Boakye., Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
Citation: Anthony E Boakye., Tekpertey R., (2025), Beyond Unplanned or Unwanted: do we consider Self-Reported Health Status, Sexual Activity and Fertility Preference of Women as Predictors of Abortion in Ghana? Journal of Clinical Surgery and Research, 6(4); DOI:10.31579/2768-2757/170
Copyright: © 2025, Anthony Edward Boakye. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 April 2025 | Accepted: 22 April 2025 | Published: 30 April 2025
Keywords: abortion; fertility preference; inspire; self-reported health status; sexual activity
Background: Although, in Ghana, an induced abortion occurs in every society, and a substantial proportion of pregnancies are resolved by abortion. Objective: In line with this, the study set out to investigate how self-reported health status, sexual activity and fertility preference of women influence abortion in Ghana.
Methods: Data were extracted from the 2022 GDHS. Frequency, percentages, Pearson’s chi-squared test of independence and binary logistic regression were used to make meaning to the data.
Results: Good health status was significant at p<0.001, (OR=1.241, 95%CI ([1.171-1.315]). Moderate health status was significant at p<0.001, (OR=1.819, 95%CI [1.701-1.945]). Bad health status was significant at p<0.001, (OR=1.622, 95%CI [1.448-1.816]). Very bad health status was significant at p<0.001, (OR=1.777, 95%CI [1.358-2.327]). Not active in last 4 weeks - postpartum abstinence was significant at p<0.001, (OR=0.705, 95%CI ([0.650-0.765]). Undecided was significant at p<0.001, (OR=0.720, 95CI ([0.638-0.813]). Wants after 2years and above was significant at p<0.001, (OR=0.608, ([0.564-0.654]).
Conclusion: Regardless of whether abortion is legal or restricted, it is recommended that provision of post-abortion care should be made a core obligation in Ghana under the right to sexual and reproductive health.
Abortion becomes an option after one has discovered that the life of the baby has a health problem or congenital disorder [1,2]. Others also choose abortion when they realise continuing with the pregnancy may put their own health at risk [3,4]. Each year, worldwide, about 73 million induced abortions take place [5]. Surprisingly, among all the unplanned pregnancies, 3 out of 10 (29%) and 6 out of 10 (61%) ends in induced abortion [5]. As of 2018, 37% of the world’s women had access to legal abortions without limits [6,7]. In places where abortion is legalised and accessible with less stigma, people access it safely with no risk [8]. However, in places where abortion is stigmatised, criminalised or restricted, people are forced to resort to unsafe abortions [8]. A woman who is engulfed with pregnancy complications, including placental abruption, bleeding from placenta previa, preeclampsia or eclampsia, and cardiac or renal conditions, abortion is the only measure to preserve her health or save her life [9]. Responsibility for existing children, ideal conditions for motherhood and abortion decisions are interrelated [10-12], with abortion sometimes being a means to achieve desired fertility outcomes or manage unintended pregnancies [13,14]. Women’s sense of responsibility for their existing and future children influences their decision to seek an abortion [15-16]. In many cases, women choose abortion because they are motivated to be good parents [17,18]. Women who have no children want the conditions to be right when they do; women who already have children want to be responsible and take care of their existing children [19,20]. Studies have established that the immediate reason women often give for seeking induced abortion is that the pregnancy was unplanned or unwanted [18,21-27]. It is noted that induced abortion is 7% in Ghana [28], indicating that although induced abortion occurs in every society in Ghana, and a substantial proportion of pregnancies are resolved by abortion [29-32]. However, there is an inadequate empirical research evidence on self-reported health status, sexual activity and fertility preference that underlie abortion among women in Ghana [29,33]. Based on this, the current study is essential. Specifically, the study seeks to: 1) analyse if self-reported health status of women influences abortion in Ghana; 2) ascertain whether sexual activity of women predicts abortion in Ghana; 3) examine whether fertility preference of women influences abortion in Ghana. The study further hypotheised that statistically significant relationship does not exists between self-reported health status, sexual activity as well as fertility preference of women and abortion in Ghana.
Variable Constructs
Self-reported health status, sexual activity, and fertility preference were the explanatory variables while abortion was the outcome variable. Self-reported health status was measured with “self-reported health status”; sexual activity was measured with “recent sexual activity”; fertility preference was measured with “fertility preference, desire for more children, ideal number of children [group], ideal number of boys, and ideal number of girls” while abortion has (ever had a terminated pregnancy, month pregnancy ended, completeness of last termination information, months when pregnancy ended, and other such pregnancies). Therefore, data revolving them were extracted from the 2022 Ghana Demographic and Health Survey for analysis.
Data Processing and Analysis
Data were processed with SPSS version 27. Frequency distribution, Pearson’s chi-squared test of independence and binary logistic regression were used to summarise the data. The frequency distribution was used to compute the responses of the study participants into proportions. The Pearson’s chi-squared test of independence was used to test the hypotheses stated in the study to ascertain whether a relationship exists between the explanatory variables and the outcome variable. The binary logistic regression was used to test the influences of self-reported health status, sexual activity, and fertility preference on abortion among women in Ghana.
Table 1 has outcome of abortion among women in Ghana. This variable was measured with “ever had a terminated pregnancy, month pregnancy ended, completeness of last termination information, months when pregnancy ended, and other such pregnancies.” When asked if women had ever had a terminated pregnancy or not, the results revealed that 71.8Percentage of the women never had a terminated pregnancy while 28.2Percentage indicated they ever had a terminated pregnancy.
| Variable | Frequency | Percentage |
| Ever had a terminated pregnancy | ||
| No | 24876 | 71.8 |
| Yes | 9787 | 28.2 |
| Total | 34663 | 100.0 |
Source: GDHS (2022).
Table 1: Abortion among Women in Ghana.
Among the 9787 participants that indicated they ever had a terminated pregnancy, 24.5Perecentage said the pregnancy ended in the third month while 0.7Perecentage indicated on the tenth month (see Table 2). On completeness of last termination information, more than thirty per cent (37.1Percentage) reported month, year and a day while 0.2Perecentage indicated none (see Table 2).
| Variable | Frequency | Percentage |
| Months pregnancy ended | ||
| 1 | 1452 | 14.8 |
| 2 | 2137 | 21.8 |
| 3 | 2399 | 24.5 |
| 4 | 1079 | 11.0 |
| 5 | 570 | 5.8 |
| 6 | 480 | 4.9 |
| 7 | 290 | 3.0 |
| 8 | 235 | 2.4 |
| 9 | 1081 | 11.0 |
| 10 | 64 | .7 |
| Completeness of last termination information | ||
| Month, year and day | 3633 | 37.1 |
| Month and year | 1946 | 19.9 |
| From calendar | 2791 | 28.5 |
| Year | 1395 | 14.3 |
| None | 22 | 0.2 |
| Total | 9787 | 100.0 |
Source: GDHS (2022).
Table 2: Women Ever had Abortion in Ghana.
Table 3 presents the outcome of self-reported health status among women in Ghana. On participants self-reported health status, about half (45.4%) of the participants reported that their health status is good while 0.7Percentage said their health status is very bad.
| Variable | Frequency | Percentage |
| Self-reported health status | ||
| Very good | 10092 | 29.1 |
| Good | 15729 | 45.4 |
| Moderate | 6983 | 20.1 |
| Bad | 1620 | 4.7 |
| Very bad | 239 | 0.7 |
| Total | 34663 | 100.0 |
Source: GDHS (2022).
Table 3: Self-Reported Health Status among Women in Ghana.
Further analysis was conducted with Pearson’s chi-squared test of independence on participants’ self-reported health status and abortion in Ghana. This analysis was done to test the hypothesis there is no statistically significant relationship between self-reported health status of women and abortion. Statistically significant relationship was found between self-reported health status [p<0.001] and abortion among women in Ghana (see Table 4).
Note: Row percentages in parenthesis, Chi-square significant at (0.001), (0.05), (0.10)
No: never abort Yes: abort.
Source: GDHS (2022).
Table 4: Relationship between Self-Reported Health Status and Abortion among Women in Ghana.
Table 5 has outcome of binary logistic regression of self-reported health status and abortion among women in Ghana. This analysis was conducted to ascertain the influences self-reported health status has on women’s abortion in Ghana.
Source: GDHS (2022). Significant at 0.05.
Table 5: Outcome of Binary Logistic Regression of Self-Reported Health Status and Abortion among Women in Ghana.
Overall, the logistic regression model was significant at -2LogL = 40926.739; Nagelkerke R2 of 0.014; X 2 = 333.079; p lessthan 0.001 with correct prediction rate of 71.8%. More importantly, the Model Summary which shows a Nagelkerke R2 of 0.014 suggests that the model explains 1.4% of variance in the likelihood of abortion among women in Ghana. With this percentage contribution to the entire model, the results confirmed the whole model significantly predict women’s abortion in Ghana. It emerged in Table 5 that good health status was statistically significant related to abortion at p lessthan 0.001, (OR=1.241, 95%CI ([1.171-1.315]). This factor tags those women to have 1.2 times more likely to abort a pregnancy compared with women who had very good health status. Further, it was found that moderate health status was statistically significant at p lessthan 0.001, (OR=1.819, 95%CI [1.701-1.945]). This variable categorises those women to have 1.8 times more likely to abort a pregnancy compared with women with a very good health status (see Table 5). Furthermore, bad health status was statistically significant at p lessthan 0.001, (OR=1.622, 95%CI [1.448-1.816]). This factor tags those women to have 1.6 times more likely to abort a pregnancy compared with women with a very good health status (see Table 5). Additionally, very bad health status was statistically significant at p lessthan 0.001, (OR=1.777, 95%CI [1.358-2.327]). This variable has described those women to have 1.8 times more likely to abort a pregnancy compared with women with a very good health status (see Table 5). Results on sexual activity of women in Ghana are presented in Table 6. When women were asked to indicate their recent sexual activity, the results revealed that more than half (56.6%) of the women reported they were active in the last 4 weeks while 11.1% said they were not active in the last 4 weeks - postpartum abstinence.
Source: GDHS (2022).
Table 6: Sexual Activity of Women in Ghana.
Table 7 has the outcome of Pearson’s chi-squared test of independence of sexual activity of women and abortion in Ghana. This analysis was conducted to test the hypothesis there is no statistically significant relationship between sexual activity of women and abortion in Ghana. Statistically significant relationship was found between sexual activity of women [p lessthan 0.001] and abortion in Ghana.
Note: Row percentages in parenthesis, Chi-square significant at (0.001), (0.05), (0.10)
No: never abort; Yes: abort.
Source: GDHS (2022).
Table 7: Relationship between Sexual Activity of Women and Abortion in Ghana.
Source: GDHS (2022). Significant at 0.05.
Table 8: Outcome of Binary Logistic Regression of Sexual Activity of Women and Abortion in Ghana.
Overall, the logistic regression model was significant at -2LogL = 41183.127; Nagelkerke R2 of 0.003; X 2 = 76.692; p lessthan 0.001 with correct prediction rate of 71.8%. More importantly, the Model Summary which shows a Nagelkerke R2 of 0.003 suggests that the model explains 0.3% of variance in the likelihood of abortion among women in Ghana. With this percentage contribution to the entire model, the results confirmed the whole model significantly predict women’s abortion in Ghana.
It was observed in Table 8 that not active in last 4 weeks (postpartum abstinence) was statistically significant related to abortion at p lessthan 0.001, (OR=0.705, 95%CI ([0.650-0.765]). This factor tags those women to have 0.7 times less likely to abort a pregnancy compared with women who were active in the last 4 weeks. However, the other remaining variable was not significant. This could be as a result of chance.
To answer research question 3 which is “analysing if fertility preference of women predicts abortion in Ghana, ”fueled data extraction on“ fertility preference, desire for more children, ideal number of children [grouped], ideal number of boys, and ideal number of girls.” The results are presented in Table 9.
Source: GDHS (2022).
Table 9: Fertility Preference of Women in Ghana.
When asked about fertility preference of women, about half (47.8%) reported they have another child while 2.9% said they have been declared infecund. On desire for more children, nearly forty-one per cent (40.8%) reported they do not desire for more children while 2.9% reported being declared infecund. Concerning ideal number of children (grouped), more than forty per cent (46.5%) of the women reported they have more than 6 children while 0.2% intimated they only have a child. On ideal number of boys, a third (32.3%) of the women reported 2 boys while 0.0% quoted 15 boys. Whereas a third (32.3%) said ideally, they desire 2 girls 0.0% quoted 9 girls. Table 10 has outcome of Pearson’s chi-squared test of independence of fertility preference of women and abortion in Ghana. This analysis was done to test the hypothesis there is no statistically significant relationship between fertility preference of women and abortion in Ghana. Statistically significant relationships were found among all the variables studied under fertility preference of women. Namely: Fertility preference [p lessthan 0.001], desire for more children [p lessthan 0.001], ideal number of children [grouped] [p lessthan 0.001], ideal number of boys [p lessthan 0.001] as well as ideal number of girls [p lessthan 0.001] and abortion in Ghana.
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