Authors and Year	Title, Journal	Findings	Study Design	Study Setting	Strengths and limitations	Database retrieved from
1. Morhe ESK, Tagbor HK, Ankobea F, Danso KA. 2012	Reproductive experiences of teenagers in the Ejisu- Juabeng district of Ghana. International Journal of Gynecology and Obstetrics	Teenagers have their sexual debuts at young ages. 36.7% of the females have had at least one abortion.	Cross-sectional survey community-based survey.	Ejisu-Juabeng district of Ghana.	There were no questions asked as to the processes undertaken to obtain abortions.	Global Health, Popline
2. Lee QY, Odoi AT, Opare-Addo H, Dassah ET. 2012	Maternal mortality in Ghana: a hospital- based review. Acta Obstetricia et Gynecologica Scandinavica	Genital tract sepsis, often as a result of an abortion, had the highest case- fatality rate of all the causes of maternal death in this study.	Secondary data analysis of patient charts	Komfo Anokye Teaching Hospital	Comments are made that are not supported by data or references, such as, “Social stigma plays a role in preventing vulnerable women from accessing safe abortion services.” Reasons behind not accessing safe abortion services needs to be investigated.	Reference List
3. Ganyaglo GYK, Hill WC. 2012	A 6-year (2004-2009) review of maternal mortality at the East Regional Hospital, Koforidua, Ghana. Seminars in Perinatology	Abortion complications were the second leading cause of maternal mortality, behind post-partum hemorrhage. The largest proportion of post-abortion deaths were due to sepsis (29 of the 37 post-abortion deaths).	Secondary analysis of Obstetric and Gynecology ward admission and discharge books, triangulated against minutes from maternal death audit meetings and midwifery returns. Patient folders were available for 2009 only.	Koforidua Regional Hospital, Eastern Region	This is the first hospital-based study outside a major teaching hospital.	Global Health
4. Sundaram A, Juarez F, Bankole A, Singh S. 2012	Factors associated with abortion-seeking and obtaining an unsafe abortion in Ghana. Studies in Family Planning	Almost half of all reported abortions were conducted unsafely. The profile of women who seek an abortion is: unmarried, in their 20s, have no children, have terminated a pregnancy before, are Protestant or Pentecostal/Charismatic, of higher SES, and know the legal status of abortion. Younger women were less likely to seek a safe abortion, as were women of low SES and those in rural areas. A partner paying for the procedure was associated with seeking a safe abortion.	Nationally representative survey	Maternal Health Survey	This study uses nationally- representative data to investigate safe and unsafe abortion seeking. However, abortion is under-reported, and there were no questions about unwanted pregnancy, or reasons for seeking safe versus unsafe abortions.	Ovid Medline, Global Health PubMed
5. Krakowiak- Redd D, Ansong D, Otupiri E, Tran S, Klanderud D, Boakye I, Dickerson T, Crookston B 2011	Family planning in a sub-district near Kumasi, Ghana: Side effect fears, unintended pregnancies and misuse of medication as emergency contraception. African Journal of Reproductive Health	20% of the sample had had at least one abortion	Cross-sectional community-based survey	Barekese sub-district in the Ashanti Region	A relatively small sample size (n=85) of only women. There was a qualitative component, but not about abortion-related issues.	Global Health
6. Aniteye P, Mayhew S. 2011	Attitudes and experiences of women admitted to hospital with abortion complications in Ghana. African Journal of Reproductive Health	Great majority of women were young and single. The majority of women had help performing their abortion and most accessed post-abortion care at a health facility shortly after experiencing complications.	Structured survey with 131 women with incomplete abortions.	Gynecology ward, Korle Bu and Ridge Hospitals.	The authors note a need for qualitative work especially around the reasons why women are not using family planning as well as to discover who the unsafe providers are.	Ovid Medline, Global Health, PubMed, Popline
7. Gumanga SK, Kolbila DZ, Gandau BBN, Munkaila A, Malechi H, Kyei-Aboagye K 2011	Trends in maternal mortality in Tamale Teaching Hospital, Ghana. Ghana Medical Journal	The institutional maternal mortality rate was 1018 per 100,000 live births was recorded between 2006 and 2010. Complications from unsafe abortion was the leading cause of maternal death for youngest women, and the 4th leading cause overall.	Hospital records from January 1 2006- December 2010.	Tamale Teaching Hospital	Documented the causes of maternal death in the Northern Region of Ghana.	Global Health
8. Biney AAE 2011	Exploring contraception knowledge and use among women experiencing induced abortion in the Greater Accra region, Ghana. African Journal of Reproductive Health	Many respondents noted that prior to their induced abortion, they had no knowledge about contraception, but since the abortion they had been using it. Women also mentioned feeling contraception was more dangerous to their health than was induced abortion.	24 semi-structured individual interviews were conducted with women who were being treated and reported having experience with induced abortion.	Gynecology wards, Tema General Hospital and Korle Bu Teaching Hospital	This study was mainly about contraception, and so access to abortion services were not investigated.	Ovid Medline, Global Health, PubMed, Popline
9. Ohene SA, Tettey Y, Kumoji R. 2011	Cause of death among Ghanaian adolescents in Accra using autopsy data. BMC Research Notes	20/27 maternal deaths to adolescents were a consequence of abortion.	Autopsy data	Korle Bu Teaching Hospital	Demonstrated the burden of disease attributable to adolescent death	PubMed
10. Mac Domhnaill B, Hutchinson G, Milev A, Milev Y. 2011	The social context of school girl pregnancy in Ghana. Vulnerable Children and Youth Studies	Student’s knowledge of abortive methods was considerably more detailed than their knowledge of contraception. Many explicitly mentioned not using contraception because they knew how to abort a pregnancy if necessary. Participants note local and herbal methods of abortions, although they admitted they were dangerous. Abortion is seen by these participants as an unfortunate fact of being sexually active.	Focus group discussions in both rural and peri- urban settings.	Ho, Ghana	The focus-group methodology enables students to talk among themselves about sexual relationships.	Global Health
11. Schwandt HM, Creanga AA, Danso KA, Adanu RMK, Agbenyega T, Hindin MJ 2011	A comparison of women with induced abortion, spontaneous abortion and ectopic pregnancy in Ghana. Contraception	N= 585. Majority reported spontaneous abortion between June and July 2008. Those with reported induced abortion were more likely to have more power in their relationships and to have not disclosed the index pregnancy to their partners.	Surveys administered by nursing and midwifery students with women being treated for abortion complications.	Gynecology emergency wards, Korle Bu and KATH.	This is one of the only studies to look at male-female relationships and how these impact reproductive health decision making.	Ovid Medline, Global Health, PubMed
12. Mote CV, Otupiri E, Hindin MJ. 2010	Factors associated with induced abortion among women in Hohoe, Ghana. African Journal of Reproductive Health.	One-fifth (21.3%) of respondents reported having had an induced abortion. Most common reasons for having an abortion: “not to disrupt education or employment” and “too young to have bear a child.” 65.5% performed by a medical doctor, 31% by partners or friends. 60.9% in a hospital, 29.9% at home. 50.6% used sharps or hospital instruments, 31% used herbs.	408 community-based surveys	Hohoe, Volta Region	Using community-based surveys gets a broader population than hospital-based.	Global Health, PubMed
13. Voetagbe G, Yellu N, Mills J, Mitchell E, Adu- Amankway A, Jehu-Appiah K, Nyante F. 2010	Midwifery tutors’ capacity and willingness to teach contraception, post- abortion care, and legal pregnancy termination in Ghana. Human Resources for Health	Only 18.9% of the tutors surveyed knew all the legal indications under which safe abortion could be provided. These tutors were not taught manual vacuum aspiration during their training.	74 midwifery tutors from all 14 public midwifery schools were surveyed.	Midwifery training colleges country-wide	74 of 123 selected tutors returned the survey, giving a response rate of 60.2%. Importantly documented the lack of complete knowledge of the law, even among midwifery tutors.	PubMed
14. Laar AK 2010.	Family planning, abortion and HIV in Ghanaian print media: A 15-month content analysis of a national Ghanaian newspaper. African Journal of Reproductive Health	This analysis showed that family planning, abortion and HIV received less than 1% of total newspaper coverage in one national Ghanaian newspaper.	Content analysis of the Daily Graphic newspaper.	Newspaper	This analysis shows that local speculations that the quantity and prominence of reproductive health issues are neglected in local newspapers are warranted.	Global Health, PubMed
15. Clark KA, Mitchell EHM, Aboagye PK 2010	Return on investment for essential obstetric care training in Ghana: Do trained public sector midwives deliver postabortion care? Journal of Midwifery and Women’s Health	The availability of PAC in Ghana remains limited. Far fewer midwives than physicians offer PAC, even after having received PAC clinical training, although an analysis of the curriculum and training was outside the scope of this study.	Secondary data analysis of 2002 Ghana Service Provision Assessment survey. 428 health facilities working in 1448 health facilities were surveyed.	Nationally- representative sample of health facilities and health providers	Information about supplies available at the clinics, as well as whether the providers were offering CAC services, were not available in the dataset.	Ovid Medline, PubMed, Popline
16. Graff M, Amoyaw DA 2009	Barriers to sustainable MVA supply in Ghana: Challenges for the low-volume, low- income providers. African Journal of Reproductive Health.	Sustainable access to MVA equipment has been challenging particularly for low-volume, low-income providers. Although many of the midwives in rural areas had the skills to provide MVA, they did not have the equipment and thus continued to refer women to district or regional hospitals.	Interviews with 24 midwives and 16 physicians	Data gathered in seven of the ten regions of the country.	Interviews with a wide range of stakeholders is a major strength.	Ovid Medline, Global Health, PubMed
17. Hill ZE, Tawiah- Agyemang C, Kirkwood B. 2009	The context of informal abortions in rural Ghana. Journal of Women’s Health.	Key themes were related to the perception of abortions as illegal, dangerous, and bringing public shame and stigma but also being perceived as common, understandable, and necessary. None of the respondents knew the legal status of abortion, with most reporting that it was illegal.	Qualitative interviews in Kintampo, Brong-Ahafo.			Ovid Medline, Global Health, MedLine
18. Konney TO, Danso KA, Odoi AT, Opare-Addo HS, Morhe ESK. 2009	Attitudes of women with abortion-related complications toward provision of safe abortion services in Ghana. Journal of Women’s Health	Abortion-related complications accounted for 42.7% of admissions to the gynecological ward at KATH, 28% of whom indicated an induced abortion. 92% of the women interviewed were not aware of the law regarding abortion in Ghana. Most felt that there was a need to establish safe abortion services in Ghana.	Interviews of women being treated for abortion complications at KATH between May 1 and June 30, 2007.	Gynecology ward at KATH	The first study to investigate the attitudes of women being treated for abortion complications towards the provision of safe abortion services in Ghana.	Ovid Medline, Global Health, PubMed, Popline
19. Oliveras E, Ahiadeke C, Adanu RM, Hill AG 2008	Clinic-based surveillance of adverse pregnancy outcomes to identify induced abortion in Accra, Ghana. Studies in Family Planning.	1,636 women completed the questions. Younger, better educated and unmarried women are more likely to have had an induced abortion. Between 10-17.6% of women report having had an abortion. Women seeking care at a private facility were more than twice as likely to have ended their previous pregnancy by induced abortion.	Using previous birth technique, during prenatal care, nurses asked 5 questions to illicit how their previous pregnancy ended.	Three public and two private clinics in Accra that provide antenatal and maternity services.	Although this technique does not measure prevalence or lifetime exposure to abortion, it is another way to investigate abortion. Further work to elucidate differential responses based on healthcare provider asking is important.	Ovid Medline, Global Health, PubMed, Popline
20. Mills S, Williams JE, Wak G, Hodgson A 2008	Maternal Mortality Decline in the Kassena-Nankana District of Northern Ghana. Maternal and Child Health Journal	Abortion-related deaths were the most frequent cause of maternal deaths in this sample in the Northern Region.	Family members of all maternal deaths between January 2002 and December 2004 were interviewed	Northern Region	Relying on verbal autopsy requires survivors to know of pregnancy status. There may have been more abortion- related deaths than reported if those interviewed did not know the woman was pregnant.	Ovid Medline, PubMed, Popline
21. Morhe ESK, Morhe RAS, Danso KA 2007	Attitudes of doctors toward establishing safe abortion units in Ghana. International Journal of Obstetrics and Gynecology	Most physicians were supportive of playing some role in developing safe abortion units in hospitals in Ghana. However, only 54% of maternal and child health-related health workers were aware of the true nature of the abortion law, with 35% believing that the law permits abortion only to save the life of the woman. More than 50% of the workers reported they would be unwilling to play a role in performing pregnancy terminations.	Cross sectional survey of 74 physicians at KATH	Komfo Anokye Teaching Hospital, Kumasi.	The attitudes of health care providers is an important area to investigate due to the barriers these people can represent.	Ovid Medline, Global Health, PubMed
22. Adanu RMK, Ntumy MN, Tweneboah E. 2005	Profile of women with abortion complications in Ghana. Tropical Doctor	31% of the study population presented for complications from induced abortion. Those seeking care for induced abortion were younger, or lower parity, more education, less likely to be engaged in income- generating activity, in less stable relationships and had more knowledge of modern contraception than those presenting for treatment from spontaneous abortion.	Cross-sectional survey of 150 patients being treated for abortion complications.	Korle Bu Teaching Hospital	The determination of induced versus spontaneous abortion was reliant on self-report, which the authors note may be under-reported.	Reference list
23. Baiden F, Amponsa- Achiano K, Oduro AR, Mehsah TA, Baiden R, Hodgson A. 2006	Unmet need for essential obstetric services in a rural district northern Ghana: Complications of unsafe abortions remain a major cause of mortality. Public Health	Complications from abortion were the leading cause of maternal mortality. Although abortion is considered taboo in NKD, according to clinic evidence, there is a high incidence of backstreet and unsafe practices. The district hospital did not have any access to formal safe abortion services.	Secondary data analysis from chart review of all maternal deaths from January 2001 to December 2003 at the district hospital in Kassena-Nankana	Kassena-Nankana district in the Northern Region	Established abortion-related deaths are the leading cause of maternal deaths. Further research including all members of a woman’s community needs to be conducted to fully understand the social and cultural factors associated with seeking maternal healthcare.	Ovid Medline, Global Health, PubMed, Popline
24. Adanu RMK & Tweneboah E 2004	Reasons, fears and emotions behind induced abortions in Accra, Ghana. Research Review	Women having induced abortion were younger, better educated, less likely to be married. 31.3% were reported to be induced abortion. Many who reported spontaneous abortion had stories that seemed to show induced. Most induced abortions were obtained outside the formal health system.	Interviews with 150 women experiencing abortion complications.	Gynecology ward, Korle Bu	Only qualitative paper investigating the reasons behind and actions taken to terminate pregnancies.	Reference list
25. Yeboah RWN & MC Kom. 2003	Abortion: The case of Chenard Ward, Korle Bu from 2000 to 2001. Research Review	The majority of admissions are due to incomplete abortions, although there were not classified by spontaneous or induced. Reported cases of induced abortions are high.	Chart review of all abortion-related admissions between January 1, 2000 and December 31, 2001; nurse interviews	Gynecology emergency ward, Korle Bu Teaching Hospital, Accra, Ghana.	No follow-up or interviewing of patients to determine reasons for abortion.	Popline
26. Glover EK, Bannerman A, Pence BW, Jones H, Miller R, Weiss E, Nerquaye- Tetteh J. 2003	Sexual health experiences of adolescents in three Ghanaian towns. International Family Planning Perspectives.	35% of the female respondents reported ever being pregnant, and 70% of those reported having had or attempted an abortion.	Community-based surveys of never-married youth about general sexual experiences.	Tamale, Takoradi and Sunyani	Using a community-based technique sampled previously under-represented groups.	Global Health, PubMed, Popline
27. Srofenyoh EK, Lassey AT 2003	Abortion care in a teaching hospital in Ghana. International Journal of Gyneaecology and Obstetrics	30% of induced abortions had complications while 10% of spontaneous abortions had complications. 15% of maternal deaths over the study period were due to complications from abortion. Abortion complications were the leading cause of admission to the maternity ward (40.7% of all admissions).	Chart review of all patients admitted to Korle Bu for abortion complications between January 1 and December 31, 2001.	Gynecology ward, Korle Bu	Important documentation of the burden of abortion complications at Korle Bu.	Ovid Medline
28. Geelhoed DW, Visser LE, Asare K, Schagen van Leeuwen JH, van Roosmalen J. 2003	Trends in maternal mortality: a 13-year hospital-based study in rural Ghana. European Journal of Obstetrics and Gynecology.	Institutional maternal mortality rate of 1077 per 100,000 live births. Abortion complications were the leading cause (43 of the 229 deaths)	Records from all maternal deaths between 1987 and 2000 were reviewed	Berekum District hospital, Brong Ahafo Region		Global Health, Popline
29. Srofenyoh EK, Lassey AT 2003	Abortion care in a teaching hospital in Ghana. International Journal of Gynecology and Obstetrics	40% of admissions over the study period were related to abortion complications. Almost 77% were spontaneous abortions. 30% with induced abortion had serious complications while 10% of spontaneous abortion had similar complications.	Retrospective chart review of all patients treated for abortion complications in 2000.	Korle Bu Teaching Hospital	Documents the high level of burden represented by abortion complications at Korle Bu.	Ovid Medline, Global Health
30. Turpin CA, Danso KA, Odoi AT 2002	Abortion at Komfo Anokye Teaching Hospital. Ghana Medical Journal	Abortion complications accounted for 38.8% of admissions to the KATH Ob/Gyn ward in 1994. Induced abortions were more common in younger, unmarried women. The majority of induced abortions occurred in the 15-19 year old group.	1,301 of 1,313 cases of abortion admissions to KATH were analyzed retrospectively.	Obstetrics and Gynecology ward, Komfo Anokye Teaching Hospital	Established the large proportion of cases of post- abortion complications treated at KATH. Purely descriptive and reliant on information included in patient charts.
31. Blanc A, Grey S. 2002	Greater than expected fertility decline in Ghana: Untangling a puzzle. Journal of Biosocial Science	The total fertility rate in Ghana has declined at a higher rate than would be expected by the contraception prevalence rate. The authors find evidence of widespread abortion to control fertility, although accurate rates are hard to determine. The authors also note that the gap between expected fertility given contraception utilization and actual fertility is greater in urban areas than rural areas lends support to couples using abortion to limit or space births.	Demographic and Health Surveys from 1988, 1993 and 1998.	Representative sample.	As there are no reliable measures of abortion prevalence, the authors cannot rule out abortion being the reason behind the observed gap. Further, the authors note that abortion was, at the time or writing, illegal except to save the life of the mother or in the case of rape or incest.	Popline
32. Geelhoed DW, Nayembil D, Asare K, Schagen van Leeuwen JH, van Roosmale J. 2002	Gender and unwanted pregnancy: a community-based study in rural Ghana. Journal of Psychosocial Obstetrics and Gynecology	Induced abortions were reported by 22.6% of the surveyed population. 28.2% of women reported having had an induced abortion. More women than med reported an unwanted pregnancy ending in abortion, perhaps signaling female independence in deciding on abortion care.	2137 community -based surveys	Berekum, Brong Ahafo Region.	Interviewing both men and women gives a broader perspective. Questions investigating the process to obtain an abortion were not asked.	Ovid Medline
33. Ahiadeke C 2002	The incidence of self induced abortion in Ghana: What are the facts? Research Review.	The rates identified here suggest that over a lifetime, 900 abortions per 1,000 women will be performed. The majority of women reported receiving their abortion from outside the formal healthcare system (30% from a pharmacist, 11% from self- medication, 16% from a “quack doctor” and 3% from other means).	Data come from the cross-sectional community-based Maternal Health Survey in four regions		These data come from before abortion policies were liberalized.	Global Health
34. Geelhoed D, Nayembil D, Asare K, Schagen JH, van Roosmalen J. 2002	Contraception and induced abortion in rural Ghana. Tropical Medicine and International Health.	About 40% of participants had experienced an unwanted pregnancy in their lives. Socioeconomic reasons were the most common for why a pregnancy was unwanted	Community-based surveys with 2137 participants	Berekum District, Brong Ahafo Region	Using anonymous, privately administered surveys yielded a high response rate. Interviewing both men and women is a strength.	Ovid Medline, Global Health, Popline
35. Ahiadeke 2001	Incidence of induced abortion in southern Ghana. International Family Planning Perspectives	317/1,689 women aborted pregnancies (19/100, 27/100 live births, 17/1,000 women of reproductive age). Majority of women were under 30, married, Christian. Abortions happened outside the formal health sector.	As part of Maternal Health Survey Project; 1,689 pregnant women were interviewed	4 of the country’s 10 regions: Central, Eastern, Volta and Greater Accra.	Community-based survey offers a different perspective than hospital-based, although further questions regarding the process are still necessary.	Global Health
36. Agyei WKA, Biritwum RB, Ashitey AG, Hill RB 2000	Sexual behaviour and contraception among unmarried adolescents and young adults in Greater Accra and Eastern Regions of Ghana. Journal of Biosocial Science	A majority of the young adults surveyed were sexually experienced, although few were using contraception. Approximately 47% of those adolescents who had been sexually active reporting having had an abortion. While most participants were aware of modern methods of contraception, few used them.	Fertility survey data with 953 males and 829 females.	Greater Accra and Eastern regions	Investigated the knowledge and practices of adolescents regarding their sexual health. Large community-based sample allows for generalization of findings. Due to quantitative nature, hard to establish the processes undertaken by pregnant girls to end their pregnancies or how many were safe versus unsafe.	Ovid Medline
37. Baird TL, Billings DL, Demuyakor B. 2000	Community education efforts enhance postabortion care program in Ghana. American Journal of Public Health	Post-abortion care training for midwives was effective. Community- outreach was effective at educating the public about the new services being offered by midwives.	Post-abortion care training for midwives to increase their skills, coupled with community outreach to educate women about where to access safe abortion services.	Eastern Region.	No comprehensive evaluation of effectiveness was conducted.	Ovid Medline, Public Health
38. Obed SA & Wilson JB 1999	Uterine perforation from induced abortion at Korle Bu Teaching Hospital, Accra, Ghana: A five year review. West African Journal of Medicine	21.1% of the 10,518 cases of abortion complication treatments for abortion were considered to be induced. 79 (3.6%) of those had uterine perforation. 40.9% (n=29) induced their abortion because they were not ready to have a baby, 36.6% (26) cited the index pregnancy being too close to previous deliver. 81% (64) reported wishing to have future children, although almost 1/3 of the patients had a hysterectomy to treat the complications.	Prospective study of all patients being treated at Korle Bu for perforated uterus following an abortion (n=79) between 1990-1994. Patient interviews and chart review.	Korle Bu Teaching Hospital		Reference list
39. Lassey AT 1995	Complications of induced abortion and their prevention in Ghana. East African Medical Journal	58% of induced abortions were performed outside the health system and about 30% were complications from self-induced abortions using sticks, needles and herbal (often corrosive) inserted into the vagina. Only 9/212 were referrals, the rest were self-referred.	Chart review of 200 patients admitted to the gynecology ward at Korle Bu for abortion complications.	Gynecology ward, Korle Bu Teaching Hospital	Data limited by being a chart review, although this early study highlighted the problem of unsafe abortion in the Greater Accra area.	Ovid Medline