{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T22:44:28Z","timestamp":1771368268292,"version":"3.50.1"},"reference-count":27,"publisher":"BMJ","issue":"e1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2021,6,24]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women\u2019s experiences and access to induced abortion care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>The first delay (in seeking care) occurred because of women\u2019s poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women\u2019s homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals\u2019 non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study has shown the value of the Three Delays Model in illustrating women\u2019s experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2020-200903","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T13:26:10Z","timestamp":1626441970000},"page":"e75-e80","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Three Delays Model applied to prevention of unsafe abortion in Ghana: a qualitative study"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9946-5275","authenticated-orcid":false,"given":"Mercy Nana Akua","family":"Otsin","sequence":"first","affiliation":[{"name":"Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia"},{"name":"Health Administration and Education, University of Education, Winneba, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela J","family":"Taft","sequence":"additional","affiliation":[{"name":"Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leesa","family":"Hooker","sequence":"additional","affiliation":[{"name":"Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia"},{"name":"La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0030-2431","authenticated-orcid":false,"given":"Kirsten","family":"Black","sequence":"additional","affiliation":[{"name":"The Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"2025090511551961000_48.e1.e75.1","doi-asserted-by":"crossref","unstructured":"Singh S , Remez L , Sedgh G , et al . Abortion worldwide 2017: uneven progress and unequal access. New York, NY, USA: Guttmacher Institute, 2018.","DOI":"10.1363\/2018.29199"},{"key":"2025090511551961000_48.e1.e75.2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13552"},{"key":"2025090511551961000_48.e1.e75.3","doi-asserted-by":"crossref","first-page":"e1152","DOI":"10.1016\/S2214-109X(20)30315-6","article-title":"Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019","volume":"8","author":"Bearak","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2025090511551961000_48.e1.e75.4","unstructured":"Guttmacher Institute . Abortion in Africa: incidence and trends. 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Chapel Hill, NC, USA: IPAS, 2007."},{"key":"2025090511551961000_48.e1.e75.10","article-title":"Attitudes and experiences of women admitted to hospital with abortion complications in Ghana","volume":"15","author":"Aniteye","year":"2011","journal-title":"Afr J Reprod Health"},{"key":"2025090511551961000_48.e1.e75.11","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)90226-7"},{"key":"2025090511551961000_48.e1.e75.12","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/ijgo.12525","article-title":"Setting the research agenda for induced abortion in Africa and Asia","volume":"142","author":"Scott","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090511551961000_48.e1.e75.13","unstructured":"Ghana Statistical Service - GSS, Ghana Health Service - GHS, Macro International . Ghana maternal health survey 2007. Calverton, MD, USA: GSS, GHS, and Macro International, 2009."},{"key":"2025090511551961000_48.e1.e75.14","unstructured":"Lee RM . Doing research on sensitive topics. Thousand Oaks, CA, USA: Sage Publications, 1993."},{"key":"2025090511551961000_48.e1.e75.15","unstructured":"Creswell JW . Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks, CA, USA: Sage Publications, 1998."},{"key":"2025090511551961000_48.e1.e75.16","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025090511551961000_48.e1.e75.17","unstructured":"Miles MB , Huberman AM , Salda\u00f1a J . Qualitative data analysis: a methods sourcebook. 3rd edn. 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