{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:04:20Z","timestamp":1787061860179,"version":"build-2736575974"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013986","name":"UK Government","doi-asserted-by":"crossref","award":["Component Code: 203177 -101 Purchase Order: 40054781"],"award-info":[{"award-number":["Component Code: 203177 -101 Purchase Order: 40054781"]}],"id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007729","name":"Dutch Ministry of Foreign Affairs","doi-asserted-by":"crossref","award":["Activity #4000000282"],"award-info":[{"award-number":["Activity #4000000282"]}],"id":[{"id":"10.13039\/501100007729","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and\/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman\u2019s life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0308371","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T14:37:57Z","timestamp":1724337477000},"page":"e0308371","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Knowledge of abortion legality among health facility staff in Ghana"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6523-1465","authenticated-orcid":true,"given":"Grace","family":"Sheehy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1031-7074","authenticated-orcid":true,"given":"Chelsea","family":"Polis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Easmon","family":"Otupiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Moreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"pone.0308371.ref001","unstructured":"WHO, UNDESA. Global Abortion Policies Database. 2017. Available: https:\/\/www.who.int\/reproductivehealth\/topics\/unsafe_abortion\/global-abortion-policies\/en\/."},{"key":"pone.0308371.ref002","unstructured":"Republic of Ghana. Criminal Code Amendment Law, PNDC Law 102, 1985. Incorporated into the consolidated Criminal Code, 1960, Act 29, Section 58 & 57. 1985."},{"key":"pone.0308371.ref003","article-title":"Overview of the law and availability of abortion services in Ghana","volume":"40","author":"RAS Morhee","year":"2006","journal-title":"Ghana Medical Journal"},{"key":"pone.0308371.ref004","unstructured":"Republic of Ghana. Criminal Code, 1960 (Act 29). 1960."},{"key":"pone.0308371.ref005","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4010-8","article-title":"Globalisation and transitions in abortion care in Ghana","volume":"19","author":"P Aniteye","year":"2019","journal-title":"BMC Health Services Research"},{"key":"pone.0308371.ref006","volume-title":"Prevention & Management of Unsafe Abortion: Comprehensive Abortion Care Services Standards and Protocols","author":"Ministry of Health of the Republic of Ghana","year":"2012"},{"key":"pone.0308371.ref007","doi-asserted-by":"crossref","first-page":"e002130","DOI":"10.1136\/bmjgh-2019-002130","article-title":"Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017","volume":"5","author":"CB Polis","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0308371.ref008","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/9253650","article-title":"Predictors of Unsafe Induced Abortion among Women in Ghana","volume":"2019","author":"M Boah","year":"2019","journal-title":"Journal of Pregnancy"},{"key":"pone.0308371.ref009","doi-asserted-by":"crossref","DOI":"10.11604\/pamj-cm.2023.12.44.35413","article-title":"Utilization of Comprehensive Abortion Care (CAC) and associated factors among young people (10\u201324 years): a cross sectional study in the Tamale Metropolis, Northern Region of Ghana","volume":"12","author":"MN Asumah","year":"2023","journal-title":"PAMJ\u2014Clinical Medicine"},{"key":"pone.0308371.ref010","unstructured":"United Nations. Universal Declaration of Human Rights. In: United Nations [Internet]. United Nations; 1948 [cited 2 Nov 2023]. Available: https:\/\/www.un.org\/en\/about-us\/universal-declaration-of-human-rights."},{"key":"pone.0308371.ref011","unstructured":"United Nations Human Rights Committee. General comment No. 36 (2018) on article 6 of the International Covenant on Civil and Political Rights, on the right to life*. 2018. Available: https:\/\/reproductiverights.org\/un-human-rights-committee-asserts-that-access-to-abortion-and-prevention-of-maternal-mortality-are-human-rights\/."},{"key":"pone.0308371.ref012","volume-title":"Abortion Care Guideline","author":"World Health Organization","year":"2022"},{"key":"pone.0308371.ref013","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1002\/ijgo.12509","article-title":"Access to knowledge and the Global Abortion Policies Database","volume":"142","author":"JN Erdman","year":"2018","journal-title":"International Journal of Gynecology and Obstetrics"},{"key":"pone.0308371.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10691-010-9140-7","article-title":"The \u201cPsychiatric Masquerade\u201d: The Mental Health Exception in New Zealand Abortion Law","volume":"18","author":"C Leslie","year":"2010","journal-title":"Feminist Legal Studies"},{"key":"pone.0308371.ref015","unstructured":"International Planned Parenthood Federation. Legal abortion: A comparative analysis of health regulations. 2012."},{"key":"pone.0308371.ref016","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12905-019-0835-x","article-title":"Knowledge, attitude and practice (KAP) of health providers towards safe abortion provision in Addis Ababa health centers","volume":"19","author":"EM Assefa","year":"2019","journal-title":"BMC Women\u2019s Health"},{"key":"pone.0308371.ref017","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ijgo.2010.12.022","article-title":"A survey of providers\u2019 knowledge, opinions, and practices regarding induced abortion in Jamaica","volume":"113","author":"H Fletcher","year":"2011","journal-title":"International Journal of Gynecology and Obstetrics"},{"key":"pone.0308371.ref018","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2019.34.94.18107","article-title":"Knowledge and attitudes towards abortion from health care providers and abortion experts in Zimbabwe: a cross sectional study","volume":"34","author":"MG Madziyire","year":"2019","journal-title":"Pan Afr Med J"},{"key":"pone.0308371.ref019","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12978-018-0619-z","article-title":"Providers\u2019 perspectives on denial of abortion care in Nepal: a cross sectional study","volume":"15","author":"MC Puri","year":"2018","journal-title":"Reprod Health"},{"key":"pone.0308371.ref020","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1590\/S0104-12902013000300023","article-title":"Opini\u00f5es, conhecimento e atitudes de profissionais da sa\u00fade sobre o aborto induzido: uma revis\u00e3o das pesquisas brasileiras publicadas entre 2001 e 2011","volume":"22","author":"DB Cacique","year":"2013","journal-title":"Saude soc"},{"key":"pone.0308371.ref021","doi-asserted-by":"crossref","first-page":"e281","DOI":"10.1016\/j.whi.2013.06.003","article-title":"Knowledge of state-level abortion laws and regulations among reproductive health care providers.","volume":"23","author":"LE Dodge","year":"2013","journal-title":"Women\u2019s Health Issues"},{"key":"pone.0308371.ref022","doi-asserted-by":"crossref","DOI":"10.1186\/1478-4505-11-23","article-title":"Shaping legal abortion provision in Ghana: Using policy theory to understand provider-related obstacles to policy implementation","volume":"11","author":"P Aniteye","year":"2013","journal-title":"Health Research Policy and Systems"},{"key":"pone.0308371.ref023","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/1471-2458-9-296","article-title":"Health care providers\u2019 attitudes towards termination of pregnancy: A qualitative study in South Africa","volume":"9","author":"J Harries","year":"2009","journal-title":"BMC Public Health"},{"key":"pone.0308371.ref024","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.3390\/ijerph14121501","article-title":"\u201cI Am Ready and Willing to Provide the Service \u2026 Though My Religion Frowns on Abortion\u201d\u2014Ghanaian Midwives\u2019 Mixed Attitudes to Abortion Services: A Qualitative Study","volume":"14","author":"P Oppong-Darko","year":"2017","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0308371.ref025","first-page":"16","article-title":"Stigmatized by association: Challenges for abortion service providers in Ghana","author":"P Aniteye","year":"2016","journal-title":"BMC Health Services Research"},{"key":"pone.0308371.ref026","first-page":"79","article-title":"Abortion-Possible and Impossible: Stigma and the Narratives of Ghanaian Doctors Who Provide Abortions","volume":"17","author":"LA Martin","year":"2011","journal-title":"Reflections: Narratives of Professional Helping"},{"key":"pone.0308371.ref027","unstructured":"Ghana Health Service. Prevention and Management of Unsafe Abortion: Comprehensive Abortion Care Services. Standards and Protocols. 2006."},{"key":"pone.0308371.ref028","unstructured":"Ghana Health Service. Prevention and Management of Unsafe Abortion: Comprehensive Abortion Care Services Standards and Protocols. 2012. Available: https:\/\/abortion-policies.srhr.org\/documents\/countries\/02-Ghana-Comprehensive-Abortion-Care-Services-Standards-and-Protocols-Ghana-Health-Service-2012.pdf."},{"key":"pone.0308371.ref029","doi-asserted-by":"crossref","first-page":"2250621","DOI":"10.1080\/26410397.2023.2250621","article-title":"Expanding access to early medical abortion services in Ghana with telemedicine: findings from a pilot evaluation","volume":"31","author":"J Adu","year":"2023","journal-title":"Sexual and Reproductive Health Matters"},{"key":"pone.0308371.ref030","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ijgo.2007.02.023","article-title":"Attitudes of doctors toward establishing safe abortion units in Ghana","volume":"98","author":"ESK Morhe","year":"2007","journal-title":"International Journal of Gynecology and Obstetrics"},{"key":"pone.0308371.ref031","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/ijgo.12328","article-title":"Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana","volume":"140","author":"JK Awoonor-Williams","year":"2018","journal-title":"International Journal of Gynecology and Obstetrics"},{"key":"pone.0308371.ref032","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/ijgo.12674","article-title":"Implementing safe abortion in Ghana: \u201cWe must tell our story and tell it well.\u201d","volume":"143","author":"W Chavkin","year":"2018","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"pone.0308371.ref033","article-title":"Regional and residential disparities in knowledge of abortion legality and availability of facility-based abortion services in Ethiopia","volume":"33","author":"G Sheehy","year":"2021","journal-title":"Contraception X"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308371","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T14:38:20Z","timestamp":1724337500000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308371"}},"subtitle":[],"editor":[{"given":"Mubarick Nungbaso","family":"Asumah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308371","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}