Pathways to care: Factors predicting women's access to clinic versus pharmacy-based medication abortion in Ghana.

Abstract

Background: Women's decision to access medication abortion (MA) in clinics or pharmacies may be shaped by several factors, but is an area that has not been adequately researched. Little is also known about the primary predictors of choice of MA provider.

Objectives: Our study examined the factors associated with choice of MA provider and identified the primary predictors.

Design: A non-inferiority and prospective design.

Methods: We utilized data from a non-inferiority and prospective study that recruited women who had MA from selected clinics and pharmacies in Ghana. Our sample comprises 1045 and 929 women from clinics and pharmacies, respectively. We used a multivariate binary logistic model to examine the factors associated with MA providers. Following this, a decision tree model was utilized to shed light on the main predictors.

Results: Our results show that women were more likely to spend more on accessing MA in clinics than in pharmacies (adjusted odds ratio (AOR) = 1.0, p < 0.01). Notably, results from the decision tree model indicate that MA cost has the strongest effect on provider selection (χ² = 937, p < 0.01). Additionally, women over 24 years old (AOR = 0.7, p < 0.05), those with secondary education (AOR = 0.5, p < 0.01), those who learned about MA from friends or close relatives (AOR = 0.5, p < 0.01), and those who previously had MA before their recent MA (AOR = 0.6, p < 0.01) were less likely to access MA in clinics.

Conclusion: We found that cost has the strongest effect on women's choice of MA provider in Ghana. In addition, sociodemographic and abortion-related factors play a role. These factors should be considered in developing strategies to enhance equal opportunity in accessing high-quality and safe MA. For instance, developing strategies to reduce MA costs in clinical settings could reduce the burden on vulnerable women, including those younger who may prefer clinic providers.