Ethical issues in providing comprehensive abortion care to adolescents: a qualitative study of healthcare providers in the Eastern Region of Ghana

Abstract

Globally, unsafe abortion among young women is a public health concern. In 2021, 17.8% of abortions occurred among adolescents in the Eastern region of Ghana, who struggle to access comprehensive abortion care (CAC) due to conflicts over decision-making capacity and parental consent requirements. This study explores the ethical issues surrounding CAC provision for adolescents in the New Juaben Municipality, Eastern Region, Ghana. A phenomenological qualitative study approach was used to explore the ethical concerns of healthcare workers providing CAC to adolescents. Twelve healthcare workers, comprising midwives, a physician specialist, a physician assistant (provides primary healthcare), and a nurse, who had provided CAC services for at least 6 months were purposively selected for in-depth interviews. The interviews were transcribed verbatim and analyzed using ATLAS.ti software. Thematic analysis was conducted, with relevant quotations used to support the findings. Some midwives provided directive counseling to adolescents. Other ethical issues uncovered were confidentiality, and contemplation with conscientious objection. Minors required parental consent for CAC, but when it is objected the loco parentis is used albeit strict parental involvement is required in advanced gestational age. Healthcare providers resolved ethical dilemmas related to informed consent through personal discretion and consultation. Counselling, confidentiality and conscientious objection were handled through task sharing, consultation and referral to other facilities. The Ghana Health Service counseling guidelines were often used for post-abortion family planning counseling. This study identified several ethical concerns related to CAC for adolescents, including directive counseling, compromised autonomy, confidentiality, beneficence, and conscientious objection. Appropriate resolution of ethical issues is important for improving adolescents’ access to CAC services. Values clarification and attitude transformation training are required to orient healthcare workers to provide unbiased and non-directive counseling.