Awareness of abortion legality and safe abortion uptake in Ghana: assessing the moderating role of education in a cross‐sectional study

Abstract

Background and Aims: Although awareness of abortion legality has been associated with reproductive health service utilization, little is known about whether legal awareness influences safe abortion uptake in Ghana or whether educational attainment modifies this relationship. This study examined the association between awareness of abortion legality and safe abortion uptake and assessed the moderating role of education among women in Ghana. Methods: Data were drawn from 1282 women aged 15–49 years who reported an induced abortion in the 5 years preceding the 2017 Ghana Maternal Health Survey. Abortions were classified as safe if they involved a recommended abortion method, were performed by a trained provider, and occurred in a recognized health facility. Awareness of abortion legality was assessed by asking respondents whether they knew abortion was legally permitted in Ghana under specific circumstances. Responses were categorized as aware or unaware. Covariates were selected based on existing literature relevant to abortion care-seeking behavior. Multivariable logistic regression models were used to estimate adjusted associations between legal awareness, education, and safe abortion uptake. Results: Overall, 39.39% of abortions were classified as safe, while only 12.09% of women were aware of Ghana's abortion law. Legal awareness was strongly associated with safe abortion uptake (aOR = 2.09; 95% CI: 1.42–3.08; p < 0.001). Educational attainment was also positively associated with safety, with women with secondary (aOR = 1.98; 95% CI: 1.22–3.22; p = 0.006) and higher education (aOR = 3.06; 95% CI: 1.57–5.96; p = 0.001) more likely to obtain safe abortions compared with those with no education. However, education did not significantly moderate the association between legal awareness and abortion safety. Predicted probabilities indicated the highest likelihood of safe abortion among legally aware women with higher education (69%). Conclusion: These findings highlight the importance of improving women's awareness of abortion legality and strengthening women's educational attainment to enhance reproductive health autonomy and reduce unsafe abortion in Ghana.