Determinants and dynamics of repeat unsafe abortion in Ghana-a mixed-method study at Tema General Hospital.

BACKGROUND: Unsafe abortion remains a significant driver of maternal morbidity and mortality in Ghana. Despite progressive policies, many women continue to bypass safe clinical pathways. This study aims to identify the socio-demographic factors and qualitative dynamics associated with repeat unsafe abortion among women presenting with unsafe abortion complications at Tema General Hospital. METHOD: The study targeted women aged 15-49 years who were admitted for complications arising from unsafe abortions. A total of 68 women participated in the analysis, providing both quantitative and qualitative data. Quantitative data were analysed using Fisher's exact and Chi-square tests for bivariate associations, followed by Firth's penalised logistic regression to identify independent predictors. Simultaneously, qualitative semi-structured interviews explored the underlying motivations and personal dynamics behind termination decisions. All statistical analyses were performed in R, with a significance level of 0.05. RESULTS: Age at sexual debut was the strongest independent predictor of repeat unsafe abortion, with over 14-fold higher odds among women who debuted at 15-19 versus later (AOR = 14.35, 95% CI: 2.30-170.29, p = 0.003), corroborated by qualitative accounts of early, unplanned pregnancies. Higher education showed a non-significant protective trend (AOR = 0.28, 95% CI: 0.05-1.06, p = 0.062), echoed in accounts of "recovery literacy" among educated women. The model explained 47% of the variance in repeat-abortion status (pseudo-R2 = 0.466). A widespread sense of "unpreparedness," linked to financial instability and partner unreliability, led 70.6% of participants to rely on informal networks for at-home misoprostol, often unaware of complications. CONCLUSION: These findings underscore the urgent need for interventions to address the high rates of unsafe abortions in Ghana. There is a need for improved sexual education, promotion of contraceptive utilisation, and providing accurate information about safe and legal abortion options.