The role of stigma in abortion care in Ghana: influences on method choice and experiences of care.

拟议的研究旨在审查加纳堕胎护理和方法选择中的污名化作用。具体的研究问题包括：（一）耻辱感在妇女选择堕胎方法和她们对堕胎方法的经历中起什么作用（如果有的话）？㈡妇女的堕胎护理经历如何影响她们是否以及如何经历耻辱，如何衡量堕胎服务中的耻辱？提供者对堕胎的态度如何影响堕胎方法的使用？㈣旨在影响提供者态度和咨询质量的干预措施如何影响堕胎方法的使用？该研究将采用混合方法，使用以下方法的选择。通过深入访谈、焦点小组和观察，对妇女和服务提供者进行定性研究，调查对堕胎方法的污名化和看法如何相互作用。文献综述和定性研究的结果将为制定一个衡量服务提供中污名化经历的量表提供信息，以便将来使用认知和专家访谈以及客户调查数据分析进行验证。对2017年加纳孕产妇健康调查数据的分析将评估与堕胎方法使用相关的特征，包括社会人口统计学、堕胎动机和对法律的地位的认识。记录链接的卫生服务数据与提供者的态度调查，将检查提供者的态度和堕胎方法的使用之间的关联。中断时间序列分析将用于评估提供者行为干预对堕胎方法使用的影响。

The proposed research aims to examine the role of stigma in abortion care and method choice in Ghana. Specific research questions include: i) what role (if any) does stigma play in women's choice of abortion method, and their experiences of abortion methods? ii) how do women's experiences of abortion care influence whether and how they experience stigma, and how can stigma within abortion services be measured? iii) how do providers' attitudes to abortion influence abortion method use? iv) How do interventions that aim toinfluence provider attitudes and quality of counselling impact use of abortion methods? The research will employ mixed methods, using a selection of the following approaches. Qualitative research with women and providers, using in-depth interviews, focus groups and observation, will investigate how stigma and perceptions of abortion methods interact. A literature review and thefindings from qualitative research will inform the development of a scale to measure experiences of stigma in service delivery, for future validation using cognitive and expert interviews and client survey data analysis. Analysis of data from the 2017 Ghana Maternal Health Survey will assess characteristics associated with abortion method use, including socio-demographics, abortionmotivations and awareness of legal status. Record linkage of routinely-captured health service data with provider attitudinal surveys will examine associations between provider attitudes and abortion method use. Interrupted time series analysis will be used to evaluate the impact of provider behaviour interventions on abortion method use.