The model is a client centered interventional model built to drive voluntary informed consent to contraception that will prevent early unintended pregnancies and multiple induced abortions. The model is driven by two variables a) Post Abortion Contraception (PAC) drivers and b)determinants of PAC uptake in health facilities. The PAC drivers hinges on individual decisions on PAC and commences with Contraception Options Counselling before, during or after an induced abortion. During these period a client is counselled in relation to her reproductive intentions, medical eligibility and preferences for PAC.

Following a successful counselling then leads to determinants of PAC uptake in health facilities which goes beyond successful counselling in a health facility to involve determinates of PAC (i.e products, pricing, placement, promotions and people) as key factors that have to be well balanced to ensure access to the desired PAC services of choice (Figure 1).

Public health estimation from the World Health Organization (WHO) indicates that, globally, close to 20 million unsafe abortions occur each year, with about 95% of these abortions being done in developing countries. This accounts for almost 80,000 abortion related complications annually leading to about 13% of all maternal deaths in the world, 6. Although these deaths are preventable by contraceptive use, about 123 million people, particularly in developing countries, are not using contraceptives, for various reasons 7.

Although many countries have incorporated Post abortion counseling into post abortion care services to decrease unwanted pregnancies and induced abortions 8 the low uptake of contraception following an induced abortion and its associated consequences remains a public health challenge in Ghana and other developing countries hence the development of an innovative client provide centered model to address the challenge.

Post Abortion Contraception uptake Model (The Gbagbo’s Model) was developed as an interventional model to enhance uptake of contraception following an induced abortion (medical or surgical) in Ghana. The model was based on three identified drivers of post abortion contraception (i.e. Reproductive intentions, Medical Eligibility and contraceptive Preferences of clients). These variables were predominantly driven by clients because they were specific to clients’ needs at the time of Post Abortion Contraception decision making. Because abortion services in Ghana are only legally permissible in registered health facilities 9, the study looked at key determinants of Post Abortion Contraception uptake in health facilities and found that issues relating to products, pricing, placement, promotion and people/service providers contributed significantly to arriving at a decision for Post Abortion Contraception. With regards to product issues, it was observed that most young people have misconceptions about family planning hence there was a need to rebranded post abortion ‘family planning’ as post abortion ‘contraception’ to demystify young people’s perceptions of family planning to increase their acceptance to contraception. Following this was clients’ concerns about cost of abortion services of which an additional cost of contraception was deemed high.

To address this challenge, the cost of Post Abortion Contraception following an abortion was integrated into the costs of induced abortion services to ensure a one stop shop service, thus it becomes a package hence a client would not have to pay extra for contraception after paying for an abortion. The issue of client follow up visits and missing up on clients review appointments after 14days were also considered hence the concept of placement evolved there by making voluntary and immediate Post Abortion Contraception services a key quality indicator of percentage of abortions provided in all health facilities. To avoid the risk of forcing or cohesion of clients to meet this quality indicator lead to the concept of promotion where options counseling on Post Abortion Contraception and informed consenting before the abortion services is encouraged. A comprehensive abortion care service requires skilled, knowledgeable and competent service providers hence the model considered people who will provide the required Post Abortion Contraception services as required. To achieve this, the model considered capacity building and technical update on Post Abortion Contraception to all service providers as very important activity to enable quality and safe services that meets clients’ satisfaction.

The model identifies itself with the statement: “If the woman we treat for…abortion…is there because she could not get contraception, we have failed her. If she leaves without family planning we have failed her twice.” [1994, Post abortion Care (PAC) Consortium, International Conference on Population and Development (ICPD), Cairo]. In relation to this, the study observed that performance management processes and rewards that emphasize the importance of PAC in facilities encourage actions that improve uptake of PAC. Additionally, rebranding PAC, integrating PAC as a package for abortion care, making PAC a major quality indicator of safe abortion and capacity building of service providers on contraceptive updates is key for PAC uptake.

Place where respondent had the last abortion_____________________________

Code for respondent:________________________________________________

Code for Interviewer:_ ______________________________________________

Medium of communication during the interview__________________________

Interview Date:_____________________________________________________

A). Background Characteristics of Respondents After Abortion

^{I would like to ask you a few questions regarding your background. Please feel free to answer the following:}

^{I would like to ask you a few questions regarding your background at the time of having your immediate past abortion. Please feel free to answer the following:}