Article Text

Download PDFPDF
Three Delays Model applied to prevention of unsafe abortion in Ghana: a qualitative study
  1. Mercy Nana Akua Otsin1,2,
  2. Angela J Taft1,
  3. Leesa Hooker1,3,
  4. Kirsten Black4
  1. 1 Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
  2. 2 Health Administration and Education, University of Education, Winneba, Ghana
  3. 3 La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
  4. 4 The Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Mercy Nana Akua Otsin, Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia; mercyotsin{at}


Background Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women’s experiences and access to induced abortion care.

Methods We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.

Findings The first delay (in seeking care) occurred because of women’s poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women’s homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals’ non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.

Conclusion This study has shown the value of the Three Delays Model in illustrating women’s experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.

  • qualitative research
  • abortion
  • induced

Data availability statement

No data are available. Not applicable.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available. Not applicable.

View Full Text


  • Contributors MNAO designed and collected data for the study. Data were analysed by MNAO with input from all authors regarding interpretation of the results. MNAO prepared the first draft of the manuscript. All authors contributed to revising the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement statement No patients or members of the public were involved in this study

  • Provenance and peer review Not commissioned; externally peer reviewed.