Socio-Demographic Heterogeneity in Cost of Accessing Medication Abortion: Insights from Ghana

Caesar Agula, Regional Institute for Population Studies (RIPS), University of Ghana
Yuliya Kulikova, International Institute for Applied Systems Analysis
Omkar Patange, International Institute for Applied Systems Analysis
Adriana A. Biney, University Of Ghana
Michael Kuhn, International Institute for Applied Systems Analysis
Pearl Kyei, Regional Institute for Population Studies (RIPS), University of Ghana
Patrick Asuming, University of Ghana
Ayaga Bawah, University Of Ghana

This study investigates disparities in the cost of accessing medication abortion (MA) in Ghana, focusing on how MA cost differs based on women's socio-demographic status. Data from 1,974 women who obtained MA pills (Mariprist) from clinics and pharmacies were analyzed. The study estimated MA cost based on the price paid for the pills and time spent at the facility. The average cost was $24.30 at pharmacies and $46.10 at clinics, with notable variations within and between facilities. In clinics, 78% of the cost variation was due to differences between facilities, while in pharmacies, 57% was due to differences within the same facility. Further decomposition analysis using the Blinder-Oaxaca two-fold approach indicates discrimination between clinic and pharmacy clients since over 84% of the cost difference (US$ 21.80) between the two providers could not be explained. Regression analysis revealed that MA cost increased with tertiary education and never having been in a union. Additionally, MA cost increased with clinic access compared to pharmacy access. These findings highlight unequal access to MA, which could result in the use of unsafe methods by vulnerable groups. Developing guidelines targeting MA provision and access could reduce the disparities and ensure more equitable access to MA services.

Keywords: Inequality, Disadvantage and Discrimination, Decomposition analysis, Sexual and Reproductive Health and Rights

See paper.