Unsafe abortion continues to be a major public health problem in Ghana. It accounts for 22-30% of the maternal mortality in the country. Although Ghana is one of the countries in sub-Saharan Africa with a liberal abortion law, access to safe, legal abortion in public health facilities is limited. Women with unwanted pregnancies resort to unsafe abortion with the resultant heavy toll on their health and lives. This study set out to understand the barriers to and opportunities for improving access to safe, legal abortion services in Ghana. The study employed in-depth interviews with key stakeholders and analysis of relevant documents with a view to unravelling different dimensions of the problem for a deeper understanding of the situation. Key findings included the observation that Ghana's abortion law is relatively liberal but has gaps and inconsistencies making it liable for misinterpretation. There is need to provide safe, legal services; evaluation of these services might help to improve the law. Two main barriers confront provision of safe abortions: the service-related barriers constitute legal and policy ambiguities and inconsistencies, provider attitudes and lack of training. Important socio-cultural barriers were cultural values, social norms, moral and religious objection which create dilemmas in professional practice. Midwives were found to be conservative and reluctant to provide comprehensive abortion care. Most respondents, including religious people, saw `medical grounds' as legitimate for comprehensive abortion care. Medicalising abortion may help lift it out of the moral/religious sphere in people's minds, and therefore make it more acceptable. In conclusione, fforts shouldb ea imeda t future law reformt o takec areo f its current ambiguities that challenge application. In the short term, it would be better to sensitizem edicalp ractitionersto the flexibility of the law. It is essentialf or the GhanaH ealth Servicet o assisth ealthp rovidersa ndk ey stakeholdertso re-examine their values and change their attitudes towards abortion care to ensure that legal abortions are provided in public hospitals to help women in need of the services.

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The termination of pregnancy (TOP) is one of the most commonly performed gynaecological procedures in England. Despite the prevalence of the TOP procedure, limited research to date has investigated male partner's experiences of a TOP. The aim of the present study was to investigate the mood and effect experienced by men accompanying their female partner to a TOP. Additionally, factors influencing male partner's experiences of a TOP were also investigated; namely hegemonic masculinity and social roles. A combined qualitative and quantitative approach was used to address the research questions. Participants were 63 men accompanying their female partner to a TOP on a gynaecology day ward. Men completed questionnaire packages including self-report measures of their mood, affect and masculinity. Participants were invited to write responses to open-ended questions regarding the reasons for adopting specific roles, and experiences of the NHS environments. The most commonly reported feelings experienced by male partners were tired determined and strong. Participants did not experience significant levels of depression; levels of anxiety experienced were somewhat higher. Results suggest that men do not experience a TOP as an entirely negative procedure. Participant's experiences highlighted the confusion as to a clear role to be adopted. Men who adopted the role of 'Bystander' were more anxious. Being emotionally in control was considered a positive masculine characteristic when accompanying a female to a TOP. Clinical and theoretical implications are discussed, in terms of understanding the experiences of men, improving service delivery and contributing to the existing body of TOP research.

Cette thèse de doctorat vise à combler un vide historiographique en proposant une synthèse sur l’avortement en France à l’époque moderne. Pratique interdite, confinée au secret, elle apparaît pourtant dans de nombreuses sources. Il s’agit tout d’abord d’interroger les discours sur l’avortement afin de comprendre les conditions de possibilité d’une telle pratique. L’avortement est, à cette époque, un terme polysémique, employé dans des contextes variés. Dans le champ médical, on s’interroge sur l’animation du fœtus, sa viabilité ; dans le champ juridique, il n’est pas distinct de l’infanticide, mais cette indistinction pose problème aux juristes. Et pour la première fois en 1791, le code pénal en fait un crime spécifique. Ce travail analyse cette évolution en questionnant les différents discours dans des domaines qui s’entrecroisent : médecine, droit, théologie. Cette thèse s’intéresse donc à la criminalisation de l’avortement volontaire mais aussi à la façon dont s’organise sa répression. En effet, l’avortement apparaît dans les archives judiciaires mais toujours associé à d’autres crimes, dans le cadre de procès pour « recel de grossesse et suppression de part », ou encore dans le cadre de l’affaire des Poisons à Paris à la fin du XVIIe siècle. Ce travail interroge les difficultés posées par la répression de l’avortement volontaire, ainsi que les biais engendrés par cette association à d’autres catégories criminelles. Cette étude porte enfin sur les pratiques elles-mêmes et appréhende l’avortement comme un phénomène social. Ce travail privilégie une approche par les acteurs/trices en s’intéressant aux femmes qui avortent et aux relations à leur entourage : mari ou amant, parents, etc. Une attention particulière est également portée à la question du secret, de la rumeur et de la dénonciation dans des communautés villageoises et urbaines, et enfin aux personnes à qui elles s’adressent pour avorter, aux savoirs sur l’avortement, à l’accessibilité de ces savoirs ainsi qu’à leur transmission. / This PhD thesis aims at filling an historiographical void by proposing an overview of abortion in early modern France. Though it is a secret and forbidden pratice, abortion appears in many sources. First, this work questions speeches about abortion in order to understand the conditions that enable its existence. At this time, abortion is a polysemous word that is used in a wide range of contexts. In the medical field the animation or viability of the fœtus generates multiple debates. Abortion is considered as a crime, but not separated from infanticide in the Law, which raises multiple questions. And for the first time in 1791, the penal code considers abortion as a specific crime. This work analyzes this evolution by questioning different speeches held about abortion in different but connected fields : medicine, theology, law. Consequently this thesis analyzes the criminalization of abortion as well as its punishment. As a matter of fact, abortion appears in judicial archives but is always associated with others crimes – in trials for « suppression de part et recel de grossesse », or in the context of the repression of poisoners led by the police in Paris since the end of the XVIIth century. The repression itself presents difficulties that this work analyzes, as well as the bias generated with its connection to other criminal categories. This study finally deals with the practices themselves and examines abortion as a social phenomenon. I mostly consider the actors and actresses of abortion and specifically the women who abort and their relatives (husband or lovers, parents, etc.,). I also pay special attention to secret, rumor and denunciation in the context of urban and rural communities, and finally to the persons women solicit to get an abortion, to knowledge, to access to this knowledge as well as its transmission.