One of the primary objectives of this study was to examine the proportion of respondents exposed to options counselling before they arrived at a decision on their pregnancy. About (271, 64%) had exposure to a form of counselling whereas (151, 36%) did not. Noteworthy is the fact 84.5% had interactions with significant others before visiting the health facility. In terms of proportion exposed to options counselling, the respondents who were recruited from the NGO facilities appeared to be slightly higher compared to those from the public, although not statistically significant. It would have been expected that all clients would have been aware of options counselling because all the respondents had gone through the processes at both public and NGO health facilities (where counselling is supposed to be part of the care plan) before the interviews were conducted. Could it have been that some respondents went to health facilities having already made up their minds on what they wanted to do with their pregnancies or were they actually not exposed to options counselling as being reflected in the response from the study?
To assess the depth of counselling participants were exposed to; their awareness of the options for the unintended pregnancies was used. The multiple response data set used allowed the respondents to mention all the options they knew. The fact that the awareness of both abortion and parenting was high (40% and 57% respectively) was not surprising but the finding that only 1.9% of the respondents knew of adoption as an option was. This is because all of the respondents were either Christians or Muslims whose religions encourage adoption  and interestingly, about the same percentage mentioned ‘throwing the baby away after delivery’ and selling the child to interested parties as options. It stands to reason that there is a high probability that the options counselling given at the facility is not adequate. In Ghana where there appears to be increasing advocacy on women’s right to reproductive options including choices on pregnancy outcomes, the over emphasis on induced abortion from programmes stance and parenting from religious point of view creates an environment where other options to unintended pregnancies become limited. There is therefore a need to intensify public education on the legal options and available services, available to women carrying unintended pregnancies at any gestational age to make informed choices. In an abortion study in Ghana , it was noted that clarifying the roles and responsibilities of primary care clinicians and providing them with state-of-the-art tools and training in the management of unintended pregnancy is equally important for solving this public health challenge. Another study recommended the need to establish culturally appropriate evidence and competency based clinical guidelines for the prevention and management of unintended pregnancy that can be integrated into primary care and the broader health system and that are built on a comprehensive public health framework for pregnancy prevention that specifies the essential competencies required of all members of the health care team .
In terms of proportion, the 20 years and above respondents appeared to have been less predisposed to getting counselled and the multivariate analysis supported that observation since the odds of exposure to counselling for them was 0.1,95%CI:0.05-0.32 and was statistically significant (p<0.001). It can therefore be said that as one ages, there is less consultation with others in an event of unintended pregnancy. Those in their teens are more likely to access help from others as this might have been certainly a new area in their growth process and require the guidance of significant others. This finding is consistent with those of other studies on decision making for abortion .
Education has been found to play a vital role in abortion decision-making . In this current study, it was noted that increasing education level beyond the basic education confers statistically significant effect on being exposed to counselling. There was almost a seven-fold odds of exposure to counselling when one’s educational level is beyond the basic level. Increasing access to education beyond the basic level is vital for some level of consultation before unintended pregnancy decisions are made. Thus, access to options counselling can be increased through the School Health Programme. This will invariably lead to a better outcome for the unintended pregnancy crisis management and eventually reduce child abandonment, unsafe abortion maternal and neonatal deaths and illnesses.
Occupation as categorized into income earnings did not seem to have statistically significant influence on exposure to counselling even though in terms of proportion, non-income earners were more likely to be exposed to counselling since they may be less economically empowered to deal with the implications of each of the unintended pregnancy outcomes. In the same vein, the actual earnings (in terms of the national minimum wage of 4.6 Ghana cedis, 2013, which was still in use at the time of data collection), also failed to support any predisposition to counselling exposure. In a related study , it was observed that disclosers or nondisclosure of unintended pregnancies did not differ in occupational levels of women seeking abortion services. This shows that where a woman is desperately in need of an abortion service, the level of education does not really matter on options counselling since such women would have already made up their minds on what is best for them at the time with an aim to secure their occupations.
It was being expected that first time pregnancies would rather make more people confused when it was not anticipated and may require significant others to make their decision. Instead, the study found that being pregnant more than once rather increased the exposure to counselling by more than four folds. This observation appears to logically infer that the decisions made on previous pregnancies outcomes might have influenced the current hence need to tread more cautiously by seeking the support of significant others to resolve any pregnancy related challenges. Findings from a study in Holland , for example, shows that following the pill panic in the early 1980s women who visited reproductive health centres reported that they did not know they could get pregnant the first time they had unprotected sexual intercourse and subsequently took contraception counselling more serious as an option to prevent occurrence of future unplanned pregnancies. In the Ghanaian context the introduction of sexuality education in the educational system of Ghana with a counselling component seems to be in the right direction as it will enable young people in school to make informed choices.
Birthing experience also increased respondents’ exposure to counselling by almost three folds. This trend appears to have supported the observations made for gravidity. One other reason for both parous and multigravida women to go for counselling might have been their previous encounter with the health system through their previous pregnancies and can thus more readily locate such resources.
The respondents were about twice as likely to be exposed to counselling, when the pregnancy had travelled past the first trimester, than those within the first trimester. This might be as a result of the women’s initial inability to resolve the pregnancy crisis on their own and needed others to help them. It appears the older a pregnancy gets, the more difficult it is for the women themselves to take an independent decision and therefore resort to others to help resolve it. When juxtapose with the average reporting time of 16weeks, it presupposes that there is the need to give pregnant women more access to quality counselling to bring the best outcomes for the unintended pregnancies.
The study also found that when the perception of pregnancy at conception was in the unwanted category, respondents had an almost seven fold predisposition to receiving counselling compared to those in the mistimed category. It is logical to infer that because respondents do not require having more babies at the time of conception, they were in a more confused state than those with mistimed pregnancies and thus needed significant others to help them resolve the challenges associated with unwanted pregnancies.
All the other socio-demographic and reproductive characteristics of respondents examined did not show any statistically significant associations with options counselling for pregnancy. This observation implies that the health facilities where clients visited at the onset of their unintended pregnancies did not extensively counsel them on all the options available in resolving pregnancy related crises. Also, religion, marital status and average monthly income did not expose them to receiving the required options counselling for unwanted pregnancy. This observation is consistent with the general practice of using induced abortion as a money making venture by some health practitioners. For instance, a former Medical Officer at the Eastern Regional Health Directorate in Ghana, Dr. Joe Taylor once described the pelvis of women as a 'goldmine' where quack healthcare providers are busily making huge sums of money through galamsey (illegal mining) or unsafe abortion . In such situations, options counselling is not really a priority in most facilities that provide abortion services. Rather the focus is to have abortions done on demand and even increase the number of services by setting targets for providers in some reported facilities.