Who pays more? Exploring cost disparities in medication abortion access across socio-demographic groups in Ghana

Medication abortion (MA) may be accessed covertly in private pharmacies and clinics due to abortion-related stigma. Stigmatization may lead to information asymmetry, resulting in price discrimination. The existing literature on abortion in Ghana has primarily focused on factors associated with abortion stigma. However, the potential variations in MA cost have not been explored. Thus, we aim to explore the potential disparities in MA cost based on women's socio-demographic status in Ghana.

We used data from a study that recruited women who accessed MA using mifepristone and misoprostol combination from selected private pharmacies and clinics in Ghana. The study employed a non-inferiority and prospective design, and women were recruited as they exited the selected facilities after obtaining the MA pills. Our final analysis included 929 pharmacy clients and 1,045 clinic clients. To understand the variability in MA cost, we initially conducted two decomposition analyses using the variance and Blinder-Oaxaca techniques, followed by linear regressions to identify the socio-demographic factors that predict MA cost.

The average costs of MA were approximately US$ 46.00 and US$ 24.00 for the clinic and pharmacy groups, respectively. Additionally, the cost varied between pharmacy and clinic groups and within each group. A greater segment of the variation among the clinic group stemmed from between facilities (78 percent), whereas, among the pharmacies, the bigger share came from within facilities (57 percent). Regression results further indicate that the cost of MA increased among women with higher education, those who have not been in a union with a partner and those who accessed MA in clinics.

MA cost in Ghana is largely based on providers' discretion and at the facility's management level. Additionally, the cost differs by women's socio-demographic attributes. To reduce the disparities in MA costs, developing guidelines to address the health system challenges regarding MA provision and access is important. Educational programs on MA access, provision and legal framework could also reduce abortion-related stigma and cost variations.