Bringing medical abortion closer to women: Accuracy of women’s dating of gestational age using the gestational wheel in Ghana
Awarded 2013
Large Research Grants
Kristen Shellenberg, PhD, MPH

Objectives: The objective of this study was to determine the proportion of women, presenting for an abortion, who could accurately determine whether their pregnancy was <13 or >=13 weeks gestation using a gestational wheel. Methods: We conducted a cross-sectional study with women attending four facilities in Ghana. Interviewers administered a questionnaire and then women were seen by a provider who assessed gestational age (GA) via bimanual exam. Descriptive statistics are presented for women’s recall of last menstrual period (LMP) and use of the wheel. Using the providers’ clinical dating as a reference, we calculated the proportion of participants who accurately determined that their pregnancy was <13 or >=13 weeks using a gestational wheel. Results: Our final sample size was 780 with a participation rate of 98%. Twenty-eight percent of respondents used the wheel without verbal instructions. The other 72% were provided with verbal instructions after trying to complete the task on their own. Sixty percent said the wheel was easy to use. Overall agreement for GA between women and providers was 95% (94% agreement GA < 13 weeks, 1% agreement GA >=13 weeks). The remainder of women fell into a “low risk disagreement group” and a “high risk disagreement group,” 1% and 4% respectively. Conclusion: With either no or simple step-by-step instructions, almost all women were able to use a gestational wheel to date their pregnancies. This simple tool may aid women in the safe use of misoprostol in the community, a harm reduction strategy to decrease morbidity and mortality from unsafe abortion.