Determinants and dynamics of repeat unsafe abortion in Ghana—a mixed-method study at Tema General Hospital

Background Unsafe abortion remains a significant driver of maternal morbidity and mortality in Ghana. Despite progressive policies, many women continue to bypass safe clinical pathways. This study aims to identify the socio-demographic factors and qualitative dynamics associated with repeat unsafe abortion among women presenting with unsafe abortion complications at Tema General Hospital. Method The study targeted women aged 15–49 years who were admitted for complications arising from unsafe abortions. A total of 68 women participated in the analysis, providing both quantitative and qualitative data. Quantitative data were analysed using Fisher's exact and Chi-square tests for bivariate associations, followed by Firth's penalised logistic regression to identify independent predictors. Simultaneously, qualitative semi-structured interviews explored the underlying motivations and personal dynamics behind termination decisions. All statistical analyses were performed in R, with a significance level of 0.05. Results Age at sexual debut was the strongest independent predictor of repeat unsafe abortion, with over 14-fold higher odds among women who debuted at 15–19 versus later (AOR = 14.35, 95% CI: 2.30–170.29, p  = 0.003), corroborated by qualitative accounts of early, unplanned pregnancies. Higher education showed a non-significant protective trend (AOR = 0.28, 95% CI: 0.05–1.06, p  = 0.062), echoed in accounts of “recovery literacy” among educated women. The model explained 47% of the variance in repeat-abortion status (pseudo-R 2  = 0.466). A widespread sense of “unpreparedness,” linked to financial instability and partner unreliability, led 70.6% of participants to rely on informal networks for at-home misoprostol, often unaware of complications. Conclusion These findings underscore the urgent need for interventions to address the high rates of unsafe abortions in Ghana. There is a need for improved sexual education, promotion of contraceptive utilisation, and providing accurate information about safe and legal abortion options.