Abortion in Ghana - Where ignorance of the law can be fatal
You’d think sub-Saharan African women had enough to worry about, but a new study by the US-based Guttmacher Institute reveals that botched back-street abortions are claiming a large number of lives in Ghana – even though abortion, while nominally banned, is actually legal in many cases. According to the report, “more than one in 10 maternal deaths (11%) are the result of unsafe induced abortions. In addition, a substantial proportion of women who survive an unsafe abortion experience complications from the procedure.”
As in most of Africa, abortion had been banned in Ghana for many years. That all changed a quarter of a century ago when a new abortion law passed the country’s parliament. “The abortion law in Ghana, enacted in 1985, states that an abortion performed by a qualified medical practitioner is legal if the pregnancy is the result of rape, incest or ‘defilement of a female idiot;’ if continuation of the pregnancy would risk the life of the woman or threaten her physical or mental health; or if there is a substantial risk the child would suffer from a serious physical abnormality or disease.”
According to figures from the Ghana Maternal Health Survey, 7 percent of pregnancies are terminated by abortion, and 15 percent of women aged between fifteen and forty-nine have undergone the procedure. In 2006 the GMHS issued “guidelines for comprehensive abortion care, including counseling and the provision of contraceptives; [they] define mental health conditions that could qualify a patient for an abortion; and call for expanding the base of abortion providers by authorizing midwives and nurses to perform first-trimester procedures.”
The decision to abort a fetus is always tragic for all concerned, and nowhere more so than in a profoundly religious society like that of Ghana. And yet, 40 percent of all pregnancies in Ghana are unwanted. The reasons Ghanaian women give for ending such a pregnancy, despite the profound social stigma involved, include insufficient financial means to care for a child (21 percent) and the need to continue working (9 percent). In 6 percent cases, women cite partners who either reject the child or deny paternity.
Remarkably, hardly anyone in Ghana is even aware of the 1985 abortion law. The GMHS discovered that as of 2007 only 4 percent of women knew that abortion was legal. Among educated women, i.e. those with a high school education and higher, the figure was a mere 11 percent. As a result, relatively few women go to a hospital or clinic to have the procedure performed. Even more surprisingly, in one clinic surveyed only half the personnel was aware that abortion was legal.
According to the GMHS, 57 percent of Ghanaian women turned to a doctor to perform their abortion, whereas 16 percent sought a pharmacist and 19 percent either turned to a friend or relative or performed the abortion themselves. 4 percent went to traditional practitioners and 3 percent turned to nurses or midwives. This trend is clearly an improvement over the results of a study from southern Ghana made in 1997/98, where it appears that only 12 percent of women seeking an abortion turned to physicians, while two thirds went to untrained practitioners. Sadly, this is hardly a surprise. In an earlier report, the Guttmacher Institute found that of the 5.6 million abortions performed across Africa in 2003, only 100,000 occurred under safe conditions.
Illegal back-country abortions can be harrowing. In 2007, a 22 year-old Ghanaian woman called Gloria described her own self-abortion to BBC Radio:
"The first method I used were the leaves of the bush plant mixed with kawa, a local stone… We ground them together and inserted it into the uterus.” But that method did not work and in a small, quavering voice, Gloria said: "Then we inserted the branch of the bush plant and the blood started coming in 15 minutes."Gloria's second abortion was only four months ago. First her friend gave her melted sugar with Guinness. No effect. Then 10 paracetemol tablets ground up with local gin. Still nothing. "Finally, we tried a broken bottle ground up with seawater and "Blue", a washing detergent, which we soaked in a cotton cloth and inserted into my womanhood," she confessed. "By doing that the foetus came. I bled and bled and bled for more than five days."
Severe complications from botched procedures are rampant in Ghana and treatment is scanty. “Of women who experienced a problem following their abortion, 41% received no treatment. Almost half (47%) of women with a problem received antibiotics, and 19% received an unspecified treatment.” Ghana clearly has a long way to go to provide its women with comprehensive reproductive healthcare, and it should be obvious to everyone by this time that foreign aid programs - whether "faith-based" or otherwise - that de facto exclude abortion services and condoms are most definitely not part of the solution.
In order to close the healthcare gaps so painfully highlighted in this and other reports, the Ghanaian government is focusing on a four-prong program:
- Address unmet need for contraceptives and barriers to contraceptive use
- Educate young people in the areas of reproductive health and safe sex practices
- Raise awareness about Ghana’s abortion law in order to reduce the number of women seeking abortions from unconventional practitioners
- Conduct more research on women’s living conditions and on the cost-benefit ratio of unsafe abortions and improved reproductive health measures
Unsafe abortions are by no means the only problem facing Ghanaian women. According to USAID, the AIDS prevalence among the country's 23 million population stood at 2.3 percent in 2005 and is regarded as stable, which is something of an African success story. Some 320,000 people in Ghana are HIV positive. But by making advances in these areas, Ghana and other countries in sub-Saharan Africa can reduce at least some of the challenges facing women in an economic and social environment that is already challenging enough as it is.
For more on reproductive healthcare in Ghana and elsewhere in the world, check out the Guttmacher Institute website.