Judy Mandelbaum

Judy Mandelbaum
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JULY 26, 2010 9:59AM

Abortion in Ghana - Where ignorance of the law can be fatal

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Ghana 
Richard Lord / Ipas

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. 

Map of Ghana 

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.

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Comments

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Judy, thanks for continuing to inform and enlighten. (Love the new avatar.)_r
Judy Mandelbaum: Thank you for this vital information; given that 4 percent of women knew abortion was legal, then the 7 percent termination rate is an astounding figure.
Judy, thanks so much for posting this. I am of a generation who remembers in the US that the only way to get a legal abortion was to claim mental illness, defect etc .
I can't say it better than Joan did. Thank you and great avvy.
Judy, this is shocking. My sister has friends in Accra and she confirmed they had no idea this law was passed or that professional medical service was available. So your article has helped reach out and educate across 3 countries! Brilliant article.
Rated
I don't know why anyone would be surprised by this. This is precisely the situation that existed all over North America until the mid to late 70s. My mother was a nurse in the early 60s. She saw a LOT of young women who either died or were maimed because of botched abortions. Some emergency room doctors would refuse to treat these girls when they came in bleeding.

In one horrendous case, the family spent over 24 hours praying over their daughter and lecturing her on her "sin" as she was lying on her bed bleeding. She made it to the hospital just in time to die. This happened in Canada, and was no doubt the case all over the United States as well.

Take this story and this blog post as a cautionary tale. For years, Republicans have been trying to take away all women's right to choose. Not only are abortions more difficult to get all over this country, our kids are being denied the information they need to keep from getting pregnant in the first place.

There are people - and I've met them - who would say that dying from a backstreet abortion is just punishment for having sex in the first place.
When I lived in Haiti, my rural neighbors had very little access to contraception and no money for it, either. The nearest clinic was a long way away. I think many of them tried home methods first.

When you think about it, it requires a lot of health care delivery to provide year-round contraceptive coverage to sexually active women. Assuming sex 2 times per week, that's over 100 condoms.

The average income in Ghana is listed between $500 and $1,500/year. That makes a year's condoms between a fifth and a fifteenth of average annual income. To put that in perspective, that would be between $10,000 and 3,300$ for an American. Or between 33$ and 100$ per condom.

Other than the rhythm method, (which requires good calculation skills, good health, and regular periods, something many poor rural women don't have) all other methods should entail annual check-ups.

Annual check-ups have to be paid for and Ghana has far fewer doctors per population than the US. One fifteenth as many and how many of them practice in rural areas?

So my point is, contraception is not affordable and needs to be subsidized to prevent unwanted pregnancies.
Poppi,
Wow, fantastic!! I hope my blog can help some people!!!

Malusinka,
Condom cost is an excellent point. Clearly any programs that try to restrict the few condoms that are available to people in the developing world are moving in the WRONG DIRECTION.

Everybody else,
Thanks for your comments!
Excellent reporting. Thanks for sharing this important information with the rest of us. R
There is no question of ignorance of law. Real problem of all African countries is lack of education, extreme poverty and unemployment.That is why there is a problem of abortion, Add,child death,and many other difficulties.From last three centuries white people robbed them made them beggar never given them education not started any factories kept them uneducated and poor.
As an Nigerian woman, I never know what to think when I read articles like this. I see them from time to time on progressive websites like Salon, articles about African women and their plight--ravaged with AIDS and sexism that American women haven't experienced since the 'Mad Men' days.

I never know what to think, because these articles always seem unreal. The Africa they write about is an Africa I am only marginally familiar with, and I suppose in some ways that's a blessing, and in other ways a curse.

I guess I always feel that these articles are really disingenuous. Under the guise of sympathy for these 'poor African women,' the authors paint a hellish society where strict religiosity limit women from exercising their 'reproductive rights' and so, they chastise the American reader: "Look, this is what happens in a place where abortion isn't legal. Aren't you grateful it's legal here? Do more about it. " And it doesn't have to be abortion-- sex education, birth control, sex worker rights, and female circumcision also feature prominently in such articles.

But the bottom line is, the authors never seem to really care about these women. In the same way that those stringent pro-life organizations don't really care about the black children who are 'endangered species.' All they want to do is push an agenda, and as usual, Africans are the pawns
Tometome,
I am devastated that you would react to my article this way. Yes, I do see your point - Africans very frequently are used as pawns in a scramble to push various agendas. In my essay, though, the key phrase is "foreign aid programs - whether 'faith-based' or otherwise - that de facto exclude abortion services and condoms are most definitely not part of the solution." My point in this and other articles is to shake Westerners out of their complacency and make them realize that their actions (or their inaction) have consequences. Sadly, using graphic imagery like that used here is the best way to grab them. In my own defense, let me point out that most of my blog entries are pretty graphic - I'm an equal opportunity rabble-rouser.

Point noted and thanks very much for your input - I would like to read more of your point of view, ideally here at Open Salon!
@ Judy,

There's no need to be devestated. It's more the reactions that such articles elicit that irritate me. See Aunt Messy and Patie's comments for example.

More than anything, we just need to remember to check our motives. When it seemed as if all of gay America suddenly cared about Uganda because of that heinous gay death penalty law, for example. Where was the concern about Uganda before? How many so-called progressives could identify the country on a map, for instance?

I think progressives have a tendency to act as if these sorts of blatant, manipulative acts are things only conservatives do. Progressives can be just as exploitative.

We all just need to check our motives from time to time. That's all I'm trying to say.
Thank you for blogging about this topic, Judy. I was shocked by the descriptions of the abortion and it is clear that only those who are truly desperate would even think of undertaking these incredibly painful and risky procedures. Such a tragedy!
This is partly caused by lack of proper education which is the same cause of many other problems. Part of the reason for this is that those in power control the educational institutions and their first priority is often to maintain their own power. They don’t do this by providing the best education possible. The public needs to take more initiative to control the education system.