Making Safe Abortion Services Accessible in Ghana

Society and the Dual Morality

Abortion in the Ghanaian society, regardless of the legal context, is considered taboo. A strong derogatory moral tag is put on abortion to the extent that it is uncommon to find anyone in Ghana openly admitting to having performed or assisted in the performance of an abortion. Yet both legal (presumably safer) and clandestine practices flourish in the country. There appears to be no a shortage of clients, and word on the street in Ghana is that it is possible to get rich very quickly by performing abortions. If the majority of the Ghanaian society consider abortion as taboo and do not want to be associated with it, it is ironic that the practice is so prevalent. A community-based study in Southern Ghana estimated an induced abortion rate of 17/1000 women of childbearing age and 27 abortions for every 100 live births. ⁶ The complications of unsafe abortions make news in the country nearly on a daily basis. Thus, it appears that Ghanaian society is in deep-seated denial and showing attributes consistent with a dual morality. The unfortunate effect of the collective social denial is the blind eye turned by society to the risk faced by affected women when they go backstreet to seek abortion services. The methods and procedures these women go through, examples of which are recounted in Hill et al., ³ are simply unconscionable.

Inequity

One of the often ignored consequences of the present social and legal regime is the level of inequity in access to safe abortion services. For the upper and middle class in Ghanaian society, the process of securing safe termination of pregnancy could constitute just a minor abrasion, as a walk into any of many health facilities with the asked-for-price in hand could be all it would take to secure safe and confidential termination of pregnancy. The situation is dramatically different for the majority of women in Ghanaian society, including school-aged youth, who are caught in the lower class of society and battling with the daily vicissitudes of life. Women in this segment of society are vulnerable to quacks and backstreet practitioners whose actions have been allowed to flourish covertly as a result of a hostile social order and an impassive health delivery system. The practice where law enforcement agencies in Ghana go after backstreet practitioners with intent to arrest continues to be of little help; on the contrary, it is helping to keep the practice in even greater obscurity. The desperate measures taken by affected women, as recounted by Hill et al., ³ demonstrate that in many cases, once a woman has arrived at the decision to terminate a pregnancy, she knows very little bounds. Accordingly, quacks in backstreet practice will continue to be sought after, wherever they can be found and regardless of the legal regime.

The abortion debate in Ghana and other developing countries has gone on long enough, and it is time to put the affected woman at center stage. When a woman has arrived at the decision to terminate a pregnancy, it is only reasonable she is granted the opportunity to do so safely rather than become a statistic in the number of complications and deaths resulting from unsafe abortions.

Way Forward

At present, the statistics of backstreet abortion practices and the attendant consequences are compelling enough to merit a social interventionist approach. The goal should be to break the back of all forms of unsafe practices and, in the process, ensure equity in access to safe services. The tolerance that society shows towards the institution of mitigation measures in support of people in the lower strata of society ought to be extended to cover abortion for women in this segment of society. Safe abortion services ought to be made accessible and free of all restraints, including, where indicated, financial. The status quo, which pushes many women to be exploited by quacks, only for the public purse to be used to remedy the attendant complications cannot be a wise option. It is only by making access to safe abortion a social interventionist strategy that an impression can be made on the practice of unsafe abortion practices in the developing world.

The personal accounts of respondents presented by Hill et al. ³ provide some useful pointers to what could be further done to assist vulnerable women in places like rural Ghana. The surreptitious nature of backstreet abortion practices fits the desire of many affected women to have absolute confidentiality in the termination of pregnancy. In the absence of an approved over-the-counter effective abortificient drug that women can use discreetly, yet safely, the capacity of the health delivery system to offer confidential abortion services needs to be strengthened.

There is also the need to decentralize the capacity within the health system to offer safe abortion services. Primary healthcare facilities need to be equipped to counsel and meet requests for safe terminations of pregnancies once that decision has been taken by the woman. The establishment of safe abortion units within public health facilities in the country has been advocated. ⁷ The category and number of trained health workers able to offer safe and confidential abortion services need to be widened considerably if the objective of decentralizing services is to be achieved. Toward this end, a liberalist interpretation will need to be given the provision in the current abortion law in Ghana, which requires an abortion to be performed by “either gynecologist or registered medical practitioner.” ⁵

While acknowledging that the statistics on abortion-related complications and deaths are compelling enough to justify action to expand the provision of safe abortion services, it ought to be stated, and with even greater verve, that the very high level of unmet need for modern contraceptives, particularly among sexually active adolescents and young women, lies close to the heart of the problem. Efforts at meeting that need should go in tandem with the removal of all barriers to safe abortion services in Ghana and other developing countries.