March 14, 2013
ACCRA, GHANA – Naa, a 20-year-old woman, says she almost died five years ago from a self-induced abortion in her home in La, a slum of Accra, Ghana’s capital. She declined to publish her last name to avoid stigma in her community.
When she was 15, she realized she was two-months pregnant. She was in her final year of junior high school and worried the school administration would expel her if they found out.
“My dream was to go all the way to the tertiary level and get a good job so I can take care of my mother and sister,” she says. “I knew I couldn’t do that with the pregnancy.”
Because she is the firstborn, it is her responsibility to take care of her family, she says. So she got a bitter, herbal concoction from some friends and took it to abort the fetus.
After drinking it, she says she felt abdominal pains and began bleeding. Her mother found her less than an hour later when she came home. She rushed her to the hospital, where the doctor aborted the fetus in order to save her life.
“I nearly died taking in those herbal concoctions,” Naa says. “I thank God my mother came home early from work that day.”
Naa was able to stay in school, but she says she performed poorly in her final exams. She could not concentrate in class and was not punctual because other students made fun of her and made comments about her abortion.
She completed junior high school and managed to attend a low-ranking senior high school. After finishing high school, she was not accepted into tertiary school.
She says she had been an average student before her abortion. She blames the abortion and social stigma attached to it for her decline in performance.
Today, she still does not know that abortion is legal in Ghana under certain circumstances or that there are safe methods for abortion available in those instances. If Naa has another unwanted pregnancy, she says she would still resort to an unsafe abortion.
Doctors say young women in Ghana resort to self-induced abortions because they and even local police and health care professionals are unclear on abortion laws. Young women and doctors also fear cultural stigma in their communities and from health care providers who disapprove of even safe and legal abortion. Several organizations are educating police officers, health care workers and other stakeholders on the law. Some doctors say self-induced abortion is decreasing as a result, but others say it continues to fuel maternal mortality.
Abortion is legal in Ghana if the pregnancy risks the mother’s life or injury of her physical or mental health. It is also legal if the pregnancy resulted from rape, from incest or from defilement of a mentally disabled woman. The third legal condition is if the child may suffer from, or later develop, a serious physical abnormality or disease. Abortion in these cases is legal only if qualified health personnel perform the procedure in a registered health facility.
A 1985 law clarified and expanded on the specific circumstances under which abortion is legal in Ghana. The Ministry of Health and Ghana Health Service, an autonomous public service agency under the ministry, developed protocols in 2006 to ensure the safe provision of legal abortions.
Yet less than 4 percent of women ages 15 to 49 who said they had never had an abortion knew that it was legal under these circumstances, according to the 2007 Ghana Maternal Health Survey. Nearly 87 percent said they thought they could not legally obtain an abortion.
The survey attributed more than 10 percent of maternal deaths of women ages 15 to 49 to unsafe induced abortions.
Unsafe, homemade methods to induce abortion include drinking herbal concoctions, bleach or ground-up glass, according to several medical sources and nongovernmental organizations. Other young women may insert sticks or a small “Chorkor” bomb into their private parts.
When the bomb explodes, it tears open the vagina, says Dr. Maurice Ankrah, an obstetric gynecologist at La General Hospital in Accra. Although most women survive, they are unable to enjoy a healthy sex life.
Girls learn about these methods from their peers, according to Ipas, a global nongovernmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion.
Women resort to self-induced abortions because they don’t know that abortion is legal in some circumstances, says Dr. Patrick Aboagye, deputy director of the Reproductive and Child Health Department, a unit under the Family Health Division of the Ghana Health Service.
“There is still fear in the public domain that abortion is illegal, so people are afraid of going to the hospital, lest they be reported to the police,” Aboagye says.
Even authorities, including physicians and police officers, have been unclear on abortion law, says Dr. Samuel Otu-Nyarko, the director of public health in the Ghana Police Service.
“The police enforce laws,” Otu-Nyarko he says. “However, unfortunately because most of them did not know about the law on abortion, they were arresting health providers and women who were doing abortion legally and leaving those who were doing it illegally.”
Joel Akwetey, president of the Federation of Ghana Medical Students Association, says he first learned about abortion law in May 2012.
“I personally did not know that abortion was allowed in this country until Ipas came to train us,” he says.
Even with awareness, people still may not accept it.
“I found it difficult to accept this in the beginning because it just did not seem right,” he says. “I am a Christian, you know? I think the more people understand that abortion is a human rights issue, the more they will accept it, though I know it will be difficult.”
But stigma is currently strong. Young women fear judgment from society when seeking safe and legal abortion services, Otu-Nyarko says. This pushes them to resort to unsafe means to abort pregnancies.
Cultural stigma often prevents girls and young women from pursuing safe abortion services, says Makafui Attipoe, the clinic records officer of Planned Parenthood Association of Ghana, a nongovernmental organization affiliated with the International Planned Parenthood Federation. Some women, especially young women, do not come to the health facility because they are shy and fear health providers will morally judge them.
Edmund Agbeve, 27, says they have reason to fear. He says that 13 years ago, his 14-year-old friend and neighbor attempted abortion by drinking an herbal concoction. She bled to death because health care providers refused to help her, his neighbors told him.
“I was very angry when I heard the nurses on duty that day failed to attend to her because she attempted an abortion,” Agbeve says. “She bled to death when they could save her life.”
Social stigma is prevalent in the health care industry, Aboagye says. Some health care providers refuse to offer abortion services based on their moral views.
“The main challenge in providing comprehensive abortion care services has been providers who do not approve of abortion, especially when they are the managers of the health facilities,” Aboagye says.
Otu-Nyarko says health professionals who perform abortions face stigma from their communities and even from their medical peers.
“If you come out to say abortion is legal and that the woman has a right over her own body and the right to decide what is good or bad for her, you are stigmatized,” Otu-Nyarko says.
Ankrah says he is called the “abortion doctor” even by his own medical colleagues for offering safe and legal abortion services.
Nongovernmental organizations, such as Ipas Ghana, Marie Stopes International and Pathfinder International, arrange workshops and community outreach programs to train health professionals on safe abortion procedures. They also educate pharmaceutical professionals, human rights advocates, police officers, local leaders and other stakeholders on abortion law.
Ipas Ghana, the country branch of the international organization, trained 3,000 new recruits at the Ghana Police Service training school in 2011 on the abortion laws before they became police officers. The Ghana Police Service administration approved this training in line with the service’s responsibility to save lives, Otu-Nyarko says.
“We are currently focusing on reversing the trend,” Otu-Nyarko says, “so that we protect those who are providing safe abortion services legally and arresting and prosecuting those who are doing it illegally.”
Meanwhile, the Ghana Health Service is targeting state health care professionals by training all its workers on the issue, Aboagye says.
“What we have done is that in any facility that we introduce the comprehensive abortion care services, there is an orientation for all the health workers,” he says. “They counsel the patients who come seeking abortion.”
The Planned Parenthood Association of Ghana clinic is open to the public and provides sexual and reproductive health information, services and counseling.
Although there are no official statistics, the number of women accessing safe abortion services is increasing, Aboagye says. Meanwhile, the number of women suffering complications from self-administered abortions is decreasing.
“Anecdotally, we are seeing that those gruesome complications have significantly reduced,” he says. “I said anecdotally because we haven’t really done any research to confirm that.”
But during a stakeholders review meeting organized by Ipas Ghana during December 2012 in Accra, Dr. Koma S. Jehu-Appiah, Ipas Ghana’s country leader, said more needed to be done to encourage safe abortion procedures.
“The women are dying, and we are doing nothing about it,” Jehu-Appiah said. “We are talking about it because we do not want the women to die. Refusing women access to comprehensive abortion care services leads them to quack doctors.”