ABORTION: GHANAIAN WOMEN UNAWARE OF ITS LEGALISATION

INTRODUCTION

In 2007, I was struck by a very sad and inconsolable life-story narrated by a 22 year-old Ghanaian lady called Gloria (probably not her real name) on BBC radio. Listening to the news on my newly acquired radio set on the campus of Tamale Nurses’ Training College (NTC) now Tamale Nurses’ and Midwifery Training College (NMTC), she described how she personally carried out abortion on herself.

According to Gloria, the first method she used were the leaves of a bush plant mixed with “kawa” (a local stone that is used for cooking, etc). She said they ground them together and inserted it into the vagina, adding that that method didn’t work. “We inserted the branch of the bush plant and the blood started coming in about 10 to 15 minutes time”, she indicated.

Gloria's second abortion was barely four months ago, according to the BBC news. First her friend gave her melted sugar with Guinness. No effect. Then 10 paracetemol tablets mixed with local gin, and still nothing. "Finally, we tried a broken bottle mixed with seawater and "Blue", a washing detergent, which we soaked in a cotton cloth and inserted it into my womanhood," she confessed. "By doing that the foetus came. I bled and bled and bled for more than five days."

I listen to this story on the BBC radio when I was in my first year in NTC or NMTC as a student nurse. By then I had no idea of how a complicated case as a result of unsafe abortion could be like, because we (first years) were not assigned to the wards yet. But having read extensively on abortion, the dangers of unsafe abortion and seeing with my naked eyes how victims of unsafe abortion at the gynaecology unit of the Tamale Teaching Hospital suffered in pain, I asked myself whether women are aware that abortion in Ghana is no longer illegal and that one can access it at any recognize medical centre provided they offer such services. I also asked myself whether women who engage in illegal (unsafe abortion) were aware of the consequences ahead of them in their life?

I am concerned because reports say more than 1 in 10 pregnancy-related deaths in Ghana are the result of unsafe abortions. In addition, 13% of Ghanaian women who have had an abortion experience complications resulting from unsafe procedures, and fewer than half of them received the needed follow-up care. These statistics are all remarkable because Ghana is one of the few African countries where abortion is legal under fairly wider justifications, and abortion performed by a qualified medical professional under proper conditions is an extremely safe procedure.

WHAT IS ABORTION?

I asked my research assistant, Mr. Joseph Ziem to define abortion and he said, “Abortion is the murder of an unborn child either through orthodox or unorthodox means”. “I think you’re correct”, I said to him and laughed jokingly.

Abortion is actually the expulsion of the uterine content before the twenty-eighth week of a pregnancy. This can occur spontaneously (naturally) and commonly known as miscarriage. On the other hand, it can also be induced (intentional). This can be done legally in some instances and illegally in other instances.

CAUSES OF ABORTION

The causes of abortion occur, base on two factors; Maternal and Foetal.

Some maternal factors are; uterine abnormality, example fibroid, ovarian tumour, malformation of the uterus, cervical incompetence, etc. This results in poor accommodation for the foetus as it grows. Endocrine imbalances such as hyperthyroidism and diabetes cause decrease production of progesterone and congenital malformation thereby resulting into abortion. Also, the intake of certain drugs during the first trimester of pregnancy, maternal malnutrition, blood group incompatibility between mother and child, psychological factors among others can lead to abortion.

The foetal factors include chromosomal abnormalities and it accounts for 60% of abortions. Besides, poor implantation of the ovum leads to easy detachment with the least uterine stress and also, placental diseases can result into poor placental functioning which lead to abortion.

TYPES OF ABORTION

Spontaneous abortion, missed abortion, threatened abortion, inevitable abortion, safe/legal abortion and unsafe/illegal abortion. Other types of abortion are Septic abortion, incomplete, complete, habitual or recurrent, cervical abortion, etc.

LACK OF AWARENESS OF ABORTION LAW

Even though there is a law in Ghana to ensure that women gain access to abortion services without too much hindrance and with less complications, it still appears that most women are unaware of the existence of such a law. They make the hospital their last resort when they do not succeed in their attempt to cause abortion through unsafe procedures. Among the many types of abortions mentioned earlier, it is realized that illegal abortion is more life threatening. This is because it is done by unqualified (quack) persons who lack knowledge and skills to do this but use different methods to carry out this procedure depending on the age of the pregnancy. Besides, the environment in which this procedure is carried out is not satisfactory as infection can be introduced during the procedure. There are also no contingency measures put in place to resuscitate the patient in case her condition is deteriorating in the process of the procedure. These are some of the reasons why this type of abortion is not advisable. Some people also take concoctions as a way of inducing labour to expel the uterine content. One may expel the foetus but not the placenta.

As in most of Africa, abortion had been banned in Ghana for many years. However, all that changed all of a sudden when a new abortion law was passed in the country’s parliament. The passage of the law received a sharp rebuttal from various religious groupings but medical experts thought it was and is still appropriate. “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.”

"Abortion in Ghana," a new report released few weeks ago by the New York-based Guttmacher Institute brings together data from various studies, including the 2007 Ghana Maternal Health Survey (GMHS), to present what is known about abortion in Ghana, including information on incidence, abortion providers and the procedures they use, and the characteristics of women having abortions.

A major factor contributing to unsafe abortion in Ghana is that only 4% of women surveyed in 2007 were aware that abortion is legal under fairly broad grounds. Unaware that they can legally obtain a safe abortion procedure, many women turn to unsafe providers/procedures. Women also face other barriers to accessing safe abortion services, including high cost, a limited number of qualified abortion providers and concerns about social stigma.

According to the 2007 GMHS Survey, at least 7% of all pregnancies in Ghana end in abortion, and 15% of women aged 15–49 admitted to having had an abortion. Abortion rates were highest among 20–24-year-olds, educated and wealthier women, and those living in urban areas. According to the same survey, just over half of the women (57%) who admitted that they had had an abortion sought a doctor to perform the procedure, while most others turned to pharmacists or traditional midwives to induce abortion. Almost 1 in 5 women induced the abortion themselves or had the help of a friend. The most common reason women sought an abortion was not having the financial means to take care of a child. Other frequently reported reasons included wanting to delay childbearing or complete school.

The situation in fact calls for serious efforts to increase awareness of the law, combined with better access to family planning services to radically reduce deaths and injuries, and improving the lives of women and families in Ghana.

More than a third of all pregnancies in Ghana (37%) are unintended. This high level of unintended pregnancy is due to the fact that many women who do not want to become pregnant are not using an effective method of contraception. It is estimated that 35% of married women who wish to avoid pregnancy are not using a method of contraception—a much higher proportion than the average level of unmet contraceptive needed in the African continent as a whole (22%).

In order to save women's lives and improve maternal health, government should increase access to family planning services and counseling in all health institutions nationwide, improving education for young people in our schools and communities about reproductive health, including about the risks of unprotected sexual intercourse and strategies for preventing unintended pregnancy; and increase public awareness about Ghana’s abortion law.

CONCLUSION: Illegal abortion can end ones life within a matter of seconds, and if for any reason you have to abort a pregnancy, do not hesitate to go to a recognized hospital or clinic for counseling and proper services. Remember, an illegal abortion done once can make you barren all your life. Say no to illegal abortion and save your uterus. “Prevention is better than cure” protect yourself if you think you don’t want a pregnancy.

Veronica T. Doohana (NSP Nurse) & Joseph Ziem (Journalist)

Tamale-Northern Region

Ghana- West Africa

Email: verndoo@yahoo.com or ziemjoseph@yahoo.com