Among African nations, which have some of the world’s most prohibitive abortion laws, Ghana has one of the continent’s most progressive abortion laws. Since the 1985 reform of the criminal code, the law permits abortion if the pregnancy is the result of rape, incest or “defilement of a female idiot”; if the pregnancy threatens the woman’s physical or mental health; or if there is substantial risk that the child would suffer from a serious deformity.

However, a progressive law does not guarantee implementation of women’s access to abortion services. Safe abortion was not integrated into the national reproductive health policy until 2003, despite postabortion care being an accepted routine service for women who had attempted unsafe abortions. Although the Ghanaian reform occurred decades ago, unsafe abortion still endangers the lives of women and girls who have unintended pregnancies.

Ghana has one of the highest maternal mortality rates in the West African region, with 540 deaths per 100,000 live births. According to the World Health Organization (WHO)and UNICEF estimates, a Ghanaian woman has a one in 35 chance of dying from a pregnancy-related cause during her lifetime. According to several hospital-based studies, it is estimated that complications from unsafe abortion are a factor in 22 to 30 percent of maternal deaths, significantly more than the World Health Organization’s global estimate of 13 percent.

Unsafe abortion is prevalent among women of all ages in Ghana, where only 13 percent of women of reproductive age use modern methods of contraception. But adolescents and young women, often unable to access or afford reproductive health services, are particularly prone to suffering injuries or dying from botched abortions they self-induce or procure from an unskilled provider.

Today, Ghana faces the challenge of implementing the existing abortion law to the fullest extent possible to preserve women’s health and lives. In 2006, the Ghana Health Service, in collaboration with Ipas Ghana, the WHO and other stakeholders, released safe abortion standards and protocols. Those guidelines outline the principles of comprehensive abortion care, which includes nonbiased counseling and provision of postabortion contraceptives to reduce the chance of repeat unintended pregnancies.  

With the standards and guidelines in place, Ghana will define the mental-health conditions that could qualify a woman for an abortion; create referral mechanisms to help women receive the best care in a timely manner; establish rules on the use of medication abortion, which can be a cost-effective abortion method in low-resource settings; and is awaiting approval to authorize nurses and midwives to perform first-trimester procedures, thus expanding the base of abortion providers.

Founded in 2006 and based in Accra, Ipas Ghana is a key voice in a national coalition of government stakeholders and nonprofit organizations united to reduce maternal deaths and injuries. As part of its role in the Reducing Maternal Morbidity and Mortality (R3M) consortium, Ipas Ghana advocates for women to have access to a full range of reproductive health services, including family planning and safe abortion.

As part of its mission to ensure a steady supply of qualified abortion providers, Ipas Ghana will sponsor trainings in comprehensive abortion care throughout the country.
In a country with 15 physicians per 100,000 people, according to World Health Organization estimates, doctors and health professionals with experience providing safe abortion care are a rarity. In addition to its training and equipping efforts, Ipas Ghana works with other relevant stakeholders to raise awareness about unsafe abortion among the general public, health professionals and the research community.

Attitudes and lack of knowledge about abortion issues can affect provision of abortion care, and a 2007 Ipas/Ghana Health Service survey of health workers and management in three regions showed that only one in five health workers were aware of all the circumstances in which abortion is permitted. Almost half of respondents cited religious concerns and uncertainty about the legality of abortion as factors in their hesitations about offering comprehensive abortion care. While an overwhelming majority of (80 percent) of hospital managers approve of safe abortion care, many other clinicians were found to be less comfortable using manual vacuum aspiration (MVA) in the first trimester or providing safe abortion for adolescents.

• Increase the number of women who receive comprehensive abortion care in targeted regions;
• Implement a national strategy for expanding comprehensive abortion care services throughout Ghana;
• Eliminate 90 percent of severe abortion-related complications at R3M-supported facilities by the year 2015.

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