photo by Richard Lord

In May I was fortunate to be asked to go to Ghana to participate in writing a proposal to expand comprehensive abortion care in that country. Because I’d never been to Africa, I decided to take a few days to travel and learn something about the country. As it turned out, my brief tour gave me an unexpected lesson in the plight of pregnant women in Ghana from its earliest days till today.

Like most visitors to Ghana, my priority was to see the infamous “castles” along the country’s Gold Coast, where more than a million people were held before being shipped across the Atlantic as slaves. The first European slave-trade fort in West Africa was built by the Portuguese in 1482 in Elmina, now a five-hour bus-ride from Accra, Ghana’s capital. Up to 200 men and women were held captive here at a time, waiting as long as three months before being herded down a pitch-dark, narrow chute, through the “door of no return,” and into the waiting boats. From a balcony overlooking a small inner courtyard, the Portuguese – and later, Dutch – traders selected women for their pleasure. The fort’s guide explained that women who were obviously pregnant before the ships arrived were banished to the nearby swamps and forests to fend for themselves; those whose pregnancy wasn’t discovered until they were on the ships were thrown overboard. Today pregnancy resulting from rape is one of a number of indications for a legal abortion in Ghana. Ipas is working with partners around the country to insure that women and health-care providers know their rights, and to make safe services available.

A nature walk also offered instruction into methods women have used to end an unwanted pregnancy. North of Elmina, Kakum National Park is a dense tropical rainforest home to elephants, several kinds of monkeys, and hundreds of species of birds and butterflies. On a hike through the thick undergrowth, the guide explained the medicinal value of many of the plants we passed. He described how achampong leaves are ground and boiled with ginger to induce an abortion. Going to a trained health-care provider is obviously a safer and more effective alternative. Since Ipas opened its office in Ghana in 2006, 12,000 Ghanaian women have had safe abortions with the manual vacuum aspirator.

Women have also long sought abortifacients from pharmacies and open markets. In Kumasi, Ghana’s second largest city, a local woman led me through the largest open market in West Africa, a 30-acre maze of narrow walkways where 10,000 traders sell everything from the rat-like bushcutter, roasted and sold as a delicacy, to imported used shoes refashioned into new ones. To make a salve for an infected wound, my guide bought penicillin, sulfa, and other capsules from a street vender, no prescription, no questions asked. For women wanting an abortion, misoprostol is also available, although it is legal in Ghana only with a doctor’s prescription for treatment of peptic ulcer. Street vendors offer no guidance on dosage or what to do in case of an incomplete abortion. The health-care providers trained by Ipas, on the other hand, learn both to counsel women and to properly administer medical abortion drugs.

Unsafe abortion is prevalent among women of all ages in Ghana, where only 14 percent of married women of reproductive age use modern methods of contraception. Adolescents and young women, often unable to access or afford reproductive health services, are particularly vulnerable to suffering injuries or dying from botched abortions they self-induce or procure from an unskilled provider. Ipas Ghana advocates for women’s access to a full range of reproductive health services, including family planning and safe abortion.

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