The Context of Informal Abortions in Rural Ghana

“A number of studies have been conducted on maternal mortality in Ghana [8,11,13-15,18,19]; however, only one [11] attempted to analyze causes of maternal mortality with respect to socio-demographic groups, and did so with limited detail.”

“This would seem to reflect a social dichotomy reported in some studies in Ghana that indicate that even though abortion in Ghana is culturally abhorred when exposed, when secrecy is achieved and the outcome of abortion is successful, the procedure is accepted [31,32].”

“Owing to stigma associated with an unsafe abortion, women keep their pregnancy to themselves and only confide in close relatives and friends who may help by guiding them as to where to obtain a clandestine abortion (19,22,23).”

“Restrictive abortion laws in some countries also make women resort to adopting clandestine unsafe abortion strategies, which possess greater risk for women to survive later pregnancy and child bearing [38, 42].”

“In comparison, more invasive methods such as the insertion of foreign objects [20] through the vagina or physical methods such as intensively massaging the abdomen [37] were less frequently cited.”

“These results are similar to other studies [15-17].”

“No anonymous access, high stigma Alsibiani [49] Arambepola [50] Silveira [22], Arilha [51], Diniz [52], Madeiro [53], Nunes 2013, Heilborn [54] Casas [55], Palma Manriquez [56] Ramos [57] Coast [59], Freeman [60], Cresswell [61], Dahlback [62] Izugbara [63] Osur [64], Mitchell [66], Izugbara [65], Jayaweera [48], Penf…”

“going as a surrogate to a chemist or pharmacy, identifying a facility-based provider, or financing the procedure [30, 31, 35, 36, 38, 41, 44, 46, 48, 52, 54, 67, 70, 74] In many of these instances, male partners also made the decisions about method and source on behalf of the woman; however, it was not always clear wh…”

“Research shows that ‘moral-, social- and gender-based reservations about induced abortions appear to influence health service providers’ perceptions of and attitudes towards induced abortions and, consequently, their relationship with the patient who wants an abortion’ [22].”

“Performing an abortion is viewed as morally wrong, and abortion has profound social consequences for women.(25,35) People who have had abortions – particularly younger women – are ostracised, often branded “killers” and “prostitutes”, and are perceived as a bad influence on other women in the community.”

“The methods and procedures these women go through, examples of which are recounted in Hill et al., 3 are simply unconscio-nable.”

“Death/complications 23 (12) Spiritual/fear of Godly punishment 12 (15) Social stigma/avoiding disgrace 32 (41) Late gestation 7 (10) Law/arrest 3 (5)”

“Hill et al. (2009) indicate the complications that arise from unsafe abortion in Ghana are usually dealt with at home.”

“In common with other settings, women in this study area were reticent to discuss early pregnancy losses and induced abortions [15].”

“The lower probability of women in the northern zone of Ghana practicing repeat induced abortion may be their perception of illegality, danger and public shame associated with induced abortion [35].”

“38 However, it is important to highlight that parents’ decision-making in selecting a particular provider for their daughters is a function of a combination of reasons, which may include those related to stigma.”

“In terms of implementation of abortion policies, barriers in the health system include paucity of designated facilities, inadequacy of trained providers who are willing to offer abortion services, lack of equipment and provider attitudes (Warriner et al. 2011; Kumar et al. 2009; Harries et al. 2009; Hill et al. 2009;…”