Ghana has one of Africa’s most liberal abortion laws but because of lingering stigma, fear and misunderstanding, safe, affordable abortion services remain virtually non-existent and unsafe abortion is a major cause of death, observers say.

While some activists are pushing for lifting restrictions altogether, health experts say the focus should be on ensuring the health sector effectively provides what the current law allows.

Under a law passed in 1985, abortion is allowed in cases of rape or incest, defilement of the mentally handicapped, foetal impairment and to save the life or physical or mental health of the woman. But stigma attached to abortion and ignorance about the law are such that even women who are within their legal rights are afraid to seek an abortion, and many health facilities do not offer such services, experts say.

“Because of the fear of falling foul of the law, health facilities will not dare to offer abortion services,” Faustina Finn Nyame of the Ghana office of Marie Stopes International said. “Because of this, women who seek abortion cannot get access to quality abortion care. They either do it themselves through crude means or go to traditional medicine men for the service.”

Nana Ama Asantoa, 19, used a common method when she recently drank a concoction including powdered soap and broken glass and inserted a stick into her uterus to end her three-month pregnancy.

Asantao survived after an emergency operation, but many women do not. Maternal mortality in Ghana stands at about 540 per 100,000, and it is estimated that 22 to 30 percent of those deaths are from unsafe abortion, health experts say.

The World Health Organization (WHO) in a report released this year said as of 2003 nearly 12,000 women in West Africa were dying annually from unsafe abortion. “A woman dies every eighth minute somewhere in a developing country due to complications arising from unsafe abortion,” WHO says.

The Ghana Health Service is working to expand abortion services in public hospitals, Gloria Quansah Asare, national family planning manager, told IRIN. Safe abortion services exist in some private facilities but the cost puts the procedure out of reach for many.

Accessible or not, many women fear coming forward to seek abortions, even if it is within their legal rights.

Ignorance of the law

Asare told IRIN many women remain ignorant of the abortion law, even though it has been on the books for more than two decades. “This feeds the perception that abortion is wholly illegal.”

Abortion remains taboo in Ghana. The Ghanaian newspaper The Statesman said in a recent article: “Social perceptions, religious beliefs, moral values and stigma attached to obtaining an abortion play a part in the large [number] of women seeking unsafe or ‘backstreet’ abortions.”

The Health Ministry in 2006 issued guidelines on comprehensive abortion care to medical workers, as part of its efforts to educate communities. But activists say implementation has been slow, partly because of attitudes towards abortion.

Ipas an international organisation that advocates better reproductive health services, says despite Ghana’s relatively progressive law, unsafe abortion continues to endanger women’s lives.

“Attitudes and lack of knowledge about abortion issues can affect provision of abortion care,” Ipas said in a paper on Ghana. A 2007 survey by Ipas and the Health Ministry found 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 hesitation about offering comprehensive abortion care,” Ipas said.

Calls to liberalise the law

Under the current law, Asantoa - abandoned by her boyfriend and afraid of her parents’ reaction - would be subject to a five-year prison term for terminating her pregnancy.

Many activists want Ghana to make abortion legal in any and all circumstances. But they acknowledge such drastic change is a long way off.

“It is going to be long and drawn out, but ultimately people like [Asantoa] should have the liberty to walk into a health centre and see a doctor to consider her options for abortion,” Marie Stopes International’s Nyame told IRIN. “We want a review of the law to make it absolutely legal to make a professionally guided choice. So [a woman] can take a decision which is her own but which is safe.”

Patrick Frimpong, the doctor who operated on Asantoa, said he is concerned by the number of such cases he sees come through the La General Hospital in the capital, Accra.

He is in favour of making abortion legal, arguing that doing so would improve women’s health and not necessarily increase the number of abortions.

“Let’s legalise it,” he told IRIN. “After all, our law as it stands now allows for abortions and it recognises the need for it, so why can’t we go the extra mile and remove its criminal aspect...? That will at least give us a chance to counsel [women] out of an abortion if indeed it is not absolutely necessary. It is their right; they deserve to be able to choose whether they want to keep their pregnancy or not.”