Afr J Reprod Health 2013;17(2):118–28

Why women are dying from unsafe abortion: narratives of Ghanaian abortion providers

Payne CM, Debbink MP, Steele EA, Buck CT, Martin LA, Hassinger JA and Harris LH

Abstract

In Ghana, despite the availability of safe, legally permissible abortion services, high rates of morbidity and mortality from unsafe abortion persist. Through interviews with Ghanaian physicians on the front lines of abortion provision, we begin to describe major barriers to widespread safe abortion. Their stories illustrate the life-threatening impact that stigma, financial restraints, and confusion regarding abortion law have on the women of Ghana who seek abortion. They posit that the vast majority of serious abortion complications arise in the setting of clandestine or self-induced second trimester attempts, suggesting that training greater numbers of physicians to perform second trimester abortion is prerequisite to reducing maternal mortality. They also recognized that an adequate supply of abortion providers alone is a necessary but insufficient step toward reducing death from unsafe abortion. Rather, improved accessibility and cultural acceptability of abortion are integral to the actual utilization of safe services. Their insights suggest that any comprehensive plan aimed at reducing maternal mortality must consider avenues that address the multiple dimensions which influence the practice and utilization of safe abortion, especially in the second trimester.

Comment: This paper, which is well worth reading, again concludes that most complications, including fatal ones, occur as a result of illegal abortions. Therefore the best way to prevent these complications, next to good sexual education, consists of adequate provision of legal abortion care. (Hans Vemer)