Unwanted Pregnancies: Major Cause of Maternal Mortality

In Ghana about 35% of married women in their reproductive age and 20% of sexually active unmarried women who would want to suspend pregnancy are not using any form of contraceptives.

According to a reproductive health rights advocacy group, Global Doctors for Choice (GDC)-Ghana, this situation commonly referred to as unmet need for family planning accounts for high incidences of unwanted pregnancies most of which due to restricted laws on abortion in the country end up in unsafe abortion, a consequence the group says is a major contributive factor to the high maternal and child mortality rates in the country.

Addressing participants at a stakeholders’ conference on strategies for building alliance for effective advocacy and how to engage next generation of Safe Abortion Care service providers, the group’s Lead Dr. John Koku Awoonor-Williams said available statistics indicate that 37% of all pregnancies in Ghana are unintended, 23% are mistimed and 14% are unwanted. He said these statistics have many unforeseen ramifications for maternal and child health in the country and yet there is limited access to safe abortion services in the country.

Dr. Awoonor-Williams noted that, even though Ghana’s anti-abortions law has been described as one of the most flexible in the world because of the many exceptions it provides for a woman or girl to access legal abortion including health risk in mother or baby, pregnancy resulting from incest or violence such as rape and defilement, limited awareness and poor interpretation of the law coupled with unsurmountable stigma have made abortion services virtually unavailable and where it is available access is highly challenged.

Dr. Awoonor-Williams who is also the Regional Director of Health Services for the Upper East Region disclosed that GDC is a network of like-minded physicians who by virtue of their privilege position have access to data and first-hand experience with some of the terrible outcomes of unsafe abortion and have decided to advocate for the right of women and girls to information, access to high quality services, and freedom of choice to make their own reproductive health decisions including legal and safe abortion.

He said the group has existed for the past three years and has worked extensively in building a network of safe abortion advocates among physicians and midwives across Ghana with funding support from Safe Abortion Action Fund (SAAF). The group has been at the fore front of advocating the inclusion of family planning service in the National Health Insurance Scheme and has also played leading role in influencing the Ministry of Health consideration for initiating cost free family planning programme nationwide. The country has no adequate reproductive health policies says Dr. Awoonor-Williams: “It appears ridiculous to some of us that as a country we could be doing a lot to reduce maternal and child mortality including the implementation free maternal health service and yet unwilling to incorporate family planning and comprehensive abortion services into our National Health Insurance Scheme” he wonders.

He was unhappy that in spite of the existence of clear policy guideline from the Ministry of Health directing all public health facilities to provide comprehensive abortion care (CAC) services, very little was being done to train more midwives to provide services. The GDC Lead also blamed the Ministry for been too slow in designing policies for counteracting the refusal by some health care providers especially private and faith based facilities to provide CAC services. He pointed out that the group will continue to engage with policy makers and professional bodies as well as medical and midwifery training institutions for enhancing the advocacy capacity of the next generation of safe abortion care providers.

A physician obstetrician gynecologist and member of GDC-Ghana who is also a senior lecturer at the University for Development Studies (UDS) Medical School Dr. Naa-Gandau Barnabas said when a woman or girl gets pregnant and does not want the pregnancy she will do anything possible to get rid of it sometimes even at the expense of her very life. He said the limited access to safe abortion in Ghana due to heavy stigma and restrictive law have created a huge business for unsafe abortion practitioners often call ‘quack doctors’ who continue to kill and cause unrepairable damage to young girls and women. He appealed to health care providers to desist from allowing their religious and cultural beliefs to influence their professional mandates of responding to the needs of their clients.

The stakeholders’ conference which coincided with the World Sexual Health Day celebrated on 4th September every year was attended by individuals and organizations in reproductive health and community development. They were drawn from Northern and parts of Southern Ghana.

A participant from Sustainable Aid through Voluntary Establishment, (SAVE-Ghana) a Non-Governmental Organization (NGO) based in Accra with operations in the Upper West and Western Regions, Dintie Tayiru Sule, in sharing lessons and experiences from the organization’s project implementation revealed that the situation on the ground regarding unsafe abortion statistics and the attendant effect on maternal and child health calls for increased collaborative action among development partners and community leadership to restore hope and dignity for vulnerable young girls and women.

According to WHO, unmet need for Family Planning and other reproductive health services is especially high among groups such as adolescents, migrants, urban slum dwellers, refugees and women in the postpartum period.