D. Yaw Atiglo, University of Ghana and Charlotte Abra Esime Ofori, University of Ghana
Ghana’s abortion law is relatively liberal. Abortion is legally permitted in the first trimester when a pregnancy endangers the mother’s life or physical or mental health, or when it is due to rape or incest. Thus, medication abortion has become more widely available.
Medication abortion involves the use of mifepristone and misoprostol pills which stop pregnancy and enable the uterus to expel it naturally. When used correctly and with proper guidance it is an acceptable, effective and safe method.
Despite the availability of this safe method, however, it’s not always used in Ghana, especially by young women. The 2017 Ghana Maternal Health Survey reported that over a quarter of induced abortions nationally used non-medical methods. And only two out of every five induced abortions involved health personnel such as doctors, nurses and midwives.
Studies also indicate that some medical methods occur outside the health system and are not supervised by licensed health professionals. Stigma, misconceptions, privacy concerns, inequitable access to services, and cost continue to drive young women to methods that are not fully safe.
Unsafe abortions cause preventable illnesses and death, and are a serious public health issue.
The World Health Organisation classifies abortion safety into three categories: safe, less safe, and least safe.
Abortion is safe if it is a WHO-recommended method appropriate for pregancy duration, and provided by trained health professionals in an appropriate health facility. Less safe abortions are cases where a recommended method, such as medication abortion, is used without proper medical supervision or outside appropriate health facilities. Least safe abortions involve non-recommended methods often administered by untrained individuals and not conducted in an approved health facility.
It is not safe to use abortion pills without professional supervision, insert foreign objects, ingest herbal concoctions, alcoholic and sugar liquids or assorted tablets, or attempt heavy massage or rigorous physical activity.
Our team of demographers and social scientists investigated the prevalence, drivers and spatial distribution of abortion methods in Ghana.
We conducted research, using data from the 2017 Ghana Maternal Health Survey, to test the assumption that the rise of medication abortion automatically guarantees safety. Our study analysed data from 1,561 women aged 15 to 34 who had an induced abortion in the five years preceding the 2017 survey.
The results were stark: only about 11.5% of abortions were deemed safe; 40.7% were less safe; and 48% were least safe. In other words, most abortions among young women in Ghana fell into the less safe and least safe categories, even though safe methods are available.
The reason is that many young women obtain abortion pills from community pharmacies or chemist shops without prescriptions, medical assessment, or guidance on dosage. Others use non-recommended and dangerous methods. These gaps matter. The WHO and Ghana Health Service protocols require specific dosages based on duration of pregnancy to prevent complications. Without this oversight, even what is supposed to be a safe method becomes a risky method.
The study revealed that demographic, socioeconomic and spatial factors help explain abortion choices. Younger women, particularly those aged 15-19 and 25-29, were more likely to use less safe methods compared to their older counterparts.
Education played a protective role, with women who had attained secondary or higher education more likely to use safe abortion services. The number of children a woman had also influenced her abortion choices. Women without children tended to opt for less safe methods, while women with at least one child were more likely to use least safe methods.
Financial support mattered. When someone other than the woman herself or her partner paid for the abortion, they tended to use least safe methods. This suggests limited autonomy or possible pressure in getting the abortion.
The research unearthed striking spatial differences. In 11 out of 16 regions, least safe methods dominated. The remaining five, Central, Ashanti, Ahafo, Oti and Northern regions, had less safe methods as the most common. Essentially, not a single region showed the dominance of safe abortion methods. Safe abortions were less common everywhere.
The findings also show that less and least safe methods are clustered in urban areas and vary significantly by region. Urban clusters of less safe abortions reflect easier access to pharmacies, while rural reliance on traditional methods underscores barriers to formal healthcare. Women in the coastal regions and urban areas were more likely to use less safe methods. Those in rural areas relied more heavily on traditional or folkloric and least safe practices.
The spatial analysis also showed a clustered pattern, meaning unsafe practices tend to concentrate in specific areas. This suggests that social networks, local norms and uneven health infrastructure influence abortion choices. These findings underscore how age, education, reproductive history, financial support, and geography collectively shape abortion safety among young women.
The findings matter firstly because medication abortion, a major improvement to abortion safety, does not address systemic gaps. Such gaps include poor regulation, stigma, and limited access to comprehensive care.
Secondly, the findings reveal who is at risk of unsafe abortions and where they are. If least and less safe abortions are concentrated in particular regions and cities, then targeted interventions can match the realities and needs of those places to help save lives and improve care at less cost.
Unsafe abortion remains a leading cause of maternal mortality in Ghana. It also has implications for the mental and physical health of young women. The persistence of less safe and least safe methods threatens progress towards Sustainable Development Goal 3 (health) and Goal 5 (gender equality).
First, stepping up efforts towards contraceptive use is the surest way to prevent unintended pregnancies and the risk of unsafe abortion. Globally, more than half of all pregnancies are unintended, and many are aborted.
Second, the Ghana Health Service must strengthen its oversight of pharmacies and chemist shops to ensure compliance with abortion care protocols.
Access to comprehensive abortion care services, including counselling and post-abortion care, must expand. Comprehensive abortion care is a key strategy for improving access to safe abortion services. If young women feel safe and supported in the hospital setting, they will be less likely to use least safe options.
Interventions must address the underlying social and geographic drivers of using less and least safe options. This includes improving access to health facility and provider services, enhanced sexual health education and youth-friendly services especially in underserved areas. This approach must work to reduce stigma and shame at the community level.
Medication abortion improves access to safe and effective abortion and maternal health care, but without proper systems, it risks becoming a false promise. Safety is not just about the method; it’s about the conditions under which it is used.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
(The Conversation/HG)
