Students opt for unsafe abortions despite legal services

Despite the liberal nature of Ghana’s abortion laws, the prevalence of unsafe abortion is still high among female undergraduates, a group of researchers at the University of Health and Allied Sciences in Hohoe has said.

The researchers said most undergraduate students resort to unsafe termination of pregnancy whenever they get pregnant, even more than once. The researchers pointed out that “the high prevalence of unsafe abortion among university undergraduates is particularly troubling, as it may also imply that more of the students engage in unprotected and unsafe sex”.

Abortion is a common health intervention. It is safe when carried out using a method recommended by the World Health Organization (WHO), appropriate to the pregnancy duration, and by someone with the necessary skills. Six out of 10 of all unintended pregnancies worldwide end in an induced abortion, according to a WHO fact sheet.

Annually, more than four million unsafe abortions are carried out in Africa, predominantly among poor, rural and young women who are not aware that safe abortion services are available. Maternal deaths resulting from unsafe abortions are higher in Africa than in other developing countries.

Religious and cultural views

In the study, ‘Knowledge and attitude towards Ghana’s abortion law: A cross-sectional study among female undergraduate students’ published in the journal PLOS Global Public Health on 21 April 2023, the researchers reported that the prevalence of induced abortion was 95% with 79% of all abortions unsafe, and they attributed this to the fact that “most cultural and religious groups in Ghana regard abortion as murder and ostracise those engaged in it”.

The researchers said their study is a warning of the considerable risk of HIV/Aids and other sexually transmitted diseases, which has implications for the rising maternal death rate among women in Ghana and the poor reproductive health outcomes among females.

“This, if it persists, may, in the long run, hinder Ghana’s progress towards achieving Sustainable Development Goal 3, target 1: reducing the global maternal mortality ratio to less than 70 per 100,000 live births. Similarly, abortion safety appears as a key contributor to achieving the aim of the safe motherhood initiative which was launched by the Ghana Health Service in 1995 as a strategy to reduce maternal mortality and morbidity,” they said.

The researchers said their findings draw the attention of health practitioners and health educators to the fact that unsafe abortion methods are the only acceptable method to students due to the stigma attached to pregnancy termination, and students always prefer an undetectable abortion.

Accordingly, they suggested that reproductive health practitioners should make efforts to de-stigmatise abortion to ensure that students use the safe abortion and reproductive health services that are available.

In addition, they said, abortion services should be made available and accessible to students, and education about abortion legislation intensified. Awareness should also be created about where women can get safe and legal abortions.

They found a high prevalence of unsafe abortions even though there generally is a high level of awareness and favourable attitudes regarding the abortion law of Ghana. The researchers said factors associated with a low level of knowledge and awareness are: the year of study, residential status and poor attitudes toward the legislation.

Stigma plays a role

The researchers said Ghana amended its abortion law to permit abortion under certain circumstances due to the impacts of unsafe abortion. Even though the abortion law in Ghana is liberal, most women do not utilise the services.

They said the decision on whether to abort or not depended on factors pertaining to the individual, including marital status, economic independence and educational background. In addition, partner and parental support are among the interpersonal determinants. Societal determining factors include social norms, religion, the stigma of premarital and extramarital sex, and autonomy in society.

According to the study, of the 240 participants, 24 (10%) reported having been pregnant. Among these pregnancies, 20 (83.3%) ended in abortions, 15 (75%) of them unsafe. The majority (53.3%) of the participating students knew the conditions under which abortion is allowed in Ghana and most (61.7%) of them had positive attitudes towards the abortion legislation in the country.

From the total number studied, 143 (59.6%) were between the ages of 21 and 24. Of the participants, 29.6% come from households earning between GHS1,000 and GHS2,000 (US$85.40 and US$170.78) a month, while 9.6% came from households earning less than 500 cedis (US$43) a month.

Overall, the authors said, the majority (53.3%) of the study participants had good knowledge of Ghana’s abortion law. School teachers (45.6%) were the most important source of information. Most (77.9%) of the respondents were aware of the legal status of abortion in Ghana.

Among these, 75% correctly stated that abortion is not legal in all circumstances in Ghana. Out of the total, 83% correctly stated that abortion in Ghana is legal in some circumstances; and 77% correctly stated that abortion is not illegal in Ghana in all circumstances.

Safe abortion increases promiscuity

The researchers said 61.7% of the students had a positive attitude towards Ghana’s abortion legalisation. About 41% of the study participants disagreed that a woman should be able to choose abortion if she is financially unable to care for her child, and 39.1% disagreed that a woman should be able to terminate her pregnancy if she so desires. Safe abortion services in public health facilities, according to 51.7% of respondents, will increase promiscuity.

According to the authors, the study demonstrates that knowledge and attitude towards Ghana’s abortion legislation among the students was fairly good and said, “increasing young women’s knowledge of the abortion law may lead to more favourable attitudes towards abortion, improving the utilisation of safe and legal abortion services”.

They sought to estimate the incidence of unsafe abortion and assess the knowledge and attitudes of undergraduate female students regarding Ghana’s abortion law in the Hohoe municipality. Their aim was to inform policymakers about how much young women know about the abortion law in the country and their attitudes towards it, which can help authorities plan information dissemination on how and where to obtain safe and legal abortion services.

A programme officer of the Alliance for Reproductive Health Rights, Isaac Nyampong, told University World News that there is a need to educate young people on the consequences of unsafe abortion, adding that the curriculum has no space for sex education.