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Making safe abortion services accessible in Ghana.

According to the World Health Organization (WHO), Ghana has a high maternal mortality rate of 540 deaths per 100,000 live births. Hospital-based studies put abortion-related complications as the leading cause of maternal mortality in the country, reaching as high as 30%. This is in spite of a liberalized legal abortion regime. In this issue of the Journal, Hill et al. present findings of a study into the social context of induced abortions in rural Ghana. Their findings highlight prevalent inequities in access to safe abortion services and the risk, born out of desperation, that many women are pushed into in the attempt to secure termination of unwanted pregnancies. By adopting a case study approach, Hill et al. succeed in drawing attention to an aspect of the abortion debate that is often overshadowed by considerations made at the population level; that is, the failure to put the affected woman at the center of discussions and to dare to consider the tacit impetus that a contradictory social value system gives to backstreet abortion practices. The law on abortion in Ghana prior to 1985 was predominantly focused on prohibition and punishment. It was generally regarded as restrictive and identified as a contributory factor to the high incidence of backstreet practices and the attendant complications. Liberalization of the law in 1985 was, therefore, met with much anticipation. It was expected that the new legal regime would facilitate provision of safer options within public and private health facilities in the country. Unfortunately, two decades later, there does not appear to be much to cheer about. This is because the number of and complications of backstreet practices are as much a concern today as they were in the period prior to 1985. Anecdotal evidence suggests that two thirds of abortions in Ghana are secured illegally and under unsafe conditions. Unsafe practices continue to maim and kill many women, particularly adolescents. The case in Ghana appears to epitomize the notion that the legal status of abortion is not necessarily the most important factor determining the availability of safe abortion services.