Women's Health and Action Research Centre (WHARC)

Destigmatising Abortion: Expanding Community Awareness of Abortion as a Reproductive

Health Issue in Ghana
Author(s): Nana Oye Lithur
Source: African Journal of Reproductive Health / La Revue Africaine de la Sant
Reproductive, Vol. 8, No. 1 (Apr., 2004), pp. 70-74
Published by: Women's Health and Action Research Centre (WHARC)
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Destigmatising Abortion: Expanding

Community Awareness of Abortion as a
Reproductive Health Issue in Ghana
Nana OyeLithur

ABS'I1AA('T
Traditional and cultural values, social perceptions, religious teachings and criminalisation have facilitated stigmatisation of
abortion in Ghana. Abortion is illegal in Ghana except in three instances. Though the law allows for performanceof abortion
in three circumstances,the Ghana reproductivehealth service policy did not have any induced legal abortion services component
to cover the three exceptions until it was revised in 2003. The policy only had 'unsafe and post-abortion'care components, and
abortionsperformed in health facilities operated by the Ghana Health Service were performed under this component. Though
the policy has been revised,women and girls who need abortionservicesin Ghana more often resort to the backstreetdangerous
methods and procedures.Criminalisationof abortion and those who perform abortions has contributed to unsafe abortion, the
second leading cause of maternal deaths in Ghana. Most of these are performed outside the formal health service structures.
abortion is perceivedas a shamefulact and the communitymay shun and give a woman who has caused an abortion
Traditionally,
derogatorynames. Would provision of legal abortion services be culturallyacceptable within a Ghanaian community?Yes, if
they are made aware of the reproductivehealth benefits of providing safe abortion services. Three major strategiesthat would
help to destigmatiseabortion in the community are (1) the liberalinterpretationof the three exceptions to the law on abortion;
(2) expandingcommunityawarenessof its reproductivehealthbenefits; and (3) improvingand increasingaccess to legal abortion
serviceswithin the formal health facilities.(AfrJ ReprodHealth2004; 8[1]:70-74)
R'-SUMt`
Destigmatisation de l'avortement. Accroissement de la conscience communautaire de l'avortement comme un probl6me de
la santk de reproduction au Ghana. La stigmatisationde l'avortementau Ghana a ete rendu facile par la traditionet les valeurs
culturelles,les perceptions sociales, les enseignements religieuxet la criminalisation.L'avortementest illegal au Ghana sauf en
trios cas. Bien que la loi permet l'avortementen trios cas, la politiquedu Servicede la Sant6 de Reproductiondu Ghana, n'avait
aucun service de I'avortementlIgal provoqu6pour couvrirles trios exceptions avant sa revision en l'an 2003. La politiquen'avait
quc des coustituants du soin pour '1' avortement a risque et lc post-avortement' et tous les avortements pratiques dans les
institutionsde sant6 g6rees par le Servicede Sant6du Ghana ont 't6 realisessous ce constituant. Bien que la politiquesoit revis6e,
les femmes et les filles qui ont besoin des services d'avortementau Ghana ont recours, le plus souvent, aux proc6dureset aux
methodes clandestinesdangereuses. La criminalisationde l'avortementet ceux qui se font avorteront contribu6' l'avortement
a risque, la deuxi'me cause principaledes dices maternelsau Ghana. La plupartd'entre eux ont lieu en dehors des structures
de service de sant6 formelles. Traditionnellement,I'avortementest perqucomme un acte honteux et la femme qui se fait avorter
risque d' etre 6vit6e et denigr&epar la communaut6. Est.ce que l'assurancedes services d'avortemet legal sera culturellement
acceptable au sein d'une communaute ghandenne?Oui, si l'on la sensibilise aux avantages des services d'avortement. Trois
strategies principales qui aideront i d6stigmatiserl'avortement dans la communaut6 sont (1)l'interpretationliberale des trois
exceptions a la loi sur l'avortement (2) l'extension de la conscience de la communaut6 sur les avantages de la sant6 de
reproduction;ct (3) l'amelioration et l'augmentation de l'accis aux services d'avortement l6gal dans le cadre des institutions
formellesde sante.
Afr Santi Reprod2004; 8[1]:70-74)
(Ret,

Ki-Y WORDS:
Abortion,Ghana,law,policy,community-based
approach

Mrs.Nana OyeLithur,AfricanWomen
HouseNo. C663/3, Crescent
Assodation,
Avenue,Asylum
C(orrespondence:
Lawyers
233-24-704641(Cellular);
Fax:233-21-228887;
Down,Accra,Ghana.Tel:233-21-251296(Office),
nanaoyeKgyahoo.co.uk
E-mail"

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Abortion:ExpandingCommunity
Awareness
HealthIssuein Ghana 71
Destigmatising
ofAbortionas a Rproductive
It is accepted that there is a stigma attached to abortion
and those who perform abortions in Ghana.Traditional
and cultural values, social perceptions and religious
teachings have engendered negative perceptions of
abortion. The criminalisation of abortion in Ghana, a
colonial legacy, has not helped the situation, and has
been a major contributory factor to this stigmatisation.
The concept of 'stigmatisation', as used in this
text, refers to a situation where a person is discredited
for having a markedcondition or experience. It involves
exclusion, discriminationand ascriptionof blame.' This
paper addresses 'felt' stigma, which a victim perceives
and 'enacted' stigma, which refers to actions upon the
individual or group.'
Generally what is the cultural relativism of
reproductive rights in Ghana as an internationalnorm?
Ghana is a state party to and has adopted international
and regional conventions, charters, treaties and
declarations that guarantee the reproductive rights of
women.2 Ghana's 1992 constitution guarantees human
rights. The paradox is that though a woman's
reproductive right is guaranteed by these legal norms,
her autonomy and ability to exercise this rightis closely
linked to the customary laws and traditional practices
of her community.These practicesmay limit the exercise
of this right.
The Ghanaian individual is completely merged
within his/her community and does not have an identity
distinct-from his/her family or clan (abusua).He/she
adheres to the community value systems. Rites of
passage including birth, initiation, puberty, marriage,
inheritance and burial ceremonies are determined by
ethnic lineage. The community is therefore a fulcrum
for the Ghanaian and an important consideration in
discussing ways of destigmatising abortion. This
community,by its practices,stigmatisesabortion.Formal
institutions of governments additionally stigmatise
abortion by failingto integratelegal abortion services as
provided by the law.
Abortion is illegalin Ghana, with three exceptions
to the rule. Section 58 of the Consolidated Criminal
Code of 1960 (Act 29) was amended in 1985. It defines
abortion as the premature expulsion of conception
from the uterus or womb before the period of gestation
is completed. Itis a crime for any woman to administer
or cause to be administered on her any poison, drug or
other noxious thing, or to use an instrument to cause
an abortion. Any person who administers the drug is

also guilty. The maximum term is five years

imprisonment.
The threeexceptions are applicableif the pregnancy
was as a result of rape, defilement or incest; would pose
a risk to the life of the pregnant woman or injuryto her
physical or mental health; or where there is substantial
riskthatif the child were born may suffer from a serious
abnormality or disease. Prior to the amendment,
abortion was criminal in all circumstances and the
maximum sentence was ten years imprisonment.
Ghana adopteda nationalreproductivehealthpolicy
in 1997. Though Ghanaian law allows for the
performance of abortion in three circumstances, the
policy does not make provision for health services for
legal abortions. One of the components of the policy
is the management of unsafe abortion and postabortion care.Following the Ghana reproductivehealth
policy, therefore, health services will only be provided
for women who have gone through an unsafe abortion
or need post-abortion care. The Ministry of Health
reviewed the policy in 2003 and has included a section
on provision of legal abortion services in its revised
policy. The reviewed policy is in the process of
implementation.
Abortion stigmatisation permeates officialdom
and is a silent and ignored contributor to statistics on
maternal mortality in Ghana. It has been noted that
Ghana's high levels of maternal mortality could be an
effect of the legal restrictions on abortions for some
subgroups in Ghana.3
Abortion is one of the leading causes of maternal
mortality in Ghana.' There is however limited data on
abortion in the country. The Ghana demographic and
health survey of 1998 had as its primary objective
'provision of current and reliable data on fertility and
family planning behaviour'; it however lacks basic
information about the prevalence of abortionin Ghana.
In the section entitled 'pregnancy outcome', the survey
explains that 9.7% of all pregnancies would be lost
through spontaneous or induced abortion. It does not
desegregate the data to show how many early
pregnanciesoccurredbecause of induced abortion,both
legal and illegal.
Enacted stigmatisation has contributed to unsafe
abortions in Ghana. Abortion services for the three
exceptions, as prescribedby law,are not readilyavailable
at health centres across the country. Even where they
are, there is ignorance about the law and the three legal

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72 Afiican Journalof Reproductive

Health
GhanaPoliceServiceover a three-yearperiod- from 1999
to 2002 - (775 cases) account for less than the 1,000
abortions performed in only one of the 110 districtsin
Ghana over a period of one year.
Unsafe abortion is silently being performed
underground within the communities in Ghana and
outside the formal health service structures.This is as a
result of stigmatisation coupled with the lack of health
services for abortion. It is perceived that those who
perform abortions are criminals breaking the law.
Traditionally,abortion is perceived as a shameful
act.In the Ga tradition,familieswhere women areknown
to have performed abortions are branded as 'the family
where its womenfolk remove pregnancies'.A derogatory
tag is attached to the family and it may adversely affect
the chances of getting married for girls in such family.
This is because a big premium is placed on fertilityand
abilityto have children;the performance of an abortion
is perceived as limitinga woman's chances of childbirth.
Traditionally,the community may give a woman who
has caused an abortion derogatory names, which
sometimes connotes immorality.
Certain Ghanaian customary practises facilitate
recourse to abortion. A marriage ceremony cannot be
performed for a pregnant woman. In certain tribes in
Ghana, it is a taboo for a woman to get pregnantbefore
puberty rites are performed for her. The dipocustom is
a puberty rite performed for Krobo girls.They have to
be virgins to undergo the puberty rite. A girl who gets
pregnantbefore performance of these rites may decide
to abort the pregnancy to pave way for performance of
the custom. This is because great shame would be
brought upon the familyif it becomes public knowledge
that she was pregnant and could not go through the
ceremony. To avoid disclosure, abortion is carried out
secretly. Unorthodox methods are used, resulting in
needless deaths and reproductive health consequences
for women.
Religion also plays a major role in stigmatisation
of abortion in Ghana. The Catholic doctrine, for
instance, is against abortion. It is perceived by some
religiousleaders as being againstbiblical teachings;they
Analysing statistics from the studies at Korle-Bu therefore preach against it. There isn't yet an organised
and Komfo Anokye and reports from the Asikuma religious anti-abortion pressure group in Ghana.
District, it is obvious that the incidence of unsafe
Theresa Azigli is a 22-year-old petty hawker from
abortion is high. It is the second leading cause of Krobo-Odumase district in Ghana. She has three
maternalmortalityin Ghana. In Asikuma District alone, children who are not being maintainedby their fathers.
over 1,000caseswere reportedandyet cumulativenational She got pregnant with a fourth child when her third
statisticsfrom the Criminaland InvestigationUnit of the child was five months old and decided to abort the

exceptions. Some health personnel are not aware that

abortion is legal in certain circumstances and do not
provide abortion services to cover them. There is a false
perception that all abortions are criminal.
The law criminalises activities of those who assist
women to procure abortions. To avoid prosecution
and a custodial sentence, some health workers are wary
of providing legal abortion services even where it is
available. This is because they would not risk being
identified with a criminalrecord for providing abortion
services. Some women and girls need the services at all
costs becauseof unwanted pregnanciesand would resort
to dangerous methods and procedures like insertion
of objects, taking dangerous doses of over-the-counter
drugs,douching with poisonous and caustic substances,
enema with potent herbal preparations, instead of
seeking professional health services.'
Despite the prevalence of abortion in Ghana and
the fact thatit is criminalisedin certaininstances,women
are rarelyprosecuted for abortion under section 58 of
the criminal code. This fact can be ascertained by
comparing statistics on police reports on abortion and
statisticson reportedcases from the two largesthospitals
in Ghana.
Hospital-based studies7indicate that 22% and 30%
respectively of maternal deaths in Komfo Anokye
Hospital, Kumasi, and Korle-Bu Teaching Hospital are
due to unsafe abortion. A newspaper report"indicated
that complications from abortions are the leading causes
of admissions in the Asikuma District of Ghana; more
than a thousand cases are reported annually at the
hospital. A study in Ghana' that explored people's
perception and behaviour related to abortion found
that 11.2% and 16% of males and females respectively,
who were sexually active, reported that they caused or
assisted a woman to procure an abortion.
On the other hand, 70 cases of abortionwere heard
the
by
High Court in Accra between 1965 and 1969 and
three
resulted in convictions. From 1999 to 2002,
only
the totalnumber of abortion cases reportedto the police
in Ghana rose from 172 in 1999 to 256 in 2002, and 177
in 2002.

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Awareness
Abortion:ExpandingCommunity
HealthIssuein Ghana 73
ofAbortionas a Reproductive
Destigmatising

A healthinspectordiscoveredthe fetusand abortion would not promote promiscuity.

pregnancy.
There are risks and challenges in destigmatising
shewasarrestedandprosecuted.Shepleadedguiltyand
waswronglysentencedto a maximumsentenceof ten abortion. The following two examples illustrate how
years.

The judge applieda repealedlaw in passingthe

sentence.Section 58, as amended,stipulatesthat the
maximumsentencefor abortionis fiveyears.The judge
did not considerwhetherher case fellwithinthe three
discussed
exceptions.Thecasewasextensively
stipulated
in the media.An appealwas filed on her behalfby a
team of lawyers offering pro-bonoservices."'The
judgementwas quashedand she was discharged.It is
interestingthatthe trialjudge,afterconvicting,gaveher
the maximumsentence.Afterherreleasefromprison,
Theresaleft her communitybecause of the taunts,
stigmaand derogatorynames she was given by some
membersof her community.Shehas hadto resettlein
anothercommunityand starta new life there.
The issueis whetherlegalabortionserviceswould
be culturally
acceptableandpatronisedif setupin health
facilitiesbygovernmentin thecommunities.Expanding
awareness of the reproductive health benefits of
providingandaccessingsafeabortionservicesin health
facilitieswould be key to destigmatisingabortion.
Another significant intervention that would
of abortionis a moreliberal
facilitatedestigmatisation
of
the
law
on abortion. The three
interpretation
aspossible
to
be
asliberally
interpreted
exceptionsought
to allaythe fearsof healthworkerswho wouldhaveto
provide the service to women. They would readily
providethesaidserviceif theywereassuredthatitwould
not leadto prosecutionby the police.
Strategicstakeholderswouldhaveto be identified
andan advocacyplanimplementedto improveaccess
to safe abortion services. They should be made to
understandthe consequencesof stigmatisingabortion,
its linkto thehighratesof unsafeabortionandmaternal
mortality,and the justification for advocatingand
improvingaccess to safe abortionservicesat health
facilities.
Traditionalleaders have to be provided with
informationon the implicationsof unsafe abortion
andits contributionto maternalmortality,encouraged
to incorporateinformationon consequencesof unsafe
abortionin pubertyandinitiationrites.Politicalleaders
should be encouraged to make safe abortion less
controversial.Religious leaders should be made to
understand that providing sexuality education on

criminalisinga cultural,religious or traditionalpractice

thathas community supportwithout creatingawareness
or seeking community legitimacy will not ultimately
protect the reproductive rights of women. The
promulgation of legislation to criminalise the harmful
traditional practise of trokosi,for instance, has not led
to a significant reduction in the number of girls being
held in bondage by shrine owners. Female circumcision
was criminalisedin Ghana in 1994. Nine years after the
law was passed it still remains prevalent in remote parts
of the Upper East and Upper West Regions of Ghana,
where it affects an estimated 86% of the rural female
population." Strategies for destigmatising abortion
should be multi-faceted and should involve the
community.
Notwithstanding these challenges, we can learn
from some best practices. Domestic violence that was
hitherto perceived as a private matter is now discussed
within the public domain and considered a violation of
women's rights after sustained advocacy and
sensitisation of the community.
Abortion is a controversial issue touching on
religious, cultural, moral and traditional values.
Unfortunately,these considerations currentlyoutweigh
its health implications in Ghana. The need for
destigmatising abortion by expanding community
awareness, adopting a liberal interpretation of the law,
and improving access to legal abortion services, can
therefore not be overemphasised.

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Goffmanl963; Parker and Aggleton 2002; Schurl984;

Weiss and Ramakrishna 2001.

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The International Covenant on Economic, Social and

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of All Forms of Discrimination Against Women, The
African Charter on Human and People's Rights, The
ICPD the Beijing Platform of Action, Beijing +5, the
Dakar platform, The UN Millennium Goals.

3.

Ahiadeke Clement. Incidence of induced abortion in

southern Ghana. Int Fam Perspec2001; 27(2): 96-101,
108, 101.

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