Disparities in Abortion Experience and Access to Safe Abortion Services in Ghana: Evidence from a Retrospective Survey

John K. Ganle, Bernard Obeng, Joseph Y. Yeboah, Eva Tagoe-Darko Tagoe-Darko, Charlotte M. Mensah


In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in women’s experiences of abortion and access to safe abortion care. Disparities in rates of abortion experience and access to safe abortion care were assessed using absolute (the difference in rates between groups), relative (the ratio of rates between selected and reference groups), and mean measures. Results suggest that 24% of women had at least one abortion in the five years preceding the survey. However, large gradients of socio-spatial disparities in abortion experience exist. The majority of abortions were also potentially unsafe: 53% of abortions occurred outside of any healthcare facility. Women themselves and medical doctors, respectively, performed 57% and 4% of all abortions. The majority of women also felt they could not get safe abortion even if they wanted one. Together, these results highlight the need for concerted multi-sectorial strategies, including legislative reform and provision of family planning services, to help transition from unsafe to safe abortions. (Afr J Reprod Health 2016; 20[2]: 43-52).

Full Text:



World Health Organization: Safe Abortion: Technical and Policy Guidance for Health Systems (Second Edition). Geneva: World Health Organization; 2012. 2. Coast E and Murray FS: “These things are dangerous”: Understanding induced abortion trajectories in urban Zambia. Social Science & Medicine, 2016, 153:201-209. 3. Haddad LB & Nour NM: Unsafe abortion: Unnecessary maternal mortality. Reviews in Obstetrics & Gynecology, 2009, 2(2): 122-126. 4. Rasch V, Sørensen HP, Wang RA, Tibazarwa F & Jäger KA: Unsafe abortion in rural Tanzania – the use of traditional medicine from a patient and a provider perspective. BMC Pregnancy and Childbirth, 2014, 14:419 5. Norris A, Harrington JB, Grossman D, Hemed M &

Ganle et al. Disparities in Abortion Experience

African Journal of Reproductive Health June 2016; 20 (2): 52

Hindin JM: Abortion experiences among Zanzibari women: a chain-referral sampling study. Reproductive Health, 2016, 13:23. 6. Ghana Health Services: Reproductive and Child Health Annual Programme of Work. Ghana Health Services, Ghana, Reproductive and Child Health; 2006. 7. Baiden F, Amponsa-Achiano K, Oduro A, Mensah T, Baiden R & Hodgson A: Unmet need for essential obstetric services in a rural district in northern Ghana: complications of unsafe abortions remains a major cause of mortality. Journal of Royal Institute of Public Health, 2006, 120(5): 421-426. 8. Abor PA, Abekah-Nkrumah G & Sakyi K: The socio- economic determinants of maternal health care utilization in Ghana. International Journal of Social Economics, 2011, 38(7): 628-648. 9. Asamoah OB, Moussa KM, Stafstrom M & Musinguzi G: Distribution of causes of maternal mortality among different socio-demographic groups in Ghana: a descriptive study. BMC Public Health, 2011, 11(159): 1-10. 10. Daily Guide, ‘Abortion Cases Rise’, August 21, 2012. 11. Ministry of Health: National Consultative Meeting on the Reduction of Maternal Mortality in Ghana: Partnership for Action. Synthesis, Ministry of Health, Ghana, Policy Planning Monitoring and Evaluation Department; 2008. 12. Oduro YA & Ostin ANM: “Abortion—It Is My Own Body”: Women’s Narratives About Influences on Their Abortion Decisions in Ghana. Health Care for Women International, 2014, 35:918–936. 13. Morhee RAS & Morhee ESK: Overview of the law and availability of abortion services in Ghana. Ghana Medical Journal, 2006, 40(3): 80-86. 14. Ganle JK, Parker M, Fitpatrick R, & Otupiri E: Free maternity care and equity of access to maternal health services in Ghana: a descriptive study. International Journal for Equity in Health, 2014, 13:89. 15. Ganle JK, Parker M, Fitpatrick R & Otupiri E: A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy and Childbirth, 2014, 14:425. 16. Ganle JK: Ethnic disparities in utilisation of maternal healthcare services in Ghana: Evidence from the 2007 Ghana maternal health survey. Ethnicity and Health, 2015, DOI:10.1080/13557858.2015.101 5499.

Ganle JK, Parker M, Fitpatrick R, & Otupiri E: Addressing Health System Barriers to Access to and Use of skilled delivery services: Perspectives from Ghana. International Journal of Health Planning and Management, 2015, DOI: 10.1002/ hpm.2291. 18. Ganle JK, Otupiri E, Parker M & Fitpatrick R: Socio- cultural barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. International Journal of Maternal and Child Health, 2015, 3(1): 1-14. 19. Ganle JK: Why Muslim women in northern Ghana do not use skilled maternal healthcare services at health facilities: A qualitative study. BMC International Health & Human Rights, 2015, 15(10): DOI 10.1186/s12914-015-0048-9. 20. Ghana Statistical Services (GSS), Ghana Health Service (GHS), & Macro International: Ghana Maternal Health Survey 2007. Calverton, Maryland, USA: GSS, GHS, and Macro International; 2009. 21. Ghana Statistical Service: Ghana Demographic & Health Survey 2014. Accra: Ghana Statistical Service; 2014. 22. Lauro D: Abortion and Contraceptive Use in Sub- Saharan Africa: How Women Plan Their Families. African Journal of Reproductive Health, 2011, 15(1): 13-23. 23. Say L & Raine R: A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bulletin of World Health Organization, 2007, 85:812-819. 24. Ahmed S, Creanga AA, Gillespie DG & Tsui AO: Economic Status, education, and empowerment: implications for maternal health service utilization in developing countries. PLOS ONE, 2010, 5(6): e11190. 25. Asante AD & Zwi AB: Factors influencing resource allocation decisions and equity in the health system of Ghana. Public Health, 2009, 123:371-377. 26. Osur J, Orago A, Mwanzo I & Bukusi E: Social Networks and Decision Making for Clandestine Unsafe Abortions: Evidence from Kenya. African Journal of Reproductive Health, 2013, 19(1): 34-43. 27. Mundigo AI: Determinants of unsafe induced abortion in developing countries. In I.K. Warriner, I.H. Shah (eds). Preventing Unsafe Abortion and its Consequences: Priorities for Research and Action. New York:AGI, 2006, Pp.51–57.


  • There are currently no refbacks.