Abortion Stigma | Generally, many people are very hostile to the subject matter, and don’t even want to hear it mentioned.
According to Ipas, Abortion Stigma is “A negative attribute ascribed to women who seek to terminate a pregnancy that ‘marks’ them as inferior to ideals of womanhood.”
The irony of the issue with abortion is that, the number of illegal abortion far outweighs that of comprehensive safe abortion.
Even though Abortion legislation is flexible, the practice of comprehensive safe abortion in hospitals remain unknown to many .
The law in Ghana allows abortion only under a few conditions such as an incest pregnancy, impregnation of a ‘female idiot’ mad female, impregnated rape victim, or when health care workers determine that the baby, if born, will not be able to have a meaningful life, or if the pregnancy threatens the health or life of the mother, should she continue with the pregnancy.
In Ghana, abortion complications are a large contributor to maternal morbidity and mortality.
According to the Ghana Medical Association, abortion is the leading cause of maternal mortality, accounting for 15–30% of maternal deaths [Asamoah BO, 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]
Furthermore, for every woman who dies from an unsafe abortion, it is estimated that 15 suffer short and long-term morbidities. [Eades CA, Brace C, Osei L, LaGuardia KD. Traditional birth attendants and maternal mortality in Ghana. Soc. Sci. Med. 1993;36(11):1503–1507.]
In 2016, 110,000 adolescent girls in 352 basic schools across the country got pregnant. [Ghana Health Service]
Within the same period 9,612 cases of unsafe abortion were recorded throughout the country
Unsafe abortion accounted for 15 per cent of maternal deaths in Ghana and also for 25 to 30 per cent of maternal deaths in leading teaching hospitals in the country last year.
This is impeding the country’s efforts at achieving Sustainable Development Goal 3 (SDG 3), which is primarily aimed at ensuring healthy lives and promoting well-being by 2030
Even though the country’s laws allow for comprehensive safe abortion to be done under some circumstances or conditions, knowledge of it is scanty.
Many women are not aware of an abortion law in the country.
For those who have had an abortion too, merely disclosing to a third person attracts suggestive looks and scourges.
For those who decide on having an abortion too, they dare not even mention it because of the viewpoint of the general public on abortion.
Chances are that, most girls or women would rather visit a quack and develop complications later, rather than go to the hospital.
Ipas Ghana, A non-governmental organization (NGO)’s call for the process to be covered by the NHIS was met with harsh comments, especially on social media.
Abortion remains one of the most sensitive and stigmatized issues among the range of Sexual and Reproductive Health services offered.
Safe abortion is not as patronized as unsafe abortion is.
Abortion is viewed very negatively and associated with sin, crime, irresponsible behaviours or promiscuity.
Normally people think that it’s murder and a sinful act.
It is also perceived that, only those women who have illicit affairs commit abortion.
The stigma that comes with abortion happens in different forms and at different levels.
ABORTION STIGMA | SELF STIGMA
According to Edna Astubury-Ward in her Phd thesis to the Glyndwr University, Department of Nursing, on Stigma, Abortion, and Disclosure—Findings from a Qualitative Study;
Women in her study saw abortion as “highly a taboo and a potentially personally stigmatizing event.”
These perceptions continued to affect disclosure to others, long after the abortion, and affected women’s perceptions of the response of others, including society in general, significant others, and health professionals.
Most women or girls who have been through the process of abortion live with a lot of self stigma.
They see themselves as having committed the unforgivable.
Speaking to a few girls on the street, Ama (not her real name) exclaimed upon my inquiry on what she thinks of abortion;
“Eiii, as for this one, they say if you do it, you have to fast for 21days before God can forgive you”
In a little survey of ladies in my office, their immediate response was that, “why would anyone do that? It is a sin to start with”
These comments represent the general way in which the public sees abortion.
Thus, when one finds herself in a situation where it becomes the only way out, even when it is through no fault of hers, one feels they have committed sacrilege.
ABORTION STIGMA | COMMUNITY LEVEL
At the community level, abortion could easily make one feel like an outcast and not part of the community anymore.
One dares not disclose to her immediate family and friends that they have had an abortion.
The immediate reaction is one of hypocritical surprise.
Next thing you know, majority of people in the locality get to know and start pointing fingers at you.
This leads to a tight lip stance on the discussion on abortion.
The end result is that, within communities, few people become aware of the provision of comprehensive abortion care.
Quacks are thus given a firm grip of their practice through an “open secret” as the community would not even talk about abortion in the open.
ABORTION STIGMA | NATIONAL LEVEL
The immediate response to a story on covering abortion services with the National Health Insurance Scheme was a true representation of how most citizens see abortion.
On social media, comments to such stories were:
“Why should the NHIS be used to pay for murder?”
“This is going to make girls more promiscuous”
And many more.
Nationally, many are unaware that, giving certain circumstances, one can opt for safe abortion at the health facility.
Many would fight any attempt to use state funds to pay for such services, but would gladly welcome the idea of using state funds to pay for complications resulting from an attempted abortion at home.
ABORTION STIGMA | CLINIC LEVEL
Stigma around abortion poses a significant barrier to women being able to access safe abortion.
Attitudes and practices of clinic staff and service providers sometimes increase the fear of women who have a need for the service.
Staff portray a different attitude towards women who have an induced abortion as opposed to those who have a spontaneous abortion (miscarriage)
The stigma at the clinic level extends to service providers.
They are sometimes branded as “abortionists”
WHAT CAN WE DO?
At all levels, there must be initiative to address the causes and manifestations of abortion stigma.
There should be increased recognition and awareness of the impact of abortion stigma at all levels.
To gain a greater understanding of abortion stigma, there should be increased research into the area.
ABORTION STIGMA | WITHIN THE CLINIC – MANAGING STIGMA
The way that clinics are set-up and laid out does not consider stigma, and can exacerbate its impacts.
The Clinic system rely on clients providing the real reason for their visit at reception.
Upon visiting the clinic, your temperature, weight and BP is taken.
You are then asked to disclose your reason for visiting, (what is wrong with you) and sometimes directed to which consulting room to queue for.
This can be particularly challenging for clients accessing abortion-related services.
Even in hospitals where there is a place designated for such, many do not know the name of the place.
In a country where there is already pressure on health facilities, it would be prudent to prevent complications that would call for more experts than rather have comprehensive safe abortion care.
Should it be a necessary evil?