Unsafe abortion is defined by the World Health Organisation (WHO) as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards.
From the WHO, 47 000 women die from complications of unsafe abortion each year. Deaths due to unsafe abortion remain close to 13% of all maternal deaths.healthylifegh.com takes you back into the story of New Juaben Municipality in the Eastern Region of Ghana.
According to the Adolescent Health and Development Programme Report of the Ministry of Health, 8,717 girls went through unsafe abortion in 2009, 10,785 in 2010 and 16,182 in 2011.
The statistics obviously defeats efforts being made to bring the dangerous practice under control and impedes the country’s efforts at achieving the Millennium Development Goals four and five.
The aim to reduce maternal mortality by 75 percent by 2015 seems impossible in the face of these figures. The increase in the numbers year after implies less knowledge in reproductive health and the use of contraceptives to prevent unwanted pregnancies.
Currently, unsafe abortion accounted for 15 percent of maternal deaths in Ghana.
The New Juaben Municipality currently stands out as one of the fastest-growing municipalities in Ghana for several reasons, its proximity to the National capital which is already experiencing an explosion in the number of people per square meter and is spilling over into the municipality which houses a regional capital.
Per population indicators, it is a municipality that demographers and all professionals with interest in the social make-up of Ghana ought to watch keenly.
I set off on a cold afternoon on a mission to inquire from managers of healthcare in this municipality exactly what the situation on unsafe abortion looks like.
“Look, if a woman or lady does not want pregnancy and we don’t help her, she would go somewhere and try aborting it, and if there are complications, she would be brought to us and to do the dirty work, she could die. We should not create a financial barrier”
These were the stern words of Dr L. K. Senaya, the Municipal Director of Health Services of the New Juaben Municipality when I visited his outfit to have firsthand information on unsafe abortion in the municipality.
My first point of call was at the office of the Municipal Public Health Nurse, Mrs. Evelyn Owusu-Acheaw.
Her immediate statement to me was that of “not too bad a picture” for a municipality.
“We’ve had only one case of unsafe abortion this year for the municipality, we’ve had two referrals from other districts, and the Regional hospital is a referral hospital so we’ve had two cases from other districts making it three”
Upon hearing this, one would think the situation was under control, further conversation with the Public Health Nurse revealed the reason for the low recorded figures.
I inquired of how bad the situation of unsafe abortions get before they are brought to the health facilities in the municipality, her answer begun to bring to mind the logic of why records on unsafe abortion are low.
My question was straight forward, “how bad are some of these situations when they come in?”
And her answer was as well, “sometimes it’s too late to do whatever because whatever they take, they start bleeding and then they think that all the products have come out, yet they are not sure, so when they are there and they fell unwell, there is fever, then they report, by the time they report, some infection would have started, at times they are put on heavy antibiotics but sometimes it is too late and they lose their lives”
Recounting the sad story of a teenager who passed away last year (2013), she said “the young girl had traveled from Accra to her brother in Koforidua purposely to abort a pregnancy and her brother didn’t know. The brother thought his sister had come just for holidays, she took some concoction; her brother was only called from work that the sister had collapsed. By the time they brought her to the facility, it was too late, her situation had worsened. It was at the hospital that she confessed to haven attempted aborting a pregnancy. She passed away as a result of an infection in its advanced stage.”
It then dawned on me why the figures are low. Most women who practice unsafe abortion risk their lives for it. If there aren’t any complications in the immediate, they live with it and no one gets to know, if complications emerge, they go to the hospital, and they report when it is too late. It is at this point that it is recorded.
The figures from the Adolescent Health and Development Programme Report of the Ministry of Health can thus be said to be an underestimation of what the actual situation is.
It presupposes that the numbers that are recorded are numbers of people who have tried and had life-threatening complications.
Speaking to a mother of one, aged 24, she told me she has had more than three abortions using various methods. The only one she failed to abort resulted in the birth of a boy child. She tried and did not succeed; she quit trying because she was afraid of losing her life if she continued.
UNSAFE ABORTION | Why would they not go to the hospital?
Mrs. Owusu-Acheaw’s answer to why women would not visit a health facility for comprehensive abortion when it was needed was quite revealing.
“I don’t know, but sometimes, people just want to hide in their own corners and do their own thing without anybody noticing, at times too they have quacks in their community who they rely on, and ignorance. For the quacks, the community would never own then up. Most women who abort pregnancies too don’t want to be noticed and would not come near a health facility. Others too for the cost involved, they would prefer not to come to the hospital at all, others do it for self-esteem”
After her answer, I probed further to find out why anyone would want to perform an abortion for self-esteem.
For her answer to this, She recounted a rather brave story of a 27year old lady who would not opt for any family planning method, accordingly, “when members of the family planning unit of the Municipal Health Directorate visited her neighborhood to give talks on family planning methods, she would boldly tell them, she does not like any of them” the woman would tell the team that, they should not worry her with family planning methods, and that if she gets pregnant, she would abort.”
Mrs. Owusu-Acheaw was quick to add that such statements implied that the said lady might have had a number of abortions without any complications; this could be the reason for her bold statement.
Strangely enough, young girls would want to pride themselves as having been able to successfully abort a pregnancy. This act is something they pride themselves with and unconsciously, make clients of their friends who find themselves in need of their services.
The warning of Mrs. Owusu-Acheaw was that “Abortion is not a family planning method so if you don’t want a pregnancy in the first place, just do family planning.”
UNSAFE ABORTION | Cost Factor
With respect to cost, I sort to find out exactly how much it cost to have a comprehensive abortion, the response was rather surprising. “It depends on the age of the pregnancy, the higher the pregnancy, the higher the price. Sometimes, when the medical staff takes a look at the situation, they could even ask the client to go free. When they listen to the story behind the incident and the client can’t afford to pay, they ask you to go free” When pushed to mention a figure, she said, “it’s between GHC 30.00 to GHC 50.00”
I took the time to visit the Municipal Director for a confirmation of the cost and he did not miss words. Looking very stern, Dr. L. K. Senaya hit the nail on the head, “it is not more than GHC 50.00. That is the directive from the Regional office when a person walks in to have an abortion, it means we as an institution have failed in the family planning campaign and we should find a way of doing it safely otherwise she would somewhere and die, and we want to reduce maternal mortality. It is called comprehensive abortion.”
I asked how come the price is not more than that, contrary the perception among many youths, he come strong with this explanation “look, if a woman or lady does not want a pregnancy and we don’t help her, she would go somewhere and try aborting it and if there are complications, she would be brought to us and we would have to do the dirty work, she could die. We should not create a financial barrier”
Dr. Senaya, however, added that if a person came to the hospital with a complication from the house, it falls in a class of its own and may attract a different cost.
“Induced abortion” as he told me it is called could result in various complications including a ruptured womb that would require expensive corrective surgeries.
According to the Director of the New Juaben municipality, free counseling services are provided to women who visit health facilities for comprehensive abortion.
UNSAFE ABORTION | Advice to youth
Mrs. Owusu-Acheaw advised the youth to walk freely into any health facility and receive free counseling on family planning methods. Apart from the condom, male or female, all other family planning methods would only prevent unintended pregnancies and not Sexually Transmitted Infections (STIs), she stressed.
If all else fails and there was the need for an abortion, one could walk into any health facility and request a comprehensive abortion rather than try to self abort which could cause complications and sometimes death.
UNSAFE ABORTION | Talking to the youth
Speaking to a group of young men and women after my visit to the health directorate, I received varied and surprisingly contrary perceptions from what actually prevails in the hospitals.
They told me, it costs at least GHC 200.00 to have a safe comprehensive abortion in the hospital.
A young man in his mid-20s Ebenezer strongly told me it was murder to terminate a fetus, “if you had been aborted, would you be here to enjoy life the way you are enjoying, even if carrying the pregnancy would put the life of the mother danger, they should pray for her, God can protect them”
He spoke to me as though he had been waiting for me to pour out his mind, “even if you cannot take care of the child, the government should take such children and take care of them”
It became obvious to me that, many youths held several opinions which were not the case and did not know exactly what the policies on safe comprehensive abortion were.
Reproductive health and sex education to the numerous youth of this country is an absolute need.