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Unusual Presentation of Phaechromocytoma in a Child- A September 2006 Volume 40, Number 3 GHANA MEDICAL JOURNAL OVERVIEW OF THE LAW AND AVAILABILITY OF ABORTION SERVICES IN GHANA R.A.S MORHEE AND *E.S.K. MORHEE1 Faculty of Law, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana and 1De- partment of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana. SUMMARY this form of behaviour with the aim of preventing Introduction: In Ghana unsafe abortion remains a its occurrence and to deter people with like minds major public health problem despite apparent lib- from indulging in such a practice. History how- eralization of the law on abortion over two dec- ever, shows that abortion is a fundamental human ades. The contention is that the current law on behaviour that has been practiced in all cultural abortion makes enforceability difficult and leaves settings and that no level of restrictive laws has 1,2 room for untrained personnel to engage in danger- succeeded in controlling it. Thus when a woman ous abortion procedures and that there is need for decides to end an unwanted pregnancy she will law reform. often go to extreme length to do so, regardless of Objectives: To bring into focus how the current whether the procedure is safe or legal and as long law affects the availability of safe abortion service as there is unwanted pregnancy abortion will be a in Ghana and to bring out suggestions that may be fact of life. Unsafe abortion accounts for at least useful in future amendment of the law. 13% of global maternal mortality that is dispropor- 3,4 Methods: Using the information gathered from tionately high in Africa Most of these deaths as literature review the current law on abortion in well as the long-term complications of unsafe Ghana and relevant sections of the criminal code abortion are preventable through improved access were critically analyzed from medico-legal per- to effective family planning methods and contra- spective. ception to reduce the incidence of unwanted preg- Findings: Since 1985 the Ghanaian law on abor- nancy, post-abortion care and provision of safe tion has changed from its preoccupation with pro- abortion services. Besides the health complications hibition and punishment towards liberalization of of unsafe abortion the socioeconomic cost is so abortion but there has been delay in policy formu- high that in some centres in developing countries, lation and implementation to translate the law into treating abortion-related complications may con- services. Hence safe abortion services on medico- sume up to 50% of hospital budgets and resources, social grounds as permitted by the law are not including medical staff time, medicines and sup- 5 readily available in national health institutions. plies Some aspects of the law still appear implicit and th may hamper implementation of safe abortion ser- Until the second half of the 20 century abortion vice in the country. was illegal in most countries and was associated Conclusion: For clarity there is need for more with high illegal and unsafe abortion rate and amendments in the law in order to regulate abor- correspondently high maternal morbidity and mor- 6 tion and to enhance the right of the woman to tality. Recent years have seen the liberalization of make a choice on her own. There is also the need abortion laws in almost all countries of the Euro- to expedite action on development policy and pean Union, the United States and Canada. This standard guidelines for practitioners. together with better and wide spread promotion and use of contraceptives led to rapid decline in Keywords: Unsafe Abortion, Legal abortion the rate of unsafe abortion and its associated mor- 2,7 tality in the developed world. It has been ob- INTRODUCTION served that in many developing countries safe Unsafe abortion is a major public health problem abortion services are not available to the full extent in developing countries where abortion is re- permitted by law. In Ghana, despite the amend- stricted by laws which seek to prevent and punish ment of the law on abortion in 1985 to broaden the indications for legal abortion, unsafe abortion re- * Author for correspondence 80 September 2006 RAS Morhee and ESK Morhee Law on abortion mains a major public problem and a leading cause or consent to be administered to her any of maternal deaths in the country. It also causes a poison, drug or other noxious thing or significant morbidity among women in reproduc- uses any instrument or other means what- tive age. 8,9 soever; or b. any person who— It is important to note that the translation of the (i) administers to a woman any poison, law into services requires enabling policy formula- drug or other noxious thing or uses tion and implementation which in turn depend any instrument or other means what- heavily on the clarity of the law.10 The contention soever with intent to cause abortion however, is that the current law on abortion in or miscarriage, whether or not the Ghana makes enforceability difficult and leaves woman is pregnant or has given her room for untrained personnel to engage in danger- consent ous abortion procedures and that there is the ne- (ii) induces a woman to cause or consent cessity and pressing need for law reform. This to causing abortion or miscarriage; overview is aimed at bringing into focus how the (iii) aids and abets a woman to cause current law affects the availability of safe abortion abortion or miscarriage; service in Ghana and to make suggestions that may (iv) attempts to cause abortion or miscar- be useful in future amendment of the law. riage; or (v) supplies or procures any poison, METHODS drug, instrument or other thing know- Extensive literature review was done by hand ing that it is intended to be used or search of relevant books and journals and by elec- employed to cause abortion or mis- tronic search from web sites on the internet using carriage; shall be guilty of an offence words like ‘Abortion, policy and the law’, ‘Trend and liable on conviction to impris- of abortion laws’, ‘unsafe abortion in Ghana’, ‘ma- onment for a term not exceeding five ternal mortality and abortion in Ghana’. Critical years. analysis of the law, as stated in the 1999 revised version of the Consolidated Criminal Code of the 2. It is not an offence under section (1) if an Republic of Ghana, 1960, Act 29 was made to find abortion or miscarriage is caused in any of the out how it promotes or hampers establishment of following circumstances by a registered medi- safe abortion units in the country. The current cal practitioner specializing in Gynaecology Ministry of Health Reproductive Health Policy on or any other registered medical practitioner in unsafe abortion was reviewed in relation to the a government hospital or a private hospital or law. Reference was made to the law on abortion in clinic registered under the Private Hospital other jurisdictions particularly the current UK law and Maternity Home Act, 1958 (No. 9) or in a since the original abortion law in Ghana was fun- place approved for the purpose by legislative damentally based on the old British statute, ‘the instrument made by the Secretary: Offences against the Person Act of 1861’. Discus- a. where pregnancy is the result of rape or sions were made based on the authors’ understand- defilement of a female idiot or incest and ing of the law as well as the World Health Organi- the abortion or miscarriage is requested zation recommendations on the provision of safe by the victim or her next of kin or the abortion and the global trend of liberalization of person in loco parentis, if she lacks the abortion laws. Other relevant sections of the capacity to make such request; criminal code are also discussed. b. where the continuance of the pregnancy would involve risk to the life of the preg- RESULTS nant woman or injury to her physical or The Current Law on Abortion in Ghana mental health and such a woman consents In Ghana abortion is a criminal offence regulated to it or if she lacks the capacity to give by Act 29, section 58 of the Criminal code of such consent it is given on her behalf by 1960, amended by PNDCL 102 of 1985. It states her next of kin or the person in loco par- that:11 entis; 1. Subject to the provisions of subsection (2) of c. where there is substantial risk that if the this section child were born it may suffer from or a. any woman who with intent to cause abor- later develop a serious physical abnormal- tion or miscarriage administers to herself ity or disease. 81 September 2006 Volume 40, Number 3 GHANA MEDICAL JOURNAL 3. For the purposes of this section Abortion or miscarriageClearly, means the pre-Act takes the stance that human life mature expulsion or removal of conception from thebegins uterus ator conception womb and seeks to protect the fetus. before the period of gestation is completed. Thus according to the law once a woman con- ceives or becomes pregnant, the said pregnancy, The Policy and Availability of Safe Abortion right from conception till the foetus is born, cannot Service in Ghana be terminated except under the stated circum- Over the years the reproductive health policy of stances. Ghana on reduction of unsafe abortion only dwelt on promotion of family planning, contraception Definition of abortion or miscarriage and post-abortion care but not provision of safe The definition of abortion or miscarriage as stated abortion within the confines of the law as recom- in the Act seems to depart from the generally ac- mended by World Health Organization12.
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