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Incidence of Abortion and Provision of Abortion-Related Services in Ghana

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Incidence of Abortion and Provision of Abortion-Related Services in Ghana FACT SHEET Incidence of Abortion and Provision of Abortion-Related Services in Ghana In Ghana, abortion is highly Incidence of unintended pregnancy over 327,600 abortions annually in stigmatized, despite relatively liberal and abortion Ghana. laws. As a result, many abortions • Nationally in 2017, the estimated • Mean abortion rates varied among are not captured in official records, pregnancy rate was 194 the three ecological zones, from and accurate information on pregnancies per 1,000 women 24 for the Northern zone to 51 for abortion incidence and unintended aged 15–49, and the unintended the Middle zone and 45 for the pregnancy—information that is pregnancy rate was 103 per 1,000. Coastal zone. essential to planning reproductive health services—has been lacking. • The unintended pregnancy rate Provision of abortion and This fact sheet presents new varied widely across the country’s postabortion care estimates of unintended pregnancy three ecological zones—from 50 and abortion rates, as well as in the Northern zone to 94 in • Among a nationally representative the availability of abortion and the Coastal zone and 131 in the sample of all health facilities postabortion services in Ghana. Middle zone. providing either abortion or postabortion care in 2017, 63% • About half (53%) of all pregnancies Legal status of abortion in Ghana had postabortion care services nationally were unintended, available and 22% had safe • According to Ghanaian law, abor- ranging from 23% in the Northern abortion services available. A small tions are legal in cases of rape, zone to 51% in the Coastal zone proportion of these facilities did incest, fetal abnormality or disease, and 66% in the Middle zone. not provide these services to any or “defilement of a female idiot,” • An estimated 23% of all clients in the previous 12 months. or if they are performed to protect pregnancies in Ghana in 2017 physical or mental health; they • Provision of both abortion and post- ended in abortion. must be provided by registered abortion care was nearly universal and trained health personnel in an • Three estimation methods at teaching hospitals and regional approved facility.* considered internally valid hospitals (90–100%). Among other and reliable produced national types of hospitals and polyclinics, • Despite efforts by the Ministry abortion rates of between 30 and 86–93% provided postabortion care of Health and the Ghana Health 61 abortions per 1,000 women and 20–52% provided abortion. Service to expand postabortion aged 15–49. The mean of these Among lower-level facilities, 41–61% care and safe abortion services, rates yields a national abortion provided postabortion care and several factors impede use of these rate of 44. This is equivalent to only 8–14% provided abortion. services. These include stigmatiza- tion of abortion, poor knowledge of abortion’s legal status among the public and medical profession- More than half of pregnancies in Ghana are unintended als, misperceptions about the safe- ty of legal abortion and inadequate 1.4 million pregnancies, by outcome, 2017 access to services. • Many women in Ghana seek illegal abortions, which vary widely in Intended pregnancies 39% Births terms of safety. Complications from unsafe abortions contribute sub- 8% Miscarriages stantially to Ghana’s high maternal 23% Births mortality, which was estimated at 310 maternal deaths per 100,000 Unintended pregnancies live births in 2017. 23% Abortions 7% Miscarriages * In this fact sheet, we refer to abortions meeting all of these criteria as “legal” and to abortions not meeting all of these criteria as “illegal.” 1.0 Planned birth 0.8 Miscarriage of intended pregnancy Unplanned birth 0.6 Abortion 0.4 Miscarriage of unintended pregnancy 0.2 0.0 National circumstances in Ghana and dis- seminate information on how and The estimated abortion rate in Ghana varies by zone where to obtain safe and legal abortion services. All Ghana 44 • Continue to expand access to safe, legal abortion services and Northern zone postabortion care by increasing 24 the number of trained providers Middle zone and approved facilities that offer 51 these services, in order to reduce Coastal zone complications and deaths from 45 unsafe abortions. • Train lower-level health care No. of abortions per 1,000 women (mean estimate) workers to provide comprehensive abortion care services. • Improve contraceptive services through offering a wide range • About 58,000 legal abortions were resulting from an illegal or legal of methods and high-quality performed60 in health facilities in abortion in 2017 was 5.7 per 1,000 Estimacounselingte services, so Ghana in 2017. District hospitals Ghanaian women aged 15–49. The 50 that women can identify and provided 35% of legal abortions, rate was substantially higher for adopt methods that best meet NGO facilities40 25% and health cen- women obtaining an illegal abor- their needs and prevent ters 15%. tion (5.2) than for those obtaining 30 unintended pregnancies. a legal one (0.5). • Nationally, nearly 70,000 post- 20 abortion care cases were treated • The proportion of all abortions that Sources in health facilities.10 This includes were illegal was estimated to be Information in this fact sheet can be found in the cases resulting from miscarriages 71% nationally, 60% in the Coastal following sources: Keogh SC et al., Estimating 0 the incidence of abortion: a comparison of five or abortion. DistrictNational and universityNorthern zone zone,Middle 72%zone in theCoastal Northern zone zone and approaches in Ghana, BMJ Global Health, 2020, hospitals handled 37% of all cases. 78% in the Middle zone. 5(4):e002129, doi:10.1136/bmjgh-2019-002129; and Polis CB et al., Estimating the incidence of • Abortion complications overall abortion: using the Abortion Incidence Com- Recommendations plications Methodology in Ghana, 2017, BMJ accounted for an estimated 43,000 Global Health, 2020, 5(4):002130, doi:10.1136/ bmjgh-2019-002130. facility-based postabortion care The national government in Ghana, cases, and complications of illegal along with nongovernmental part- Acknowledgments abortions accounted for 38,000 ners, should take steps to reduce the The study on which this fact sheet is based was of these. burden of unsafe abortion. made possible by UK Aid from the UK Govern- ment and a grant from the Dutch Ministry of Foreign Affairs. The views expressed are those • The treatment rate for women • Ensure that women know abortion of the authors and do not necessarily reflect the experiencing complications is legally allowed under some positions and policies of the donors. Good reproductive health policy starts with credible research guttmacher.org 125 Maiden Lane New York, NY 10038 212.248.1111 [email protected] April 2020.
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