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Pre and Post Abortion Experiences Among Young Females in Cape Coast Metropolis, Ghana

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Pre and Post Abortion Experiences Among Young Females in Cape Coast Metropolis, Ghana Esia-Donkoh et al. Pre and Post-Abortion Experiences ORIGINAL RESEARCH ARTICLE Who Cares? Pre and Post Abortion Experiences among Young Females in Cape Coast Metropolis, Ghana Kobina Esia-Donkoh*1, Eugene K.M. Darteh1, Harriet Blemano2 and Hagar Asare3 Department of Population and Health, University of Cape Coast, Ghana1; Asamankese Senior High School, Eastern Region, Ghana2 and Hagar Asare, Institute for Development Studies, University of Cape Coast, Cape Coast, Ghana3. *For Correspondence: E-mail: [email protected]; phone: +233 265 217 616, Abstract Issues of abortion are critical in Ghana largely due to its consequences on sexual and reproductive health. The negative perception society attaches to it makes it difficult for young females to access services and share their experiences. This paper examines the pre and post abortion experiences of young females; a subject scarcely researched in the country. Twenty-one clients of Planned Parenthood Association of Ghana (PPAG) clinic at Cape Coast were interviewed. Guided by the bio- psychosocial model, the study revealed that fear of societal stigma, shame, and rejection by partners, as well as self-imposed stigma constituted some of the pre and post abortion experiences the respondents. Other experiences reported were bleeding, severe abdominal pain and psychological pain. The Ghana Health Services (GHS) and other service providers should partner the PPAG clinic to integrate psychosocial treatment in its abortion services while intensifying behaviour change communication and community-based stigma-reduction education in the Metropolis. (Afr J Reprod Health 2015; 19[2]: 43-51). Keywords: Ghana abortion; young people; experiences. Résumé Les questions de l'avortement sont essentielles au Ghana en grande partie due à ses conséquences sur la santé sexuelle et de reproduction. La perception négative que la société attache à elle, le rend difficile pour les jeunes d'accéder au service et de partager leurs expériences. Cet article examine les expériences d’avant et d’après avortement des jeunes gens, un sujet à peine étudié dans le pays. Vingt-et-un des clients de la clinique de Planned Parenthood Association de Ghana (PPAG) à Cape Coast ont été interrogées. A l’aide du modèle bio-psycho social, l'étude a révélé que la peur de la stigmatisation sociale, la honte et la perte de partenaires, ainsi que la stigmatisation auto-imposé constituaient. L’expérience d’avant et d’après avortement des interrogées rencontrées. L’hémorragie, les douleurs abdominales intenses et de la douleur psychologique ont également été signalées. Les services de santé du Ghana (GHS) et d'autres fournisseurs de services devraient collaborer avec la Clinique du PPAG d'intégrer le traitement psychosocial dans leurs services d'avortement tout en intensifiant la communication sur le changement de comportement et l'éducation à base communautaire destinée à la réduction de la stigmatisation dans la métropole. (Afr J Reprod Health 2015; 19[2]: 43-51). Mots-clés:avortement, jeunes, expériences 4 Introduction and women’s rights . For instance, an estimated 529,000 adolescent girls and women die from Since the adoption of declarations from the pregnancy-related causes each year, almost all of International Conference on Population and them in Africa, However, 13% of these deaths are Development (ICPD) in Cairo in 1994 and the due to unsafe abortion5-7. Fourth World Conference on Women (FWCW) in Say et. al.,8 estimated that about 8%of all Beijing in 1995, issues about sexual and maternal deaths in the world between 2003 and reproductive health in general and abortion in 2009 were as a result of abortion. Estimates for particular have gained currency globally. The sub-Saharan Africa was about 10% while that of interests in abortion issues have increased over the North Africa was less than 3%. Of the 6.4 million recent decades particularly due to the abortions carried out in 2008, only 3% were consequences associated with maternal mortality1-3 performed under safe conditions6,9. African Journal of Reproductive Health June 2015; 19 (2): 43 Esia-Donkoh et al. Pre and Post-Abortion Experiences Although abortion is a criminal offence regulated The proponents of pro-choice argue that laws by Act 29, section 58 of the Criminal code of against abortion rather kill women and 1960, amended by PNDCL 102 of 1985 in Ghana, discriminate against low income women who the country’s abortion law is considered to be cannot travel to access safe abortion service fairly liberal10. The law permits qualified medical elsewhere. Thus, laws per se do not prevent practitioners to undertake abortion if the abortion but rather allow the service to be accessed pregnancy is a result of rape, incest or defilement secretly and practiced illegally with obvious of a ‘female idiot’; if the continuation of the consequences. On the other hand, the pro-life pregnancy could result in risk of the life of the debate centres on the premise that personhood woman or threaten her physical or mental health; begins immediately after conception and that the or if it is a risk to the life of the unborn child. This termination of a fetus is murderous and defeats the notwithstanding, unsafe abortion is not uncommon practice of human rights20. in the country contributing about 11% to maternal From a policy perspective, abortion was mortality11-16. The incidence of abortion with its only integrated into the national reproductive consequences is considered to be highest (25%) health policy in 2003 with comprehensive abortion among women aged 20-24 years15, with a reported care (CAC) becoming a reproductive health rate of 34 per 1000 among women in urban areas17- service in 2006 when the Ghana Health Service 20. introduced the new standards and protocols for Societal perception and religious doctrines safe abortion services Nevertheless, the law still surrounding abortion make it difficult for young tends to be interpreted as prohibiting abortion people to access abortion services in the country making it difficult especially for young people to and also share their pre and post abortion access services21. experiences. The study therefore examines the pre Existing evidence shows that abortion is and post abortion experiences among young highest among the youngest cohorts of women. females in Cape Coast Metropolis. While sixteen per cent of pregnancies among women age less than twenty years end Abortion, Conceptual, policy and empirical issues almost fifty per cent of young unmarried women in Greater Accra and Eastern Regions of Ghana The concept and definition of health have well who had ever been pregnant had terminated a been espoused by world governing bodies and pregnancy12,21,22. In a comprehensive study by the institutions such as the World Health Organization Ghana Health Services known as the Ghana (WHO) as a state of complete physical, mental and Maternal Health Survey (GMHS), among women social well-being. For instance, the health reporting on their most recent abortion in the five governing body defines reproductive health as years before the Survey in 2007 reveals that, 16% ‘Reproductive health is a state of complete terminated their pregnancy with tablets young physical, mental, and social well-being and not people go through various related experiences not merely the absence of disease or infirmity, in all only to access service, but first coping with the matters relating to the reproductive system and to pregnancy result, deciding to abort and coping its functions and processes’. By extension, the with post-abortion experience. Literature available definition provides a condition for every young indicates that reasons such as poverty, fear of female to decide and terminate a pregnancy if she education discontinuity, stigma and shame are is unstable and mentally unhealthy as a result of among the main reasons young people abort21-23. the pregnancy. In fact, the ICPD in 1994 and These reasons continue to put psychosocial stress FWCW in 1995 affirmed the human rights of on many a young people; more so because women in this area of health18. abortion among young female is secretive. The The above conceptualization especially Ghanaian society also does not approve of pre- within the framework of human health and rights marital sex and abhors every decision to abort, still heightens the pro-choice and pro-life debate. hence, the difficulty of this group sharing their African Journal of Reproductive Health June 2015; 19 (2): 44 Esia-Donkoh et al. Pre and Post-Abortion Experiences experiences. projects that target abortion services to the whole Consequently, research has not focused populace especially young people. These include much on their pre and post experiences due in part the Global Comprehensive Abortion Care to the societal perception about the subject and Initiative (GCACI), and the SALIN+ project. With young people’s difficulty in sharing their abortion the GCACI, some of the objectives were to experiences24. The present study adopted the bio- increase access to comprehensive abortion care psychosocial model to examine these experiences services resulting in a total of 405 clients being (Figure 1). The model explains that biological, attended to by the end of 2012 and to increase psychological and social factors collectively play access to treatment for incomplete abortion vital roles in human functioning such as cognitive services resulting in a total of 117 clients served appraisal and coping behaviour in the context of by the end of 2012. As an achievement under this health24. Health is best understood in terms of project, 881 females had been provided with these factors, a view also held by the WHO18. Comprehensive Abortion Care (CAC) at the time of the study. These included 176 incomplete Figure 1: The biopsycho-social model abortions and 613 Post abortions Family Planning services. From January to December 2010, a total of 42 abortions were carried out at the Cape Coast clinic.
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