Incidence of Abortion and Provision of Abortion-Related Services in Ghana
In Ghana, abortion is highly stigmatized, despite relatively liberal laws. As a result, many abortions are not captured in official records, and accurate information on abortion incidence and unintended pregnancy—information that is essential to planning reproductive health services—has been lacking. This fact sheet presents new estimates of unintended pregnancy and abortion rates, as well as the availability of abortion and postabortion services in Ghana.
Legal status of abortion in Ghana
- According to Ghanaian law, abortions are legal in cases of rape, incest, fetal abnormality or disease, or “defilement of a female idiot,” or if they are performed to protect physical or mental health; they must be provided by registered and trained health personnel in an approved facility.*
- Despite efforts by the Ministry of Health and the Ghana Health Service to expand postabortion care and safe abortion services, several factors impede use of these services. These include stigmatization of abortion, poor knowledge of abortion’s legal status among the public and medical professionals, misperceptions about the safety of legal abortion and inadequate access to services.
- Many women in Ghana seek illegal abortions, which vary widely in terms of safety. Complications from unsafe abortions contribute substantially to Ghana’s high maternal mortality, which was estimated at 310 maternal deaths per 100,000 live births in 2017.
Incidence of unintended pregnancy and abortion
- Nationally in 2017, the estimated pregnancy rate was 194 pregnancies per 1,000 women aged 15–49, and the unintended pregnancy rate was 103 per 1,000.
- The unintended pregnancy rate varied widely across the country’s three ecological zones—from 50 in the Northern zone to 94 in the Coastal zone and 131 in the Middle zone.
- About half (53%) of all pregnancies nationally were unintended, ranging from 23% in the Northern zone to 51% in the Coastal zone and 66% in the Middle zone.
- An estimated 23% of all pregnancies in Ghana in 2017 ended in abortion.
- Three estimation methods considered internally valid and reliable produced national abortion rates of between 30 and 61 abortions per 1,000 women aged 15–49. The mean of these rates yields a national abortion rate of 44. This is equivalent to over 327,600 abortions annually in Ghana.
- Mean abortion rates varied among the three ecological zones, from 24 for the Northern zone to 51 for the Middle zone and 45 for the Coastal zone.
Provision of abortion and postabortion care
- Among a nationally representative sample of all health facilities providing either abortion or postabortion care in 2017, 63% had postabortion care services available and 22% had safe abortion services available. A small proportion of these facilities did not provide these services to any clients in the previous 12 months.
- Provision of both abortion and postabortion care was nearly universal at teaching hospitals and regional hospitals (90–100%). Among other types of hospitals and polyclinics, 86–93% provided postabortion care and 20–52% provided abortion. Among lower-level facilities, 41–61% provided postabortion care and only 8–14% provided abortion.
- About 58,000 legal abortions were performed in health facilities in Ghana in 2017. District hospitals provided 35% of legal abortions, NGO facilities 25% and health centers 15%.
- Nationally, nearly 70,000 postabortion care cases were treated in health facilities. This includes cases resulting from miscarriages or abortion. District and university hospitals handled 37% of all cases.
- Abortion complications overall accounted for an estimated 43,000 facility-based postabortion care cases, and complications of illegal abortions accounted for 38,000 of these.
- The treatment rate for women experiencing complications resulting from an illegal or legal abortion in 2017 was 5.7 per 1,000 Ghanaian women aged 15–49. The rate was substantially higher for women obtaining an illegal abortion (5.2) than for those obtaining a legal one (0.5).
- The proportion of all abortions that were illegal was estimated to be 71% nationally, 60% in the Coastal zone, 72% in the Northern zone and 78% in the Middle zone.
The national government in Ghana, along with nongovernmental partners, should take steps to reduce the burden of unsafe abortion.
- Ensure that women know abortion is legally allowed under some circumstances in Ghana and disseminate information on how and where to obtain safe and legal abortion services.
- Continue to expand access to safe, legal abortion services and postabortion care by increasing the number of trained providers and approved facilities that offer these services, in order to reduce complications and deaths from unsafe abortions.
- Train lower-level health care workers to provide comprehensive abortion care services.
- Improve contraceptive services through offering a wide range of methods and high-quality counseling services, so that women can identify and adopt methods that best meet their needs and prevent unintended pregnancies.
Information in this fact sheet can be found in the following sources: Keogh SC et al., Estimating the incidence of abortion: a comparison of five approaches in Ghana, BMJ Global Health, 2020, 5(4):e002129, doi:10.1136/bmjgh-2019-002129; and Polis CB et al., Estimating the incidence of abortion: using the Abortion Incidence Complications Methodology in Ghana, 2017, BMJ Global Health, 2020, 5(4):002130, doi:10.1136/bmjgh-2019-002130.
*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.”
The study on which this fact sheet is based was made possible by UK Aid from the UK Government and a grant from the Dutch Ministry of Foreign Affairs. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donors.
The high number of illegal abortions in Ghana—many of them unsafe—is cause for concern in a country where abortion can be legally obtained. These findings indicate an urgent need for the government and NGOs to raise awareness among health providers and the general public on how to access legal abortion.