Celebrate Solutions: Government Initiative Improves Abortion and Post-Abortion Care in Ghana

By: Sara Pellegrom, Women Deliver

Although Ghana has one of the most progressive abortion laws in sub-Saharan Africa, mortality from unsafe abortion is still a problem. The 2010 maternal mortality ratio (MMR) in Ghana was 350 maternal deaths per 100,000 live births, compared to an average MMR of 240 in the developing world. One of the largest contributors to maternal deaths are complications from unsafe abortions. The 2007 Ghana Maternal Health Survey estimates that approximately 40% of abortions are performed by untrained providers. Evidence also suggests that many health care providers are not aware of the abortion law. Others may feel that performing an abortion conflicts with their religious beliefs. This lack of knowledge, along with social stigma that surrounds women seeking an abortion, drives the practice underground, resulting in clandestine procedures that are often performed by untrained providers or attempts at a self-induced abortion.

To confront the issues, the Ghanaian government introduced changed to its reproductive health policy and issued new guidelines for the provision of comprehensive abortion care services (CAC) in 2003. In 2006, the Ministry of Health brought together a consortium of international partners, including Ipas, EngenderHealth, Marie Stopes International, the Population Council, and the Willows Foundation to ensure the full implementation of the new policy. The program, called “Reducing Maternal Mortality and Morbidity” (R3M) focused on building the capacity of health workers to provide CAC and increasing access to family planning services to reduce the number of unwanted pregnancies.

A new study by the Guttmacher Institute shows that government initiative has been a huge success. Health care providers exposed to the program were more likely that those who were not to provide safe abortion (54% v. 13%) and post-abortion care (66% v. 33%). Exposed providers were more likely to be trained in abortion techniques (84% v. 52%) and were also more confident in their abailoty to provide safe abortion care (77% v. 36%). Interestingly, confident providers were almost eight times more likely than others to perform a safe abortion and provide safe post-abortion care.

The success of the program relies heavily on the comprehensive basket of services provided by the initiative’s partners, including technical training, sensitivity workshops, and provision of equipment and products. Ipas and the Ministry of Health train providers in public health facilities, while Marie Stopes International trains health care workers in private health facilities. EngenderHealth trains health workers on contraceptive counseling and services, while the Willows Foundation and Population Council educate the community and provide overall guidance on the project.

The program’s first phases ran between 2006 and 2011. Currently, the project is being extended further to reach all districts within the target areas.

Flickr photo via USAID

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