Reducing Maternal Mortality Due to Unsafe Abortion: The Ghana Paradox

Samuel Antobam, Private Consultant

Abstract A major contributing factor to the high maternal mortality ratio in Sub-Saharan Africa is unsafe abortion. The contribution of unsafe abortion to maternal mortality in the region is estimated to be over 37 deaths per 100000 live births. It follows that there is a positive relationship between unsafe abortion and abortion-related maternal mortality. However, Ghana does not follow this expected trend, at least in the last ten years or so. In 2007 maternal mortality due to unsafe abortion was substantial, estimated to be 11%.To reduce it, Ghana Health Service (GHS), with support from various partners implemented a policy to increase access to safe abortion services by expanding the provider cadre to include midwives. The implementation of this policy has been largely successful in reducing maternal mortality due to unsafe abortion from 11% to just 4% between 2007 and 2017. However, in the same period, unsafe abortion as defined by the World Health Organization and enshrined in GHS's Standard and Protocol, increased from 39% to 62%. In this paper we attempt to explain this paradox and raise some fundamental questions about the definition and measurement of unsafe abortion as well as the provision of abortion services. We suggest a policy change to reflect the current realities.

Keywords: Sexual and Reproductive Health and Rights, Mortality and Longevity, Population Policies, Health and Morbidity

See extended abstract.