Knowledge, Awareness and Perceptions of Females on Clandestine Abortion in Kintampo North Municipality

Abstract

Clandestine Abortion will continue to be an integral part of human society as long as people continue to accept and engage in sexual activities without being prepared to give birth. Despite the risks (death and other health complication) involved in clandestine abortion, people continue to engage in the act. The central inquiry is; why do people continue to do clandestine abortions despite its associated risk? Do people have knowledge on abortion concerning its legalities and associated risks? This paper thus seeks to clarify the above questions by examining the knowledge, awareness and perceptions of females on abortion, with focus on clandestine abortion in the Kintampo North Municipality of Ghana. The paper reveals that, though most females have little knowledge on the 1985 abortion law, they are aware of the risks associated with criminal abortion. Despite being aware of the risks, circumstances such as unwanted pregnancies, poverty, desire to pursue education and career goals, and job related issues compel most to abort pregnancies through dangerous means. The paper therefore calls for public education on abortion laws in Ghana to be intensified and possibly, consider shifting the existing paradigms of the abortion law in order to curb clandestine abortions and its associated fatalities.

Full text

European Scientific Journal April 2016 edition vol.12, No.12 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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Knowledge, Awareness And Perceptions Of Females
On Clandestine Abortion In Kintampo North
Municipality, Ghana
Alhassan Yakubu Alhassan
Department of Global Development and Planning,
University of Agder, Norway
Abdulai Abdul-Rahim
Paul Boniface Akaabre
Department of Planning, Kwame Nkrumah University of
Science and Technology, Kumasi, Ghana.
doi: 10.19044/esj.2016.v12n12p95 URL:http://dx.doi.org/10.19044/esj.2016.v12n12p95
Abstract
Clandestine Abortion will continue to be an integral part of human
society as long as people continue to accept and engage in sexual activities
without being prepared to give birth. Despite the risks (death and other
health complication) involved in clandestine abortion, people continue to
engage in the act. The central inquiry is; why do people continue to do
clandestine abortions despite its associated risk? Do people have knowledge
on abortion concerning its legalities and associated risks? This paper thus
seeks to clarify the above questions by examining the knowledge, awareness
and perceptions of females on abortion, with focus on clandestine abortion in
the Kintampo North Municipality of Ghana. The paper reveals that, though
most females have little knowledge on the 1985 abortion law, they are aware
of the risks associated with criminal abortion. Despite being aware of the
risks, circumstances such as unwanted pregnancies, poverty, desire to pursue
education and career goals, and job related issues compel most to abort
pregnancies through dangerous means. The paper therefore calls for public
education on abortion laws in Ghana to be intensified and possibly, consider
shifting the existing paradigms of the abortion law in order to curb
clandestine abortions and its associated fatalities.
Keywords: Knowledge, Awareness, Perceptions, Abortion, Clandestine or
Criminal Abortion

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Introduction
Procreation or birth is a central component of human life and this can
be traced to both Biblical and Quranic origins. This can be seen in the
flowing quotations: “God blessed them and said to them, be fruitful and
increase in number: fill the earth and subdue it” (Genesis 1:28a). “Wealth
and children are an adornment of the life of this world….…” (Quran, 18:46).
This is not different in the traditional African society as birth comes with
pride. Birth is therefore part of every human society and is much valued in
many cultures especially in the African context (African Holucost, 2015).
However, pregnancy and birth come with many complications ranging from
heath, physical, economic and social. These complications have made
pregnancy and child bearing dangerous and unsafe for most women in many
parts of the world (World Health Organization, 2011). Medical
complications during pregnancies and unwanted pregnancy situations lead to
abortions (Gutmacher Institute, 2015; Finer and Zolna, 2014). Pregnancies
are not always born out of intended acts, thus leading to the concept of
unwanted pregnancies. Even in cases where pregnancies are pre-meditated,
they are certain times complications that lead people to abortion. Generally,
an estimated 40-50 million abortions occur annually in the world; that is,
approximately 125,000 abortions per day (WHO in World meters, 2015).
In the views of Mohee and Mohee (2006), abortion is the termination
of pregnancy before viability. Viability in medical spheres has pegged at 28
weeks of pregnancy but improvements in modern technologies now appear
to be changing this (Hesse and Samba, 2006). Abortion is therefore the
termination of pregnancy before its 28th week (WHO, 2012). It includes the
termination of pregnancies resulting from natural causes or otherwise.
Abortion resulting from natural causes is termed as spontaneous abortion
while that resulting from intentional act of human is termed as induced
(Worldometers, 2015).
Induced abortions are both legal and illegal depending on the
circumstance in which they are undertaken. What constitute legal and illegal
abortion varies across countries. Generally, abortion becomes legal when it
done within the legal provisions of a country. However, if abortion is done
out of the domain or the legal provision, it becomes illegal (Biswas et al,
2012). According to McKechnie (1983), abortion becomes illegal or criminal
when it is outside the provisions of law (unlawful). What makes abortion
criminal is in terms of the legalities and circumstances under which the act is
undertaken. For the purpose of this study, criminal abortion refers to any
induced abortion undertaken for any reason outside medical or outside legal
provisions and supervision within a given jurisdiction.
The main cause of criminal abortion; particularly in developing
countries is unplanned or unwanted pregnancy (Singh et al., 2014), which

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results from the fact that knowledge on contraceptive technology has not
reached the point at which sexual intercourse can be handled without
becoming pregnant (Gutmacher Institute, 2015; Sedgh and Hussain, 2014;
Ahmed et al, 2014: Imegen, 1997). Unplanned pregnancies are mostly
unforeseen by parties, which are often deliberate irresponsibility. However,
for a woman, the discovery that she is pregnant leads to mixed feelings:
surprise, fear of fetal abnormalities, fear of childbirth, and sometimes a
distress and probable consequences (Social, Educational, Economic or
Emotional) of having a baby. Thus, unplanned pregnancy often results in
women pondering over three options: continue the pregnancy and keep the
baby; continue the pregnancy and have the baby abandoned or adopted; seek
legal or clandestine abortion (illegal abortion), (Jacobs et al, 2014).
In many instances in Sub-Saharan Africa, most women, particularly
the teenage opt for clandestine (illegal/criminal) abortions due to legal
limitations, limited knowledge and negative cultural values when they are
faced with unwanted pregnancies (Vallely et al, 2015: Paltrow, 2015:
Thompson et al, 2014). Mohee and Mohee (2006) argues that, when women
decide to end an unwanted pregnancy they will often go to extreme length to
do so, regardless of whether the procedure is legal, safe or not. They
reiterate that as long as unwanted pregnancies occur in societies, abortions
will be a fact and part of live. The basic effects of most criminal abortions is
medical complications and eventual death of young women (Biswa et al,
2012: Berhan & Berhan, 2014: Smith, 2013: Baiden et al, 2006). Recent
evidence on abortions indicates that the percentage of maternal deaths
resulting from unsafe abortion ranges from 8% to 18%, and the number of
abortion-related deaths in 2014 ranged from 22,500 to 44,000 (Say L et al,
2014: Kassebaum et al, 2014) and almost all death from clandestine or
criminal abortions were recorded in the developing world (Gutmacher
Institute, 2015).
In Ghana, the real concern with this phenomenon is that, despite the
alarming statistics and glaring dangers of deaths in clandestine abortions,
young women particularly, teenagers still opt for it. Though there is limited
existing data on clandestine abortion in many developing countries including
Ghana, it is believed that dangerous methods and procedures are used by the
pregnant women and some unqualified doctors to do away with the
pregnancy (Payne et al, 2013: MOH, 2008: Mohee and Mohee, 2006).
According to Payne et al (2013), supported by Oduro & Otsin (2014), unsafe
abortion remains a major public problem in Ghana and a leading cause of
maternal deaths in the country. Though there are legal provisions in Ghana to
reduce criminal or clandestine abortions, the current law makes
enforceability difficult and still places some restrictions to it. This leaves
room for untrained personnel to aid females in dangerous abortion activities

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(Rominski et al, 2014: Mohee and Mohee, 2006). This has made it difficult
to put an end to criminal abortion act in the country. It is therefore important
to explore more avenues that can help reduce criminal or clandestine
abortion in the country. It is on this premise that this study seeks to
understand the knowledge, awareness and perceptions of females who are
mostly victims of the act and issues surrounding it in the country. It also
seeks to find out why people keep practicing clandestine abortion despite the
risk involved.
The paper uses women in Kintampo North Municipality as the focus
and seeks to determine their knowledge, awareness and perceptions on
induced criminal abortion in the area. It finds out the proportion of the
women who have ever practiced induced criminal abortion, their knowledge
on the effects or risks associated with the act, and factors inhibiting the
prevention of clandestine abortion in the area. This helps in providing policy
directions and reforms towards efforts to combat clandestine (criminal)
abortion in Ghana and beyond. The outcome of the study can also aid in
designing reproductive health educational tools and programme
implementation strategy aiming at reducing clandestine abortion and its
associated deaths among young girls in the developing countries;
particularly, in sub-Saharan Africa and Ghana per say.
Study setting and approach
Kintampo North Municipality is one of the local government units in
the Brong-Ahafo region of Ghana. It lies between latitudes 8º45’ N and 7º45’
N and Longitudes 1º20’W and 2°1’E. Central Gonja Municipal; Bole
Municipal to the West; East Gonja Municipal to the North-East, Kintampo
South Municipal to the South; and Pru Municipal to the South- East (See
Figure 1) bound the area to the north. Kintampo is the administrative capital
of the Municipality. It is strategically located at the center of Ghana, with
well-known Sceneries; that is, Kintampo waterfall and Fullerfalls, attracting
tourists daily from both local and international level.
Figure 1 Map of Kintampo Municipality
Source: Ghana Statistical Service, 2014

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According to Ghana Statistical Service (2014), as at 2010, the
population of Kintampo North Municipality was about 95,480 representing
4.1 percent of the population of Brong Ahafo region of Ghana. The area is
female dominated, as they constitute 50.4 percent of the population. This is
important for this study as the focus is on female who are the majority in the
area. The area has a general youthful population with people less than 15-
year-old constituting 42%. About 44 percent of the populations aged 12
years and older are married and 45% have never married. By ages 25-29
years, more than three quarters of females (64.0%) are married compared to
33.1% of males. Generally, the Municipality has a Total Fertility Rate of 3.9,
which reflects the national figure of 3.86 as at 2013. Fertility Rate of the
Municipality is about 115.1 births per 1000 women aged 15-49 years. This
has implications for this study as it shows the nature birth related activities
within the municipality (Ghana Statistical Service, 2014).
Considering the nature of the variables involved and what is
practical, the study employed the explorative research design. This is
because little knowledge about the phenomenon studied. Exploratory
research clarifies problems, gathers data and creates initial hypothesis and
theories about subjects (Punch, 2004). The study adopted both the
quantitative and qualitative research strategy but more attuned to the
qualitative strategy due to it being explorative in nature. It seeks to determine
the knowledge, awareness and perceptions of females in Kintampo North
Municipality on clandestine or criminal abortion. The study population was
adolescents and adult aged 15 years and above who are females and
classified within the childbearing age, 15-44 years (WHO, 2012). These
people stand the risk of getting pregnant or bearing a child and are more
likely to be involved in illegal abortion activities. About 250 females
randomly selected from ten communities within the Municipality and five
institutions to take part in the study. Random sampling, purposive and
systematic sampling techniques were employed for this study. The selection
of areas for visit was through simple random. Houses to visit and female
respondents were selected through systematic sampling. The purposive
sampling was used for selecting institutions for interviews. Structured
questionnaire containing both written and closed questions were used
together with structured interview schedules and interview guides. The
questionnaire contained both open ended and close-ended questions.
Both primary and secondary data were used for the study. For the
purposes of secondary data, the study reviewed relevant materials on the
subject matter already in existence. Some of these sources included books
and reports from libraries and the internet where electronic books, journals,
reports and web pages where reviewed. Primary data was collected from
female adolescents and adults, health institutions and District Assembly.

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Data obtained from the field was analyzed using both qualitative and
quantitative techniques. Deductive and Inductive methods were used for the
analysis. The type of data collected influenced a more qualitative and little
quantitative analyses using to meet the research objectives.
Results and discussion
This section presents the results and discussions of the data on the
perceptions, knowledge and awareness of females on abortion, specifically
clandestine abortion in the Kintampo North Municipality.
Characteristics of Respondents
About 91.3% of the respondents were within the reproductive age
group of 14 - 44 whiles 8.7% were above the reproductive age of 44 years.
About 34% of respondents within the reproductive age group were teenage
adolescents. The involvement of various age groupings was important in
coming out with general findings on the knowledge and awareness of
females on clandestine abortion in the area. The 91.3% of women in the
reproductive age group (14-44 years) that the study recorded is important as
it gives clear view of the awareness level potential clandestine abortion
females in the area (WHO, 2010). These people stand the higher risk of
involving in criminal abortion, as they are sexually active (Singh et al, 2009).
They are also the people who have some sort of independence from their
parents and are more likely to involve in sexual activities.
The respondents had strong religious affiliation. About 58.6% were
Christians while 37.3% were Muslims. The remaining 4.1% were followers
of the African Traditional Religion. The commitment of some respondents to
religious values and beliefs affects their decision and likelihood of
undergoing criminal abortion. This is because; certain interpretations in these
religions have strong beliefs against abortion (Peer Research Centre, 2013).
Hence, victims of unplanned pregnancy in the area are likely to opt for
clandestine abortion due to religious beliefs and commitment, as decision to
abort a fetus is mostly tragic for all concerned, and nowhere more so than in
a profoundly religious society like Ghana (Open Saloon, 2010). However,
religious affiliation and beliefs can also be a control factor to check sexual
behaviors women, which will in turn help reduce unplanned pregnancies
among unmarried women.
Generally, most of the respondents had low-level educational
background falling between Junior Secondary or Middle School (36.7%) and
Senior Secondary or Vocational School (23.3%). About 32.6% had education
higher than senior secondary level while 7.4% never had any form of formal
education or had never been in school. Despite 92.6% of respondents having
obtained some level of education, only 59.8% could read and write the

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English language or the local dialects. The relatively higher proportion of
literates in the area will aid the adoption of the English and the local
languages, particularly; Twi and Bono in educating people on issues of
criminal abortion. This also means that they could be educated through the
print and electronic media, and they (59.8%) can even learn on their own due
to their literacy level.
About 47.3% of the respondents had no children while 52.6% had
either one or more children. Majority of the respondents, 60.4%, though did
not consider themselves as married, had sexual partners with whom they
have sexual relationship. They are like consensual marriage since most are
sexually active in these relationships. In the case of some, they were sleeping
together and doing most things together as marriage couples except that they
had not performed the needed rites to recognize them as married couples.
They could break the relationship as easily as they wished, with little
anticipation of unfaithfulness from any side. The higher proportion (60.4%)
of these forms of unions in the area often results in unplanned pregnancies,
hence clandestine abortions. People might be tempted to abort pregnancies in
circumstances they break-up with their partners in early periods of the
pregnancy. This is more likely because these people are not married and
might not be willing to raise children as single parents. Besides, they may
want to abort pregnancies to continue satisfying their sexual needs, which
they cannot do often during pregnancy periods or at birth.
Sexual Life of Respondents
About 20.6% respondents had changed three or more sex partners
within the last two years whereas 53.4% had been with one sex partner since
getting into relationships (excluding married couples). About 20% of the
respondents attested that, though they had no permanent sex partners within
the last two years, they have had sex within the period. These people appear
unstable and could encounter problems when they get pregnant as to who
would be responsible. This can therefore tempt them to engage in clandestine
abortion.
Surprising, about 27.3% had their first sexual activity as early as
before 15 years. About 45.3% of the respondents had their first sexual
activity with people the respondents mentioned as boyfriend and 17.3% had
their first sex with playmates in their early childhood days. Perhaps, this
affirms that sex with boyfriends and girlfriends are common among the
teenagers in the area. The high sexual activities among teenagers who are
unmarried explain why perpetrators of criminal abortions in Ghana are
mostly those in girlfriend/boyfriend relationships (Lithur, 2013). About
32.6% of the respondents had their first sexual activity with their husbands.
This calls into a question the chastity of females in the area since majority of

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them had their first sexual activity even before marriage. Unplanned sexual
activities among respondents were 75%. These sexual acts occurred from
situations (romance) without prior agreement on that. In these acts, no
contraceptives were used as a measure to prevent pregnancies or Sexually
Transmitted Diseases. The study also revealed that 38.7% of respondents
who had sex before marriage also had unprotected sex. This confirms the
fact that knowledge and willingness to use contraceptives has not reached the
desired levels many in the society (Gutmacher Institute, 2015)
The prevalence of early sex and unplanned sex in the area has
implications for unwanted pregnancies, which is mostly the main cause of
clandestine abortion. Having unprotected sex has a tendency of leading to
pregnancy and so do early sex. Pregnancies at early ages of a woman’s life
may lead to considering possibilities of aborting it. This results from the
stigma unmarried young girls with children in the area face. The cultural and
religious perception about these people also serves as a threat to keeping
unplanned pregnancies.
Induced Criminal Abortion in the Area
There was general knowledge among the respondents as to what
abortion is, most referred to it as the termination of an unwanted pregnancy.
However, their knowledge and understanding on abortion was deficient as
they limited it to induced abortion taking. Trying to ascertain the statistics on
prevalence of clandestine abortion in the area, responded were asked on their
involvement in the undertaken act and the responses are show in Figure 2.
Figure 2: Respondents Engagement or Involvement in Clandestine Abortion
From Figure 2, there was general knowledge and involvement of
women in the area in criminal abortion. About 1.3% of respondents had ever
engaged in clandestine abortion in their lives. Also considering involvement,
8% had ever helped someone do clandestine abortion and 56.8% know
1,3% 8,0%
54,6%
36,1%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
Personally
Involved
Aided Someone Know Someone Non
Percentage
Mode of Knowledge

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someone who has ever committed the act. There were however respondents
(11.7%) who fell into more than one of the categories. About 36.2% of the
respondents were however reluctant in answering this and gave no response.
The reluctance of people to answer question regarding this section is a
general problem in the Ghanaian society as Ahiadeke (2001) asserts that
Ghanaian women participating in community-based surveys on sensitive
topics such as pregnancy and abortion are likely to underreport or may be
unwilling to provide information.
The survey further revealed that, 53.5 % of those who had ever done
clandestine abortion did it before the age of 19 and 19.4% committed the act
after marriage. The remaining were those who committed the act before
marriage but not teenagers. These findings support data from Ministry of
Health that, a sizable proportion of the demand for abortion services comes
from relatively young women, both married and unmarried. The inclusion of
non-married women shows that people undertake clandestine abortion at a
tender age when they are not married but get pregnant. This is allied to pre-
marital sex and pregnancy, which comes with much stigmatization in the
African society. These youngsters therefore choose to abort pregnancies to
save them from negative societal view when they find themselves in that
situation. In committing this, the study found local Pharmacists (41.3%) and
herbalist (28.4%) to be the commonest place where women commit
clandestine abortion as shown in Figure 3.
Figure 3: Common Ways of Clandestine Abortion in Kintampo
From Figure 3, the use of pharmacist and herbalist appears to be a
place where women think clandestine abortions are easily carried out. This
appears to support the findings of Ahiazhe (2001) in the study of induced
abortion in southern Ghana, where 65% of the women said they obtained an
abortion from pharmacists and other methods such as self-medication and
from "quack doctors". The higher percentage of people choosing herbalists
41%
28%
14%
10%
7%
Pharmacist
Herbalists
Clinic/Hospital
Homebase/Self Preparation
Other

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and pharmacists as the likely destination for abortion in the area also affirms
the findings of lithur (2013) that the commonest method used to conduct
illegal abortion in Ghana from 2009 to 2012 was by concoction ("drugs" or
"poisonous substance"). This is very hazardous because such agents might
not practice any infection prevention technique and might cause sepsis or
Pelvic Inflammatory Diseases to their clients. It is also inferred from the data
that, the sexual activeness of the women noted earlier has effect on
clandestine abortion in the area. The sexual activeness has resulted in many
unplanned pregnancies that can result in illegal abortions. The high religious
affiliation of the people has done very little in controlling criminal abortion,
as its rate is still high despite their religious commitments. Most of the young
people had either committed illegal abortion or aided someone to commit the
act. They received illegal abortion services from local agents and herbal
preparations, which is dangerous to human health and life.
Knowledge on the Effects of Clandestine Abortion
It was impressive that respondents (71.3%) know that professional
medical Doctors should perform abortion. However, they did not use them
but rather adopted different methods despite its risk. The study examined
respondents’ knowledge on the effects of clandestine or criminal abortion.
This was to understand whether it was done without knowing the risk or
otherwise. The study revealed that, most respondents were aware of the
dangers associated with criminal abortion. Figure 3 shows responses from
participants on knowledge regarding the effects of criminal abortion and on
people who were suffering or had suffered from some of the effects
specified.
Figure 3: Knowledge on the effects of criminal abortion and on victims of the effects
specified.
From Figure 4, about 92.0% of respondents indicated that abortions;
particularly, clandestine abortion can result in deaths confirming literature on
92,0%
86,6%
79,6%
57,3%
0,0%
20,0%
40,0%
60,0%
80,0%
100,0%
Percentage
Effects Mentioned
56,0%
19,3%
30,6%
57,3%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
Percentage
Effect Ever Seen in Area

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alarming rate of mortalities resulting from criminal abortions (Biswa et al,
2012: Berhan & Berhan, 2014: Smith, 2013: Baiden et al, 2006). In addition,
86.6%, 79.6% and 57.3% respectively mentioned bareness, excessive
bleeding and psychological trauma as the major effects associated with
abortion. With regard to knowledge or awareness of respondents on the
occurrences of these effects in the area, about 56% indicated that they know
someone who died through such act (abortion) in the area. In addition, about
57.3% revealed that they had ever seen people going through psychological
trauma after going through abortion. Besides, 19.3% and 30.6% had seen or
known someone becoming barren and going through excessive bleeding
respectively, after undergoing criminal abortion. This findings show that, the
awareness of the effects of criminal or clandestine abortion among women in
the area is not just from education, but also from its occurrences within their
environment. Women in the area are therefore well aware of the dangers
associated with abortion in both abstract and practical terms but do practice it
when the need arise. This finding shows that people do criminal abortion not
because of ignorance but for other reasons peculiar to their situation. This is
due to the fact that majority of women who engage in clandestine abortion
are well aware of the dangers associated with it.
Causes of Induced Abortion in the Area
The study tried to ascertain the major causes of induced abortion or
reasons why people practice clandestine abortion in the area. Considering the
fact that it was not feasible to get people testifying to undergoing clandestine
abortion, the study adopted a perceptional approach to gather this data.
Respondents’ perceptions on some of the major causes of abortion,
particularly clandestine or criminal abortion in the area are depicted in
Figure 4.
Figure 4: Perception on the Causes of Induced or Clandestine Abortion in Kintampo
48,0%
15,3% 21,3%
10,0% 5,4%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
Financial
Difficulty
Illiteracy Ignorance Career
Development
Others
Percentage
Causes of Abortion

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From Figure 5, poverty is the major cause of criminal abortion, with
48% of respondents citing it. Thus, the inability to take responsibility of
pregnancies and take care of the child due to poverty normally results in
people aborting pregnancies. About 15.6%, 21.3%, 10% and 5.4%
respectively attributed the cause to illiteracy, ignorance, career development
and other issues as the major causes of abortion in the area. Issues mentioned
under the others included, social stigma, illegality of certain types of
abortion by law, pregnancy during nursing period among others. This data
captured only major causes stated by respondents, though some gave more
than one. However, poverty still appeared the most attributed cause
mentioned by about 98% of the respondents. Poverty being the dominant
cause noted by the respondents confirms the findings by Gamatcher Institute
(2014) in the study of abortion in the United States where 69% women who
undertook abortion were economically disadvantaged. Poverty as used by the
respondents was limited to income poverty in the area. According to the
respondents, inability to afford the cost of abortion with qualified medical
personnel often tempt women to use the criminal ways which are mostly less
costly. This, they attributed to the low cost of abortion through the use of
herbalist and certain pharmaceutical drugs which appeared to be the most
common point of abortion for people in the area.
The issue of illiteracy as a cause of criminal abortion is closely
associated with ignorance. Respondents attributed both factors as major
causes of criminal abortion, however, explanations given for both support the
case of ignorance. Respondents therefore viewed ignorance as the
consequence of illiteracy. This might however be false in some cases as
literates can be ignorant on abortion issues. According to the respondents,
societal perceptions on abortion make it difficult to comprehend issues
surrounding clandestine abortion. In addition, 60% of respondents attributed
low level of knowledge on laws of abortion as the reason why women opt for
clandestine abortions when they genuinely could have sought legal abortions
in their case. They think any abortion is illegal in Ghana regardless of the
complications and hence, resort to dangerous means to get rid of the
pregnancy. This confirms the claim by Lithur (2013) that “despite that the
1985 exemptions clause (rape and incest, risk to pregnant mother, risk to
unborn child), which allows for abortions in Ghana, some of the cases were
perpetrated even when they qualified for a legal abortion”.
Another important cause the respondents noted was the desire to
continue or develop a woman’s career. According to some respondents,
people in the area sometimes resort to criminal abortion in cases they have
pregnancies which might disrupt their careers. One of the respondents who
attested to have engaged clandestine abortion remarked that, “I undertook
abortion because I just got employed and got pregnant. I had to do that to

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keep my job because giving birth might have cost me my job”. The study
noted that, some women in developed countries abort pregnancies to pursue
employment or otherwise conserve the limited financial resources of their
young family. Similarly, some Ghanaian women seek abortion because they
are pursuing an education, have employment obligations or have a young
child (Ahiadeke, 2001).
Generally, women in the area appear to blame the occurrence of
criminal or clandestine abortion on the society. This was captured in
interactions with culprits but was well noted by a medical officer in the area
who indicated that,
“The society in which we live is actually the cause. Abortion is not
well accepted in the society; women who intend to do that feel bad and
are mostly treated like devils when they appear in a special clinic for
a better service. In order to rip them off the shame of carrying babies
without being married, they turn to try getting rid of babies through
life threatening means, with some going to the extent of drinking
grinded bottles or resorting to concoctions secretly”
The revelation support the claims made by Akinla and Adadevoh, et
al. (1960s) cited in Hesse and Samba (2006) that, abortion in Ghana is a
‘medico-social problem. This means that abortion in the country goes
beyond the medical spheres as some social factors also drive it.
Recommendation
To reduce the incidence of clandestine abortion in the country, there
is the need to intensify education on abortion concerning its laws. The study
revealed that, most females lacked knowledge on laws on abortion in Ghana,
hence could not tell the circumstance in which one is legible to seek legal
abortion from qualified or professional medical practitioners. They were of
the view that abortion is illegal in Ghana. However, per the abortion Law of
1985, not all cases of abortion are illegal in Ghana. The laws indicate that, an
abortion is considered legal if it is performed by a qualified medical
practitioner or if the pregnancy is the result of rape, incest or ‘defilement of a
female. It further point out that if continuation of the pregnancy would risk
the life of the woman or threaten her physical or mental health; or if there is
a substantial risk the child would suffer from a serious physical abnormality
or disease, then abortion can be sort legally. Considering the provisions of
the law, not all cases of abortion is illegal in the Ghanaian context. However,
not many women know the provisions of the law, this is based on the fact
about 96% of the women in the study were ignorant of the provision.
Ignorance of this could result in women opting for criminal when they could
have sought for legal abortion from qualified medical practitioners.

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The ministry of Gender and Children Affairs, reproductive health
Non-Governmental Organizations like Planned Parenthood Association of
Ghana, district level agencies like Social Welfare and Community Service
Departments should liaise with the National Commission for Civic
Education to embark on public education and awareness creation programs
on the abortion laws. The programme should focus on the components of the
laws and conditions under which one could seek legal abortion in Ghana. It
should also take into account the need to eliminate stigmatization on
pregnant young women and the perception that when a young lady becomes
pregnant or gives birth, her education or professional career or goals has
come to an end. This will help reduce the rate of clandestine or criminal
abortion in Ghana and it adverse effects.
Besides, as revealed in the survey, the root cause of many criminal
abortions is unplanned and unwanted pregnancies. To minimize the rate of
clandestine abortion in societies, efforts be directed towards curbing
unplanned pregnancies. To achieve this, a collaborative effort from parents,
young women, government, and religious leaders, NGOs as well as the
Adolescent Reproductive Health Unit of the Ghana Health Service is
necessary. Parental upbringing should inculcate sex education as well as
providing basic needs of females. It is important for young women to focus
on building their careers. Women should try to wait until they get married
before having sex with their spouses. The religious leaders have the role to
intensify their religious education to maintain sex as a sacred institution for
only the married. Intensification on calamity involved in illegal abortions is
paramount to deter females from indulging in clandestine abortions in the
society. The researchers are of strong conviction that these recommendations
would immensely reduce clandestine abortion in the society that adversely
affects females.
Conclusion
Despite the widely held view that unplanned pregnancies lead to
abortion or clandestine abortion, other factors like ignorance, poverty, desire
to continue career and illiteracy also play key role. Public education and
awareness creation on the existing abortion laws should be intensified. This
will help parents, girls, NGOs and government institutions to reduce
unplanned pregnancies in the country.
Though abortion is an undesired phenomenon in the society, it has
now become an integral part of it. Whether society accepts it or not, abortion
whether legal or illegal, has become part of it and thus, need significant
attention in that regard. In Ghana, most people do clandestine (criminal)
abortions and this is because of societal perception and stigmatization on
young people who get pregnant in societies. Society will argue and continue

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to argue on whether to legalize all kinds of abortion in the country, or upheld
the current laws. Perhaps, most will go against legalizing it and will argue
that it is against the doctrines and provisions of their Holy Scriptures of the
various religions. There is the need to admit the fact that sex is now an
integral part of the society as both married and unmarried; particularly, the
youth now practice it. If society and authorities do nothing about that and
accepts sex practice among all; particularly, the teenagers and unmarried
people, then it must be prepared to give these people the freedom to either
keep pregnancies or abort them if they so desire. Perhaps, a new shift in the
paradigms of the abortion laws in Ghana needed to avert the effects of
criminal or clandestine abortion. Laws that will allow people to seek legal
abortion from qualified medical practitioners if they so desire not to keep the
pregnancies, regardless of the condition. This will help reduce cases of
clandestine abortions in Ghana and its associated risks (deaths and other
health complication) females do encounter in trying to abort unplanned
pregnancies.
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