Published on International Journal of Health, Nursing, & Medicine
Publication Date: April 27, 2019
Bliss Dziedzorm Addo
Department of Health, Physical Education and Recreation
University of Cape Coast
Cape Coast, Ghana
The study investigated the perception of Senior High School girls’ in the New Juaben Municipality on legalisation of abortion in Ghana. A descriptive survey study was conducted with four research questions posited to guide, using a combination of purposive, stratified and simple random sampling techniques to select the sample size of 455 girls from the Senior High schools in the municipality. A pre- tested, self-administered questionnaire was used for data collection. Seven out of fifteen schools were purposively selected for inclusion in the study. The stratified sampling technique was used to select 65 students each from the selected schools while the simple random technique was used to select 16 students from each of the classes. The data were analysed using descriptive statistics of frequencies, percentages and tables. The study revealed that SHS girls had inappropriate knowledge of methods of abortion, but adequate knowledge of safety methods (mixture of sugar and Guinness, n = 235), venues (clinic, n = 408) and providers of abortion (medical doctor, n = 419). They resort to abortion to enable them continue with their education (n = 218). They considered abortion not to be a right and suggested that it should not be legalised but only provided at the government hospital (n = 272) without the NHIS covering it (n = 370). The students’ perception about legalisation of abortion is that abortion is not a right and should not be legalised. It is recommended that the Government through the National Commission for Civic Education should educate SHS students on the abortion law in Ghana so that individuals will know what is required of them on issues connected with abortion.
Keywords: Perception, Abortion, Legalisation, High School girls, Abortion laws, Health Education, Adolescent Reproductive Health.
Abortion is one of the most controversial issues of modern times because of its nature, process and consequences as well as the moral and ethical issues relating to it. So getting accurate data on abortion is difficult to come by in Ghana. Abortion is termination of pregnancy by the removal or expulsion of a embryo from the uterus (Dutt, 1998). Again abortion is where a powerful suction tube with a sharp cutting edge is inserted in the womb through the cervix. This suction destroys the body of the developing baby and tears the placenta from the wall of the uterus, sucking blood and other tissues into a bottle (Ghana Celebrities, 2011). Abortion can occur spontaneously due to complications during pregnancy or induced in humans and other species. The context of human pregnancies, abortion induced to preserve the health of the gravida is termed therapeutic abortion, while an abortion induced for any reason is termed an elective abortion.
Abortion has low risk of maternal mortality except for abortions performed unsafely, which results in 75,000 deaths and 4,5 million disabilities per year globally (Shah & Ahman, 2009). Unsafe abortion is significant cause of morbidity and maternal mortality in the world. Most unsafe abortions occur where abortion is illegal (Rosenthal, 2007) or in developing countries where health care is at a generally low level (Chaudhuri, 2007). About one in eight pregnancy-related deaths worldwide have been associated with unsafe abortion (Maclean & Gaynor, 2005).
The World Health Organisation (WHO) reports that each year nearly 42 million women are faced with unintended pregnancies. They go ahead to have abortions, of which 20 million are unsafe (WHO, 2011; Rosenthal, 2007). According to WHO and Institute Guttmacher (2010), approximately 68,000 women die annually as a result of complications of unsafe abortion and between two million and seven million women each year survive unsafe abortion, but sustain long-term damage or disease such as incomplete abortion, infection (sepsis), haemorrhage, and injury to the internal organs (tearing of the uterus).
Glenn (1996) indicates that about 50 million self-induced abortions occur per year worldwide and half of these occur outside the health care system. Since most of the self-induced abortions are performed outside the health care system, the risks are higher for the girls. In order to reduce the risks and loss of lives, there are still struggles as to whether abortion should be legalised or not though it is illegal in Ghana now, Glenn concludes.
Research review by Yeboah and Kom (2003) states that between 10% and 15% of all pregnancies terminate as spontaneous abortion and about 10-60% are terminated by an induction either legally or illegally. About 80% occur in the first trimester that is within the first to the third months of pregnancy. This can lead to hazards such as pain, ill health, infertility as well as other long-term complications (Taylor & Ablordey, 1993).
Research conducted by Pathfinder International (2009), an international non-governmental organisation, revealed that the proportion of women aged 15-19 who had had an unsafe abortion in Africa, was higher than any other region in the world. Pathfinder International also reported that about 60% of worldwide unsafe abortions are performed on African women under the age of 25, causing danger to their reproductive health (Modern Ghana, 2008).
In an interview on abortions by the Ghana News Agency (GNA) Mrs Hectorina Yebuah, Deputy Director of Nursing Services, Korle-Bu, indicated that the Department of Obstetrics and Gynaecology treats at least a case of unsafe abortion a day. She gave the monthly trend in 2005 as 91 cases in January; 99 in February; 100 cases in March; 103 cases in April and 75 cases in May. According to Ayiku (2007), the teenager saves at least 20 pesewas a day at a nearby “susu” kiosk so that when they are pregnant they can use that money for abortion, although they are aware of diseases, abstinence and condom use, but still cannot do without sex because, they earn a living through sex. Some also see sex as fun and a way of showing love to their boyfriends.
It cannot be said that the Senior High School (SHS) girls in the New Juaben Municipality are all unblemish, are innocent or do not engage in unsafe abortions on their own. Indeed, it is common knowledge that some of these school girls do engage in unsafe abortions using high doses of paracetamol, chloroquine, ergot, coffee, grounded bottle, alcoholic drinks, grounded ants, cockroaches, gun powder and herbal preparations inserted into the vagina or enemas (GNA, 2005).
Scheper-Hughes and Lock (1987) identified three bodies: individual body-self, social body, and body politic. The authors described these three bodies as individual body-self is a biological body which is obtained by birth. The social body is a socially defined and culturally constructed body; it is a body which is needed in order to live within a particular society and cultural group such as societal norms, values and perceptions which shape the perception and decisions of Senior High School girls to where, whether, how and when to undertake abortion. Body politic (abortion legislation) exerts a powerful control over all aspects of the individual body; its behaviour, in reproduction and sexuality, in work, in leisure and in other forms of deviance and human differences. The social aspects of the body and body politic are important concepts to explain the lived experience of the girls ‘contraceptive use and abortion. “Cultures are disciplines that provide codes and social scripts for the domestication of individual bodies in conformity with the needs of social and political order and that the stability of the body politic depends on its capability to control the social bodies and to discipline the individual bodies” (Scheper-Hughes & Lock [as cited in Alemu, 2010]). The authors argue that the relationship between the individual and social body is about power and control of the body politic; the body politic has two main purposes; one is to shape the bodies according to the needs of the society, and the other is to control the external boundaries of the group to maintain a particular social order within the society. Abortion is highly debatable in Ghana where culture and religious values are widely practiced. Abortion is condemned by religions in Ghana. Moreover, wide presence of gender inequalities hindered women from deciding over their own bodies. Safe and unsafe abortions are performed on women’s body in which they are the primary beneficiaries as well as victims of physical, psychological and economic damages. Even though, women are the primary beneficiaries or victims, they cannot decide on the self-body because they should consider self-body position in the culture and society. Above all their decision is directly or indirectly influenced by the body politic, abortion law.
1.2 Statement of the problem
It is common knowledge that Senior High School (SHS) girls engage in unsafe abortions. Boseley (2009) reports that about 70,000 women die every year and many more suffer harm as a result of unsafe abortions in countries with restrictive laws on ending a pregnancy. The abortion law in Ghana, enacted in 1985, state that an abortion performed by a qualified medical practitioner is legal if the pregnancy is the result of rape, incest or defilement; 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 that the child would suffer from a serious physical abnormality or disease. This leaves room for untrained personnel to engage in dangerous abortion procedures (Morhee& Morhee, 2006). Also the pregnant school girls who are afraid of talking to their parents about their pregnancy for fear of being beaten or thrown out of the house solicit help from their friends. These friends introduce them to traditional or crude methods of aborting their unwanted pregnancy by drinking grounded bottle, washing detergents “blue”, local gin, and inserting hot metal into their vagina, so that they can continue with their education. These methods cause infertility, sexually transmitted infections, miscarriages and death.
A report by Goldsmith on Wednesday, 10th January 2007 on BBC radio 4’s Crossing Continents indicated that thousands of women in Ghana are seeking dangerous illegal abortions every year with many ending in death or disability. According to her as many as two-thirds of all terminations are unsafe and large numbers of women are dying. In 2003, 1,356 cases of unsafe abortion was reported at the Komfo Anokye Teaching Hospital and 1,368 in2004 which represents 29% and 32% of maternal death (GNA, 2005). On the other hand, Eastern Region recorded 3,867 abortion cases in 2005, 500 being students and 157 deaths (GNA, 2006).
Owing to these reports, it can be deduced that several young productive women who are the future of our nation are being lost through unsafe abortion related cases. Should abortion be legalised so that these teenagers can freely access safe abortions to forestall the high incidence of unsafe abortion-related deaths? It is therefore imperative to research into the perception of SHS girls on whether legalisation of abortion in Ghana, would help reduce its unsafe practices.
1.3 Purpose of the Study
The purpose of this study was to investigate the perceptions of Senior High School girls in the New Juaben Municipality on legalisation of abortion in Ghana in the light of the many reported cases of unsafe abortions and the numerous health problems associated with them.
1.4 Research Questions
The following research questions were posed to guide the study;
a. What is the knowledge level of SHS girls on abortion practices?
b. Why do SHS girls seek abortion when they are pregnant?
c. What is the knowledge level of SHS girls on abortion law?
d. What is the perception of SHS girls on legalisation of abortion in Ghana?
1.5 Significance of the Study
The stakeholders such as health educators, parents, teachers, and students will find this study useful. It will help to increase the understanding and knowledge of issues bothering on unsafe abortion and its health complications to the general public so that they will support the legalisation of abortion. To law makers and government, these can serve as formative feedback for law review. It will provide policy makers with ideas about actual competencies relevant to unsafe abortion among the school girls for establishment of a competency based education in the future.
2. Research Method
The research was a descriptive survey with four research questions which assessed the perceptions of SHS girls on legalisation of abortion. The purpose of such a design is to provide an explicit description of the phenomenon explored so that it can be addressed in the main issue (Burns & Grove, 2005).
A combination of the purposive stratified and simple random sampling techniques were used to conduct the study. Purposive random sampling technique was used for the selection of the seven SHSs in the Municipality. Each school was considered as a stratum. This sampling technique was used because the issue under discussion which was abortion involved girls. A random sample of 455 out of 9,100 SHS girls in New Juaben Municipality was used for the research. This sample size was used based on Bouma and Atkinson’s study (as cited in Agyedu, Donkor & Obeng, 2007) on determination of the sample size to use for research. The authors indicated that:
a. If statistics are to be used in the analysis and the interpretation of the data, there are usually requirements for sample size. Some statistics demand that the sample size must be large whilst others do not.
b. The more accurately we accept the data to reflect the total population, the larger will be the sample size and the more reliable and valid the results based on it will become.
c. The more questions asked, the more controls introduced, and the greater the details of analysis of the data, the larger the size will have to be in order to provide sufficient data for the analysis.