“We no longer hear cases of abortion-related deaths in Cape Coast, Ghana” -- PPAG clinic nurse

For more than two decades, Adwoa* has worked as a sexual and reproductive health (SRH) provider in Cape Coast, the capital of Ghana’s central region. In the early years of her career, Adwoa would be troubled by the numerous cases of unsafe abortions and related deaths in Cape Coast. In recent years, however, she has noted a remarkable shift with this regard, which she attributes to the efforts of IPPF's Member Association (MA) in the country –Planned Parenthood Association of Ghana (PPAG) where she works. Adwoa speaks more about her experiences in this article.

By Maryanne W. WAWERU

The Cape Coast region in Ghana is highly significant to the work of IPPF’s MA in the country - PPAG. It is home to several educational institutions including secondary schools, colleges, and universities with a notable student population comprising young people aged 10 – 24 years.

Globally recognized as a leading provider of SRH services and a strong advocate for sexual and reproductive health and rights (SRHR), IPPF continually strives to address the challenges that young people face regarding their reproductive health. These challenges include early pregnancies, difficulties in accessing contraceptives, high rates of sexually transmitted infections (STIs) -including HIV, and unsafe abortions. Young people also struggle to find healthcare providers who can offer supportive, friendly, and non-judgemental SRH services. Ghanaian youth are not exempt from these challenges.

Combined education, outreach and clinical care activities by PPAG

PPAG’s Cape Coast clinic helps in addressing these challenges through its different programmes. By working with trained peer educators and service providers, the organization regularly conducts outreach activities in learning institutions and in community settings where young people gather. The informative sessions empower youth to make healthy and informed decisions about their sexual and reproductive health.

PPAG also offers youth-friendly SRH services in its static clinics and through regular mobile clinics. The introduction of telemedicine has further complemented the organization’s service delivery efforts. The telemedicine approach entails provision of remote consultation, medication delivery, and follow-up support for medical, diagnostic and treatment services. This includes abortion services.

Telemedicine for abortion

Telemedicine for abortion in early pregnancy ensures that clients do not have to make in-person visits to clinics or hospitals, thus addressing several barriers attached to abortion-seeking services in health facilities, such as fear of judgement, stigma, and transport challenges. These barriers significantly contribute to women’s procurement of clandestine, unsafe abortions.

Adwoa*, a nurse at PPAG’s Coast Clinic demonstrates the success of the telemedicine for abortion approach.

“I have been in this clinic for slightly over 20 years. One of the major challenges that the Cape Coast community has always grappled with is unplanned pregnancies among adolescent girls and young women. This, considering the high youthful population that largely comprises of learners from schools, universities and colleges. In my earlier years working at the clinic, we would receive many cases of life-threatening complications from unsafe abortions procured by young women,” she says.

The magnitude of the situation would be exemplified whenever she would participate in outreach activities in the community.

“We would always learn about the unfortunate deaths of young women, including students, from botched abortions. They had procured the services from unskilled individuals -quacks. Their deaths greatly saddened me,” she says.

For those who survived, Adwoa and her PPAG colleagues would offer post-abortion care services at the clinic. However, the worrying problem of unsafe abortions persisted.

“We intensified our awareness campaigns in the community and in learning institutions about the need for contraception to prevent unplanned pregnancies. We needed more people to hear this message as we believed that this would reduce the cases of unsafe abortion morbidity and mortality. To widen access to safe abortion care, we introduced telemedicine for abortion services, which have subsequently benefitted hundreds of young women in Cape Coast,” she says.

Expanding safe abortion care access

To ensure quality of care in delivery of abortion care information and services, PPAG endeavours to continuously build the capacity of its service providers and peer educators.

“Through different initiatives and programmes, the organization carries out regular trainings for its peer educators, thus increasing their capacity to conduct outreach activities in learning institutions and in the community. Additionally, PPAG has facilitated training opportunities for its clinicians and other service providers in and around Cape Coast on comprehensive abortion care (CAC), including telemedicine for abortion. This has not only strengthened the capacity of PPAG clinicians but has also increased the number of skilled abortion care service providers who can offer these services in Cape Coast. With this expanded network, it means that more women are now able to conveniently access life-saving abortion services without having to visit a health facility,” she says.

The results have been evident, according to Adwoa.

“Nowadays, when we go out for our regular outreaches in the community and in learning institutions, we no longer hear of girls and women who have died from unsafe abortions. On account of the heightened information awareness activities about safe abortion care, more women have been empowered to make safer choices when faced with the predicament of an unplanned pregnancy. We no longer receive cases of girls and young women presenting with complications from unsafe abortions. This is success to me,” a beaming Adwoa says.

Adwoa attributes these achievements to increased awareness of telemedicine services especially among the student population, the community’s trust in PPAG’s services, as well as the increased network of trained service providers who can offer quality safe abortion care services in and around Cape Coast.

*Name changed for privacy purposes