Understanding the Concept of Abortion: Historical Background of Abortion in Ghana
Abortion, whether safe or unsafe, are undeniable public health problems in developing countries, including Ghana. This first chapter which is the underpinning of this study aims at presenting the general understanding of abortion in Koforidua and its environs. It will also attempt to give an overview of the concept of abortion from different perspectives and in a global view. In recent years, many people have various inputs and definitions about abortion. The researcher will make a review of those related inputs and texts by focusing on the topic.
1.0 Definition of abortion from different perspectives.
Most at times the word “Abortion” has been used without the understanding of its root word, the medical, legal, grammatical or even the moral meaning or definitions of it. Etymologically, “the word abortion is derived from the Latin preposition ab meaning from and the verb orior which is translated as to grow. The noun abortio in Latin means abortion.[ Bernard J. Ficarra, M.D., K.S.G., Abortion Analyzed, Health educator publications, Inc. Maine, Old town. 1989, p.24]
Abortion is “a medical operation in which a developing baby is removed from a woman’s body so that it is not born alive.”[ cf. Macmillan English Dictionary for Advance learners, International student edition, Bloomsbury Publishing Plc 2002.] On the other hand, abortion can also be defined as a “deliberate ending of a pregnancy at an early stage.”[ Cf. Oxford Advance learners Dictionary]
In her book, Linda Lowen describe abortion as “a procedure in which a woman, assisted by members of the medical community or not, terminates her pregnancy, generally within the first few months, before the embryo is old enough to live outside of the womb.”[ Cf. Internet sources, Linda Lowen, what Are the Different Types of Abortion?’ Updated June 28, 2019]
From these definitions, we note very well that there is an act perform against a child (a human being) who is still developing in a woman’s body (his or her mother’s womb), and also there is an act which is being done deliberately on that innocent human being (the foetus). “Deliberate” means “intended, not done by chance or by accident: it is intentional:”[ cf. Macmillan English Dictionary for Advance learners, International student edition, Bloomsbury Publishing Plc 2002.]
Another attempt to defining abortion is that of the Encyclopaedia of bioethics that highlights viability and the two types of abortion. It defines abortion as “putting to an end a gestation either spontaneously or by our intervention prior to viability.”[ Cf. W.T. Reich, ed., Encyclopaedia of bioethics, 2.] In the above definition, there is spontaneous and induced abortion underlined. By spontaneous abortion it is that which come by itself without human intervention while the induced abortion is basically a human intervention to end a pregnancy. The Reader’s digest also proposes that abortion is “a situation of miscarriage following an intervention especially as an illegal operation.”[ Cf. Funk and Wagnals, The Reader’s Digest Great Encyclopia Dictionary, 4.] A careful reflection on the definition of abortion according to Stephen Schwarz, is “ending of pregnancy by the removal of the child from the womb.”[ Cf. S. Schwarz, The moral Question of Abortion, 20.]
Abortion is also defined by the Medical dictionaries as “the expulsion of the product of conception before the child is viable. When this occurs during the first three months, it is termed an abortion. From this time to (three months) to viability, the terms immature delivery or miscarriage have been applied. Expulsion of the product of conception from the period of viability to full term is referred to as premature delivery.”[ Bernard J. Ficarra, M.D., K.S.G., Abortion Analyzed, Health educator publications, Inc. Maine, Old town. 1989, p.24]
1.1 Historical background of abortion in Ghana.
Currently in Ghana, abortion is a criminal offense regulated by Act 29, section 58 of the Criminal code of 1960, amended by PNDCL 102 of 1985.”[ Google Scholar, Morhe RAS, Morhe ESK. Overview of the law and availability of abortion services in Ghana. Ghana Medical Journal. 2006;40(1):80–86. ]
According to a 2007 survey of women, there were at least 15 induced abortions for every 1,000 women of reproductive age (15–44).”[ GSS, GHS and Macro International, Ghana Maternal Health Survey 2007, Accra, Ghana: GSS and GHS; and Calverton, MD, USA: Macro International, 2009.] However, since abortion is heavily stigmatized in Ghana, actual incidence of the procedure is very likely under-reported in face-to-face interviews.
While recent, reliable national abortion figures for Ghana are not available, the World Health Organization estimates that there are 28 procedures per 1,000 women each year in Western Africa.”[ World Health Organization (WHO), Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011.] The true incidence in Ghana likely approaches this rate. According to Ghanaian women, there are many reasons why they go in for abortion. Frequently mentioned among others include; being financially bankrupt in taking care of a child, the need to delay childbearing to be able to continue schooling or work. Also, to limit the number of children they want to have, and to space the children. These and many other reason has contributed for the unsafe abortion practices which has resulted in the high maternal mortality rate in the country
1.2. African understanding of abortion.
Life is valuable and precious according to the different African cultural beliefs with regards to marriage and procreation. This is because procreation is an obligation after marriage for the offspring comes to complete marriage ties. According to John Mbiti, ‘unhappy is the woman who fails to get children for, whatever other qualities she might possess, her failure to bear children is worse than committing genocide: she has become the dead end of human life, not only for the genealogical line but also for herself.'[ MBITI, J. S., African Religions and Philosophy, p. 110)]
In order to preserve the life of a baby, many taboos and rituals surround the whole period from conception to the birth of the new baby. For instance, according to the African mentality, ‘if conception is an occasion of joy, a good, uncomplicated birth of a healthy child is much more so as it validates the relationships [existing between the parents, the nearest of kin, the ancestors and God Himself]. It is a sign of tranquility in the universe, the pleasure of the ancestors, the good moral standing of the parents, and a sigh of the defeat of bad people or malevolent spirits by the protection of the ancestors.'[ MAGESA, L., African Religion: the Moral Traditions of Abundant Life, p. 84).] Conceptions are important events in African traditional Religion, because it indicates that the universe is in good order. “Conception brings about the validity and consolidation of the marriage contract, and it is therefore a blessing because it reveals that both God and the ancestors are happy. Traditional indigenous Africans see conception from a religious point of view. They see conception as God coming to create by using a man and woman. So man and woman must copulate and God creates, and the ancestors then come to take care of the conception.”[ Cf. R. Ngong, Whom shall I send Hospitality, p. 42] This simply means that in African traditional religion, it is God, man and woman and then the ancestors who cooperate in a harmonious way in the process of conception.
A book published in 2014 by Mwakio P. Mwambi, entitled ‘the Right to life and African Concepts about life,’ has positively helped to clear people’s understanding on the concept of life. From the African context, Mwambi takes a very critical stand with regards to abortion, and Africans as he puts it, “have a very good sense of interrelationship between one another. When one person suffers, the whole community also experiences the same.” He thus divides suffering caused by abortion into two parts: a) “directly we are affected because it is an individual of the community who is being slew through abortion. b) indirectly because the wound is shared by all of us even though it is an individual woman who has caused the abortion.”[ Cf. M.P. Mwambi, the Rights of Life and The African Concepts about Life, 104.]
In defending the claim that in Africa “abortion is widely accepted as a personal matter, even when viewed as morally wrong’ Emil Hagamu, in an article ‘Abortion is Foreign to African Culture,’ states that:
In African communities, the death of a child is no small matter. We have never “accepted” abortion in African culture. Expanded legalization of abortion is being forced upon us by the traditional colonizing powers of the West, who are using their money and power to “destroy innocent lives.” Pro-life Christians are working, with limited sums, to protect our culture.”[ Google scholar, https://www.hli.org/2012/10/abortion-is-foreign-to-african-culture/]
This is a strong argument or opinion in Hagamu’s case as an indigenous African and a pro-life activist from Tanzania. He went on to state that:
While investigating whether or not any African language has any word or phrase that would correspond to the English word “abortion,” I have yet to find a single example. You would think something so “widely accepted” in our culture would be named. I speak two local languages, Kinyanja and Kimatengo, neither of which has a word for abortion. Among the Igbo in Nigeria, human life is widely respected and any attempt to kill unborn human life is regarded as an abomination. When I asked colleagues in Sudan two years ago if they have word for abortion, they laughed at me and said they have never heard of such a word. I have also asked the Sotho in Lesotho, the Swazi in Swaziland, the Shona in Zimbabwe, the Chewa in Malawi and the Baganda in Uganda – all of whom unequivocally said they do not have word for abortion. Instead, they told me, there is a word for miscarriage. There is also often a special rite to bury the body of a stillborn baby, usually only women were involved. In fact, the rite was done so respectfully and secretly that children were not allowed to know.”[ Google Scholar, https://www.hli.org/2012/10/abortion-is-foreign-to-african-culture/ ]
He further on stresses the fact that.
By using the concept “safe motherhood” abortion proponents thought it would appeal to the African mind. It has not and it will never convince African fathers and mothers to kill their unborn children “safely.” For, in truth, there is no “safe abortion.” People in Africa know in every abortion one person is killed, one person is wounded and one person gets paid.”[ Google scholar, https://www.hli.org/2012/10/abortion-is-foreign-to-african-culture/]
This therefore means that, the above authors are of the opinion that abortion is not accepted in the African context, and the researcher, agrees with his support for pro-life, with the use of African cultural values.
Abortion is not in any way part of our culture, because “to ensure that conception may not be affected, precautions by means of taboo observation is taken for the child to be born safely, and for the benefit of the mother.”[ Cf. R. Ngong, Whom shall I send Hospitality, p. 42] In other words taboos and other social regulations are ultimately meant to protect the unborn child and the mother, thus it is absolutely meant to protect life. In African traditional religion, procreation stands as a pillar of marriage for it is unacceptable for a couple to stay without bearing off-springs. “The fight against immortality is conquered by the fact that one has to procreate. To avoid cutting of inheritance one has to put to birth.”[ Cf. J.S. Mbiti, African Religions and Philosophy, p. 131 ] If therefore the aim of marriage in African perspective is for procreation and sustenance of our lineage, then abortion becomes unacceptable.
1.3 Abortion case from wider perspective
Maternal mortality is a large and un-abating problem, mainly occurring in the developing world. According to the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), UNFPA and the World Bank, 287,000 women die each year worldwide from pregnancy-related causes. Sub-Saharan Africa has the highest maternal mortality ratio in the world of 500 per 100,000 births. WHO estimates 47,000 of these deaths per year are attributable to unsafe abortion, making abortion a leading cause of maternal mortality.”[ Google scholar, internet source, WHO (25th December, 2019)] Not all unsafe abortions result in death, disability or complications. The morbidity and mortality associated with unsafe abortion depend on the method used, the skill of the provider, the cleanliness of the instruments and environment, the stage of the woman’s pregnancy and the woman’s overall health. It is estimated that 5 million women per year from the developing world are hospitalized for complications resulting from unsafe abortions, resulting in long and short term health problems. The health consequences and burdens resulting from unsafe abortion disproportionately affect women in Africa.”[ Internet source, google scholar, WHO (25th November 2019)]
1.4 Ancient History of abortion Worldwide.
There is no doubt about the fact that abortion history can be traced back from the onset of when human beings believed that by avoiding the uses or the consummation of some herbs, seeds, and medicines which can helped toughen a pregnancy, women also understood that by eating the same herbs and medicines it can as well distract the pregnancy by ending or aborting it. An ancient Egyptian medical text drawn, ostensibly, from records dating as far back as the third millennium BCE. The documents further noted that, “the Ebers Papyrus suggests that an abortion can be induced with the use of a plant-fiber tampon coated with a compound that included honey and crushed dates. Later herbal abortifacients included the long-extinct silphium, the most prized medicinal plant of the ancient world, and pennyroyal, which is still sometimes used to induce abortions (but not safely, as it is highly toxic.”[ Cf. google scholar, Eve’s Herbs, John Riddel, 1997] From the above, one can conclude with a simple understanding that some things such as herbs, seeds and foods that unintentionally triggered miscarriages could also be directed to deliberately causing abortion.
1.5 Types of abortion been carried out in Koforidua – Ghana:
There is no doubt about the fact that abortion is the killing of a human being who is really a person in his or her mother’s womb, and this, therefore, becomes the basic argument against abortion. This is because “human life is a single continuum beginning at conception-fertilization, continuing through the time in the womb, entering a new phase at birth, and continuing after birth to death. If conception-fertilization is not clearly established as the first point of this continuum then the beginning of a person’s existence will be lost in obscurity.”[ Cf. Stephen D. Schwarz, The moral question of abortion, Loyola University Press, Chicago, pg. 87-88]
Here, one will also argue about the uses of I.U.D. by justifying it to be one of the contraceptive devices. This perception and argument is fundamentally wrong with the fact that this so-called I.U.D contraceptive rather causes the death of the zygote and never prevent pregnancy. For example, “the destruction of a zygote is the killing of a real human person; it is therefore a form of abortion. Abortion is therefore essentially different from contraception, which, as the name implies, means the prevention of conception; no new human being comes into existence. Abortion, in contrast, means that an existing human being is killed. Abortion implies a victim; contraception does not. Thus devices, such as the I.U.D, that cause the death of the zygote are methods of abortion and not of contraception, though they are often misleadingly labelled as contraceptive devices. They are abortifacients, devices that cause an abortion, and should be labelled as such.” 5 the moral question of abortion, Stephen D. Schwarz, Loyola University press, Chicago, pg. 87.
Basically, there are two ways of which abortion can be procured, and these are artificial and natural abortion. To start with, the natural abortion is that which happens spontaneously without any human interventions. Most at times people normally term it as miscarriage. On the other hand, artificial abortion is that which is induced, either by drugs or any external influence. This is what is term as embryotomy which is an intentional ending of life of the embryo.
Artificial or induced abortion is the type of abortion that is done deliberately with complete consent of the will. Thus, an artificial/induced abortion is the type that is done decisively, and this can be done in two ways. There is direct and indirect abortion. Direct abortion is the premeditated killing of the unborn which may be influenced by fear or shame, of getting a child out of wedlock, or because of genetic disorders. Indirect abortion comes unintentionally. This may come as a consequence of an ectopic pregnancy.
From the above definition of indirect abortion, we distinguish between the three main types of procuring abortion, which are ‘the medical abortion, the surgical, and the induction and uterine contractions methods.
1.5.1 The medical abortion
Medical abortion is the type that involves the use of drugs for the procurement of abortion. In medical abortion, there are drugs that prevent the implantation of the fertilized egg. Some examples of such drugs includes the morning after pill and mifepristone.
1.5.2 The surgical abortion
On the other hand, most of these women in Koforidua also go for the surgical abortion which is been done by the use of different methods such as the Dilation and Curettage (the D and C) method, and the Vacuum Aspirator (dilation and evacuation) method. During the D and C method, the cervix of the woman is expanded by the use of a spoon-shaped instrument to permit the scraping of the uterine content, the embryo. This method is very dangerous because if the clinician is not careful, it can lead to a perforation of the uterus with its resultant haemorrhage that could be deadly to the mother. During the dilation and evacuation method, the suction machine is used to aspirate the content of the uterus.
1.5.3 The Induction and Uterine contraction method
The third way of procuring abortion is the ‘Induction and Uterine contraction. The uterus is a muscular organ that can contract. During this method of procuring abortion, a given quantity of amniotic fluid is removed from the womb of the woman and it is replaced by the same quantity of a saline solution. This will cause a cardiac arrest of the fetus leading to its death. If prostaglandin solution is used, the woman is automatically induced to labour thus fetal expulsion.”[ Cf. P.O Okoth, Biomedical Moral Theology; An Introduction, 192-193.]
This chapter has presented the general overview of abortion: the meaning of abortion from different sources, such as, some prominent personalities, groups and traditions. The core purpose of this first chapter has been to highlight the world view of abortion, and this will open the way into the next chapter of this essay which will dealt with the causes and the effects of abortion in Koforidua.