By mathias aboba
Global Doctors for Choice (GDC) Ghana, a network of Physician and Midwife advocates working to promote the freedom of choice for women in reproductive health decisions, has initiated the first quantitative study about conscientious objection to care for abortion services in Ghana, and the first Ghanaian study with conscientious objection as its main focus.
Conscientious objection is a term used to describe the refusal to participate in an activity that an individual considers incompatible with his or her religious, moral, philosophical or ethical beliefs. Itis a value-based argument exercised by some health professionals that allows them to refuse to care for women who demand and are entitled to safe abortion services under the Ministry of Health and Ghana Health Service guidelines for comprehensive abortion care (CAC).
Speaking at a stakeholder briefing in Bolgatanga, Dr. John Koku Awoonor-Williams, GDC-Ghana Country Lead and Regional Director of Health Services for Upper East region observed that in Ghana, unsafe abortion accounts for a larger proportion of total hospital admissions than for complications of pregnancy and birth, and contributes about 11% of maternal mortality.
He said in the past three years of GDC-Ghana?s advocacy work on safe abortion care, the network has heard anecdotally that conscientious objection to care is a matter of serious concern, for which reason the network has taken the initiative to research into the problem to establish its prevalence and make necessary proposals for policy development.
GDC-Ghana was launched in November, 2011 with funding from Safe Abortion Action Fund (SAAF) for the implementation of a three-year advocacy project. According to the Country Lead,in three years the network has reached an estimated 5831 health workers with its advocacy efforts in a determination for influencing and creating a more tolerable environment for safe abortion services within the health set up.
Similarly, the group has worked to promote the introduction of free family planning services under Ghana?s National Health Insurance Scheme. It has also made big strides in building ties with key professional health and training institutions for the promotion of expanded use of health exceptions in Ghana?s abortion laws, and the introduction of safe abortion in the training curriculum of some Midwifery Training Schools and Colleges.
Dr. Awoonor-Williams noted that in addition toconscientious objection to care, stigma against patients and abortion care providers, inadequate numbers of trained practitioners for safe abortion services and difficulties with getting medical schools to adopt revised curriculum on abortion care remain the major obstacles to abortion care services in the country.He therefore entreated the stakeholders to make their various voices heard on the subject to reduce stigma and improve women?s access to safe abortion care.
The GDC-Ghana Country Co-Lead and Medical Director of the Bolgatanga Regional Hospital Dr. Peter Baffoe said although the Standards and Protocols of the Ghana Health Service state clinicians can claim conscientious objection to abortion provision, the same documents bind these clinicians by duty to refer women in need to an accessible qualified provider. He noted that the absence of stipulated sanctions or other control measures for offending individuals and institutions have not helped the policy.
Dr. Baffoe revealed that, given the small numbers of providers in Ghana and particularly in the three northern regions, conscientious objection among abortion providers can increase the risks of women resorting to unsafe abortions and increase preventable complications.
The proposed study will be conducted in the three regions of the north namely Northern, Upper West and East regions. The survey willexamine the prevalence of conscientious objection by facility ownership (faith-based, public and private), urban or rural facility location, and by provider type: doctors and midwives.Ms. Laura Harris, GDC New York, a research officer was happy to note that the study is taking off in Ghana and reiterated the importance of the study in shaping policy and addressing challenges in conscientious objection.
The stakeholder meeting was held to introduce the study topic to the partners and solicit their views on the proposed design and methodology. The meeting was attended by Civil Society Organizations (CSO) working in the area of maternal and reproductive health, state departments and professional institutions including the Navrongo Health Research Center(NHRC), Department of Social Welfare, the Nurses and Midwives Council and the National Population Council. The group expressed great enthusiasm for this groundbreaking study, and gave helpful input on content and study design.