Girl Child Education On Adolescent Reproduction Health, The Way To Teenage Pregnancy And Maternal Death Eradication In Ghana

The introduction of special education as a subject, public lectures on contraceptives, and legalization of medical abortion is our first step as a country to eliminate teenage pregnancy and teenage death. Over the years the battle to promote girl-child education is been compromise by so many factors the same areas we have neglected. Fifty seven thousand teenage pregnancies were recorded nationwide in the first half of 2017 which included those having their final examination at the junior high level and senior high level. GBC on January, 24th 2017 reported on its website that the just ended 2017 BECE experienced High Rate of Pregnant Candidates. Parents, teachers and society must understand that the teenage girl getting pregnant during her basic education has a lot of health and economic hazards with social implications.

The consequences include the embarrassment brought to the family as a result of the pregnancy, dropping out of school, attending antenatal clinics, her inability to write the Basic Education Certificate Examination (BECE) or going to write the examination in her pregnant condition and increase in the family budget for the upkeep of the pregnant daughter and grandchild.

Just to mention a few, In the Eastern Region it was reported that 36 pregnant girls were among the Junior High School candidates who wrote the BECE in seven districts. A 16-year-old girl of the Akyem Apiredi JHS in the Birim South District, is reported to have given birth to a bouncing baby boy whilst writing her examination in the classroom. Three pregnant girls, including a 21-year old from Apuya D/A JHS at Jacobu, were among candidates in the Amansie Central District of the Ashanti Region who wrote this year’s BECE. In the Huni/Prestea Valley District of the Western Region, eight pregnant girls wrote the examination.

Ten girls in the Agona West Municipality of the Central Region who sat for the BECE were reported to be pregnant, an increase from four in 2013. Two girls, who delivered two days before the commencement of the examinations, could not take part. Statistic available at the Nabdam Girls Child Education Unit of the Ghana Education Service (GES) of the Upper East Region revealed that since the beginning of the 2013/14 academic year, a total of 43 teenage school girls were made pregnant. Out of the 43, 30 of them were said to be candidates in the 2014 BECE with ages ranging between 14 to 17 years. Seventeen out of the 30 pregnant candidates delivered before the examinations began.

The reason of the pregnant girls in almost all the districts mentioned, was attributed to financial constraints of their parents, poverty, insufficient time for sex education, inadequate monitoring due to lack of resources, and irresponsible parenting among others. Parents are obliged to provide for their adolescent girls, their basic needs including shelter, food, clothing and relating well with them, to save them from temptations. To curb this menace, there is the need for a comprehensive sex education programme in JHSs and SHSs to protect female students from not only unwanted pregnancies but also sexually transmitted diseases (STDs). Also, because adolescent girls go through many stages of development, they should be helped to manage themselves well through sex education.

This is informed by the fact that the adolescence stage involves many complicated issues, and therefore it needs all concerned, especially teachers, parents, religious organizations and civil Society Organizations, to make girls aware of issues such as sex, to save them from things which can disrupt their education, and shatter their future. This will also go a long way to sensitize students on the dangers of premarital sex and unsafe abortion. Even though the panacea for unwanted pregnancies is abstinence from sex, girls who cannot abstain ought to be provided basic information on dangers associated with teenage pregnancy, diseases associated with unprotected sex, reproductive health, family planning and nutrition, to protect them.

It should be noted that, the notion of most Ghanaians that sex education promotes sexual promiscuity among teenagers, is factually inaccurate and should be discarded. At the end of the day we will be saving female students, teachers, parents and all concerned from inconveniences and uncertainties associated with unwanted pregnancy. A total of 31 teenage pregnancy related deaths were also recorded during the period. This was made known by Mr. Simeon Kwabena Acheampong, the Ashanti Regional Manager of Marie Stopes International, Ghana, an international NGO, providing contraception and safe abortion services. According to him, a total of 9,100 adolescents reportedly got pregnant in the Ashanti Region during the first half of this year. He also said three teenage pregnancy related deaths were also recorded in the region during the period.

Mr. Acheampong was speaking at a three-day adolescents’ camp meeting organized jointly by the Ghana Health Service (GHS) and the Ghana Education Service (GES) in Kumasi. It brought together members of the adolescent health ambassadors clubs in senior high schools (SHS) across the country.

These ambassadors are being supported to create awareness on reproductive health in both their schools and communities as part of stepped up effort to prevent unwanted pregnancies which we can’t even see today.

The meeting was held under the theme “Equipping young people as health ambassadors for sustainable development”.

Mr. Acheampong expressed concern about the high rate at which many young girls were getting pregnant and dropping out of school.

This, he indicated, was unhelpful to the fight to reduce poverty and asked that all combined their effort to give protection to adolescent girls.

Dr. Gloria J. Quansah Asare, the Deputy Director General of GHS, labelled the youth as valuable asset and said everything should be done to help them to avoid missteps and pitfalls.

He spoke of the need to reach out to them with reproductive health services to make the right choices and decisions.

Statistics show that majority of the Ghanaian adolescents are in school and she said that made the school a critical platform for providing adolescent and youth-friendly health services.

That, she indicated, informed the decision by the GHS to form the clubs to get to them, with the right health information and services. (Source; citifmonline.com)

The problem is not only with girls dropping out of school due to pregnancy but also high death among them due to illegal pregnancy termination. Recent revelations shows that Abortion among adolescents in the Kumasi metropolis is on the rise. Some uses poisonous Tree branches sticking out of uteruses, Concoctions of herbs, bleach, mashed glasses and burnt sugar. These are some of the ways women choose to have unsafe abortions in Ghana, a practice that is leading to countless of deaths and injuries each year, leaving many other women infertile. In Ghana, despite relatively progressive laws, women’s access to abortion services is still extremely limited and unsafe abortion continues to be a leading cause of maternal mortality.

Maternal mortality is the second most common cause of death among women in Ghana and more than one in 10 maternal deaths or 11% are the result of unsafe abortions. Each year an estimated 20% (~42 million) of all pregnancies worldwide end in induced abortions, 20 million of which are performed under unsafe conditions. Thirteen per cent of maternal deaths worldwide are attributable to unsafe abortions, most of them in developing countries. Additionally, an estimated five million women in developing countries are hospitalized each year with complications of induced abortions. Unsafe abortions are frequently carried out by individuals lacking the necessary skill and sometimes self-induced. Africa has one of the highest induced-abortion rates in the world (29 per 1000 women of reproductive age) and more than 90% of these are unsafe. These induced abortion rates tend to be higher in settings with high unmet need for contraception and are likely to keep rising unless women’s access to effective contraception and safe abortion care are improved.

The abortion law in Ghana was amended in 1985 to make it more liberal. The current law permits abortion carried out by a registered medical practitioner in a registered public or private health facility under the following circumstances: rape, defilement and incest; where the pregnancy poses substantial risk to the physical or mental health of the woman; or in cases of severe fetal anomaly. In 2003, a policy to provide abortion care to the full extent of the law was developed. And since 2006, service delivery standards and protocols on prevention and management of unsafe abortion including provision of comprehensive abortion care have been implemented nationwide. Despite the less-restrictive legal environment, about 15 induced abortions per 1000 women of reproductive age are performed in the country each year and two-thirds of these are unsafe.

This we call as disheartening why we don’t legalize abortions other than the conditions mentioned above to decrease incidence like this. In Ghana, induced abortion complications account for 11% of maternal mortality nationwide, and up to 12% of gynecological admissions in leading public tertiary hospitals. These voluntary terminations of pregnancy are more common in urban areas and among younger women. Different methods are used for these terminations. Recent evidence from one study, indicated that over 80% of the women self-induced abortions with misoprostol. According to research done by KATH in 2017, Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana. Misoprostol is a prostaglandin E₁ analogue that is licensed for the treatment of peptic ulcer disease due to a prostaglandin, it also causes uterine contractions and cervical softening that has rendered most teenagers in Ghana to use that drug as a medication to induce abortion.

With increasing popularity of misoprostol as an over the counter self-administered abortifacient in Ghana, it is imperative that the morbidities associated with its use are investigated. While most studies on induced abortions have compared complications of spontaneous and induced abortions, there is paucity of research on morbidities associated with misoprostol-induced abortions. This study aimed at comparing socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana

(Source; ncbi.nlm.nih.gov/pmc/articles/PMC4118200/)

Brong Ahafo Region recorded 1,224 cases of unsafe abortion among teenagers in 2016, the Ghana Health Service report has revealed.

The report said the figure represented 12.7 percent of 9,612 cases of unsafe abortion recorded in the country within the period.

Mr. Raphael Godlove Ahenu, the Chief Executive Officer of Global Media Foundation (GLOMEF), an anti-corruption media advocacy Non-Governmental Organization (NGO), made this known in Sunyani on Tuesday March 28^th 2017.

Addressing a news conference to announce the outcome of a safe abortion project his NGO was implementing in the region, Mr. Ahenu observed with regret the increasing trend of teenage pregnancy and unsafe abortion in the country.

He said 110,000 adolescent girls in 352 basic schools across the country got pregnant in 2016 adding that out of the figure, the Brong-Ahafo Region alone recorded 12,112 cases in 38 basic schools.

Mr. Ahenu said there is the need for adolescent people to easily access safe abortion services at public health facilities to lower the high unsafe abortion rates which contributes to maternal deaths in the country. He called for a national policy guideline for the distribution of condoms in all public places and gatherings to ensure easy access. Mr. Ahenu said when the stigma attached to the use of condoms and other family planning methods such as pills, are addressed, teenagers who could not control their sexual desires would feel at ease and demand for the services. An interview with Diana Appiah, who has gone through seven unsafe abortions, is a typical example of a woman who has undergone the dangerous procedure. In an interview with The Weekend Globe, she recounted the trauma she went through as a result of her unsafe abortions. “I would bleed and bleed to the extent that I sometimes lose consciousness,” she said. “The issue became aggravated when I was told my womb was twisted. It was at that point that I decided not to commit anymore unsafe abortions.” According to Diana, her boyfriend gave her drugs to induce an abortion after they realized they could not care for the baby. Globally, 47,000 women die as a result of unsafe abortions and eight million women suffer serious and sometimes permanent injury as a result of complications. The issue disproportionately affects women in Africa and South America. And although improvements have been seen recently in the global maternal mortality rate, the proportion of deaths attributable to unsafe abortion is holding steady at 13%.

Research shows that making abortion illegal does not stop it from occurring, but rather just drives it underground, forcing women to obtain clandestine and unsafe procedures.

But in Ghana, unlike in other countries where abortion is illegal, the problem is not with the law. The country’s abortion laws are already relatively liberal in cases of rape, incest or the “defilement of a female idiot.” Abortion is also permitted if the life or health of the woman is in danger, or if there is risk of fetal abnormality. However, few women are knowledgeable about the law. Only 3% of pregnant women and 6% of women seeking an abortion are aware of Ghana’s abortion law. Also, some doctors may arbitrarily choose to deny women abortions at a hospital even when the procedure should be allowed, forcing many women to undergo an unsafe procedure elsewhere.

In Ghana, unsafe abortions remain a huge problem because the existing abortion law is not implemented as it is written. And implementing the law would not only save lives, but it would save money, as well. A substantial proportion of women who survive an unsafe abortion experience complications – such as severe bleeding – and end up in government hospitals with very life-threatening health problems that must then be paid for.

Another long-term result of unsafe abortion is that ladies who have the procedure outside of a registered clinic do not receive any education about contraception or family planning, and are likely to get pregnant again – and perhaps even seek another abortion.

In an interview with The Weekend Globe, Faustina Fynn-Nyame, country director for the reproductive health and family planning non-governmental organization, Marie Stopes International, said the government had set up policies to ensure safe abortions are the norm, but doctors sometimes do not adhere to those policies.

She said many women pursue unsafe abortions because they are not knowledgeable about the risks and that young women are more likely to rely on their friends for abortion recommendations than seeking out qualified health care options. “We’ve had women coming here who are bleeding to death,” she said. “We’ve seen horrific injuries, where there’s a stick still in the women’s uteruses.”

Fynn-Nyame said that some of the cases they have seen at the clinic have been so bad that they have had to remove the uterus or fallopian tubes in order to save the woman’s life.

“An unsafe abortion can lead to a woman being infertile for the rest of her life,” she said. “And that’s if she’s lucky. If she’s unlucky, she’ll lose her life.”

Fynn-Nyame called for more sensitization and education on unsafe abortions and their repercussions.

But there should also be an emphasis on family planning, she said, as unintended pregnancy is the root cause of most abortions and access to quality family planning information and services can reduce unintended pregnancy rates. Experts say the best way to reduce the need for abortion is not by denying women access to safe and legal abortion procedures, but by giving them the power to control their fertility and prevent unintended pregnancy. Unfortunately many teenagers are unware the birth control methods in Ghana are absolutely free. Government hospitals and an NGO like marie stopes are known for these services as well as free consltations.

Educating the youth on the use of contraceptives whether long term or short term methods can prevent these pregnancies. Till now a lot of teenager don’t even know that these contraceptives are free at government hospitals or NGO’s like Marie Stopes who are into these health services. Contraceptives are birth control methods. It is termed as hormonal and barrier contraception or fertility control. There are 15 different types of contraceptives which will prevent the teenager from becoming pregnant or inducing an abortion after the pregnancy to risk his life. These include condoms, the diaphragm, the contraceptive pill, implants that can take up to 5yrs prevention, IUDs (intrauterine devices) that can take up to 3yrs, sterilization and the morning after pill, injections that takes up to 3months.

(Source:http://www.dred.com)
WHO, United Nations Development Programme, and sexual and reproductive health experts in the United States and abroad unanimously recommend certain actions to reduce the incidence of unintended pregnancy and abortion.

1. Improve women’s access to contraceptive information and counseling and to a full range of contraceptive methods. Ensure that these services are available to all women, regardless of their age, marital status, religion, ethnicity, sexual orientation, or number of existing children. Remember that the goal is to reduce unintended, mistimed, and unwanted pregnancies and to reduce the incidence of abortion.

2. Eliminate laws and policies that discourage or deter women of any age or condition from seeking contraceptive and family planning services. Remember that the goal is to reduce unintended pregnancy and the need for abortion. In addition, mandating parental involvement or consent too often causes teens to delay an abortion beyond the safest period (the first eight weeks of gestation). Thus, such policies can increase teens’ risk of death or injury from abortion.

3. Legalize abortion and make services widely available. Remember that making abortion illegal does not prevent abortion. It only prevents safe abortion. Unsafe abortion costs the lives of up to 75,000 women and damages the health of millions of women every year.

4. Provide all teens and young adults with accurate, age-appropriate sexual health education, including accurate information about contraceptives, STIs, pregnancy and parenting. Good education will best equip youth to make appropriate choices about delaying the initiation of sex and about protecting themselves and their partners when they choose to have sex.

(Source; Written by Sue Alford, MLS Advocates for Youth © April 2011)