| Summary: | Unsafe abortion continues to be a major public health problem in Ghana. It accounts for 22-30% of the maternal mortality in the country. Although Ghana is one of the countries in sub-Saharan Africa with a liberal abortion law, access to safe, legal abortion in public health facilities is limited. Women with unwanted pregnancies resort to unsafe abortion with the resultant heavy toll on their health and lives. This study set out to understand the barriers to and opportunities for improving access to safe, legal abortion services in Ghana. The study employed in-depth interviews with key stakeholders and analysis of relevant documents with a view to unravelling different dimensions of the problem for a deeper understanding of the situation. Key findings included the observation that Ghana's abortion law is relatively liberal but has gaps and inconsistencies making it liable for misinterpretation. There is need to provide safe, legal services; evaluation of these services might help to improve the law. Two main barriers confront provision of safe abortions: the service-related barriers constitute legal and policy ambiguities and inconsistencies, provider attitudes and lack of training. Important socio-cultural barriers were cultural values, social norms, moral and religious objection which create dilemmas in professional practice. Midwives were found to be conservative and reluctant to provide comprehensive abortion care. Most respondents, including religious people, saw `medical grounds' as legitimate for comprehensive abortion care. Medicalising abortion may help lift it out of the moral/religious sphere in people's minds, and therefore make it more acceptable. In conclusione, fforts shouldb ea imeda t future law reformt o takec areo f its current ambiguities that challenge application. In the short term, it would be better to sensitizem edicalp ractitionersto the flexibility of the law. It is essentialf or the GhanaH ealth Servicet o assisth ealthp rovidersa ndk ey stakeholdertso re-examine their values and change their attitudes towards abortion care to ensure that legal abortions are provided in public hospitals to help women in need of the services.
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