“The Struggling Mother”

One of my first days in Accra I was stopped by a street artist enthusiastically selling his paintings to unsuspecting newcomers like myself. Of course I was a perfect target and ended up with one of his paintings as my first souvenir from Ghana. It depicts a woman carrying both a large load on her head and a baby on her back; this scene, a favorite of Ghanaian souvenirs, is commonly referred to as “The Struggling Mother.” I did not know it at the time, but this scene has become a symbol of my time in Ghana and reinforced to me the importance of Pathfinder’s work.

Motherhood in Africa is vastly different from motherhood in the US or other developed nations. The image of the struggling mother is not one from years past conjured up for the sake of tourists; everyday I see women carrying huge loads on their heads either vending right there on the street or walking to the market with babies of all sizes strapped to their backs. There is no such thing as maternity leave for these women who struggle each day to raise their family and earn a meager living; they give new meaning to the term “working mother”. On average, women in Ghana have four or five children. For the poorest fifth of the country whose access to family planning is limited, this figure jumps to six or seven children per woman, staggeringly high in a country as economically and politically stable as Ghana.

Although fertility rates are commonly used as theoretical benchmarks in development work, each pregnancy and childbirth for a Ghanaian woman represents not only an addition to her family, but also a life-threatening physical endeavor. In the poorest fifth of Ghanaian society, where an average woman will have six or seven children, only 18% of births are attended by a skilled professional. Malnutrition among women, especially in the rural communities, is rampant and can lead to low-birth weights and deadly complications during labor such as post-partum hemorrhage. A Ghanaian woman has a one in 35 lifetime chance of dying in childbirth; an American woman, in comparison, has a one in 2,500 lifetime chance of dying in childbirth. In developed nations where maternal deaths are encountered very rarely and access to family planning is taken for granted, we forget about maternal mortality; we don’t grapple with its causes or attempt to understand its effects on the children, families and communities. The image of the struggling mother represents not only the enduring struggle of being a mother, but also the hard-fought struggle even to become a mother in this setting.

Pathfinder’s work in Ghana takes the difficult and carefully tread path of decreasing maternal mortality by addressing the deadly toll of unsafe abortion. Unsafe abortion accounts for 30% of maternal deaths in Ghana; most of which are entirely preventable. Although Ghana’s laws on abortion are relatively liberal, widespread stigma and lack of access to quality care lead many women to unskilled providers or even to attempt to terminate the pregnancy themselves. Young women are particularly vulnerable, comprising 60% of the maternal deaths from unsafe abortion. Along with the Youth Friendly Postabortion Care (YF PAC) project in Accra, Pathfinder is implementing a Comprehensive Abortion Care (CAC) project in the three Northern regions of Ghana.

The CAC project has five components, each playing an important role in achieving the goal of decreasing maternal mortality. The project aims to increase access to quality abortion care services by (1) providing a safe place where pregnant women can discuss their options, (2) giving life-saving medical care to women suffering the complications of unsafe abortion, (3) providing a family planning method to avert further unintended pregnancies, (4) creating community awareness of the problem of unsafe abortion and reducing stigma and (5) providing safe elective abortion procedures when necessary. The project is comprehensive in the fact that it not only provides safe abortion and postabortion medical care, but it also addresses the root causes of unsafe abortion, including lack of knowledge, stigma and lack of access to family planning in order to prevent future unintended pregnancies as well as unsafe abortions.

For an American, it is difficult to take abortion out of the context of our own contemptuous national debate. However, to accurately assess the deadly toll of unsafe abortion on women in the developing world is to forget the American context and consider the simple fact of an African woman’s life. 97% of unsafe abortions occur in the developing world and it is estimated that 59% of all unsafe abortions are among African women under the age of 25. To ignore the consequences of unsafe abortion is to ignore the needless deaths of the women in our world’s most impoverished areas; to ignore the issue of abortion is to ignore a large portion of the world’s maternal deaths. Although controversial, comprehensive abortion care including counseling, family planning provisions and community sensitization is an effective and proven method of reducing maternal mortality. The African mother struggles in many ways in which the American mother does not; undergoing an unsafe abortion and suffering the life-threatening consequences does not have to be part of her struggle.

Facts and Figures from WHO (http://www.who.int/reproductive-health/unsafe_abortion/map.html), Population Reference Bureau (http://www.prb.org/Datafinder/Geography/Data.aspx?sn=true&category=16&region=21&region_type=2), and Ghana Health Services.