Ghana's Demographic Transition: The Role of Induced Abortion and Reproductive Health Ramifications

Abstract

Issues pertaining to reproductive health are taken seriously by developing countries, if the Millennium Development Goal of improving maternal health is to be achieved. To meet the targets of reducing by three quarters the maternal mortality ratio and achieve universal access to reproductive health care, research into reproductive needs is of paramount importance. Ghana has been experiencing a reduction in fertility levels over the last two decades. Total fertility rate (TFR), which stood at 6.4 in the late 1980s decreased to 5.5 and 4.6 in 1993 and 1998 respectively and further decreased to 4.4 in 2003. Meanwhile, the contraceptive prevalence rate has remained persistently low at 25 percent. This suggests that other factor(s), besides contraceptive use, may be more important in shaping Ghana’s fertility transition. Although there is no direct information on induced abortion, the application of an indirect technique (neo-residual method) provides insightful clues that induced abortion may chiefly account for the disjoint between Ghana’s declining fertility and the low contraceptive use. Using the 1998 and 2003 Ghana Demographic and Health Surveys, and guided by Bongaarts’ proximate determinants of fertility model, I compute an internal consistency accuracy measure to validate the indirect technique and estimate the fertility inhibiting effects of the proximate determinants. I find that, while postpartum infecundability is the most significant inhibitor of fertility, induced abortion is, increasingly, a major birth inhibitor. In view of these findings, I recommend that, care for complications from abortion should be an integral part of primary health care system.