It’s 10:00 a.m. in the heart of Okaishie, one of Accra’s busiest drug hubs, where pharmacy shops brim with activity.
Clients stream in and out, purchasing or seeking various medications, available at both wholesale and retail prices. Some come with prescription forms, while others rely on vague descriptions of their symptoms or request specific drugs they’ve heard of.
Yet, amid this flurry of transactions, there’s a concerning lack of professional guidance on the drugs being sold. Pharmacies are running brisk, unchecked businesses with minimal attention to educating customers about their purchases.
In an undercover investigation to understand how pharmacies influence the abuse of abortion pills, I posed as a 12-week pregnant woman seeking medication to terminate the pregnancy.
What I uncovered was alarming: counterfeit drugs, extreme price gouging, and blatant exploitation of women and girls’ vulnerabilities.
One of the drugs offered to me was “Medabon,” an abortion pill approved by Ghana’s Food and Drugs Authority (FDA). However, instead of being sold at its standard price of GH¢200–300 in authorised health facilities, the price in these pharmacies ranged between GH¢400 and GH¢600.
In another instance, I was handed a counterfeit drug labelled “Misabon,” falsely presented as Medabon, with assurances of its potency to terminate the 12-week pregnancy.
When I pressed for details on how to take the drug, the attendant hesitated to give his name but provided his phone number, instructing me to call later for guidance.
That evening, when I called, he directed me: “There are five tablets in the pack. Take the first one, note the time, and do not consume anything cold afterwards. After 24 hours, place the remaining four tablets in your mouth—two on each side—and let them dissolve before rinsing with water.”
This disturbing interaction is just a glimpse of the wider abuse of abortion pills in Ghana.
Medication abortion (MA)—or the use of pills to terminate pregnancies—is increasingly being misused. Although globally recognised as a safe and effective method, especially in the first 10 weeks of pregnancy, Ghana’s unregulated market tells a different story.
According to the World Health Organisation (WHO), MA can safely be performed up to 12 weeks of pregnancy using two medications: mifepristone and misoprostol. Both have long safety records, but the mismanagement of their use, particularly outside health facilities, poses significant risks.
Globally, 45 per cent of abortions are deemed unsafe, with 97 per cent occurring in low- and middle-income countries, contributing to 8-11 per cent of maternal deaths. The WHO attributes this crisis to poor access to safe, affordable, and stigma-free abortion care.
Ghana’s abortion laws, as amended in 1985, permit the procedure under specific circumstances: when there is evidence of rape, incest, fetal impairment, or when the pregnancy threatens a woman’s physical or mental health.
The 2012 National Comprehensive Abortion Care Services Standards and Protocols extend this by allowing MA up to 24 weeks, but only in licensed health facilities and under the supervision of trained professionals.
At any point within the specified gestation period, when a women decides to abort a pregnancy through MA, the law bars pharmacies or over-the-counter-medicine sellers (OTCMS) to provide the service.
They are only permitted to do referrals and offer counselling services for comprehensive abortion care (CAC).
However, the reality is far removed from these protocols.
The 2017 Ghana Maternal Health Survey (GMHS) revealed that more women in Ghana opt for MA than for surgical or non-medical methods.
The report highlighted that 38 per cent of women who had induced abortions used medication, while only 31 per cent used surgical procedures, and 27 per cent relied on non-medical methods.
Of particular concern, over 40 per cent of young women under 20 who sought abortions used pharmaceutical tablets, compared with just 27 per cent of women aged 35–49.
Research by Caesar Agula et al. in 2021 affirmed that the use of MA pills in Ghana has surged, and these medications are frequently accessed through pharmacies, not healthcare facilities.
Despite MA drugs being classified as “Class A” and requiring a valid prescription from a medical officer, some pharmacies and OTCMS continue to distribute them illegally.
Dr Cynthia Yeboah Mintah, Deputy Registrar of the Pharmacy Council, admits this illegal activity.
“While people may access abortion pills through illicit means, the approved ones, classified as ‘Class A’ prescription-only drugs, should only be sold by licensed pharmacies,” she said.
“With OTCMs, they are not supposed to stock or sell class A and B medicines which abortion pills fall under. These prescription drugs should be returned to the health facility for proper administration under medical supervision.”
Compounding the issue, Dr. Joseph Adu, Medical Director of Marie Stopes International (MSI) Ghana, noted that most abortion-related complications arise from incorrect drug use.
“We found out in a study we did that 99 per cent of complications associated with abortion is because either a wrong medicine was used, wrong dosage is used or wrong timing and 80 per cent of those rushed to hospital for complications was due to pain and bleeding because something went wrong during the procedure.
Abortion performed with the right medication, by the right person, at the right place, is safe. The first point of call for anyone considering abortion should be a health facility, where they can be examined and prescribed the right medication,” he stressed.
The FDA has approved only three medications for MA in Ghana: Medabon, Mariprist, and MM Kit. Yet the open market is flooded with unapproved drugs claiming to terminate pregnancies, placing the lives of countless women and girls in danger.
In a country where abortion carries a heavy stigma, unsafe practices thrive in the shadows.
Public education about abortion laws is sorely lacking, and healthcare professionals need better training to safely administer MA.
Most critically, regulatory authorities must act decisively to rid the market of dangerous counterfeit drugs and ensure that no woman loses her life to unsafe abortion.
As the American Civil Liberties Union (ACLU) aptly puts it: “The ability to decide when and whether to have a child is a fundamental right. No matter where we live, how much money we make, or who we are, we should all be able to control our own bodies and make the best medical decisions for our lives and families.”
BY ABIGAIL ANNOH
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According to the World Health Organisation (WHO), MA can safely be performed up to 12 weeks of pregnancy using two medications: mifepristone and misoprostol.
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