On 13 May 2013, Kermit Gosnell was convicted of three counts of first-degree murder, and one count of involuntary manslaughter. Kermit, a doctor with a West Philadelphia practice, illegally committed late term abortions and infanticide. Whilst justice has now been served for the victims of Gosnell, the victims of Joshua Drah in Ghana have received no such recompense.

Joshua Drah masqueraded as a doctor in Madina, a suburb of Accra, and raped women who visited his ‘Mission Clinic’ seeking terminations. Even though an award winning investigative journalist, Anas Aremeyaw Anas broke the story of Joshua Drah’s illegal practice in September 2012, Drah is currently out on bail, and there is no indication of when a state trial against him will commence.

There are some parallels in the Gosnell and Drah cases. Katha Pollitt’s article on ‘Dr. Kermit Gosnell’s Horror Show’ indicates that poorer women frequented Gosnell’s practice. In Ghana, many of the women who visited Drah’s practice were students from a university nearby, and many of the women who patronized his service would have included women and girls with low incomes. Research on unsafe abortions in Ghana has shown that cost is the most important factor preventing women from accessing safe abortion care.

Illegal practices run by the Gosnells and Drahs of this world will continue to flourish in spaces where poorer women do not have ready access to comprehensive abortion care. In the case of both Ghana and the state of West Philadelphia in the USA, abortions are not covered by state/national insurance. What is also clear from both of these cases is that women who are desperate to end pregnancies will go to any lengths to do so, even seeking out the services of people who operate on the wrong side of the law.

A glaring difference in the two cases is that whilst Kermit Gosnell has been convicted and is now facing life in jail, Joshua Drah has been released on bail. 

Like Gosnell, Drah’s illegal activities resulted in at least one death. Anas Aremeyaw Anas, a Ghanaian investigative journalist covertly filmed Joshua Drah raping women who had come to his Madina based clinic for terminations said in a phone interview,

“Yes there are deaths, there are deaths. In fact we have located one family, and I think the police should continue. We have located one family where a girl died.”

Cases like Gosnell and Drah’s occur because of continued stigma, myths and misunderstanding about abortions. Philadelphia, where the Gosnell case occurred, has progressive abortion laws, and Ghana has one of the most progressive abortion laws on the African continent. In spite of this, the sense of shame associated with terminating pregnancies, and the lack of free access to abortion care, leads many women to seek assistance from doctors running illegal practices. In Ghana, women desperate to terminate pregnancies will try anything including approaching pharmacists who sell, without prescriptions, drugs like Cyrotex, which is widely known to cause miscarriages. Ghanaian women requiring abortion care resort to seeing quack doctors, attempt to induce abortions themselves, or take any number of herbal and medicinal concoctions to induce a miscarriage.

According to the Ghana based Health Sector Advisory Office’s paper on ‘Maternal Mortality: The proportional role of unsafe induced abortions and mitigating interventions’, Ghana’s law on abortion is covered by Criminal Code (29) section 58 and states induced abortion is not an offence if it is,

“caused by a medical practitioner specializing in gynaecology or other registered practitioner in a government hospital or registered private hospital or clinic” when the pregnancy is the result of rape, defilement of a female idiot or incest; when continuation of the pregnancy would involve risk to the life of the pregnant woman or injury to her physical or mental health; or where there is substantial risk that if the pregnancy were carried to term the child would suffer from or later develop a serious physical abnormality or disease."

If one can ignore the language around ‘a female idiot’, one can infer that Ghana’s law on abortions is progressive. Additionally, there is enough scope within the language in which Ghana’s law on abortion has been couched to allow virtually all women in Ghana to access abortion care if required. Injury to a woman’s physical or mental health is broad enough to include circumstances such as pregnancy induced depression, and being unable to bear the financial responsibility of caring for a child. In spite of a relatively progressive act on abortions, the general misunderstanding in Ghana is that abortions are ‘illegal’ which has led to the cloud of stigma around women who seek abortions. Doctors known to offer abortions are also stigmatised. In an interview with Dr Jehu Appiah, Head of IPAS in Ghana he said,

“Even doctors and midwives who have been trained to carry out the abortion procedure are stigmatised. If a doctor who carries out abortions builds a house for e.g. people point fingers and say that is an ‘abortion house’, it’s the money you’ve made from carrying out abortions that has enabled you to build the house.”

Ghana’s maternal mortality rates are estimated at 450 per 100,000 life births. Unsafe abortions account for 21% of maternal deaths and are the leading cause of Ghana’s astronomical maternal mortality rates. These maternal mortality rates will not reduce as long as shame and stigma around abortions continue. Women will continue to die at the hands of the Drahs and Gosnells of this world who take advantage of women’s desperation and rape, maim and kill those who turn to them for help. On the other hand, data on safe abortions show that whilst abortions are safer in countries where the service is legal, and easily accessed, countries with liberal abortion laws also have lower abortion rates than countries with restrictive abortion laws.

The case of Drah and Gosnell should be a rallying call for safe abortions to be a part of every country’s comprehensive family planning service. Abortions should be free and accessible in Ghana via the National Health Insurance Scheme, and in the United States and other countries around the world as part of standard medical insurance, and national health schemes. People need to realize that high maternal rates, escalating levels of unsafe abortions, and cases like that of Drah and Gosnell, are what occurs when health systems fail to provide comprehensive family planning care, including abortion care, to women.