Perspectives on Unintended Pregnancy and Abortion among Ghana’s Kayayei (Female Head Porters)

Presenter: Samantha Lattof, London School of Economics

Background: Sexual initiation among young migrants in Ghana occurs at earlier ages than the national population.  Despite their growing urban presence, the migrant kayayei (girls and young women who work as head porters) are a vulnerable population exposed to sexual and reproductive health risks including rape, unintended pregnancies, sexually transmitted infections, and unsafe abortion.  Does the agency and independent decision making that kayayei have demonstrated by migrating in search of economic opportunities extend to their decisions pertaining to unintended pregnancy and abortion?

Methods:  This mixed-methods study on female migration and health in Accra involved surveying 627 kayayei and conducting in-depth interviews with 48 purposively selected kayayei.  Analyses explore kayayei’s health status and health seeking behaviours, including the motivations for use of maternal and newborn health (MNH) services.

Results:  In a largely illiterate population where most have never attended school, kayayei’s first introduction to family planning is most likely to occur at infant weighing visits after they have already given birth.  Analyses of in-depth interviews reveal that unintended pregnancy is a concern for kayayei in Accra and also in their home villages in northern Ghana, where unintended pregnancy can actually serve as a driver of migration.  Unsafe abortion is commonplace.  Whilst participants disclosed that they had considered abortion after instances of rape and domestic violence, familial pressures and the threat of dying from an unsafe abortion led many of these young women to ultimately keep their unintended pregnancies.

Conclusions:  Kayayei’s lack of education, combined with their vulnerability to sexual violence, impedes this population’s ability to make their own health decisions and access MNH services.  The paper concludes with policy and programmatic recommendations focused on health education among adolescent migrants in Accra and northern Ghana from where this population originates.