Tree branches sticking out of uteruses. Concoctions of herbs and bleach.

These are some of the ways women choose to have unsafe abortions in Ghana, a practice that is leading to countless of deaths and injuries each year, leaving many other women infertile.

Maternal mortality is the second most common cause of death among women in Ghana and more than one in 10 maternal deaths – or 11% – are the result of unsafe abortions. Experts believe there will be about 126,000 abortions in Ghana in 2013 and that the majority of those will be unsafe procedures done outside of registered clinics or the Ghana Health Service.

In Ghana, despite relatively progressive laws, women’s access to abortion services is still extremely limited and unsafe abortion continues to be a leading cause of maternal mortality.

Abortions can be unsafe for a variety of reasons. Some procedures, such as those outlined above, are clearly life-threatening and may leave a woman infertile. But procedures are also unsafe if they are done by someone who was not accredited or in a way where a woman is not properly counseled about her options (such as keeping the baby), family planning or abortion after-care.

Diana Appiah, who has gone through seven unsafe abortions, is a typical example of a woman who has undergone the dangerous procedure. In an interview with The Weekend Globe, she recounted the trauma she went through as a result of her unsafe abortions.

“I would bleed and bleed to the extent that I sometimes lose consciousness,” she said. “The issue became aggravated when I was told my womb was twisted. It was at that point that I decided not to commit anymore unsafe abortions.”

According to Diana, her boyfriend gave her drugs to induce an abortion after they realized they could not care for the baby.

In 2007, there were at least 15 induced abortions for every 1,000 women of reproductive age (between the ages of 15 and 44) in Ghana. However, since abortion is heavily stigmatized in Ghana, the actual incidence of the procedure is very likely underreported.

While recent, reliable national abortion figures for Ghana are not available, the World Health Organization estimates that, in Western Africa, there are 28 procedures per 1,000 women each year. The true incidence in Ghana likely approaches this rate.

Globally, 47,000 women die as a result of unsafe abortions and eight million women suffer serious and sometimes permanent injury as a result of complications. The issue disproportionately affects women in Africa and South America. And although improvements have been seen recently in the global maternal mortality rate, the proportion of deaths attributable to unsafe abortion is holding steady at 13%.

Research shows that making abortion illegal does not stop it from occurring, but rather just drives it underground, forcing women to obtain clandestine and unsafe procedures.

But in Ghana, unlike in other countries where abortion is illegal, the problem is not with the law. The country’s abortion laws are already relatively liberal in cases of rape, incest or the “defilement of a female idiot.” Abortion is also permitted if the life or health of the woman is in danger, or if there is risk of fetal abnormality. However, few women are knowledgeable about the law. Only 3% of pregnant women and 6% of women seeking an abortion are aware of Ghana’s abortion law. Also, some doctors may arbitrarily choose to deny women abortions at a hospital even when the procedure should be allowed, forcing many women to undergo an unsafe procedure elsewhere.

In Ghana, unsafe abortions remain a huge problem because the existing abortion law is not implemented as it is written. And implementing the law would not only save lives, but it would save money, as well. A substantial proportion of women who survive an unsafe abortion experience complications – such as severe bleeding – and end up in government hospitals with very life-threatening health problems that must then be paid for.

Another long-term result of unsafe abortion is that ladies who have the procedure outside of a registered clinic do not receive any education about contraception or family planning, and are likely to get pregnant again – and perhaps even seek another abortion.

In an interview with The Weekend Globe, Faustina Fynn-Nyame, country director for the reproductive health and family planning non-governmental organization, Marie Stopes International, said the government had set up policies to ensure safe abortions are the norm, but doctors sometimes do not adhere to those policies.

She said many women pursue unsafe abortions because they are not knowledgeable about the risks and that young women are more likely to rely on their friends for abortion recommendations than seeking out qualified health care options.

“We’ve had women coming here who are bleeding to death,” she said. “We’ve seen horrific injuries, where there’s a stick still in the women’s uteruses.”

Fynn-Nyame said that some of the cases they have seen at the clinic have been so bad that they have had to remove the uterus or fallopian tubes in order to save the woman’s life.

“An unsafe abortion can lead to a woman being infertile for the rest of her life,” she said. “And that’s if she’s lucky. If she’s unlucky, she’ll lose her life.”

Fynn-Nyame called for more sensitization and education on unsafe abortions and their repercussions.

But there should also be an emphasis on family planning, she said, as unintended pregnancy is the root cause of most abortions and access to quality family planning information and services can reduce unintended pregnancy rates. Experts say the best way to reduce the need for abortion is not by denying women access to safe and legal abortion procedures, but by giving them the power to control their fertility and prevent unintended pregnancy.