Perceived factors shaping unsafe abortion practices among young women in Bongo District, Ghana.

Background: Unsafe abortion remains a critical public health challenge among young women in Ghana, persisting despite the relatively liberal provisions of PNDC Law 102. Aim: This qualitative study explored perceived factors associated with unsafe abortion among women aged 15-25 years in the Bongo District, Upper East Region, focusing on contraceptive knowledge and use, health-system access, and socio-cultural determinants. Methods: Thirty-four women from five communities in Bongo District were recruited through purposive sampling and interviewed using a semi-structured guide. Data were analysed thematically using Braun and Clarke's six-phase framework. Results: Four themes were identified. First, participants perceived unsafe abortion to be common in the district. Second, contraceptive non-use was attributed less to a lack of awareness of methods than to fear of side effects, infertility, and partner disapproval. Third, formal health services were perceived as expensive, distant, and staffed by judgmental providers, which discouraged their use. Fourth, fear of family shame and expulsion from school led many young women toward cheaper, more discreet informal providers. Conclusion: Participants' accounts suggest that unsafe abortion in Bongo District reflects structural gaps in the reproductive health system, weak social support, and gaps in policy implementation, rather than a lack of individual knowledge. Findings indicate that young women in the district are generally aware of the risks of unsafe procedures but perceive themselves as having limited alternatives within their socio-cultural and religious context.