Lydia Fuseini, a nurse at La Polyclinic in Accra, is a popular woman. I have met her personally several times and seen the many nods she receives from fellow staff - but it is not her colleagues that keep her phone ringing off the hook.

Mrs Fuseini is a family planning expert. If you are having a problem inserting your Intra-Uterine Device, you can call her. If you are in need of condoms, you corner her. If you and your mate want to know the benefits of getting a vasectomy, she will be frank, honest and open.

The one-room family planning unit in which she works will see around 50 people each day, she said. Consultations are free.

Family planning is not a new concept here in Ghana – according to the Ghana Demographic and Health Survey in 1998, more than 90 percent of married men and women have heard of at least one modern contraceptive method. GDHS also recorded an increase in the use of family planning methods to 25 percent in 2003, up from 13 percent in 1988.

Still, the disparity between the knowledge and the application of family planning continues to be great.

"Family planning is a taboo here in Ghana," said Esther Sunkwa-Mills, also a nurse at La Polyclinic.

“[People] don't feel comfortable talking about it… but we don't shout at them 'You young girl, coming for an abortion',” she said.

Indeed abortion is the topic most talked about with both nurses. But it’s done with hushed voices.

“At the moment, most women are aware of what abortion is,” says Patrick Frimpong, a gynaecologist and obstetrician, also at La Polyclinic. “But everything is shrouded in secrecy.”

Two-thirds of abortions in Ghana are conducted outside the health system, according to Pathfinders International, a non-profit reproductive health organisation. Further still, complications from incomplete abortions accounts for 30 percent of all maternal deaths in the country.

As Dr Frimpong told me, however, Ghana may be on the verge of a quiet revolution.

People are talking, he said, in the media, in conference rooms, in their homes.

They are talking about family planning, about safe motherhood, about reducing the number of women who die needlessly from unsafe abortions.

Proof of this innovation – happening slowly, quietly, behind closed doors – was in Accra only weeks ago, when members of the health sector came together to discuss the introduction of medical abortion in Ghana.

The method is by no means new here, but, like is often the case for birth control and surgical abortion, medical abortion is happening exclusively, happening in secret, and uninformed. Women are taking misoprostol, a drug registered in Ghana to cure stomach ulcers. The drug causes contractions in the uterus, which can flush out the tissue inside, but on its own the process produces more side effects, takes more time and is more often unsuccessful. Right now it is just another attempt – outside of using broken glass, bicycle spokes or tree bark – to terminate an unwanted pregnancy.

Medical abortions are being performed properly – at times, in the comfort of home – in many countries worldwide, using a combination of mifepristone [which blocks progesterone, a hormone needed for pregnancy] followed by misoprostol. Nearly 30 countries – including China, Russia, South Africa, the Unites States and Britain – allow the method to be used.

Other countries, such as Canada, use a different drug combination for the method while testing continues on the safety of mifepristone.

Over the past few years, with the support of an American NGO that helps develop medical technology, Gynuity Health Projects, medical abortion trials have been conducted in Ghana.

Quietly, Dr Frimpong led a trial involving 300 women over several months in 2006, and another 300 tried the method in Koforidua. The trials were trying to establish if the method would be preferred over surgical abortion, as it can be done at home and seem less invasive. 

Quickly, word of the trials spread like wildfire, making the telephone numbers of hospital staff even more popular. Five months on, Mrs Fuseini said, women continue to call almost every day, enquiring as to whether the drugs are still available.

A huge majority of the women who participated said they preferred the method. The abortion in this case was free however, whereas regularly, surgical abortions cost anywhere from ¢200,000 to ¢2 million. Questions surrounding the prescription and administration of the drug, for instance whether it should be given over the counter, have also come up.

Still, it may be a means to make abortion safe.

“It is better because it’s safe,” Mrs Sunkwa-Mills said. “[Otherwise] they will go and take some drugs and it will be even worse."

Since the results of the preliminary trials were released last month in Accra, the national Food and Drug Board, which claims it was not informed of the testing, ordered that further studies on the matter be suspended until a review is conducted.

And so here we are, nearly one year since Ghana Health Service issued a letter to regional directors of health services, bringing attention to the “lack/inadequacy of knowledge… limited access to information and safe abortion care services and contraception, particularly among the poor and women living in the rural areas.” Changing those conditions is key, it said, to achieving the Millennium Development Goals, which includes a 75 percent reduction in maternal mortality by 2015.

 “[Community members] shouldn’t shun women and young girls who are pregnant. They shouldn’t insult them, they shouldn’t ostracize them… sit them down and talk to them about their problems,” Dr Frimpong suggested to start.

Mrs Sunkwa-Mills recommended a change in the way we speak about the issue.

There is no word in Twi for vasectomy, for example. Consequently, she said, many men associate the procedure with the word yasawo, meaning castration. 

Instead, staff at the family planning unit are trying to start a new trend by using awoatwa, meaning male sterilisation.

Word by word, step by step, change is possible.

 Eva Salinas is on attachment from Journalists for Human Rights