By Alex Ababio
In the heart of Ghana’s Western North Region, the dusty air tells a grim story—one of desperation, exploitation, and survival. The illegal mining towns of Manso Nkwanta and Wassa Brekum are not only known for their gold mines but for another, darker commodity being traded: the bodies of women and girls. Behind the environmental destruction lies a silent crisis in sexual and reproductive health and rights (SRHR) that is largely ignored by both the government and society.
A Midwife’s Impossible Decision
In the small, overcrowded clinic of Wassa Brekum, Community Health Nurse Ama Serwaa prepares a syringe. Known locally as Obaa Panin (The Elder Woman), she carries a title that echoes both respect and despair. “I am a nurse. I was trained to save lives, to deliver healthy babies,” Serwaa says, her voice weighed down by the harsh realities of the camp. “But here, I’m more of a crisis manager. My job is to choose the least worst outcome.”
Serwaa recounts the story of 19-year-old Abena from Senfi, who came to her clinic two months ago, bleeding heavily after an abortion. Abena had been working as a head porter, carrying heavy bags of ore for a miner who had promised her money and protection. When Abena found out she was pregnant, the miner gave her 200 cedis and vanished.
“She took some pills she bought from a local chemist in the camp. It wasn’t a real abortion,” Serwaa explains. “I stopped the bleeding, but there’s no follow-up care for her. No counseling. She will go back to carrying ore, and the cycle will continue. I see this every single week.”
The clinic is meant to serve a few thousand people, but the reality is a transient population of tens of thousands, most of them without access to basic health care. There are no STI test kits, no contraceptives, and no vaccines. Serwaa’s clinic is a reflection of a larger, systemic failure: a lack of SRHR infrastructure in one of the most neglected parts of Ghana.
The Lure of the Gold and the Price Women Pay
The journey to these mining towns often starts with hope—hope for a better life, for money, and for freedom. For 22-year-old Akosua from Juaboso, the dream was simple: enough money to continue her education.
“My friend came back from the mines with new clothes and a smartphone. She said the money was easy,” Akosua recalls, sitting on a bench outside a local bar, eyes lowered. “I came to Manso Nkwanta, but reality hit me hard. The work for women is either carrying heavy loads or… the other thing.”
“The other thing” refers to survival sex, a grim reality that many women in mining camps face. A 2023 study by the Centre for Social Policy Studies at the University of Ghana found that over 60% of young women in mining communities engage in transactional sex to survive. Miners, flush with cash, become “sponsors,” offering money for food, lodging, and protection in exchange for sex. But these relationships come with a power imbalance that often results in violence.
“The men have the money, so they make the rules,” Akosua explains bluntly. “You can’t insist on protection. If you do, there are ten other girls who won’t. So you pray you don’t get pregnant, and pray you don’t get sick.”
The “sickness” Akosua refers to is sexually transmitted infections (STIs). According to a medical officer at the Tarkwa Government Hospital, who spoke under anonymity, STI rates are disproportionately high in these mining towns. “We see cases of chlamydia and gonorrhea at three to four times the rates found in rural agrarian communities like Sefwi Wiawso. The most vulnerable are girls aged 16-24,” the officer revealed.
Toxic Legacy: Mercury and its Silent Toll
Beyond the dangers of sexual exploitation, the environmental hazards in mining areas are causing long-term damage. Small-scale miners use mercury to extract gold from ore—a highly toxic substance that is often handled with bare hands and burned in open pits, releasing harmful vapors that contaminate water and food.
Dr. Kofi Amanor, a public health researcher, explains that mercury exposure poses a significant risk to pregnant women and their babies. “Pregnant women exposed to mercury are at a much higher risk of adverse birth outcomes,” he says. “We’re seeing increased rates of stillbirths and neural tube defects in newborns in these communities compared to non-mining areas.”
The mercury crosses the placental barrier, attacking the developing fetal brain. “We are possibly creating a generation of children with intellectual disabilities—all for a speck of gold,” Dr. Amanor concludes.
This environmental disaster compounds the already dire social issues facing women and girls in the camps. A woman may survive the risks of transactional sex only to face a pregnancy that could be harmed by the same gold extraction process that sustains her economically.
Systemic Neglect: The Forgotten Communities
The real crisis here is not individual behavior, but systemic neglect. The government’s approach to illegal mining has focused almost entirely on environmental damage and security concerns, while the human cost, particularly for women, has been largely ignored.
Emmanuel Yeboah, an anti-galamsey campaigner with WACAM (Wassa Association of Communities Affected by Mining), explains the government’s blind spot. “The authorities focus on degraded land and lost revenue. They don’t see the destroyed lives,” he says. “There is no political will to invest in mobile health clinics or SRHR outreach programs for women in these areas. It’s a policy vacuum, and women’s bodies are the casualty.”
Although the government has set up CHPS (Community-based Health Planning and Services) compounds in some areas, they remain static while the mining population moves constantly from one mining site to the next. Experts argue that what’s needed are mobile health units that can reach these communities with essential services like contraception, STI treatment, antenatal care, and education.
A Glimmer of Hope: A Midwife’s Resistance
Despite the overwhelming odds, there are people like Ama Serwaa who refuse to give up. Using her own limited funds, Serwaa buys condoms in bulk from the regional capital and distributes them to women in the camps. She offers a rare space for listening, counseling, and support.
“I can’t wait for the government to remember we exist,” Serwaa says, her voice a mixture of defiance and fatigue. “These girls are someone’s daughters. They came here with hope. My clinic may be small, but it’s a battlefield. We’re fighting against disease, despair, and a system that has forgotten them.”
As she turns away to attend to another patient, a scared 17-year-old girl, the dust continues to fall—coating yet another dream, buried deep in the heart of Ghana’s golden crisis.
The Urgency of Addressing SRHR in Mining Communities
The story of Manso Nkwanta and Wassa Brekum is not just about gold, but about human lives—lives that are being lost to a crisis of sexual and reproductive health. The lack of basic health services in these areas, the prevalence of transactional sex, and the toxic legacy of mercury are all symptoms of a much larger systemic failure.
To address this, Ghana needs a comprehensive approach—one that combines environmental restoration with human-centered health policies. Mobile health units, access to contraception, STI treatment, and education must be prioritized to break the cycle of abuse, disease, and death.
By investing in the health and well-being of these forgotten communities, the government can prevent the tragedy from continuing and ensure that the gold in Ghana’s mines doesn’t come at the cost of the lives of its women and girls.