Multiple studies have demonstrated that manual vacuum aspiration (MVA) is ideal for surgical uterine evacuation in low-resource settings such as Ghana, but developing a sustainable supply to MVA has been challenging. In 2007 a situational analysis was conducted in Ghana to identify barriers to sustainable MVA supply. Information about MVA availability was gathered in seven regions of Ghana and obtained through background literature, unpublished data and reports, and 70 informational interviews with stakeholders involved with MVA policy, manufactufing, procurement, distribution, supply, training, and provision. The findings revealed that despite consensus about the dire need for MVA in Ghana, developing sustainable access to MVA instruments has proven difficult. In the public and the private health sectors, procuring MVA equipment has been particularly challenging for low-income, low-volume service providers. Research findings yielded ten recommendations for improving sustainable access to MVA, including the implementation of a revolving purchase mechanismn for health provider associations, such as the Ghana Registered Midwives Association.