Introduction <p>In Ghana, abortion is restricted except on a few legal grounds. About 11% of maternal deaths in Ghana are due to unsafe abortion. This study investigated the association between abortion motivation (the primary reason women sought abortion) and abortion safety.</p> Methods <p>We analyzed a sample of 1,425 women using the 2017 Ghana Maternal Health Survey. Abortion safety was defined using WHO three-level categorization (safe, less safe, least safe) operationalized to the Ghanaian context. We examined the relationship between abortion motivation and abortion safety using multinomial logistic regression analysis.</p> Results <p>Legal grounds for abortion accounted for 9% of all abortions. Compared to women who had a legal reason for seeking an abortion, women with non-legal reasons had significantly higher risk of a least safe abortion: women citing education/career advancements had 6.5 times higher odds (95% CI:2.37 − 17.87, <i>p</i>- value: &lt;0.0005); women seeking to delay/limit birth had 4.8 times higher odds (95% CI:1.84–12.56, <i>p</i>-value: 0.001); women citing lack of social support had 4.6 times higher odds (95% CI:1.77–12.07 <i>p</i>-value 0.002); and women who reported financial constraints had 4.8 times higher odds (95% CI:1.85–12.67, <i>p</i>-value: 0.001).</p> Conclusion <p>Women in Ghana who seek abortion for reasons not deemed legal are at a significantly higher risk of obtaining less safe and least safe abortions. Ghana’s abortion law should be expanded to include these additional abortion motivations to ensure that women can obtain legal and safe abortions on broader grounds.</p>