Document Type

Policy Points

Publication Date

8-2026

Department

International Migration Research Centre

Abstract

Over the past four decades, growing numbers of women and girls have left northern Ghana for the country's cities, drawn by the promise of work, independence, and a chance to support their families. Many end up as kayayei, head porters who carry goods through Accra's crowded markets for a negotiated fee. Their labour keeps the informal economy moving, yet it comes at a steep personal cost: unpredictable earnings, punishing physical strain, unsafe housing, and a healthcare system that too often leaves them out. This brief draws together the available evidence on the economic and health conditions of kayayei in Greater-Accra. It finds that women and girls in this trade face chronic musculoskeletal pain, high rates of psychological distress, and serious reproductive health risks, compounded by their near-total exclusion from Ghana's National Health Insurance Scheme (NHIS). These harms reflect the same structural gaps in social protection, housing policy, labour regulation, and health financing that shape the lives of the wider urban poor, and they point to the need for reforms that address these linked conditions. We recommend free NHIS enrolment, mobile reproductive and mental health services, stronger child protection, in-situ housing upgrades, market-relevant skills training, and formal recognition of head porterage as an occupation. These measures would address the harms migrant women face and extend mechanisms that already work in the north, such as pro-poor NHIS exemptions, to the migrant women who lose them the moment they move south.

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