Ghana has made laudable progress in improving modern contraceptive uptake in recent years, achieving a current prevalence rate of over 36 per cent among young women with Family Planning (FP) needs.
Background
The progress reflects the government’s commitment to enhancing reproductive health and access to a wide range of contraceptive methods for married women of reproductive age and sexually active adolescents.
FP, being a critical aspect of public health and development efforts worldwide, does not only empower individuals and couples to make informed choices about their reproductive health, but contributes to the overall well-being of societies.
Recognising that access to Sexual and Reproductive Health (SRH) services is a key fundamental human right enshrined in Ghana’s 1992 Constitution, the government has taken steps since the early 1990s, to prioritise FP services through the implementation of legislations, policies, interventions and programmes aimed at expanding access to commodities and services nationwide.
Progress
Dr Chris Opoku Fofie, the Director, Safe Motherhood Programme, at the Family Health Division of the Ghana Health Service (GHS), told the Ghana News Agency, that actions including age specific or appropriate SRH education, information and services have targeted women aged between 15 and 49 years in the quest to prevent maternal mortality and morbidity.
The United Nations Population Fund (UNFPA), which is the UN Agency for sexual and reproductive health, and other key implementing partners including the Planned Parenthood Association of Ghana (PPAG), are providing various support to ensure equitable, quality and timely access FP commodities and services.
Youth-friendly corners have been created in health facilities, to provide welcoming environment for young people to receive SRH counselling and FP services, while other information and education are channeled through electronic platforms, like Facebook, WhatsApp and You Tube among other adolescent safe spaces.
Dr Fofie indicated that that efforts at reducing stigmatisation and demystify contraceptive usage are underway through sustained public education, to prevent maternal deaths and empower women to make informed choices and key decisions concerning their own well-being and development.
He also mentioned the expansion of the National Health Insurance Scheme (NHIS) to include long-term contraception, as a major win for women’s reproductive health rights, saying this will save millions of women of reproductive age covered by the scheme, from out-of-pocket payment for long-term FP methods, which will enhance uptake and future government savings in direct case costs.
Ms Abena Adubea Amoah, the Executive Director, PPAG, expresses joy at the inclusion, saying it will bring about lasting peace of mind for women, girls and their families with a potential impact on their health and economic life.
She pledged the Association’s commitment to support the government’s awareness campaign on preventing maternal mortality and morbidities, deliver quality FP services and programmes through its permanent and mobile clinics in urban and rural communities, providing fertility management, as well as voluntary counselling and testing for STIs including HIV and AIDS.
Challenges
Despite the progress, Ghana still faces significant challenges, in regional disparities in contraceptive use, limited access in rural areas, and persistent unmet FP needs among some segments of the population. (Multiple Cluster Indicator Survey-MICS 2017- 2018).
Among the high levels of challenges that confronts Ghana’s contraceptive uptake, are deep-rooted cultural and religious beliefs that consider the advocacy aspect of education on sexual anatomy as a taboo.
The statistics shows that Ghana’s population is quite youthful, with nearly one in three Ghanaians aged between 10 and 24, hence most of these young people are at risk or already struggling with the consequences of an unplanned pregnancy or Sexually Transmitted Infections (STIs), including HIV and AIDS.
Ghana’s current maternal mortality ration of 308 per 100,000 live births, is still higher than the SDG target of less than 70 deaths per 100,000 live births by 2030.
Dr Fofie explains that for those still with unmet FP needs, it may be challenges with age differences, non-availability of a specific type of contraceptive required by clients at a particular facility or lack of skilled health personnel to administer the method.
However, efforts are underway to boost the capacities of service providers and dispatch more healthcare workforce to take care of the existing spaces in facilities to expand access to FP services across the country.
Statistics
Dr Wilfred Ochan, the UNFPA Country Representative, in an interview with the media debunked arguments that introducing young people aged 10 to 15 years to contraceptives, empowers them to indulge in promiscuous behaviours, saying such opinions have long been advanced, comparing the evidence of supportive and opposing views.
“On the contrary we have seen situations where people who have been exposed to RH and life skill education, have tended to delay initiation of sexual relationships, have adopted healthy lifestyles resulting in positive health outcomes, leading to a drop in teenage pregnancy rates, HIV and STIs, with the age of first sexual intercourse being higher because of their empowerment and understanding of the implications of their decisions.”
In contrast, in countries where the topic of SRH has been treated as taboo or sensitive, it’s been seen that young people have turned to look for other options to get information from uninformed and ill-prepared sources, resulting in their adoption of lifestyles that push them into pitfalls of engaging in sexual intercourse, leading to unwanted and teenage pregnancy, HIV and STIs among others, he said.
“So, the evidence points to the contrary of the fear, and the challenge for all, especially the media, is to bring factual evidence to the conversation, to allay the fears of those who think contrary,” he said.
He said indeed young people aged 10 and 15 years per the legal definition are considered as children, but agreeably this is the period where they go through several physical and psychological changes, a development process that needs to be guided to ensure their safe and smooth transition into adulthood.
Statistics reveals that approximately 10 per cent of adolescents aged 10 to 19 indicate an initiation of sexual activity before reaching age 15, whereas seven per cent of boys within the same age report commencing sexual activity during a similar timeframe. (Multiple Cluster Indicator Survey-MICS 2018).
He said out of the girls who start sexual intercourse at that age, 11 per cent have sex with men who are 10 years older than them.
This puts such groups in critical situations, even worse if they are not being prepared in terms of refusing sex (abstinence) or protecting themselves from HIV and Sexually Transmitted Infections (STIs), saying “We have seen more HIV and STIs in younger people, as well as unplanned and unwanted pregnancies,” he said.
Again, in Ghana, teenage pregnancy accounts for about 15 per cent of adolescent girls aged between 10 to 19, noting that comparing these figures to the country’s population where adolescent are made up of 6.9 million, out of which 3.5 million (10 per cent, about 350,000) are young girls having sex before age 15.
“So, if 14 per cent are pregnant, it is not a small thing for parents, and if these girls are dropping out of school, we are looking at a large potential of the country being held back from education, gaining skills, being economically engaged late in life, and contributing to national development,” Dr Ochan said.
“This means that all these percentage of young people are being held back from contributing to the development of the country or chiefdom, therefore this calls for action from all to reduce this problem to ensure total national development,” he said.
He said fortunately in Ghana, policy provides that anyone sexually active and require contraceptives, provided they were appropriately educated and counseled may involuntarily decide to use a method of choice.
Consequently, the role of duty bearers is to ensure the availability of the different contraceptive methods, to meet the choices and reproductive needs of clients, and increase skilled workforce to provide appropriate counselling and services to young people within the national guidelines.
Role of partners
Achieving the ambitious goal of zero unmet family planning needs, however, requires acknowledging and highlighting the pivotal role that Development Partners (DPs) play in shaping the country’s FP landscape.
The UNFPA annually, supports Government and other partners to mark the World Contraceptive Day which falls on September 6, as part of efforts to raise awareness about the importance of Family Planning and the theme for the 2023 celebration is: “Family Planning, My Choice, My Freedom”.
It emphsises the critical role of FP in empowering individuals and the need to galvanise the support of relevant partners and deploy innovative and resilient strategies to finance FP supplies and services, and this years’ event will also engage stakeholders in a dialogue on sustainable domestic resources for FP in Ghana.
Financing
Dr Ochan said the UNFPA currently provides about 40 per cent funding for Ghana’s contraceptive procurement, aside other support including advocacy on SRH information and education for young people which are age appropriate.
He acknowledged the government’s massive investment in storage infrastructure, regional distribution systems, supply chain management and training of the workforce among others, saying these are indirect support that helps in pushing FP commodities and services to the end user at the last mile.
He also praised the government for being forthright with its support to FP services, by instituting conducive policies and making commitment like the FP 2030, which takes certain actions to ensure sustainable service delivery.
Additionally, the Government of Ghana’s Compact agreement with the UNFPA, is among other concrete steps towards enhancing the mobilisation of domestic funding to procure FP commodities, Dr Ochan said.
He stressed that the sustainability of a system however, hinges on the existence of strong infrastructure, efficient FP environment, trained healthcare workforce and Ghana has an elaborate system already, hence when UNFPA and other donor funding ends it would not collapse.
Notwithstanding these achievements, there is the need to always push for more domestic financing through private sector support, to prevent the overreliance on donors for healthcare.
