Improving Family Planning uptake in Ghana

Stakeholders working to promote Family Planning (FP) in Ghana have made several recommendations to strengthen ongoing efforts at influencing increased FP uptake in the country.

The recommendations include broad strategies that are expected to reinforce ongoing efforts at addressing the imbalances in the quality and quantum of FP services currently available to the different segments of the Ghanaian population.

The recommendations were captured in a report of  a ‘Day of Dialogue’ on FP in Ghana convened by the Ministry of Health/Ghana Health Service, in partnership with the United Nations Population Fund (UNFPA), to galvanise multiple stakeholder support for improving FP uptake in Ghana within the next five to seven years.

The participants, from academia, government agencies and institutions, civil society organisations, the private sector, professional associations, the media and development partners, critically reviewed the current FP trends, identified the underlying causes of the country’s sluggish performance with family planning and made recommendations for the way forward. 

The discussions centred on issues surrounding the policy perspectives that shape FP programming, FP service delivery, the social marketing of FP commodities, the socio-cultural factors influencing demand for FP and the role of Development Partners and civil society in FP programming.

Family Planning in Ghana

Ghana has long prioritised Family Planning (FP) as a key strategy for addressing the country’s health, social and economic issues and the country’s first organised efforts towards scaling up FP started in 1969 with the establishment of an advisory team on population affairs led by Prof. Fred T. Sai.

The first population policy was developed and the Ghana National Family Planning Programme (GNFPP) was launched the following year to implement the plans as outlined in the 1969 population policy. A number of programmes, including the contraceptive social marketing and the family planning and health programmes were then implemented.

The policy was first revised in 1994 and emphasised a systematic integration of population variables into development planning, with a renewed emphasis on fertility reduction through family planning programmes. An important goal of the revised policy was to reduce the total fertility rate (TFR) from 5.5 to 5.0 by the year 2000, to 4.0 by 2010, and to 3.0 by 2020 through increased contraceptive use.

Evidence from data since 1988 paints a picture of both gains and stagnation in FP programming. On one hand, knowledge of any contraceptive method is almost universal in Ghana. Modern methods of contraception are widely known and available. Between 1988 and 2014, the use of modern methods of contraception almost doubled from 13 per cent  to 22 per cent.

On the other hand, while TFR declined from 6.4 in 1988 to 4.0 in 2008, preliminary results from the 2014 Ghana Demographic and Health Survey (GDHS) report indicate that TFR has increased over the last six years to 4.2. Use of FP methods has been less than desired, despite the almost universal knowledge and awareness. Contraceptive Prevalence Rate (CPR) for modern methods has fluctuated from 19 per cent in 2003, decreasing to 17 per cent in 2008 and increasing to 22 per cent in 2014, an indication that even after a decade, still less than a quarter of married women are current users of modern contraception in Ghana. Yet, 30 per cent of married women in Ghana have an unmet need for family planning.

The stagnation of the TFR and CPR ten years after the revision of the policy, necessitated the implementation of a comprehensive strategy to reposition FP services in Ghana. In this regard, a roadmap was developed in 2005 to facilitate the effective integration of FP into the various service components of reproductive health for a more vibrant service delivery within a five-year period.

Heavy Investments

Over the past decade, heavy investments have been made by government and several stakeholders to improve FP uptake in Ghana and in training service providers to increase access and quality of FP service delivery, procurement and distribution of contraceptives, demand creation activities, and health systems strengthening including the scaling up of the Community Health-based Planning and Service (CHPS) initiative with support from a myriad of development partners.

 In spite of these investments, the country has been unable to register any marked and sustained improvements in its FP indicators. At best, the gains made can be described as sluggish, fluctuating and below expectations.

Participants’ observations

Participants at the forum repeatedly expressed their concern on the noticeably minimal commitment from the highest levels of government and the heavy dependence on international donor support for FP and agreed on the need to intensify advocacy efforts to increase and sustain government ownership and investment in FP as a cost-effective socio-economic development intervention.

They also agreed on the need to have an integrated and coordinated FP programme, starting with a critical assessment of the strategies that work, setting of realistic targets, and the institutionalisation of a multi-sectoral management arrangement to facilitate the effective implementation of the programme..

The non-existence of a Legislative Instrument (LI) to support the policy, they noted, also contributed to the abysmal performance of the national population programme.

Participants acknowledged a need to focus more attention on on-the-job trainings to enable the continuous offering of FP services at the facilities.

Recognising that faith and religion wield great influence on FP, the forum participants agreed on a need to explore innovative culturally sensitive approaches for more diversified populations.

Touching on social marketing of FP commodities in the country, participants agreed on the need to employ advocacy and related approaches to reduce the duties on FP commodities and to promote and build economically sustainable brands.

Of much concern is the seemingly competitive approaches employed by CSOs in the delivery of social mobilisation programmes. The quest of CSOs to mobilise donor resources result in the implementation of fragmented and ad hoc programmes leading to a potential loss of focus and misalignment with the priorities of the GHS. The forum participants agreed that harmonised CSO interventions and partnerships with government agencies could help sustain the country’s FP agenda.

With regard to comprehensive sexuality education (CSE), as a channel for information and ASRH services for young people in and out of school and other vulnerable groups, they contended that it remains inadequate and pointed out  the gaps in CSE and RH service provision, including access to contraceptives, to young people in basic schools and community levels. In recognition that the high unmet need for FP among sexually active unmarried women include young girls in and out of school, the forum participants proposed the refocusing of strategies on CSE and contraceptive services to address the needs of young people in and out of school.

Key recommendations

Key among the several recommendations were that FP is positioned as a broad development issue within the context of the long-term development planning agenda. 

In addition, there should be effective coordination of FP programmes by MOH/GHS and National Population Council; (NPC) and a follow-up on the implementation of the inclusion of FP commodities in the national health insurance scheme.

With regard to service delivery and commodity supply, the key recommendations were to strengthen CHPS compounds to provide quality counselling and regular FP services,  and  to advocate with the Ministry of Finance on the inclusion of a budget line for the procurement of contraceptive commodities.

To generate demand for FP, participants called for intensified engagement of local authorities, men, traditional and religious groups in promoting culturally sensitive innovative approaches on FP uptake.