Ghana is one of the first countries in sub-Saharan Africa to adopt an explicit and comprehensive population policy in 1969. The major goal of the 1969 policy was to stem the high rate of population growth in order to facilitate socio-economic development. To achieve this, the Ghana National Family Planning Programme was launched in May 1970 as a coordinating department within the Ministry of Finance and Economic Planning. Due to its over-emphasis on the supply side of the family planning component, as well as poor institutional coordination among organisations engaged in population-related issues, the programme achieved limited success. Against this backdrop, and coupled with other emerging issues such as HIV/AIDS, the 1986 National Conference on Population and National Reconstruction recommended a revision of the 1969 policy. The policy was revised in 1994 and the National Population Council (NPC) was established as the highest statutory body to advise the government on population issues. The revised policy emphasized 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. Various governmental and non-governmental organizations in Ghana have become actively involved in the promotion of family planning methods aimed at regulating fertility and enhancing reproductive health outcomes.
Through the activities of vibrant social marketing programmes such as the Ghana Social Marketing Foundation (GSMF) and the Planned Parenthood Association of Ghana (PPAG), family planning has virtually become a household name in Ghana. Evidence from the 2008 Ghana Demographic and Health Survey indicates that knowledge of any contraceptive method is almost universal in Ghana, with 98% of all women and 99% of all men knowing at least one method of contraception. Modern methods are widely known in Ghana and these include condoms, sterilisation, the pill, the IUD, injectables, implants, diaphragm, foam tablets and jelly, and emergency contraception. Between 1988 and 2008, the use of any method of contraception almost doubled (from 13% to 24%), while the use of modern methods more than tripled (from 5% to 17%). During that same period, Ghana’s TFR dropped from 6.4 to 4.0, making Ghana’s TFR one of the lowest in sub-Saharan Africa. With a TFR of 4.0 in 2008, the country is clearly on course at achieving its fertility target set forth in the revised National Population Policy of 1994. Data from multi-year demographic health surveys in Ghana provide other indicators that can be used to assess the impact of family planning programmes in Ghana. These include reductions in the national HIV prevalence rates, rising age at first birth and a growing interval between successive births. All these achievements are reflected in the recent improvements in maternal health outcomes as well as the reductions in early childhood (neonatal, infant and under-five) mortality rates.
While knowledge and awareness about family planning methods in Ghana are almost universal, use has been less than desired. For instance, just about a third of married women are current users of contraception in Ghana, compared to more than three-quarters in North America. Similarly, 35% of married women in Ghana have an unmet need for family planning – not wanting any more children or wanting to wait two or more years before having another child and yet not using contraception. Looking at the country’s remarkable fertility reduction between 1988 and 2008, and the increase in contraceptive prevalence over the same period, has led some to argue that the fertility transition in the country could not be attributed to increased use of contraception. Numerous studies exist that examine the factors that constrain the adoption and use of family planning services in the country. Notable among these are socio-cultural and institutional factors that tend to promote high fertility. These factors include the patriarchal nature of the household decision-making processes, fears and anxieties about the side effects of contraception, high child mortality, religion, and the low status of women.
Although Ghana has already achieved the targeted TFR set up in the revised population policy, total demand and utilisation of family planning methods and services have been quite low. Current contraception prevalence must be improved by reducing the unmet need for contraception as well as improving the quality of family planning methods and services. Regarding product quality, for instance, Parr in his study on discontinuation of contraception in Ghana, has shown that among women who had ever used contraceptives, the fear of side effects or the concern for one’s health is a major barrier to current contraceptive use. Addressing this and the other socio-cultural and institutional barriers identified above would most likely increase the use of family planning methods and services. As direction for future research, it is suggested that studies should examine factors that might help in addressing the issue of side effects in particular. If users of family planning methods are not convinced about the safeness of such methods, they are less likely to adopt such methods. It is also pertinent to know whether the gravity of these side effects is unique to the Ghanaian or sub-Saharan African context. Answers to this question would go a long way in achieving better and appreciable family planning results in Ghana.
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