Stephen Abodein, family planning volunteer at Dagmeo and Ben Asoah, family Planning volunteer at Pobaga
Thirty-three-year-old Susana Alhassan sits in the single room structure converted into a family planning (FP) unit at the Bolgatanga Health Centre.
She has her head bent towards her small black handbag placed on her laps and intermittently blows her nose with her pink handkerchief.
Madam Francisca Darko, the principal community health nurse, family planning unit, calls as she taps Susana. “It will be okay, it is normal for you to feel like this but since you are having your monthly flow there is nothing wrong with you,” she says.
Susana had come to the health sector to report complications she is experiencing after using one of the long-term contraceptive methods she used was removed.
“When it is time for me to menstruate, my stomach will pain me aaah,” she explains. But Francisca says with examination and medication, Susana will be fine.
Susana, a mother of three children, the oldest 17 years and youngest eight years, after sensitisation by community health workers, decided to go for a long term family planning method.
“I wanted to do it so that my children will grow well and also so that I can get healthy,” she explains.
Susana says her decision to use the five-year implant, Jadelle, was taken with the support of her husband, a businessman in the town, adding that he was okay with the idea after hearing about family planning at a durbar.
She received support from her husband throughout the process from start to finish. “If it had not been my husband supporting me, I would not have done it because I am the only wife and I do not want him to go for another woman because of child bearing,” she indicates.
Thus, Susan’s husband was the main agent of change in her uptake of modern family planning.
FP Progress In Ghana
Family planning services have been expanding in Ghana for the past 50 years through private and public service providers.
Efforts by the government, civil society organisations, NGOs and the private sector have been successful in creating awareness, addressing misconceptions and ensuring availability of FP trained health service providers.
As a result of the efforts of the different players, including government, Ghana’s fertility rate has reduced from 6.4 in 1988 to 4.2 children per woman in 2014.
Currently, the contraceptive prevalence rate (CPR) for Ghana is 27 percent for both modern and traditional methods.
In 2015, the Government of Ghana (GoG) launched the Ghana Family Planning Costed Implementation Plan (GFPCIP) that clearly defines the country vision, goal, and strategic priorities for family planning.
The GFPCIP aims to increase the modern contraceptive prevalence rate (CPR) to 30 percent amongst married and 40 percent amongst unmarried, sexually active women by 2020.
However, changes in attitudes and practices have not been commensurate with interventions.
Fear of side effects, misconceptions, inadequate spousal support, inadequate number of trained FP health service providers and sometimes unavailability of commodities continue to militate against efforts to increase FP uptake to compare with other successful developing countries such as Brazil.
Thus, it will take men who are the final decision makers in families to make the move in first understanding what family planning is and the methods available and then accepting for their spouses to use them.
Like the husband of Susana, other like-minded male personalities within the Bolgatanga Municipality have teamed up as volunteers to, through advocacy, ensure that other men join the family planning move.
Seventy-year-old Stephen Abodein, a former assembly member, is one of the local champions advocating for family planning uptake by spouses in the Bolgatanga Municipality, particularly Dagmeo community.
Since he got involved in the family planning campaign in 1996, Mr Abodein has not looked back from supporting hundreds of families over the period to practise family planning.
“It is an interesting thing but very important to the development of a healthy family. See, family planning saves us from a lot of things, food to feed the children, education and health care can properly be managed if the family is planned,” he says.
He believes men may take a longer time to adapt to change, taking into consideration their cultural beliefs of marrying multiple wives and many children, but adds that throughout his advocacy targeted at men especially, understanding how the methods work is key to its success.
“If you do not understand the issue very well and go and convince someone to do it and they have challenges they will blame you,” he adds. “But so far, majority of the men I talk to whose wives use family planning have beautiful families with the children well spaced.”
Ben Asoah is the family planning advocate for the Pabaga community, where he has worked as a community volunteer for the past ten years.
Mr Asoah who practised family planning with the wife uses his story as a testimony to convince other men in the community to also use their preferred method.
“I always tell them that when they plan their families buy limiting the number of births or properly space their children they do not only benefit but the children also benefit. They grow well and they get good education,” he adds.
Development Partners’ Expectations
Although the right to health is a basic human right that every woman should enjoy regardless of their educational background or where they are located on the map, yet every day almost 1,000 women die in pregnancy and childbirth globally.
Ghana’s maternal mortality rate also remains high at 310 per 100,000 live births. Unintended pregnancies, unsafe abortions leading to death continue to account for high maternal deaths.
Erika Goldson, Acting Representative of United Nations Population Fund (UNFPA), in a speech to commemorate the World Contraceptive Day in Accra says Ghana has committed to increasing the modern contraceptive prevalence rate (CPR) to 30 percent amongst married and 40 percent amongst unmarried, sexually active women by 2020.
“It is known that uptake of family planning can reduce pregnancy related deaths by over 30 percent and therefore imperative to invest in family planning to improve survival of women. I am happy to note that Ghana Health Service (GHS) is reporting CPR of 33 percent in 2017 as reported at the 2017 Health Summit,” she indicates.
UNFPA has remained committed to ensuring reproductive health commodity/contraceptive security in Ghana.
Over the years, they have provided technical and financial support to the Ministry of Health and the Ghana Health Service to conduct forecasting and quantification of national contraceptive requirements per year.
In 2016, UNFPA procured about 46 percent of contraceptives into the country, showing strong commitment to investments that ultimately improve the lives of women, the youth and the adolescent girl.
“That is why as an agency, we have the passion to ensure that everyone counts, and that every pregnancy is, indeed, wanted and that women and younger populations reach their fullest potential,” she adds.
Ms Goldson points out that the agency will continue to support the government to achieve FP2020 commitments made at the recent London Summit in July which, among other things, included FP services and supplies in the national health insurance package and make them free of charge at public sector facilities and private sector facilities subscribed to the scheme.
“We will to support government’s commitment to increase domestic funding to procure FP commodities amidst the dwindling donor funding for procurements; and to increase contraceptive use among unmarried sexually active adolescents from 31 percent to 35 percent by 2020,” she says.
The Deputy Director of the Ghana Health Service (GHS), Dr Gloria Quansah Asare, speaking at the same forum, agrees with the fact that there is compelling evidence that practising family planning yields many health and socio-economic benefits by managing and slowing population growth, reducing exposure to unwanted pregnancies, preventing unsafe abortions and reducing maternal deaths.
“In Ghana, many unintended pregnancies end up as unsafe abortions, which according to recent studies, account for between 20 to 30 percent of all maternal deaths. The availability of reliable contraception, regardless of age or ability to pay, is an essential step in preventing such deaths,” she adds.
She says the role of male advocates cannot be over emphasized in facilitating the goal of the health sector to increase the availability and access to quality family planning across the length and breadth of the country.
“They are our support system and we need them to make this work,” she adds.
By Jamila Akweley Okertchiri