family planning
family planning

At the International Conference on Population and Development (ICPD, 1994) in Cairo, most participating countries including Ghana demonstrated their basic level of political support and commitment for family planning by signing its programme of action. Similarly, Ghana’s support and ratification of other International agreements including the just ended Millennium Development Goals (MDG’s) as well as the recent Sustainable Development Goals (SDG’s) suggests some degree of political commitment to Reproductive Health and Family Planning.

The National Population Council (NPC), established by an Act of Parliament (Act 485) 1994, strategically placed at the presidency is mandated to advice parliament, and for that matter government, on all population related issues. At the same time, the NPC is to ensure that population growth do not assume certain dimensions for it has the potency of erasing or reversing all social and economic gains made. Therefore the establishment of Ghana’s Population Council is a further indicative of government’s commitment to population management and fertility regulation at the national level.

NPC has since come out with a number of policies, programmes and recommendations in line with its mandate. It has developed and operationalized a number of documents to its credit. Among these are explicit Population policy, Adolescent Sexual and Reproductive Health policy, Re-positioning Family Planning, State of Ghana population Report and YELO a popular TV-drama series. The latest addition to its collection is “The Engaged-Ghana on the Rise” a short video documentary on population and development linkages is a must watch for all demographers, policy or decision makers, development managers and practitioners.

A supportive policy environment for fertility regulation do not only include formulation and implementation of appropriate policies, but also the involvement of wide range of stakeholders, the allocation of sufficient funds as well as a broad consensus that family planning programmes are necessary and beneficial to the well-being of the individual, the family and society as a whole.

We are familiar with the associated benefits when a well-coordinated family planning system is in place. It could mitigate the high rates of unintended pregnancies and unsafe abortions. Fertility declines to an unimaginable proportion when women have access to high quality voluntary family planning information and services. Increased family planning helps slow population growth, fights poverty and eases pressure on natural resources. The demand for health, education and infrastructural services also becomes manageable with family planning use.

In spite of all these benefits, investment in family planning is woefully inadequate, therefore revisiting the issue and giving it prominence is critical especially when there is evidence to show that benefits of family planning goes beyond health.

There exists considerable number of factors responsible for low contraceptive usage in Ghana. In most cases commonly established barriers to demand and use of family planning services are not that complex to address. Most girls and women have little or no access to comprehensive education and information about how their body works or know that contraception is even possible, let alone choose from the contraceptive mix available.

Spouses, family member’s, community and religious leaders may be in conflict with family planning citing fears, myths, misinformation and inadequate knowledge about a particular method or pricing as well as contrasting views from theology or tradition.

Others may even reject the option that girls and women should have decision-making rights on matters concerning sexuality and fertility since it is often perceived as male determinant. Indeed lack of knowledge about multi-sectorial benefits of family planning is largely to be blamed for the low contraceptive usage.

Contraception has become a priority not only because of the health and economic benefits of family planning services but also changes in our demographic trend, high unmet need for family planning and declining development assistance. It is important to recognise that a good value of investment in the health and life’s of many thousands of women and young people lies in the availability of contraceptive commodities and their utilisation. However this realisation may be hampered by the demographic trend. As per the 2010 Population and Housing Census, the nation’s total population stands at 24.6 million, currently the population is around 27 million of which more than half are women though still counting. A little above 16 percent of the population is between the ages 15-19. Additionally, 15 percent of the total population falls within the 20-24 age brackets; these constitute the sexually active population. Ghana’s population can therefore be described as youthful and that probably accounts for the high and numerous adolescent and Reproductive Health related challenges.

According to the National Population Council (RAPID, 2015), Ghana’s population is projected to be 45.8 million by 2040 and 60 million in 2050 assuming the existing growth rate of 2.5 remains unchanged. This continuous growth has implications on socio-economic shift. An indication that more resources such education, health, sanitation, water among others will have to be provided to match up with the increasing population. Therefore we may be jeopardising the health and lives of millions of women and young people who are in need of supply by our inability to provide them with adequate contraceptives. By our actions we may be putting them at risk of unintended pregnancies and maternal mortality, a major scare of social justice and inequality. High fertility rate couple with climate change, declining real income, hunger and unemployment staring at us, the challenges ahead may be more terrifying than anticipated.

Unmet need for family planning may be defined as a measure of the percentage of women, sexually active, who wants to space birth or do not want to become pregnant but are not using any contraceptive. Currently, 30 percent of married women have unmet need for family planning a situation demanding urgent attention. Although donors have played their part in this regard, the big question on sustainability remains unanswered. Even though Ghana has a contraceptive target of 50 percent by the year 2020, available statistics indicates that among currently married women only 22.2 percent of the population between the ages of 15 and 49 are using any modern form of contraception. This is one of the major reasons adduced for the relatively high fertility rate coupled with decline mortality in the country.

The way to go is to scale up immediately so as to reap the benefits stated earlier. Population growth and increasing advocacy on use of modern contraceptives by the population council and partners calls for additional funding source to meet this growing demand.
In Ghana as well as many African countries, supply of contraceptive commodities are mostly donor funded, however these funding is gradually becoming unpredictable, unsustainable and could suffer in the near future. The current changing trends in development assistance with regard to donor funding signalled a concern that family planning programmes will be adversely affected due to insufficient funding. The European Union (EU) is currently battling with migration issues and heading towards zero or decline funding for family planning commodities. The Great Britain, a major donor in this sector is unlikely to increase funding following Brexit challenges and subsequent decline in the value of its currency.

The Trump administration on the other hand re-instated the “Global Gag Policy”, a decision that seeks to block funding for health providers on abortion services and funding cuts to the UNFPA. Interestingly some key donors, such as Denmark and Sweden are likely to follow the trend and subsequently reduce contributions to the UNFPA. Their focus is now directed towards trade and partnership rather than donation. These global trends provide us with an opportunity to bring family planning concerns unto the discussion table of national priorities. Doing this only mark the first phase as it is our responsibility as a nation to ensure the process remains open and that family planning obtains adequate funding among competing priorities.

To help ensure sufficient funding these strategies be considered:

First, put in place a budget line item exclusively for family planning and Reproductive Health. However having a budget line item is only a first step. As we must ensure that the line is active all year round. This is relevant especially at the time that donor funding is declining and demand for contraception increasing. It is an important factor that cannot be overlooked at least in the short term.
Again, possible avenues are to be exploited to include contraceptives on the essential drug list and be tagged as ’’essential commodities’’. Although we are aware of the limited essential drug list, adding contraception, would not be too much a burden.

Once done means they can be purchased with public funds as in the case of malaria, Tuberculosis and antiretroviral drugs as well as immunisation vaccines among others. Expanding access to family planning is vital to safe motherhood, healthy family and a prosperous community and nation. Therefore making a mix of contraceptives available will ultimately expand and respond to the needs of the growing demand.
Furthermore, creating a National Family Planning Accounts and Reproductive Health Subaccounts independent of the population council’s subvention, are additional measures required to better understand funding for family planning. The National Family Planning Accounts and Reproductive Health Subaccounts if adhered to will measure the extent to which data and contraceptive commodities have been utilised between financing and expenditure sources in both public and private sectors. Information and learning experience gathered will be useful for tracking trends over time as well as regional and international comparability.

Furthermore, an important aspect of stimulating demand for modern contraceptive, fertility awareness methods and sourcing funding for family planning is by engaging a full range of appropriate stakeholders. This is due to absence or limited availability of government funding for family planning services. Therefore involving the private and commercial sectors in the supply chain management to ensure contraceptive adequacy that meets the needs and desires of the people is a game changer. This strategy shifts the responsibility of addressing family planning commodity supply to a larger set of provider organizations, this way the financial obligation do not rest entirely with the public sector. This also means demand creating activities be implemented by NPC and partners through multimedia channels to attract private sector participation.

Finally, contraception when used as a development tool achieves sustainable national development. This is based on the premise that actions of individuals and communities could have serious consequences on their demographic change, resource utilisation and quality of economic, social and environmental development. Thus a well-designed population information education and communication strategy aimed at addressing the contraceptive gap will ultimately link population management to environmental management. At the same time proper understanding and analysis of the nation’s demographic profile at regional, district and sub-district level could be utilised and integrated into their programmatic plans and for decision-making process. Therefore a perfect collaboration between NPC and the proposed Development Authority could yield maximum benefits should such collaboration be adhered to. This is because population influences development in so much as development affect population.

Conclusion

Voluntary family planning programmes play an important role by enabling couples to understand, plan and determine their reproductive preferences. It shapes a country’s demographic path, improves health and education outcomes as well as increases savings and investments across development sectors. With unpredictable future in donor funding, the possibility of government funding its contraceptive is a promising answer.

A Comprehensive Population Information, Education and Communication (PIE&C) intervention, culturally sensitive and aimed at Social Change Communication will be required to address the contraceptive gap. Therefore achieving contraceptive security, translates into specific workable actions based on commitment, coordination and availability of sustained resources. Consequently programme designs that failed to address contraceptive funding gaps, usage and environmental sustainability challenges are not likely to make the desired impacts. Once done it could be recognised as our collective effort at adequately funding contraceptives, improving quality of life and promoting social justice and equity. This will be the new face of NPC

article by Frank Ofosu-Asante, Western Regional Population Council, GNA/NewsGhana.com.gh

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