Family planning is part of the entire demographic and population policy of each country and globally.

It has been a priority for the Government of Ghana for many years and is highlighted as a key factor in population management and national development outlined in the GhanaShared Growth and Development Agenda II: 2014-2017 (NDPC 2014).

Important policy documents have been prepared to guide the implementation of the country’s national family planning programmes. These documents include the National Population Policy, the Reproductive Health Service Policy andStandard, the 2000 Adolescent Reproductive Health Policy, the Reproductive Health Commodity SecurityStrategy (2011-2016), the Draft National Condom and Lubricant Strategy and Market Segmentation Analysis for Family Planning, among others (MoH 2011).

Family planning, in its basic meaning, is defined as a number of methods and procedures intended to influence the number of pregnancies and timeframe between them. Family planning, in its broader meaning, is part of the entire demographic and population policy of each country and the planet as a whole. In almost every surrounding, the objectives of family planning commonly highlighted include unwanted pregnancy prevention, extensive population growth reduction, and health improvement of women, children and the population as a whole.

The use of methods for family planning reduces maternal mortality, prevents unwanted and highly risky pregnancies and the need for (un)safe abortions, and provides protection from sexually transmitted diseases. More than 500,000 women die every year due to pregnancy-related problems. According to WHO, approximately 120 million couples in the world do not use contraception and 300 million are not satisfied with the method applied.

Victor Owusu Boateng is Demographer/Statistician at Ghana Statistical Service

There are more than 80 million unwanted pregnancies registered in the world annually and more than half of them end with abortion. There are 78,000 women who die each year due to the consequences of jeopardized abortion. This number may decrease with the use of family planning methods. The lowest reported rate of abortion in Europe is in Germany (8 in 1,000 women), while the highest is in Ukraine (45.4 in 1,000 women). In England, the abortion rate in 2004 was 17.8 in 1,000 women, aged 15-44 (in 1990 the rate was 15), and in the USA the rate was 16 in 2001. Of particular concern is the fact that a great number of abortions occur amongst adolescents, accounting for 11.4 million interrupted adolescent pregnancies per year in the world.

Comprehensive and timely estimates on global trends in family planning are critical for assessing current and future contraceptive demand and setting policy priorities to ensure universal access to sexual and reproductive health and therealization ofreproductive  rights. Contraceptives are used by the majority of married or in-union women in almost all regions of the world. 

In2015, 64 percent of married or in-union women of reproductive age worldwide were using some form of contraception. However, contraceptive use was much lower in the least developed countries (40percent) and was particularly low in Africa (33percent). Among the other major geographic areas, contraceptive use was much higher, ranging from 59 percent in Oceania to 75 per cent in Northern America. Within these major areas there are large differences by region and across countries (UN, Social and Economic Affairs, 201).

The UnitedNations General Assembly reaffirmed these commitments when it adopted the 2030 Agenda for Sustainable Development (UnitedNations,2015b). The new development agenda includes two targets relevant forfamily planning under broader goalson health andgenderequality and the empowerment of women and girls. Both targets aim to ensure by 2030“…universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes” (Target3.7)and “…universal access to  sexualand  reproductive healthand  reproductiverights  as agreed  in  accordance with the Programme of Action of the International Conferenceon Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences” (Target5.6).

Knowledge of contraception is universal in Ghana. Twenty-seven percent of currently married women use contraception; 22percent use a modern method. The three most popular modern methods used by married women areinjectables (8 percent), implants (5 percent), and the pill (5 percent). Use of modern methods has more than quadrupled in the past 25 years,rising from 5 percent in 1988 to 22 percent in 2014. 

The government sector remains the major source of contraceptives inGhana, providing them for 64 percent of current users, an increase from 39percent in 2008. Overall, one in four contraceptive users discontinued using a method within12 months of starting its use. Six percent of episodes of discontinuationoccurred because of side effects or health concerns. Thirty percent of currently married women have an unmet need for familyplanning services, with 17 percent having an unmet need for spacing and13percent having an unmet need for limiting.

The Table below shows proportions of contraceptive use among currently married women by their educational status. The three main variables involvedare:

1. Any method used by currently married women which can either be modern or traditional
2. Any modern method used by currently married women which includes Female sterilization, male sterilization, pills, IUD, injectables, implant, male condom, female, diaphragm, foam/jelly, LAM and other form of modern contraceptive
3. Any traditional Method used by currently married women which include rhythm, withdrawal and other forms of traditional contraceptive.

Trends in contraceptive use among currently married women by education

Method	Any method					Any modern method					Any traditional method
Background of  Education	2003	2008	2014	2017		2003	2008	2014	2017		2003	2008	2014	2017
No Education	15.3	13.6	18.6	23.8		11.0	10.8	17.4	21.8		4.2	2.7	1.1	1.9
Primary	26.1	26.6	28.9	32.7		20.7	18.0	26.8	28.7		5.3	8.7	2.0	4.0
Middle/JSS/JHS	32.4	27.4	28.5	34.3		23.9	19.6	22.8	27.2		8.6	7.8	5.7	7.1
Secondary	39.8	30.4	34.3	30.6		28.1	18.5	23.7	21.2		11.7	11.8	10.6	9.4

Source: 20003, 2008, 2014 GDHS and 2017 GMHS(GSS)

Overthepast10 year,theuseofcontraceptivemethodshasmarkedlyincreasedamong married women with no education and primary education across any methods, any modern methods and any traditional methods but decreased among married women with middle/JSS/JHS and secondary education across the same variables.

This can be attributed to the belief that those with no education and lower education easily approach medical personnel such as Community Health Nurses for advice on what type of contraceptive method to use to control their birth. Those with higher education sometimes shy away from accessing contraceptives from family planning officers.

In other to reduce unmet need for contraception and eliminate barriers to obtaining family planning services, there is the need to provide greater access to comprehensive family planning services, including offering a range of contraceptive options which will reduce the number of unintended pregnancies. This, in turn, will reduce the incidence of unsafe abortion and associated maternal deaths and ill health.

 

By:  Victor Owusu Boateng

Demographer/Statistician

Ghana Statistical Service