Women’s Autonomy in Ghana: Does Religion Matter?

This paper examines the role of religion in women’s autonomy in Ghana. The study uses data from the 2008 Ghana Demographic and Health Survey, with an analytic sample of 1,424 women married to men of the same religious affiliation. The results indicate that the effect of religion on women's autonomy is non-existent. The results show that, Muslim women are as autonomous as Christian women once region and other socio-demographic factors are controlled. Contrary to expectation, women in northern Ghana, who are disadvantaged in terms of education, economic status among others, appear to be more autonomous in some domains of household decision-making than women in southern Ghana, a setting which is more developed and expected to be egalitarian. Majority of Ghanaian women appear to be autonomous across various domains of their lives; however, they largely participate as opposed to solely making decisions

Issues for consideration in the scale-up of the inclusion of family planning in the National Health Insurance benefits package in Ghana

Ghana is working toward achieving universal health coverage (UHC). This is driven, in part, by the Sustainable Development Goals (SDGs), specifically SDG 3—Good Health and Well-Being, which seeks to ensure healthy lives and promote well-being for all at all ages. Achieving this feat will improve equity of access as people, especially the poor can access quality health services without financial hardships. Ensuring equitable access to family planning (FP) is essential to securing the well-being of women and supporting the health and development of communities. One pathway to ensuring equity is the inclusion of FP in affordable insurance. While the inclusion of FP in the National Health Insurance Scheme is critical to the equity of FP distribution, the issues identified in this brief would have to be addressed before or in the course of scale-up to achieve the desired results

Evaluating the inclusion of family planning within the National Health Insurance benefits package in Ghana

Contraceptive use in Ghana has remained low despite annual increases since 2012. Having a high unmet need for family planning (FP) suggests that there may be barriers to access and uptake. Over time, several policies, including Ghana’s Costed Implementation Plan from 2015–20, have suggested FP initiatives to improve contraceptive use yet they have not been entirely implemented. Further, although FP was included in the health insurance act passed in 2003, amended in 2008, and revised in 2012, which indicated that health-care benefits include FP, people continue to pay out of pocket for services at National Health Insurance Authority facilities because the policy is yet to be implemented. In some settings, evidence suggests an increase in contraceptive uptake with the removal of out-of-pocket costs for FP services, therefore embedding an FP package into Ghana’s national health insurance scheme may increase uptake of FP service and method mix and improve health outcomes. As noted in this report, this study assessed the impact of the FP pilot intervention, namely out-of-pocket cost removal for FP services, demand generation for FP, and provider training on long-acting reversible contraceptives service provision on FP service uptake

Introduction of DMPA-SC self-injection in Ghana: A feasibility and acceptability study using Sayana® Press

This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among health-care providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health-care providers were trained to administer DMPA-SC and to train clients on self-injection. Clients assessed as being competent self-injected under the provider’s supervision and could take two DMPA-SC doses home for future self-injections. Results indicate that DMPA-SC self-injection is feasible and acceptable to both providers and FP clients. The report also examines the socio-demographic profile of providers and clients, method continuation, and feasibility and acceptability of home self-injection. Results have informed the national scale-up of DMPA-SC in public and private facilities, which began in April 2019

Modeling the impact of inclusion of family planning services in Ghana\u27s National Health Insurance scheme

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the past decade. The Ghana Ministry of Health, the National Health Insurance Authority, Marie Stopes International Ghana, and the Population Council launched a pilot in nine districts from 2018–20. This report uses data from pilot activity to model four scenarios involving implementation of cost removal, demand generation, and long-acting reversible contraceptives training to estimate impact on mCPR. These are input into the Health Policy Project’s ImpactNow tool to obtain estimates of health and economic benefits, intended to inform decisions regarding scale-up of these activities across the country

Risky Sexual Behaviour among Sexually Active Never Married Ghanaian Women: A Latent Class Analysis (LCA)

This paper examined risky sexual behaviour patterns among sexually active never married Ghanaian women using the 2008 GDHS data. The LCA technique was utilised to identify categories of women based on their risky sexual behaviours. Age at first sex, multiple sexual partnerships, condom use at first and last sexual intercourse, lifetime sexual partners and alcohol consumption at last sex were used for the categorisation. Preferably, a 3-class model that reflected “low risk takers,” “risk takers” and “high risk takers” was selected. Generally, the sexual behaviours followed similar patterns. For instance, the conditional probability for unprotected sex at first sexual intercourse was 0.34 in Class 1-“low risk takers”, 0.84 in Class 2-“risk takers” and 0.86 in Class 3-“high risk takers”. Latent multinomial logistic regression model was used to examine the predictors of class membership. Older women were more likely to be classified in both the “risk takers” and “high risk takers” classes

Registered or unregistered? Levels and differentials in registration and certification of births in Ghana

Abstract Background The birth of a child is a vital event that needs to be registered but this is not always the case as an estimated 40 million births go unregistered annually. Birth registration safeguards the basic rights of children and gives them an identity, citizenship/nationality and legal protection against violence, abuse and human rights violations. It is therefore necessary that all births are registered and even more critical that the registration of a birth is followed by the issuance of a birth certificate. But sadly, birth registration in many African countries continues to remain below acceptable international standards and not all registered births are certified. This paper examined birth registration and certification in Ghana. Differentials in the characteristics of children and mothers of children whose births are registered and certified, children whose births are registered but not certified and children whose births are not registered were examined. Methods This paper analysed data from the 2014 Ghana Demographic and Health Survey drawing on variables from the household and children’s data files. Descriptive analytical tools (frequencies, percentage and cross tabulations) and multinomial logistic regression analysis were used to examine differentials in birth registration status among an analytical sample of 3880 (weighted) children aged 0–4 years. Results The birth of about every 1 in 4 (28.89%) children in Ghana have never been registered. Birth registration and certification was lowest among children born to young mothers (15–19 years), children whose mothers have no formal education, mothers who reside in rural areas and mothers in the poorest wealth quintile. Additionally, home births and births that were not assisted by a medical professional were observed to have the lowest proportion of registered and certified births. Furthermore, the birth of children who are less than a year old was significantly more likely not to be registered or issued with a birth certificate. Conclusion Efforts aimed at improving birth registration and certification in Ghana need to target groups of children and mothers with low levels of registration and certification particularly children who are born at home, children born to young mothers and children whose mothers are poor and or reside in rural areas

Dynamics of women\u27s autonomy in household decision-making in Ghana

This study examines dynamics of women’s autonomy in household decision-making in Ghana. Using 57 in-depth interviews with married women and men, purposively selected in Accra (Greater Accra region) and Tamale (Northern region) reveal that culture and religion shape power structures and gender roles in household decision-making. Important in the socialisation process are religious institutions that reinforce the status quo in household decision-making. While men insist on maintaining the status quo in household decision-making, women do not contest it. Despite men’s authority in household decision-making, women are active players in the household decision-making process. When decisions are not in their favour, they employ tactics such as \u27taking decisions without their partners\u27 consent\u27, involving ‘significant others\u27, and \u27nagging\u27 to get decisions to turn in their favour. However, there appears to be socially acceptable punishments for women making household decisions without their partners consent

What distinguishes women who choose to self-inject? A prospective cohort study of subcutaneous depot medroxyprogesterone acetate users in Ghana

Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) is an all-in-one injectable contraceptive administered every 3 months, either by a trained health care provider or community health worker or by training a client to self-inject. Using a prospective cohort of family planning (FP) clients in Ghana, this study explores patterns of DMPA-SC use and mode of injection administration over a 6-month period. This study also examines the predictors of self-injection adoption 6 months after initiating DMPA-SC. Our analysis focuses on 378 women who were using DMPA-SC at the 6-month interview. Adjusted odds ratios accounting for clustering show that clients who were new FP users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection. Results of this study suggest that in Ghana, adding DMPA-SC to the method mix may improve access to FP, especially among new users. Results of this study may inform FP projects and programs aiming to improve access to contraceptive methods and increase contraceptive prevalence by introducing or scaling up DMPA-SC self-injection. The findings also provide a sociodemographic profile of FP clients most likely to adopt DMPA-SC self-injection over time, which could serve as an evidence base for social marketing strategies

Impact of COVID-19 on the use of emergency contraceptives in Ghana: An interrupted time series analysis

The Coronavirus disease pandemic has disrupted reproductive health services including decline in the use of pre-coital contraceptives. However, evidence of its impact on the use of emergency contraceptives, often, post-coital methods, is limited in the emerging literature, hence this study. Data on total number of emergency contraceptive users from January 2018 to February 2020 (pre-pandemic) and March to December 2020 (during the pandemic) were extracted from the Ghana Health Service District Health Information Management System. Interrupted Time Series analysis was used to estimate the impact of the pandemic on the trend of emergency contraceptive use, adjusting for serial autocorrelation and seasonality. The results showed a gradual upward trend in emergency contraceptive use before the pandemic, increasing at a rate of about 67 (95% CI 37.6–96.8; p = 0.001) users per month. However, the pandemic caused a sudden spike in the use of emergency contraceptives. The pandemic and its related restrictions had an immediate effect on the use of emergency contraceptives, increasing significantly by about 1939 users (95% CI 1096.6–2781.2; p = 0.001) in March 2020. Following March 2020, the number of emergency contraceptive users continued to increase by about 385 users per month (95% CI 272.9–496.4; p = 0.001). The evidence shows that use of emergency contraceptives, often used as post-coital methods for unprotected sex was not negatively impacted by the pandemic. In fact, it is the opposite. Hence, in planning for similar situations attention should be given to the distribution of post-coital contraceptive methods