Repositioning community-based family planning in Ghana: A case study of Community-based Health Planning and Services (CHPS)

The Population Council conducted a diagnostic appraisal of delivering family planning services using the community-based health planning and services (CHPS model) in Ghana. This study’s results indicate that the CHPS program is well appreciated by rural communities where it is operational. However, the study identified several developments with implications for service delivery: increased community health officer (CHO) workloads and concomitant reductions in outreach services and home visits by community health visitors (CHVs) have weakened the CHO-CHV working relationship, leaving both cadres working in isolation. CHPS has significantly improved health indices but its contribution to increasing family planning is limited and seems to have decreased from the original model’s initial promise, mainly due to CHPS restructuring, change in priority and focus, with increased a range of services required of CHOs. The report recommends interventions and strategies for addressing identified gaps, strengthening the model, and thereby increasing family planning service access

What are the sexual and reproductive health needs of adolescents in Ghana’s slums?

To address the need for quality evidence on the sexual and reproductive health (SRH) needs of adolescents in slums, the STEP UP project conducted a study in four slum settings in Ghana. This policy brief highlights key points, including the need for a well-designed, comprehensive sex education curriculum; interventions that address sexual coercion and violence as an integral component of current adolescent reproductive health programs; and the need to involve all stakeholders including parents/guardians and community leaders in addressing adolescent SRH needs. Evidence from the study can be used to improve ASRH programming so that it better meets the needs of slum-dwelling adolescents

Factors influencing the intention of women in rural Ghana to adopt postpartum family planning.

BACKGROUND: Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa and very little is known about how pregnant women arrive at their decisions to adopt PPFP. This information is needed to guide the development of interventions to promote PPFP. METHODS: We conducted a survey among pregnant women attending antenatal clinics in a rural district in Ghana. We used univariate and multivariate logistic regression analysis to explore how knowledge of various family planning (FP) methods, past experience with their use and the acceptability of PPFP to male partners and close relations influenced the intention of pregnant women to adopt PPFP. RESULTS: We interviewed 1914 pregnant women in four health facilities. About 84% considered PPFP acceptable, and 70% intended to adopt a method. The most preferred methods were injectables (31.5%), exclusive breastfeeding (16.7%), and oral contraceptive pills (14.8%). Women whose first choice of PPFP method were injectables were more likely to be women who had had past experience with its use (O.R = 2.07, 95% C.I. 1.50-2.87). Acceptability of PPFP by the pregnant woman (O.R. = 3.21, 1.64-6.26), perception of partner acceptability (O.R. = 3.20, 1.94-5.48), having had prior experience with the use of injectables (O.R. = 3.72, 2.61-5.30) were the strongest predictors of the intention to adopt PPFP. Conversely women who knew about the diaphragm (O.R. = 0.59, 0.38-0.93) and those who had past experience with IUD use (O.R. = 0.13, 0.05-0.38) were less likely to want to adopt PPFP. CONCLUSIONS: Acceptability of PPFP to the pregnant woman, male partner approval, and past experience with the use of injectables are important factors in the PPFP decisions of women in this population. Antenatal and early postnatal care need to be adapted to take these factors into consideration

Community opinion leaders in Ghana speak out on adolescent sexuality: What are the issues?

This policy brief reports on a study that is a component of a larger study that assessed the sexual and reproductive health (SRH) needs of adolescents in four slums in two regions of Ghana. The study’s focus on this perspective stems from the fact that there is a lack of evidence surrounding the outlook of community opinion leaders on adolescent reproductive health in this setting. Understanding what adults think about major adolescent SRH issues in their communities (including the SRH rights of adolescents, adult–adolescent communication about SRH issues, and service-seeking and sexual behavior outcomes) provides insight into how adults perceive and influence the lives of young people, and therefore, how programs could be designed to better serve the sexual health needs of adolescents. The brief summarizes key findings that identify the issues facing these community opinion leaders

Introduction of medical abortion in Ghana

To significantly expand women’s access to modern family planning and comprehensive abortion care services a provisional license was awarded to Marie Stopes International-Ghana by the Ghana Food and Drugs Board for the introduction and provision of the first medical abortion regimen (mifepristone and misoprostol) in Ghana. The Population Council conducted this study to document the introduction process; findings from the study will provide much needed evidence to inform policy decisionmaking and the scale-up phase. Overall the study has shown that medical abortion is a viable option for Ghanaian women--an overwhelming number of those who have benefitted from the procedure are content and will use or recommend it. The report recommends that products and service be made easily accessible and available to all women, especially the vulnerable, in order to stem the mortality rates associated with unsafe abortion

Acceptability and promotion strategies for LNG-IUS in Ghana: A public health assessment

In response to concerns about the side effects of the IUD, the commonly known reversible, long-term method in Ghana, and to curb the shift from long-term to short-term methods, the Ghana Health Service decided to expand women’s contraceptive method choices by introducing the Levonorgestrel-releasing Intrauterine System (LNG-IUS), a hormonal IUD, into the contraceptive method mix. The LNG-IUS is a uterine contraceptive that provides effective long-term protection up to five years. Even though the product has been certified as safe and effective, it was necessary to ensure that it satisfies client’s needs and meets provider expectations. The Population Council, in collaboration with the Reproductive and Child Health Unit of the Family Health Division of the Ghana Health Service and EngenderHealth, implemented an intervention to evaluate the acceptability of the LNG-IUS among family planning clients and to explore effective ways of scaling it up throughout the country. As noted in this report, the study also explored promotion and sustainability strategies to enhance the integration of the product into the family planning method mix

Comparing the effectiveness and costs of alternative strategies for improving access to information and services for the IUD in Ghana

The Ghana Health Service (GHS) was prompted to explore ways of increasing interest in the IUD through increasing awareness of this and other long-acting and permanent methods via interpersonal channels and by intensifying campaigns to dispel rumors about the method. The Health Research Unit of the GHS, EngenderHealth’s Quality Health Partners project, and the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project collaborated with the GHS to test innovative approaches to increase awareness of the IUD and to improve access to the method. The study examined the general and method-specific knowledge of long-acting family planning methods among clients and providers, as well as the level of contraceptive use by method in the intervention and comparison communities. In general, community health officers (CHOs) exhibited adequate knowledge of and a positive attitude toward the IUD. The report concludes that increases in the numbers of new IUD and implant users recorded by CHOs who undertook insertions at the community level, together with the much lower cost for this model, suggest that training CHOs to educate communities about long-acting methods and enabling them to provide them at the community level should be considered

Are parents talking to adolescents about sexuality? Evidence from four slums in Ghana

This evidence brief summarizes the essential information from a part of a larger study that assessed the sexual and reproductive health (SRH) needs of adolescents in four slums in two regions of Ghana. The objective of this brief is to provide evidence to support and facilitate the improvement of parent–adolescent communication on sexuality. This study echoes several other studies by providing evidence that a majority of parents are not opposed to in-school sex education for their children and welcome the idea of empowering themselves (parents) to have productive discussions with their children. Nevertheless, there is a mismatch between the proportion of parents who believe they have discussed sexuality with their adolescents, and the number of adolescents who report they have had these discussions. Among several conclusions, the report identifies the need to better educate parents and guardians about adolescent sexual and reproductive health, as well as provide guidance on how they can effectively have these conversations

Understanding the reproductive health needs of adolescents in selected slums in Ghana: A public health assessment

Over the past decade, adolescent sexual and reproductive health (ASRH) concerns have increasingly been on the development agenda of the government of Ghana. This concern has been driven by such factors as early age of sexual debut, early childbearing, and prevalence of HIV/AIDS among this subgroup of the population. The overall objective of the study was to generate evidence on the knowledge, perceptions, and practices regarding ASRH among slum communities in Ghana. The findings of the study indicate a need for intensifying efforts to inform and educate adolescents living in the slums about responsible and healthy attitudes toward sexuality, delaying the onset of sexual activity, and reducing risky sexual behaviors; incorporating sex education appropriate for each educational level; and involving all stakeholders including parents/guardians and community leaders in addressing adolescent SRH needs which will, in turn, enhance community participation and address cultural barriers and inhibitions to the optimum realization of ASRH

An assessment of trends in the use of the IUD in Ghana

Use of the IUD in relation to other contraceptive methods is reported to have either stagnated or declined in a number of countries including Ghana. The overall aim of this study was to inform the Ghana Health Service, USAID, and other partners on future directions for contraceptive promotion and supply. The stagnating demand for the IUD as a family planning method can be attributed to several factors, including perceptions and rumors about the method. The study recommends: intensified marketing of the IUD through the Ghana Life Choices Program; IUD-focused training and creation of a critical mass of trained IUD providers; and a Ministry of Health review of the National Reproductive Health Service Protocols on who qualifies to insert the IUD, and clarification of the eligibility criteria with regard to nulliparous and HIV-infected clients. The study also identified a need to address issues related to cost