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Opinions of Saturday, 20 September 2014

Columnist: Aboba, Mathias

Cost-free Family Planning: Making a Case for Safe Motherhood

A group of women at a health center

Child bearing and raising a family is oftentimes a very prideful event in the lives of women. Considering that a woman must survive her pregnancy first to become a mother, a woman’s health and welfare during and following her pregnancy is paramount. This is the point that experts say makes reproductive health services, especially access to family planning, a major priority for the promotion of better lives for mothers and their families.

Ghana is on course to meeting its 2004 revised national population policy target, with the government continuing to show determination for improving family planning usage. Reproductive health advocates contend however that the recent national efforts are not enough to bring about the needed change. In Ghana 35% of married women and 20% of unmarried women have unmet need for contraception. This indicator refers to the percentage of women in their fertile years of age and sexually active but are not using any method of contraception. This indication to space or limit child bearing speaks volumes about women welfare and their freedom of choice to make their own reproductive health decisions. In the case of Ghana therefore, the high number of women who report not wanting any more children or seeking to delay the next child and yet not using contraceptives means more women are at risk of unintended pregnancies and its associated dangers.

It is against this backdrop that proponents believe cost free family planning would empower women and enhance their freedom to effectively take charge of their destinies. It is well known that knowledge and awareness about family planning methods in Ghana are almost at par with most developed societies, the rate of use however has been less than desirable. Yet policy statements from the Ministry of Health seeking to remove financial barrier, one of the major challenges limiting family planning uptake, are not backed by practical implementation plans.

Referring to what he calls lethargic policy statements, a member of the Advisory Council of Reproductive Health and Safe Abortion Advocacy group, Global Doctors for Choice (GDC) Ghana, Mr. Alagsekomah Asakeya Noble said it is close to a year after the announcement by Hon. Sherry Ayittey, past Minister of Health, that the government was to incorporate family planning services into the free maternal health care under the National Health Insurance Scheme and over two years after similar pronouncement was also made by another former Minister of Health, the Hon. S. K. Bagbin, and yet women are still paying for family planning services.

Mr. Alagsekoma pointed out that it was not enough to make public pronouncements about the intention of the government to carry out a particular programme if there is no definite plan and resources to implement such programmes.

He observed that considering how Ghana has seen significant improvement in its health infrastructure across the country, helping to reduce geographic barriers to family planning, it is imperative to bring on board policies that will target the removal of financial barriers to the service. The intention of government to initiate cost free family planning therefore marks an important step. Unfortunately the same government that is quick to announce its good intentions seems to lack the ability to carry them through. Mr. Alagsekoma commended the implementation of cost free family planning services in the Upper East region as part of measures to improve maternal and newborn health and challenged other regions to emulate the Upper East Region’s example.

In an interview with the Upper East Regional Director of Health Services, Dr. Koku Awoonor, an ardent supporter of the implementation of the cost free family planning program in the region, he indicated that the Upper East Region is excited to be playing a pioneering role in health system development in the country. The region was therefore thrilled to take led in rolling out cost free family planning services. Dr Awoonor-Williams observed that access to family planning provides women and girls the power to take control of their reproductive life so that they can escape the four principal dangers of motherhood, getting pregnant too early, too often, too many times or too late. He also noted how other family planning methods, such as condoms, help to reduce the risk of HIV and other sexually transmitted infections.

He disclosed that the region piloted cost free family planning in the Talensi-Nabdam district in 2012 and has since scaled up to seven additional districts with the remaining six soon to be brought on board. He revealed that the region has embedded extensive community sensitization efforts alongside this rollout, with a strong emphasis on male involvement. He expressed hope that such efforts would help reduce significantly existing cultural and financial barriers, which have been cited as the two major hurdles impeding family planning acceptance in the region.

The Regional Director of Health emphasized that when initiating cost free family planning services, the health workers are no longer sitting at health facilities and sending messages to women that family planning has now been made free, expecting them to rush for the services. Instead, by engaging directly with communities through durbars and talking to men and opinion leaders, they are seeking to educate communities on the importance of birth spacing, limiting birth and the dangers of early or late pregnancy.

In traditional Ghanaian communities and the Upper East region in particular, there is strong male resistance to family planning. Family planning has been routinely misconceived as a way to limit births; a proposition that contradicts traditional family values to have large families, a sentiment which still reigns in the hearts of most men.

Although one might believe that times have changed and that these are not the days having large family size was perceived as a sign of wealth and respect. This however it is not the case, especially in communities living in the Upper East Region.

Thankfully it appears the Regional Director anticipated such cultural challenges. He intimated that ‘cost free’ at the moment is a major theme being used to seek attention in communities in the region to talk about family planning and the misconceptions of side effects. At the same time they take the opportunity to prepare key messages and target everyone in the community, including men, and making sure that they understand that contraceptive use does not affect fertility, but rather provides an opportunity for women and men to space birth. Spacing births can help women stay healthier, stronger and more productive so they can better help their families grow. Spacing births has also been found to promote the survival of children.

The Regional Directors believes removing cost is crucial in increasing family planning service uptake, “You and I may say the 50 pesewas, one Cedi, or two Cedis is not any big money, but that is not true”, he stressed. Several studies have quoted women citing cost as a major barrier of their use of family planning.

There is even a more curious twist to the money factor, he indicated, which was greatly affecting women chances of using family planning services. That is the issue of internally generated funds (IGF) at district health facilities. Since providers are allowed to retain a percentage of the cost of devices after sales while returning the principal cost to the regional and national level, most providers often stock only devices with highest returns and therefore making some devices perpetually unavailable.

Certainly the motive for IGF crowd out most potential users of family planning in some places. With the introduction of cost free services however, all methods now have equal chance of being available and that for Dr Awoonor-Williams increases a woman ability to use the family planning type of her choice. It is evident that the push for cost free family planning is therefore a strong case for safe motherhood and must be looked at from a broader perspective.