Feature Article of Saturday, 13 May 2017

Columnist: Jamila Akweley Okertchiri

Too early, too many

“I work but the income I make is not enough to take care of my family,” says 20-year-old Salamatu Abubakar.

Although not married, Salamatu is a mother of three children. At age 17, she was already a mother of a set of twin boys, two years later, she got pregnant again and gave birth to a baby girl but says she did not plan for both pregnancies.

“I already come from a big family and it is difficult for us to survive, so I did not want to be in such a situation like my mother but it just happened,” she explains.

But it did not just happen as Salamatu puts it, she, like many other adolescent girls in Ghana, was exposed to sexual situations when she lacked the right information to negotiate for safe sex through the use of modern contraceptives.

Unmet Need

The Ghana Demographic and Health Survey (GDHS) data analysis shows that over 564, 000 Ghanaians aged 15 to 19 years are currently sexually active.

On average, adolescents who had sex before the age of 20, adolescent girls first have sexual intercourse at age 16.7 years and adolescent boys at 16.8 years.

Among adolescents who become parents before age 20, the average age at which Ghanaian adolescent girls have their first baby is 17.2 years, while the average age at which adolescent boys first become fathers is 18.4 years.

Almost all active adolescent girls report not wanting a child in the next two years, yet more than a half of sexually active adolescents are not using any form of contraception, creating a huge unmet need for contraceptive usage in the country.

Only one out of four married women who want to space their birth or do not want to get pregnant use a modern contraceptive method while one out of two unmarried women use contraceptives in Ghana.

Thus, if all married and unmarried women like Salamatu were to use FP methods, the contraceptive prevalence rate (CPR) of the country is projected to significantly increase to over 55 percent, according to the Ghana Family Planning Cost Implementation Plan.

Dr Olive Sentumbwe-Mugisa, Family Health and Population Advisor, World Health Organisation (WHO) Uganda, says contraceptive use reduces maternal mortality and improves women’s health by preventing unwanted and high-risk pregnancies and reduce the need for unsafe abortions.

“It is estimated that 2,000 maternal deaths could be avoided each year if all women who said they want no more children were able to stop childbearing,” she says.

Demographic Dividend

Salamatu is not as worried over taking care of her three children as taking on the responsibility for her other nine siblings.

She is responsible for their school and their up-keep because their parents do not earn enough income from peasant farming. “Once a while, they bring us some food stuff but since I am the first child and I am working, I have to take care of them,” she says.

Taking care of her children and siblings all by herself is a huge task she has been shouldering alone in the past five years with the meagre income she earns in her beads trade.

“I don’t have a man to support me and sometimes when they get sick, it is very difficult for me. But we are surviving,” she narrates.

Salamatu expresses her wish to have limited or spaced the number of children she had had but already she has three in three years. “I love my children but I wish I had not had them now,” she says.

Dr Jotham Musinguzi, Director General, National Population Council, Uganda, explaining the benefits of birth spacing or limited pregnancies, says when family size is lower, more resources are available to benefit all members of the family, especially the mother and children.

“This means more food, better clothing and school achievement, for the children and improved maternal health and economic productivity for the mother… These choices when added together can have profound effects on the country, one such effect is the Demographic Dividend (DD),” he asserts.

Demographic dividend as not only an improved health and well-being for the family but an opportunityfor economic growth and development that arises as a result of changes in population age structure.

This is because when fertility rates decline significantly, the share of the working-age population increases in relation to previous years.

A larger working-age population can enable a country to increase its GDP and raise incomes because they are able to save and invest rather than spend on supporting a large non-working (young) population.

Dr Musiinguzi says Africa still has an opportunity to reduce the fertility rate but it is not automatic as it depends on investments and reforms in three sectors: family planning, education, and economic policy.

“It is late but not too late, we must start now or we miss it and once it is closed it has closed,” he added.

FP2020

In line with ensuring that every woman has access to family planning information, services and suppliers, world leaders representing close to 70 countries pledged to specific commitments to ensure that additional 120 million women and girls in 69 of the world’s poorest countries have unlimited access to family planning methods by 2020.

Achieving the targets of the agreement (FP2020) would mean preventing a staggering 100 million unintended pregnancies, 50 million abortions, 200,000 childbirth-related and maternal deaths, and three million infant deaths.

Ghana, recognising that the high rate of population growth strains the country’s natural resources, which in turn drives up the poverty rate and threatens future development gains and knowing that Ghana’s population dynamics can be turned into a valuable ‘demographic dividend’ only if investments are made in FP and reproductive health (RH) signed up to the agreement.

Since then, the country has laid up plans in achieving its target. Government has committed to offering expanded contraceptive choices, including a wider range of long acting and permanent methods.

Presently, the method mix includes condoms, pills, implants, IUDs/IUS, vasectomy and bilateral tubal ligation.

Health care officers have also been trained in adolescent reproductive health and are encouraged to offer adolescent friendly services.

Ghana has 218 fully functional adolescent friendly corners and 54 were built in 2015-2016 currently.

But there are hindrances that still face young people like Salamatu in accessing modern family planning methods. Factors like infrequent sex, fear of the side effect or health concerns and breastfeeding are barriers that prevent people like Salamatu from opting for a voluntary family planning method.

“When I go to the hospital the nurses think I am a bad girl so I make my new man use a condom because I do not want to get pregnant again. Now I want to take care of my children and siblings,” she says

PF & SDGs

Family planning can accelerate progress across the five Sustainable Development Goals (SDGs) themes of people, planet, prosperity, peace, and partnership and is critical to achieving the goals and the post-2015 development agenda.

Dr Sentumbwe-Mugisa says empowering women to choose the number, timing, and spacing of their pregnancies is not only a matter of health and human rights but also touches on many multi-sectoral determinants vital to sustainable development, including women’s education and status in society.

“Without universal access to family planning and reproductive health, the impact and effectiveness of other interventions will be less, will cost more, and will take longer to achieve,” she adds.

Global strategies and partnerships—and health decision makers at all levels—must leverage the abundance of available research, evidence, and the range of justifications presented here to prioritize family planning as a foundational component of health, rights, and long-term development strategies.

Thus, like Salamatu, countless number of teenage girls are missing out on family planning methods while they await a friendly adolescent clinic.

“If I get a clinic where they will not judge me but give me the assistance I need, I will go there,” Salamatu says.

PIX SAVED IN NEWDAILY AS FP

PULL OUT

The central role of family planning in achieving the Sustainable Development Goals (SDG) across the five themes of people, planet, prosperity, peace, and partnership.

PEOPLE

Family planning advances human rights. Family planning helps reduce poverty. Family planning contributes to improved nutrition outcomes. Family planning saves lives. Family planning prevents HIV/AIDS transmission. Family planning supports women’s and girls’ education. Family planning advances gender equality and empowerment.

PLANET

Family planning mitigates population growth’s effects on access to water and sanitation. Integrated population, health, and environment projects can expand access to clean and renewable energy. Family planning contributes to building resilient infrastructures. Family planning contributes to building safe, resilient, sustainable cities. Family planning helps reduce population effects on food and chemical waste. Family planning helps address the challenges of climate change. Family planning helps to protect declining marine resources. Family planning helps mitigate the effects of deforestation and unhealthy interaction among humans, domestic animals, and wildlife.

PROSPERITY

Family planning contributes to economic growth.

PEACE

Family planning promotes inclusive societies by addressing the needs of disadvantaged populations. Family planning contributes to peace and stability.

PARTNERSHIP

Family planning partnerships can support the achievement of the SDGs.