The silent noise drowning Family Planning in Ghana

Madam Akua Mansa lived with her ten children, one of whom was a special-needs child, in a house that was about to collapse over them in Mankraso in the Ashanti Region.

Their story was told in a feature story titled, “Living in Abject Poverty: 50-year-old mother with ten children living in a nearly-collapsed structure”, aired on JoyNews television Tuesday July 19, 2022, as they appealed for help.

The story brought to fore the state of poverty, impoverishment, squalor and frustration that some single mothers and their children experience.

One would be moved to tears watching the miserable living conditions that this large family have had to endure.

However, beyond the themes of poverty and squalor projected by the news report lay other critical issue. One of such is family planning.

Ten children. Would Madam Akua Mansa’s circumstances be different if she had practised family planning to control her number of children, and spaced the intervals between their births more appropriately?

The concept of family planning is not new in Ghana. The conversation on the subject dates as far back as 1969 when the country adopted its first National Population Policy.

The issue was however on the low until the 1980’s and 90s where the government through deliberate policy stepped up family planning campaigns.

Several messaging formats were deployed including advertisements and posters by both Government and some non-governmental organisations to promote family planning through the mass media.

Today, family planning services are now commonly offered in both public and private health facilities nationwide, with organisations such as the Planned Parenthood Federation of Ghana and Marie Stopes International as the most popular offering such services at subsidised rates.

As of January1, 2022, the service was captured in the National Health Insurance Scheme with the motive of promoting sexual reproductive and maternal health, healthy spacing of births, and down-sizing of family to suit financial means and capacities of families among other benefits.

Despite its numerous benefits, there still remain many barriers preventing the high patronage of family planning methods in the country.

Ghana, like many developing countries, have deep-rooted cultural, religious and structural barriers that work against family planning, particularly, the use of contraceptives as birth control methods.

Traditionally, reproductive decisions particularly those in the confines of marriages rest not only with couples only, but also the extended family, lineage members or even close friends. These persons usually expect or even demand a couple to start reproducing within a few years of marriage, whether they are prepared or not. According to Nukunya, 1992 cited by Akafuah and Sossou (2008) in Research Gate article: “Attitudes Towards and the Use of Knowledge about family planning among Ghanaian Men”, a discussion on the number of Children a couple should have, in the typical Ghanaian society is seen either as a taboo or culturally unacceptable because, it is widely believed that children are ‘gifts from God’ therefore their numbers is non-negotiable regardless of a couples financial and job security.

In Akan land for example, there is a saying that “Nyame Na 3hw3 ba”, to wit, “It is God who takes care of children.” Community members and family often use this statement in attempts to convince or to goad young couples who, for one reason or another, are not seen to be having children as much as they expected.

Another entrenched position against the patronage of birth control are messages propagated by some religious preachers.

Some Christian preachers, in particular, cite the story of Tamar and Onan in the Biblical book of Genesis, chapter 38: Onan, was required by Ancient Israeli law of Leviratic marriage to inherit Tamar, his brother’s widow as wife and produce children with her in his late brother’s name.

The story records that Onan spilled his semen anytime he has sexual intercourse with Tamar, because he knew that any children that would be borne from their union, by the prevailing tradition, would not be considered his, but his deceased brothers’ and he (Onan) was not enthused with. This, according to the account, angered God who kills Onan as a result.

The displeasure Onan suffered is used by some of the Christian preachers to outrightly condemn family planning methods like the use of condom, mastectomy (female sterilization), vasectomy (male sterilization) contraceptive pills and injectables, saying they are evil, unbiblical and capable of incurring God’s Judgement.

Another story is told about Saudatu, a young highly-educated lady, who got reprimanded by both her immediate family and that of her husband for having an inter Uterine Device (IUD) in her womb after having two kids at narrow intervals.

She had to rid herself of it as her immediate and husband’s family accused her of not ‘respecting Gods Command’ of Multiplication and trying to depopulate her family lineage.

Apart from the above scenarios, fear of complications, adverse health side-effects and negative perceptions entrenched by socio-cultural and religious barriers are factors that prevent people, particularly, females from accessing readily available family planning services.

The consequences of the low adoption rate of family planning have been many maternal deaths, poor reproductive health, especially among females, rise in unsafe abortions. It has also affected the quality of life, produced many unwanted children and high population growth, putting a heavy strain on social amenities.

For organisations such as the Planned Parenthood Association of Ghana, the nearly half of the (3.7million) of an estimated 7.7 million of Reproductive age do not have health insurance, thus making the service unaffordable and inaccessible, despite its enrolment on the NHIS. This they say is a cause for concern.

The organisation which has been present in Ghana since 1967 further laments the inequitable healthcare facilities across the country, putting women especially, those in rural areas at a disadvantaged position, thus delaying Governments Goal to realising “Zero Tolerance for Maternal deaths and disabilities” by the year 2030.

So, one would ask, what can be done to erase negativities surrounding family planning from our society?

Many campaigns have been done espousing the benefits of spacing one’s pregnancies by way of birth control methods such as the Oral Contraceptive Pills, Implants, Inter Uterine Devices (IUDs), Tubal Ligation, Injectables and Male/Female Sterilization.

Despite the education campaigns, perceptions persist of people developing some problems as consequences of using the methods. For instance, a young, recently-married lady named Esi was discouraged by her female friend from having an implant fixed on left her upper arm with the reason that it would cause obesity and infertility.

She had the intent to space her birth for a year and half to give ample time to take her of her first child and prepare herself properly for a second pregnancy. She later regretted getting pregnant again nine months after having the first child because she was not ready.

Afraid and feeling guilty to opt for an abortion, she eventually gave birth and lost her job of one and a half years. Desperate and stressed after many months, she decided to ignore the friend’s advice and sought help at the clinic and was able to choose what suited her body with assistance from the health workers present. She swore never to follow such advice from her friend after finding a new job.

Another sexually active single woman, Dede, was reported to have developed liver cancer after frequently using emergency contraceptive pills over a long time.
The real-life stories painted above reflected the fears so many women have about some of these contraceptive methods.

This area is what should be given the utmost priority by the Ghana Health Service, Marie Stopes, Planned Parenthood, public and private family-planning clinics in their education campaigns and when client solicit their services.

At this point, more intensive engagements with Traditional Leaders, Community Opinion Leaders, families, religious bodies such as the Christian Council, Ghana Pentecostal and Charismatic Council, Catholic Bishop Conference, Ghana Muslim Mission etc should be intensified to educate their members on the need to space births, take personalised, non-compromised and non-interfered decisions concerning child bearing and what they stand to gain.

Above all the Mass media should complement Government efforts via programmes that engage resource persons, experts and stakeholders in the field to educate the masses.

These measures, among others, would help Government to, not only, achieve its goal of ensuring zero tolerance for maternal deaths and mortality, but fulfil the target of the United Nation’s first five Sustainable Development Goals: One, Two, three, four and five which aimed at Poverty Eradication, Zero Hunger, Good health and wellbeing, Quality Education and Gender Equality.