Improving Family Planning Service Delivery to Adolescents in Ghana: Evidence from Rural Communities in Central Ghana

This working paper shares findings of a study to identify the family planning (FP) needs of the adolescent populace of Ghana in the Kintampo North Municipality and the Kintampo South district and to define the best approach to satisfying their needs. The survey was conducted based on information collected from the Kintampo Health and Demographic Surveillance System, as well as a structured questionnaire consisting of closed-ended questions was administered to adolescents in the study area. Study respondents during the qualitative arm had suggestions on how best to address FP needs of adolescents, including educating the community, young people, and their service providers on the benefits of and how to access FP services. Overall, the study found that adolescents face many challenges when it comes to accessing FP information and services.

Among other findings, the survey found that knowledge of any method and modern methods of contraception was the same across age ranges and marital status - girls and women, being more knowledgeable (87.7%) than their male compatriots (82.0%). Both genders had less knowledge of traditional methods; younger adolescents had less knowledge of all forms of contraception. Adolescents in relationships had higher levels of knowledge than those not sexually active, and those recently sexually active had the highest level of knowledge among the study participants. However, the majority of adolescent girls and women (41.1%) used no FP method at their last sexual encounter, followed by the male condom (20.9%), the rhythm method (16.6%), and the birth control pill (13.8%). Male adolescents used the male condom (65.1%), but 25.1% used no method. The future FP method of choice for most females was the injectable (35.2%), followed by the pill (20.6%), male sterilisation (9.9%), no intention to use any FP method (19.4%), and the male condom (5.9%) occupying fifth place in order of preference. Other less favoured preferences were the intrauterine device (IUD) (2.0%), female condom (0.8%), diaphragm (0.8%), and the contraceptive foam or gel (0.4%).

Media information sources on FP were ranked as: radio (29.1% for females and 29.6% for males); television (19.9% females and 15.4% males); socialising (19.1% females and 10.7% males); and reading from posters (10.2% females and 10.5% males). "For females, magazines were the least popular source of information (3.8%) followed by shops (7.1%); whereas for men, shops (3.9%) were the least informative, followed by magazines (4.2%). In the context of this paper, socializing for females was taking part in such activities as fetching water from outside a compound, going to farm or market, or visiting the hairdresser or the seamstress. Socializing for males included playing indoor games such as draught, ludo, or oware; or visiting alcohol drinking spots in the community."

Most adolescents spoke favourably of the importance of access to FP information, while a few groups thought it might lead to promiscuity. Those seeking access stated that many obstacles include "poor attitudes and discrimination from healthcare providers, the community seeing adolescents practicing FP as ‘spoilt’, the perception that FP could corrupt the young population, concerns about healthcare worker approaches to care delivery, and perceived complications of FP." Suggestions on how best to address FP needs of adolescents included "educating the community on how to access FP services, the need for commitment to FP programmes from state institutions, revamping traditional norms preventing teenage pregnancy, religious leaders and parental involvement, encouraging healthcare provider attitudinal change, and providing information to adolescents about the various FP methods and their limitations."

"Stakeholders in the provision of FP services to adolescents made the following recommendations:

• Healthcare providers: There is the need for a change in attitudes and practice towards adolescents. Providers require education on the needs of adolescents and how to best approach delivery of care to them.
• Community: The community requires a change of attitude towards FP services to adolescents in seeing it not only as a program for the married. Community opinion leaders, religious leaders, chiefs, and elders should be at the forefront of educational programs to change public perceptions. These leaders should facilitate programs leading to the reinstatement of traditional customs that discourage teenage pregnancies.
• Healthcare policy makers: Consideration should be given to education of adolescents and the community as a whole about FP services, their availability and accessibility. There should also be education to de-stigmatize FP care to adolescents and provide information on its benefits. There should be a focus on educating healthcare workers about their responsibility to adolescents and put in mechanisms to ensure that they provide the appropriate services to their charges. For effective implementation of FP programs to adolescents, the necessary resources should be availed to program implementers.
• Political leadership policy makers: Study respondents wish for legislation supporting FP services to adolescents and showing commitment to FP by providing resources to enhance care delivery.
• Healthcare providers: Expand the provision of FP care to adolescents in the community as findings show the risk of pregnancy among them is higher compared to the national figures. Make accessible to adolescents varied forms of FP methods. Enhance education to younger adolescents on FP methods and their benefits and limitations, so they can make informed choices based on their needs. Program implementers should continue information dissemination on FP via electronic media outlets targeting adolescent populations.
• The research community: This study has shown a higher level of marriage, pregnancy, and delivery among adolescents in the study communities than the national average, as presented in the 2008 GDHS [Ghana Demographic and Health Survey]. Such focused studies in other communities should be engaged in focusing on adolescents to identify their situation and to implement a research into the claim that FP use by adolescents leads to promiscuity to address this concern."