CHAPTER ONE

                                                       INTRODUCTION

1.1 BACKGROUND INFORMATION

In the early days, human societies had creation of as many children as possible, a central value. Today however, relatively few societies can afford this perspective, resulting in increased attempts to limit and manage the birth rate of their families of which Ghana is no exception.

The negative effect of high fertility rate on women and their children, and the benefits of fertility control are well known. Too many or too closely spaced pregnancies, and pregnancies of a woman at too young or too old an age, give rise to health risks for mothers and the infant, with associated higher maternal and neonatal mortality rates. The health of other children in the family is also affected. These factors, among others provide health rationale for fertility regulation and family planning, which is now considered an essential element of preventive health care. The benefits from fertility regulation relate to the broader issue of the status of women. The ability of a woman to control her own fertility is one of her basic and important rights. It is presumed that a better regulated sexuality and fertility affects the status of the women socially and economically. This is perceived to be reflected in their educational, health, and economic status coupled with independence to take decisions on their role and be responsible for the total well-being.

Even though, trends of increase in contraceptive use have been acknowledged widely (RAND, 1998; Ann et. al, 2002), currently an estimated 650 million or 62 percent of the more than one billion married or in-union women in reproductive age are using contraceptives (RAND, 1998). Whereas in the developed nations, 70 percent of married women use contraceptive only 60 percent can be attributed in developing nations.

The situation in Africa is as low as 25 percent, the lowest among developing regions in the world (RAND, 1998; UNFPA, 2001). In West Africa, about 36 percent of women are using contraceptives and this rate varies from a low percentage of 22 percent in Mali, 26 percent in Togo, 32 percent in Burkina Faso, and 33 percent in Ghana (Dona et. al., 2008, UNDP, 2008).

In Ghana, a country with multiple ethnic sets and religious groupings, efforts made by the Ministry of Health (MOH) and other agencies on the use of contraceptives have resulted in a general increase over the last two decades (Duodo et.al., 1998, Ann et al 2002, UNDP, 2008). There has also been a drop in fertility rate from 6.4 percent in the 1970s to 4.4 percent in 2005 (Duodu et.al., 1998, UNDP, 2008). Currently, a national contraceptive use of 33 per cent has been estimated even though 43 percent of married women in the country desire to space their children and an additional 24 percent need to limit births. The disparity of use of family planning methods among the urban and rural, and rich and poor puts many women in most deprived settings at a disadvantage (GSS, 2003).

Offinso District in Ashanti region of Ghana implements and adheres to the policies and programme interventions of the MOH and other agencies in relation to increasing access to reproductive health services including family planning. These policies and programmes reflect in the Information Education and Communication strategies coupled with service counseling and outreach programmes that are instituted in the district. The district, largely rural and served predominantly by a Catholic Hospital, has consistently recorded low contraceptive rates in the region. The obvious consequences of the low use of contraceptives in the district on the social and economic development of the inhabitant especially mothers and children are of major concern.

STATEMENT OF PROBLEM

The problems of unmet need of family planning for the less developed nations is considered as a major impediment to the development of its people, especially the vulnerable groups including women and children. The multiplicity of factors and the complex nature of the environments of developing nations, regarding access, influences decision on health services, and contraceptive measures for that matter, even though extensively examined by many scholars, have still not been subdued.

Even though the trends of family planning indicators, total fertility rate and contraceptive use in Ghana have been improving, there is a challenge of increasing access to many women who desire to limit or space births. The non-use of contraceptives by these women, has a commensurate effect on their total well-being and that of their children. The increase in maternal mortality rate from 210/100,000 live births in the 1990’s to a projected 560 in 2005 (UNDP, 2008) is an indication of the consequence of complication resulting in pregnancies usually unplanned and unintended. In addition, risk of Human Immune Virus (HIV) and Sexually Transmitted Infections (S T I) abound. This trend is even higher in rural areas where there is largely limited access to quality care.

Offinso District has consistently been one of the lowest in terms of contraceptive use in Ashanti Region. The district, predominantly rural, recorded below a regional average of 24.9 percent (Ashanti Regional Health Report 2007) even though the trend from 2004 shows an increase as indicated in the graph below.

Figure 1:Achievement on Contraceptive Acceptance rate, Offinso District,

2004

2006

     

(%)

2 0

1 5 .8

1 7 .9

Ed

1 8

1 6

Achiev

1 4

1 2

7 .6

1 0

Percentage

8

6

4

2

0

2 0 0 4

2 0 0 5

2 0 0 6

years

Source: Offinso DHMT Annual Performance Review 2004-2006

Despite the consistently low achievement on family planning acceptance rate in the district, there has not been any investigation as to the related causes of the trend. The district has never achieved its own target of 24 percent of prospective users in the district over the period. This study therefore sought to examine the extent to which prospective users of contraceptives in the districts, perceived and were influenced by contextual factors that could account for the poor response to services on family planning.

1.3 Rationale of the study

Unplanned and unintended pregnancies account to a large extent the poor state of health of women and children in most developing nations. The choice of women to control their own health and that of their children is challenged by Social and environmental factors that mitigate their ability to decide independently and freely on their reproductive and sexual choices. There are still unanswered questions based on local settings that have not been revealed and still worsens the situation of these vulnerable groups with regard to decision and choices to make in controlling child birth.

This study was conducted to provide local and contextual expressions by deprived women that could be incorporated locally into the design, administration and implementation of contraceptive programs in districts in Nigeria and other rural

factors and knowledge about family planning. These factors have intertwined and interrelated to the use of contraceptive.

Conceptual Framework

Maternal and Infant Mortality

Maternal and Infant Morbidity