Mamuna Idrissu sits in the company of other female head porters (kayayei) under a makeshift structure they call home at Agbogbloshie, one of the biggest slums in the country.
It’s 6:15 pm and together with other female head porters who have migrated from the northern part of the country to the city in search for greener pastures, Mamuma counts her income for the day.
“Today, I made GH¢20,” says the 25-year-old junior high school drop-out who has to juggle between taking care of her three infants and working every day to earn a livelihood.
Mamuna states she wished she had spaced her children properly but she had no means of accessing family planning.
“I do not have money to buy the family planning products so I use to count the days but it did not work for me and I got pregnant six months after the first born and the same happened after the second born,” she adds.
Although Mamuma sends two of her children to a pre-school to enable her to work during the day, she says she is solely responsible for their upkeep, including accommodation, sanitation, feeding and clothing.
“If you don’t manage the money well you will not get anything to send home to your family. But now with my children I hardly save anything, they take everything at the end of the day,” she adds.
Dr Hilarious Asiwome Kosi Abiwu, Acting Deputy Director of Health Services, Krachi West District, discloses that many women like Mamuma want to properly space their births but cannot also afford the cost of family planning methods.
He says if family planning is made free for women like the case of Krachi West District, uptake would increase.
Explaining what happened at the Krachi District, Dr Abiwu says the area recorded its lowest family planning uptake of 26.3 percent between July and September last year, a situation which called for drastic measures.
“We realized that the women wanted the products but they could not afford it so we started providing free family planning service and the figures shot up,” he reveals.
“Between October and December, the family planning uptake had increased to 51.5 per cent and it is now 70.6 per cent in the first quarter of this year, and guest what, we had zero maternal mortality as well,” he says.
Free Family Planning
Executive Director of the National Population Council, Dr Leticia Adelaide Appiah, says family planning should be pegged at the same level as immunization to yield the needed results.
“Immunization and family planning mutually support each other in child’s survival. It’s like supporting both sides of one coin,” she mentions.
Dr Appiah adds that the country is reaping the benefits of its free immunization campaigns because government took the bold decision to ensure its citizens are protected against diseases.
She says as children are surviving, it is important for the numbers to also decrease.
“Naturally, that’s what happens. We are not having more children as we used to. The only positive thing is that the children are not dying, they are surviving. So the ecological balance is to make sure that the family planning uptake is there for the equilibrium,” she says.
Dr Appiah explains further that making family planning products free goes beyond preventing unwanted pregnancies which stands at 19 percent currently in the country.
“If the met need was there, it would even reduce the number of children we are having, then it will reduce our immunization cost, our education cost, it will reduce our health bill, it will reduce our sanitation bill and reduce the overall health burden of the country,” she observes.
Referring to the impressive results from Krachi West, Dr Appiah explains that when the financials barriers are taken away, myths and misconceptions also go with them.
“The women are telling us that they need free family planning. Look at how it went up by 70 percent. Where are all the myths that we are talking about? Where are all the social norms that we are talking about? Which means that if we educate the women and we give them free access, they will uptake,” she asserts.
Financial Commitment
In July 2016, the government of Ghana shared an update on progress in achieving its policy, financial and programme and service delivery commitments to FP2020.
According to the FP2020 progress report in 2015, the government dedicated a significant proportion of its support from the West African Health Organisation (WAHO) of about US $1 million to the purchase of FP commodities.
Officials of the Ministry of Health state that FP commodity gaps identified from the biannual forecast has always been filled by the government of Ghana.
The report stated that although the progress in purchasing FP commodities has been affected by two main invents: The Central Medical Stores fire of 2015, which burned all commodities including contraceptives, and the delay in release of MDG Acceleration Framework Funds, government has allocated US $3 million for the procurement FP commodities in the 2016-2017 MAF plans and budget.
How much of that has been spent is yet to be known.
“Ghana FP commodity funding remains constant but Ghana is not yet purchasing a larger share of FP commodities,” Dr Patrick Aboagye, Director of Family Health Division, Ghana Health Service, adds.
He says with the country becoming a lower-middle-income country, some key donors have pulled out, including the Netherlands and Denmark, while other donors significantly reduced funding leading to an overall decline in donor funding for health.
He stated that the Ministry of Health has begun a programme to look at alternative ways of generating funds locally for family planning.
Dr Appiah, however, says that it’s sad that the country would pay for deliveries and not pay for family planning.
“Because you see delivering a child, you deliver, take the person through anti-natal for nine months, you deliver the baby, you give immunizations, then we give all the services we give. Meanwhile, if the woman didn’t want that pregnancy, family planning would have prevented it. Look at the cost implications,” she highlights.
“So if we can pay for abortions, if we can pay for malnutrition, if we can pay for social services and take our children off the streets and we can’t pay for family planning, then it’s an issue,” she says.
Progress Made
The government, through collaboration with IPAS and MSI comprehensive abortion services, has been scaled up from two regions to eight out of the 10 regions since 2015.
“The government of Ghana committed to offering expanded contraceptive choices including a wider range of long acting and permanent methods. Presently, the method mix includes condoms, pills, implants, IUD’s/IUS, vasectomy and bilateral tubal ligation,” the report says.
“Implanon has been introduced with a smooth transition to Implanon NXT in 2015. Sino implant has been introduced in the private sector by MSI Ghana. Limited quantities of IUS have been re-introduced in a few centers in the country,” a portion of the document adds.
The government of Ghana committed to provide adolescent-friendly services for sexually active young people with 218 fully functional adolescent friendly corners active 54 of which were built in 2015-2016.
Furthermore, the National Health Insurance Scheme (NHIS) has announced that from May 1, 2018, health facilities will kick-start a pilot project to include family planning in its services in six selected municipalities and districts across the country for valid NHIS subscribers.
The introduction of family planning onto the scheme is in collaboration with the Ghana Health Service as part of efforts to reduce maternal and infant mortality, unwanted pregnancies and abortion among the youth, which mostly led to school dropouts and health complications.
Madam Stella Adu-Amankwah, the Deputy Director of Corporate Affairs, National Health Insurance Authority (NHIA), says the NHIS is always looking at opportunities to meet your needs, especially the poor and vulnerable, and that is why it covers about 95 percent of disease conditions in the country,” she says.
The communities for the pilot are Nabdam, Bawku West and the Bolgatanga Municipal in the Upper East Region, Obuasi Municipal in the Ashanti Region, Adaklu-Anyigbe District in the Volta Region and Mankessim in the Central Region.
Thus, as the country slowly takes the necessary steps to ensure family planning is accessible to all free of charge, women like Mamuna will have to keep hope that the free family planning will be introduced in Grater Accra Region, specifically in her area soon.
By Jamila Akweley Okertchiri