1. Improving Family Planning Service Delivery to Adolescents in
Ghana: Evidence from Rural Communities in Central Ghana
Yeetey Enuameh
Ernest Nettey
Charles Zandoh
Charlotte Tawiah
Abubakari Sulemana
Ellen Boamah
Alex Manu
Janine Barden-O’Fallon
Seth Owusu-Agyei
The Sexual and Reproductive Health Team of the Kintampo Health Research Centre, Kintampo, Ghana
EPC 2012, June 15, 2012
1

2. Presentation format
 Introduction
 Study objectives
 Study methods
 Study results and discussion
 Conclusions
 Recommendations
 Acknowledgment
2

3. INTRODUCTION
3

4. Kintampo Health and Demographic Surveillance
System (KHDSS)
 Geographically in Central Ghana
 Began operations in 2003
 Longitudinal data collection every 4 months
 Covers 32,329 households in 22,537 compounds with a population
of 136,356 individuals
 Team of dedicated demographers, epidemiologists, biostatisticians
and others
Source: 2010 Annual Report of the Kintampo Health Centre, Kintampo, Ghana
4

5. Map of area of coverage of KHDSS
5

6. Adolescents
 1/5th of Ghana & study population- 21.9% & 20.2%
 Pregnancy rates
 Ghana- 14% in 2000, 12% in 2007
 Brong-Ahafo- 14.5% in 2000, 13.4% in 2007
 3% births by adolescents in KHDSS area
 Knowledge of at least one contraceptive
 Females- 19.5%
 Males- 14.7%
Sources: Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. 2009. Ghana Demographic and Health Survey 2008. Accra, Ghana: GSS,
GHS, and ICF Macro.
2010 Annual Report of the Kintampo Health Research Centre, Kintampo, Ghana
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7. OBJECTIVES
7

8. Study objectives
 Overall objective
 To identify the FP needs of the adolescent populace in two administrative districts of
central Ghana and to define the best approach to satisfying their needs
 Specific objectives
 What are the FP needs of adolescents?
 Do adolescents view FP as important to their health and well-being?
 What are (a) societal and (b) health care provider perspectives on FP care delivery to
adolescents?
 What are the views of (a) adolescents, (b) society and (c) health care providers as to
how best to address their family planning needs?
8

9. METHODS
9

10. Study Methods
 Study design: Cross- sectional
 Approach: Mixed-methods (quantitative and qualitative)
 Data collection: Multi-informant sources (adolescents, community
representatives, healthcare providers)
 Ethical review: Approval by the KHRC ethical review committee (ERC)
10

11. Sampling
 Quantitative arm
 Sampling aim- to cover males and females aged 10 – 19 in the study
population
 Random sampling
 Sample size: 2641 adolescents
 1805 Females and 836 Males
 Qualitative arm
 Sampling adolescents, healthcare providers, community representatives
 Purposive sampling
11

12. STUDY RESULTS AND DISCUSSIONS
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13. Study Sample and Current Educational Attainment
Study Sample
2,128 out of 2,641 (80.6%) responses included in analysis consisting of
1,415 females (66.5%) and 713 males (33.5%)
Current Educational Attainment of Respondents
Female % (n = 1,415) Male % (n = 713)
No Education 15.5 (219) 22.6 (161)
Primary Education 59.6 (844) 65.6 (468)
JHS and Higher 23.7 (336) 10.8 (77)
No Response 1.1 (16) 1.0 (7)
13

14. Marital Status
Female % (n = 1,415) Male % (n = 713)
Married 1.6 (22) 0.4 (3)
Living together 12.1 (171) 2.4 (17)
Divorced 0.2 (3) 0.1 (1)
Separated 1.4 (20) 0.1 (1)
Never married 83.4 (1180) 96.6 (689)
No response 1.3 (19) 0.3 (2)
14

15. Age at First Sex/ Sexual Debut
Age (years) Female % (n = 389) Male % (n = 65)
9 0.3 (1) 3.1 (2)
10 0.3 (1) 7.7 (5)
11 0 (0) 3.1 (2)
12 1.8 (7) 9.2 (6)
13 5.4 (21) 1.5 (1)
14 10.5 (41) 4.6 (3)
15 25.4 (99) 13.8 (9)
16 26.4 (104) 18.5 (12)
17 18.5 (72) 23.1 (15)
18 8.7 (34) 13.8 (9)
19 2.3 (9) 1.5 (1)
Median Age 16 years 16 years
15

16. Age at First Birth
Age (years) Female % (n = 112) Male % (n = 4)
9 0.0 (0) 0.0 (0)
10 0.0 (0) 0.0 (0)
11 0.0 (0) 0.0 (0)
12 1.8 (2) 0.0 (0)
13 1.8 (2) 0.0 (0)
14 3.6 (4) 0.0 (0)
15 8.9 (10) 0.0 (0)
16 21.4 (24) 25.0 (1)
17 22.3 (25) 0.0 (0)
18 23.2 (26) 50.0 (2)
19 17.0 (19) 25.0 (1)
Median Age 17 years 16 years
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17. Age at Marriage
Age (years) Female % (n = 221) Male % (n = 25)
9 0.0 (0) 0.0 (0)
10 0.0 (0) 0.0 (0)
11 0.0 (0) 0.0 (0)
12 1.4 (3) 0.0 (0)
13 4.5 (10) 0.0 (0)
14 6.8 (15) 4.0 (1)
15 24.0 (53) 32.0 (8)
16 28.5 (63) 24.0 (6)
17 17.2 (38) 24.0 (6)
18 14.5 (32) 16.0 (4)
19 3.2 (7) 0.0 (0)
Median Age 17 years 16 years
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18. Pregnancy and birth rates
Females % Males %
Ever been pregnant n= Ever given birth n= 224 Ever impregnated n= Ever fathered n= 8
171 22
10 – 14 years 0.5 0.5 0.7 0.0
15 – 19 years 16.7 11.0 2.8 1.4
10 – 19 years 11.9 7.9 1.5 0.6
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19. Not Ready for Pregnancy so Would Accept Help for
Prevention
Percent
40
35.5
35 33.1
30
25
20 18.2
15
10 9.1
5
0
Not Ready for Pregnancy Accept help for Pregnancy Prevention
Female 10 - 19 years Male 10 - 19 years
19

20. Percent
Ever heard of FP methods
100
90 87.7
82
80
70
60
48.6
50
40 33.9
30
20
10
0
Heard of Any/ Modern Method Heard- Traditional
Female 10-19 Male 10-19
20

21. Ever used FP Methods
Percent
20
17.9
18
16
13.7
14
12 11.2
10
8
6
6 5.5
4 2.7
2
0
Used- Any Method Used-Modern Used- Traditional
Female 10-19 Male 10-19
21

22. Last, Current and Future FP use
Percent
60
53.6
50
40
30
20
10.9
9.1
10
0
Female 10-19
Current Use Use at last sex Future intention
22

23. Comparing Last Used to Preferred FP Method
Percent
45
41.1
40
35.2
35
30
25
20.6 20.9
19.8 19.4
20
15 13.8
9.9
10
5.9 6
5 3.6
2.4
0.4 0.4 0.8
0
Male The Pill Injectables Male Condom Female Condom Other Methods Used No No Response
Sterilization Method
Last FP Method Used Preferred FP Method
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24. How Adolescents Perceive FP
FP is Woman’s Responsibility
10 -14 % 15 – 19 % 10 – 19 %
Female 30.8 45.4 41.1
Male 30.3 35.6 32.4
FP Makes Women Promiscuous
Female 28.8 50.0 43.8
Male 36.1 52.1 42.5
Smaller families Succeed
Female 62.2 82.0 76.3
Male 64.8 81.3 71.4
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25. Importance of FP to Adolescents
FP Reduces unwanted pregnancies
10 -14 % 15 – 19 % 10 – 19 %
Female 39.2 74.2 64.0
Male 47.1 74.6 58.1
FP Reduces Maternal Deaths
Female 33.7 59.7 52.1
Male 42.2 66.9 52.0
FP Improves Maternal and Child Health
Female 40.4 66.1 58.6
Male 46.9 71.8 56.8
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26. Source of FP Information
Percent
35
30.1
30 29.1
25
19.9
20 19.1
15.4
15
10.7 10.2 10.5
10
7.1
5 3.8 3.8 3.9
0
Radio Television Socializing Posters Shops Magazines
Females Males
Information Source
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27. CONCLUSIONS
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28. FP Needs of Adolescents in Study
 Higher marital, pregnancy and birth rates
 Sexual debut earlier in males than females
 Less contraceptive knowledge and use in young adolescents
 Wish for help towards pregnancy prevention
 Females’ contraception preference at par with current use
 Perception that FP results in female promiscuity
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29. RECOMMENDATIONS
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30. Recommendations
 Toward practice
 Expand FP care to those at risk of pregnancy
 Educate & make accessible varied forms of FP methods
 Pursue FP information dissemination via electronic media outlets
 Towards future research
 Investigate higher marital, pregnancy and births
 Investigate change in sexual debutant's gender
 Research into perception of promiscuity with FP use
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31. Acknowledgment
 Support for the study
 The Kintampo Health Research Centre, Kintampo, Ghana
 The Measure Evaluation PRH, Chapel Hill, NC
 Support to attend conference
 The Kintampo Health Research Centre, Kintampo, Ghana
 Measure Evaluation PRH, Chapel Hill, NC
 Population Reference Bureau’s IDEA Project, Washington, DC
 Gratitude
 The citizens of the study communities
 The study team for its perseverance of purpose
 Thank you….
31

32. MEASURE Evaluation PRH is a MEASURE project funded by
the United States Agency for International Development
(USAID) through Cooperative Agreement GHA-A-00-08-00003-
00 and is implemented by the Carolina Population Center at
the University of North Carolina at Chapel Hill in partnership
with Futures Group International, Management Sciences for
Health, and Tulane University. Views expressed in this
presentation do not necessarily reflect the views of USAID or
the U.S. Government. MEASURE Evaluation PRH supports
improvements in monitoring and evaluation in population,
health and nutrition worldwide.