Unplanned pregnancies, including teenage pregnancy, perpetuated by low demand for, and lack of access to family planning are linked with higher risks of birth complications such as maternal deaths and early child deaths, and malnutrition in children under-five.
2. Background
• High fertility rates leads to undesirable economic outcomes:
- high maternal mortality and morbidity
- high child mortality and morbidity
- high dependency ratio, reducing national savings
- lower labour force participation by women.
- lower investment in (existing) children, reducing quality of labour
• These affect productivity by reducing the quality of the labour force,
reduces per capita income and therefore reduces national savings
rates and investment (Karra et al., 2017).
3. Background …
• Despite the huge success in reducing fertility rate in Ghana from 4.83 in
2000 to 3.9 in 2018, the fertility rate is still high (WB, 2020).
• Total fertility rate in Ghana is 3.93 births per woman for all women of
reproductive age (WB, 2020).
- Higher than the global average of 2.4 per woman in 2017 (WB, 2020).
- Also higher than the replacement fertility rate of 2.1 at which a
population replaces itself, assuming no migration (WB, 2020).
• The question then is how do we reduce the high fertility rate in Ghana?
- FAMILY PLANNING - CONTRACEPTION
4. Background…
• In 2015, Ghana mounted a FP program, with the objective of increasing the
contraceptive prevalence rate (CPR) of
- married women from 22.2 to 29.7 percent,
- unmarried women from 31.7 to 40 percent by 2020 (GFPCIP, 2015).
• The program has been quite successful achieving the CPR of
- 30.8 percent for married women (22.2 in 2014 before the program) and
- 38.4 percent for unmarried women (31.7 in 2014 (GMHS, 2017).
- These represent an annual average increase in CPR by
2.9 percentage points for married and
2.2 percentage points for the unmarried.
5. Background …
• Despite the success in the program, there still remain a significant
percentage of women (~30%) with an unmet need for family planning
(DHS, 2014, MICS 2017/18).
• There is also the high teenage birth rate suspected to be due to the limited
education and unavailability of family planning commodities to adolescents.
- The adolescent birth rate in Ghana, it is 75 (MICS 2017/18). This is
higher than the global average.
- According to UNICEF, In 2018, the estimated adolescent birth rate
globally was 44 births per 1,000 girls aged 15 to 19.
6. Background …
- Children of teen mothers risk high morbidity and mortality; teen mothers are
more likely to have adverse pregnancy outcomes, less likely to continue with
education, and thus pushing them (and their children) into poverty.
• Even though sexual and reproductive health education forms part of the curriculum
in Ghana, (Awusabo-Asare, 2017),
- about 77% of adolescents are exposed to SRHE
- the coverage of topics is, however, minimal, and drop out rates are
considerable for Junior (40%) and Senior (20%) High schools.
- Adequate comprehensive sex education is needed for adolescents to have a
good understanding of their reproductive health and to also know appropriate
adaptive behavior to maintain adequate sexual and reproductive health.
7. Interventions:
• Intervention One: we make a case for an extension of the current
programme (post 2020) by 5 years demonstrating that the economic
and health benefits far exceed the costs of the programme.
• Intervention Two: demonstrates that compulsory, comprehensive, and
universal sexual reproductive health education (SRHE), as well as the
provision of contraceptives, is also a beneficial intervention.
9. Intervention One: Description
• An extension of the current program (Phase 2: five-year program targeting)
- 5 year program with a target of increasing the CPR from 29.7% to 40% for
married women and
- 6 year program with the target of increasing the CPR from 38% to 50% for
unmarried women.
• This requires increasing by approximately,
- 10 pp for married women; and
- 12 pp for unmarried women from the current rates.
• We use 2% annual increase in the contraceptive prevalence rate (CPR) based on
the past performance of the Government of Ghana.
10. Costs for married women are GHS 988m over 5
program years + 1 extra year of commodity usage
Notes
- Activity cost GHS 27 per woman
targeted (Demand creation and service
delivery)
- FP commodities and direct
consumables is GHS 18 per actual user
as computed in GFPCIP (2015)
- Indirect costs of FP (transport costs and
OC of time) is GHS101 per user.
- Cost of side effects is GHS101 per user
(9 to 11% of users of pills or injectables
experienced side effects according
GHDS, 2017).
0
50
100
150
200
250
300
350
2020 2021 2022 2023 2024 2025
Ghana
cedi
Millions
Costs of intervention - married women
Side effects
Direct costs of commodities
Indirect costs (transport, time)
Activity costs (fixed cost per woman targetted)
11. Benefits are numerous but the largest by far is the demographic
dividend impact
Benefits = 81,000 avoided pregnancies by year 5
1. Demographic dividend – increase in
experienced GDP per capita due to:
- Increase in women participating in labour force
- Increased intensity of investment for remaining
children
- Short term mechanical gain in GDP per capita due to
lower population
- Total benefit = 3.5% boost to GDP per capita in 20
years
2. Health benefits
- 505 avoided maternal deaths due to fewer births
- 939 avoided newborn deaths due to better birth spacing
- Avoided health care costs (abortions, births)
Health
benefits
3%
GHS
1bn
Benefits
Demographic
dividend 97%
GHS 32bn
12. Costs for unmarried women are GHS 1013m over 6
program years + 2 extra years of commodity usage
Notes
- Activity cost GHS 27 per woman
targeted (Demand creation and service
delivery)
- FP commodities and direct
consumables is GHS 18 per actual user
as computed in GFPCIP (2015)
- Indirect costs of FP (transport costs and
OC of time) is GHS101 per user.
- Cost of side effects is GHS101 per user
(9 to 11% of users of pills or injectables
experienced side effects according
GHDS, 2017).
0
50
100
150
200
250
300
2020 2021 2022 2023 2024 2025 2026 2027
Ghana
cedi
Millions
Costs of intervention - unmarried women
Activity costs (fixed cost per woman targetted) Indirect costs (transport, time)
Direct costs of commodities Side effects
13. As with married women, largest impact is demographic dividend
Benefits = 71,600 avoided births by year 6
1. Demographic dividend – increase in
experienced GDP per capita due to:
- Increase in women participating in labour force
- Increased intensity of investment for remaining
children
- Short term mechanical gain in GDP per capita due to
lower population
- Total benefit = 3.1% boost to GDP per capita in 20
years
2. Health benefits
- 407 avoided maternal deaths due to fewer births
- 756 avoided newborn deaths due to better birth spacing
- Avoided health care costs (abortions, births)
Health
benefits
3%
GHS
797m
Benefits
Demographic
dividend 97%
GHS 29bn
14. Benefit Costs ratio for Intervention One
• The BCR for unmarried women is slightly lower than that of the married
women due to need to use contraception for longer to achieve similar
benefit (married women more at risk of pregnancy)
16. Adolescent sexual and reproductive health education
• Adolescent sexual and reproductive health education has three
components:
- Universal compulsory sexual and reproductive health education (SRHE)
for both boys and girls, 15-19 years;
- (re) training School-Based health coordinators;
- provision of male contraceptives
• Expected impact
- 10,137 avoided pregnancies in JHS and 4,479 avoided pregnancies in SHS
-> assume all would otherwise stay in school if did not fall pregnant
17. Costs of intervention for one cohort are 127m
Notes
i. Curriculum adaptation, retraining and delivery: the
cost per student is $8.73 (GFPCIP, 2015).
ii. Cost of FP commodities is $3.74 per student
(GFCPCIP , 2015).
iii. Cost of additional years of schooling: Total direct
and indirect cost is GHS 1184 per student per year
(R4D, 2015).
iv. Opportunity cost of schooling: The opportunity
cost of school is work so we used the national child
labour rate of 30% as the estimate of the number
of dropouts who would be able to secure
employment, with the mean wage of GHS5119 per
year (Turkson et al, 2019).
v. Recurrent costs were assumed to be 10% of annual
programme costs
-
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
2020 2021 2022 2023 2024 2025 2026
Ghana
Cedi
Cost of intervention
Recurrent cost
Opportunity cost of additional
school
Direct cost of additional school
years
Cost of FP commodities
Total cost of curriculum
adaptation, (re)training, delivery
JHS SHS
18. Benefits of intervention are 285m
Benefits = 10,137 avoided births in JHS; 4,479
births in SHS
1. Increased schooling – greater productivity and
income in future
- GHS 666 increase in annual future earnings for JHS
completion; GHS896 for SHS completion
2. Health benefits
- 9 avoided maternal deaths due to fewer births
- 118 avoided newborn deaths due to better birth spacing
- Avoided health care costs (abortions, births, fistula) Income
benefit
Health
benefit
0
50
100
150
200
250
300
Ghana
Cedi
Benefits of intervention
20. References
• Ashraf, Q. H., Weil, D. N., & Wilde, J. (2013). The Effect of Fertility Reduction on Economic
Growth. Population and development review, 39(1), 97–130. https://doi.org/10.1111/j.1728-
4457.2013.00575.x
• Awusabo-Asare K et al., From Paper to Practice: Sexuality Education Policies and Their
Implementation in Ghana, New York: Guttmacher Institute, 2017,
https://www.guttmacher.org/report/ sexuality-education-ghana.
• Turkson E, Wong B, Twumasi-Baffour P, 2020, Earnings by School Completion in Ghana: A
Quantile Estimation, Ghana Priorities
• Karra, M., Canning, D., aand J. Wilde (2017). The Effect of Fertility Decline on Economic
Growth in Africa: A microsimulation model. Population and Development Review, vol, 43. Iss.
S1. https://onlinelibrary.wiley.com/doi/full/10.1111/padr.12009
• World Bank, World Development Indicators (2020).
• Government of Ghana. 2015. Ghana Family Planning Costed Implementation Plan (GFPCIP),
Accra: Ghana Health Service. 2015. Washington, DC: Futures Group, Health Policy Project.
