Ghana - Counting What Counts: Tracking Access to Emergency Contraception
Publication date: 2013
September 2013 Policies support the use of Emergency Contraception (EC) in Ghana. Ghana has a comprehensive family planning program and EC is available in the public sector and at pharmacies without a prescription. International donors have procured EC for distribution in the private and public sector. However, women’s knowledge of EC in Ghana is low. ABOUT GHANA Ghana has a population of 25,199,609, of which 12,762,573 are women.1 The population is evenly divided between urban and rural areas (51.9% and 48.1%, respectively)1, and 28.5% of the popula- tion lives in poverty.2 In 1969 Ghana became one of the first countries in Sub-Saharan Africa to adopt a national family planning policy and the current government continues to support access to family planning methods.3 CONTRACEPTIVE AND EC KNOWLEDGE & USE POLICIES Essential Drug List: Levonorgestrel 1.5 mg pills specified for EC use appear on the 2010 Essential Drug List.5 National norms and guidelines: EC was intro- duced into the National Family Planning Program in 1996.6 Prescription status: EC can be purchased in most pharmacies without a prescription and can be obtained at government-run family planning clinics throughout the country.7 Post-rape care: Ghana does not have national policies or protocols to guide post-rape care. PRODUCT AVAILABLITY Registered products: There are three dedi- cated EC products registered and marketed in Ghana: NorLevo (HRA Pharma), Postinor-2 (Gedeon Richter), and Pregnon (FamyCare).7 Locally manufactured products: None. Poor quality or counterfeit EC products: While not specific to EC, there have been reports that counterfeit drugs are prevalent in Ghana.8 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: Pharmacists in Ghana are allowed to sell dedicated EC products directly to women.7 EC in the public sector: EC is available in the public sector at government-run health clinics.7 Gh an a GHANA COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION IN GHANA • Total fertility rate: 4.0 children per woman (4.9 rural, 3.1 urban) • Unmet need for family planning (among married women): 35.3% • Current contraceptive modern method use (among all women): 13.5% • Between 1998 and 2008 the overall contraceptive prevalence rate of currently married women rose only slightly, from 22% to 24%. Source: Demographic and Health Surveys, Ghana 2008.4 KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 20 40 60 80 100 ECAny Modern Method Knowledge Ever Use % o f A ll W om en Type of Contraception 97.7 42.3 35.4 2.9 Source: Demographic and Health Surveys, Ghana 2008.4 Gh an a 2 EC in the NGO, social marketing and social fran- chising sectors: Although social marketing firms in Ghana provide reproductive health services and products, including oral contraceptives,9 none are known to provide EC.10 Community-based distribution of EC: In 1999, the Ghana Health Service instituted a commu- nity-based service delivery program called the Community-based Health Planning and Services (CHPS) Initiative.11 Community Health Officers provide family planning services in CHPS zones but it is unclear if EC is included as part of these services. PROVIDERS In a study assessing knowledge of EC pub- lished in 2011, researchers found providers in the urban areas of Kumasi could give 4.1 correct answers out of 11 questions assessing theoreti- cal knowledge of EC, and 5.6 correct answers out of 8 questions assessing practical ability to provide EC.12 MEDIA COVERAGE OF EC Over 80% of women in Ghana have exposure to the mass media at least once a week.4 In the past, there has been a small amount of media covering EC. DONOR SUPPORT Three donors have purchased EC for Ghana between 2000 and 2011. IPPF made shipments in 2003 (1,550 units), 2004 (13,450 units), 2010 (10,000 units), and 2011 (3,360 units). UNFPA made shipments in 2008 (5,000 units) and 2009 (90,740 units). The World Bank made shipments in 2005 (40,000 units) and 2008 (41,880 units).13 REFERENCES 1 The World Factbook: Africa: Ghana. Retrieved April 10, 2013 from https://www.cia.gov/library/publications/the- world-factbook/geos/gh.html. 2 The World Bank. Ghana World Development Indicators. Retrieved July 19, 2013 from http://data.worldbank.org/ country/ghana. 3 Gyimah S, Adjei J, Coffie N. Ghana’s Family Planning Policy. Think Africa Press, October 2011. http://thinkafri- capress.com/ghana/family-planning-policy. 4 Demographic and Health Survey, Ghana 2008. Ghana Statistical Service, Ghana Health Service, and ICF Macro, 2009. http://www.measuredhs.com/publications/publica- tion-FR221-DHS-Final-Reports.cfm. 5 Ghana Essential Medicines List: Sixth Edition 2010. Ministry of Health Ghana National Drugs Programme, Accra, Ghana, 2010. http://www.who.int/selection_medi- cines/country_lists/en/index.html#G. 6 Williams, K. Provider-related barriers to accessing emergency contraception in developing countries: A literature review. Washington, DC: Population Council, 2011. http://www.popcouncil.org/pdfs/2011RH_ECBar- riersLitReview.pdf. 7 ICEC Status and Availability Database. Retrieved April 10, 2013 from http://www.cecinfo.org/country-by- country-information/status-availability-database/coun- tries/ghana/. 8 Harris J, Stevens P, and Morris J. Keeping it Real: Combating the Spread of Fake Drugs in Poor Countries. International Policy Network, 2009. 9 Schlein K. and Montagu D. Clinical Social Franchising Compendium: An Annual Survey of Programs, 2012. San Francisco: The Global Health Group, Global Health Sciences, University of California, San Francisco, 2012. 10 DKT International. 2012 Contraceptive Social Market- ing Statistics. Washington, DC. June 2013. http://www. dktinternational.org/wp-content/uploads/2011/11/2012- Contraceptive-Marketing-Statistics.pdf. 11 Nyonator F, et al. The Ghana Community-based Health Planning and Services Initiative: Fostering Evidence- based Change and Development in a Resource-con strained Setting. The Population Council. Retrieved July 19, 2013 from http://www.popcouncil.org/pdfs/wp/180.pdf. 12 Creanga, AA, et al. Knowledge about emergency contraception among family-planning providers in urban Ghana. International Journal of Gynecology and Obstet- rics 114 (2011) 64–68. 13 RH Access – Ghana Summary of Shipments. Retrieved April 10, 2013 from http://www.myaccessrh. org/rhi-home?p_p_id=rhiuserportlet_WAR_ rhiportlet&p_p_lifecycle=1&p_p_state=normal&p_p_ mode=view&p_p_col_id=column-1&p_p_col_count=1&_ rhiuserportlet_WAR_rhiportlet__spage=%2Fhomerun.do. This fact sheet has been prepared by the International Consortium for Emergency Contraception and represents the best information we have been able to gather. We welcome your input for future revisions. Please contact us at email@example.com. Visit our website at www.emergencycontraception.org for more information on EC.