The School of Public Health of the University of Ghana has released findings of a recent research on preferences for contraceptive delivery models in Ghana’s informal settlements.

The research is aimed at enhancing achieving universal access to family planning. Specifically,  help to identify low-cost and acceptable interventions/ models for delivering quality family planning and contraceptive services to slum dwellers in Accra.

The research which was led by John K. Ganle of the School of Public Health of the University of Ghana, Leonard Baatiema, Samuel Dery, and Augustine Ankomah was funded by a fellowship from the International Union for the Scientific Study of Population (IUSSP) as part of Bill & Melinda Gates Foundation Grant OPP1179495 aimed at supporting research and policy engagement on fertility and family planning in urban development.

Dr. Ganle in a presentation on the study on June 29, 2023, explained that there is high fertility in urban slums in Accra which could increase population growth, expand demand for urban and municipal services, and increase environment population.

He however called on government and donor agencies to increase supply of free or subsidised family planning (FP) or contraceptive commodities and services to public health facilities especially in urban slums in Ghana.

Key findings

Awareness about contraception among women in informal settlements was high

Awareness about contraception in informal settlements was 86%. This is relatively lower than the nearly 99% awareness level in the general population in Ghana. Despite the relatively high awareness rate, only 19.6% of women in slums are currently using modern contraception. This rate is far lower than the nearly 30% reported in the general population in Ghana.

Long-acting methods were the least used methods.

Majority of the women (78.4%) in slums who ever used a contraception used an emergency contraceptive pill (i.e. postinor-2, Lydia post pill, NorLevo, and pregnon). Long-acting methods were the least used methods. The dominant source of emergency contraceptive pills was over-the-counter medicine sellers.

Many women in informal settlements preferred government/donor provided free/subsidized services in public health facilities.

As regards preference, majority of women in informal settlements (57%) preferred government/donors supplying free/subsidized FP/ contraceptive commodities and services in public health facilities (figure 2).

Many of the women said they preferred government/donor-provided free/subsidized services in public health facilities because public health facilities will be relatively easy to access. Others said government/donor-subsidized products will likely reduce the cost of FP and contraceptives.

While many women said service quality was poor in the public sector, they preferred public sector provision because of time and cost constraints they face in their everyday lives. For those who preferred donors supplying free/ subsidized branded products/services in private health facilities, and private/commercial sector product/services in private facilities, perceived service quality, professionalism, and contraceptive commodity security were their topmost reasons.

Recommendations

The Ministry of Health and Ghana Health Service should improve the quality of FP and contraceptive services provided in public health facilities to take advantage of the relative ease of geographical accessibility and cheaper cost that the public sector currently enjoys compared to the private sector.

The Ministry of Health and Ghana Health Services should collaborate with the private sector to reduce the cost of FP and contraceptive services offered by private providers in urban slums. This could include persuading private providers to enroll under the National Health Insurance Scheme. This will reduce the high out-of-pocket payment women in informal settlement face when accessing services from private providers.

Call to action

The government of Ghana and donor agencies must increase the supply of free or subsidized FP and contraceptive commodities and services to public health facilities especially in urban slums in Ghana.

The Ministry of Health and Ghana Health Service must also take deliberate steps to support and strengthen the private sector to reduce the cost of FP/contraceptive commodities and services in informal settlements to benefit from its perceived reputation as provider of quality service without undermining existing public sector structures.

Background

Globally, an estimated 2 billion people will live in urban slums by 2030, and more than two-thirds of this population will reside in low-middle-income countries. The UN defines slums as areas with high population density, which lack one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living area, housing durability, and security of tenure. In Ghana, an estimated 37.9% (5.3 million) of urban dwellers lived in informal settlements (slums) in 2014.