Mid August we had our seventh girls club meeting and we covered family planning. In the session before, we focused on HIV/AIDS and did a condom demonstration. Conversation turned to contraception thus providing me with the topic for our next meeting.
To prepare, I visited a nearby clinic and our district hospital. I particularly wanted to find out more about what is available in my district. At the clinic, I spoke with a midwife and at the district hospital, the family planning office was closed for the afternoon and no one seemed to be able to answer my questions. A few days later I travelled to Tamale to do some research on contraceptive use in Ghana and gather other statistics.
I am still figuring out how best to present to a Ghanaian audience. I am never sure if people are listening or understanding. My girls often do not look at me when I speak and when I ask if they understand, they say yes. When asked to repeat what I said, they usually cannot. I hope it is just because they are shy or afraid to make a mistake (even though I reassure them it is all ok). I have translators and they do their best but even then, as I look around I wonder how much they are absorbing. And on contraceptive use, I really want them to get it. WHO states:
-adolescent pregnancies are more likely in poor, uneducated and rural communities,
-in low and middle income countries, babies born to mothers under 20 years of age face a 50% higher risk of being still born or dying in the first few weeks versus those born to mothers aged 20-29 and
-pregnancy and childbirth complications are the second cause of death among 15-19 year olds globally.
This demographic is the Tisuŋ ni Taba girls exactly. They need to understand the value of family planning. Fortunately, various forms are available to them and at a low cost. According to the midwife I spoke to, injections (one taken every three months) is only 50 pesawas (roughly 12.5 US cents) per shot. For the pill (three cycles), it costs one GHC (about 25 US cents). The implant (three or five years), costs five GHC (around $1.25). Together, these three forms of contraception are the top three used by women in Ghana as of 2014 (WHO).
Although the trend to use such forms of contraception (to avoid unwanted pregnancies or for family planning purposes) is on the rise and is very affordable, prevalence is still low. The barriers to exponential increase in use seem to be cultural. Through speaking with girls from the club, it became apparent that although contraceptive methods are available, social norms and values affect uptake. For example…
-Once married, it is expected to procreate quickly and frequently or else face ridicule and potential abandonment by the husband. It is still common that if a married woman is not getting pregnant, society will deem it her fault. It is then acceptable for the husband to leave her and remarry. Only after several wives not becoming pregnant by the same man, is he then suspected of infertility.
-Many men prefer their partners not to use any forms of contraception because they fear it makes it easier for the woman to cheat on him.
-Also, there is fear of being seen at the clinic or hospital, which is enough to give cause for speculation. Women, especially unmarried women, do not want to be found out to be using contraception (people may think them promiscuous). Talking to a midwife or going into a particular room causes enough fear in many women not to seek assistance. In rural villages and towns, everyone knows everyone and their business. To hide information is suspicious.
And this is where the development that has to happen is behavior change. Cultural norms and values are what need to change. After giving suggestions to my girls on how to handle these situations, I had to end it with “it is not easy but if things are to change, it has to start with you.” I can only hope they feel empowered to decide for themselves what is best. Gender equality is key. Having partners that respect them is a huge component. Believing (and knowing!) that they, as young women, deserve to be treated with respect and have as much say in whether to have sex, get married or get pregnant, will be life changing for them and generations to come.