By; Doreen Ampofo
Issues on use of contraceptives in our traditional setting, until recently, was barely spoken about or discussed. It is even worse when teenagers are involved. But is it time to open up the subject especially when a recent UNFPA report is indicating that one in every ten children between ages 10 to 15 is actively engaged in sex. More so when last year’s Demographic Health Survey showed an increase in teenage pregnancies, particularly in coastal communities. As Ghana joins the world to mark Family Planning Week, GBCNews’ Doreen Ampofo discusses why it has increasingly become critical to openly discuss and encourage contraceptive use in 10 to 19-year-olds.
In the heart of Ghana, amidst the rhythm of daily life,a silent challenge is growing among young people. They are actively engaging in sex, yet a lot of them are not protecting themselves. According to the latest Ghana Demographic Health Survey, Ghana reported more than 2680 teenage pregnancies, indicating a three-percentage increase from the last survey. The report also shows 51% of sexually active adolescents do not use either condoms, the IUD, pills, injectables or any form of contraceptives. I wanted to understand the challenge and so I took a trip to Anyamam, the coastal community in the Ada West District of Greater Accra. Anyamam has quite a young population, but sadly, many of them particularly the girls have dropped out of school because they get pregnant. At the Anyamam Health Center, I am meeting three girls aged 14 to 17, all pregnant.
The first girl, Jemima (not her real name) lost both parents before she turned 12. She’s pregnant at 14 years. She told me the young man who impregnated her promised to provide for her. She accepted the proposal and went ahead to have sex with him without any precaution or contraceptive.
“He is 18 years and he promised to help him through school but has denied responsibility of the pregnancy. If I had more information about contraceptives earlier, I would have found money to purchase some to prevent this pregnancy.’
The second girl, Ama, not her real name, started dating at age 13. After two years and just at age 15 she is pregnant. She dropped out of school because despite being an only child, her parents could not afford her exam fees which cost GHC 30, less than three dollars.
“I have been in a relationship with the father of my unborn child for about a year now. He said he loves me and will take care of me. Although I’ve heard a lot about Family Planning services, I did not use it. Currently, I am jobless. I wish I had a job to support myself and my baby.”
Korleki, not her real name, seems to be the favorite of health workers because they saw a lot of potential in her. Sadly, she also got pregnant just after completing Junior High School. She told me that;
“I know when I go into family planning or condoms, I will not get pregnant, but I did not use it. The man who impregnated me is 24 years and he offered to cater for my education, which he did. I do not intend to have another baby soon. I will have to use family planning to be double sure.”
I interacted with health workers at the facility who indicated that it is a common sight to have girls younger than the three mentioned, who visit the facility for antenatal services. One of the nurses Regina Gakpo who is responsible for adolescent health noted that the facility receives twenty new teen pregnancies every two months, a situation she blames on lack of parental care and misconceptions around family planning in the community.
“One major problem that we are having is the increase of teenage pregnancy especially in Anyamam. Some of the causes of this I think is poor parenting. Also lack of sexual health education. Parents do not open-up to young ones about their sexual health, what they are supposed to do at their youthful age to avoid pregnancies. There is also the issue of misconceptions about family planning which is contributing to the numbers’.
Regina added that as part of efforts by the Ghana Health Service and her unit, adolescent clubs have been established to support with the provision of sexual health education to the youth in the community. This also includes boys who they hope to become champions of family planning for their families.
Over the years, the message has been abstinence for adolescents, with little heard about contraceptives for adolescents. National Program Manager for Family Planning, Ghana Health Service Dr Claudette Diogo explained that the program has been dealing with myths and misconceptions which are hindering the uptake of contraceptives even for the older population. She said self-proclaimed doctors who sell their medications and herbal products, throw dust in the eye of the public when it comes to contraceptive use, explaining that these claims are not grounded.
“These self-styled doctors always blame every cost on family planning and because of that adolescents or even adults do not want to access the services. Unfortunately for us, we have some of our service providers that are not actually warm towards adolescents because of the perception we have as a country. We go ahead to feel we don’t need to give them the right information or it is not in their place to go ahead and have sex, but I beg to differ. Whether we like it or not, the young ones are having sex”
For the Director of Families Health Division at the Ghana Health Service, Dr. Kofi Issah, the problem goes beyond misconception. He said facilities are reporting a number of pregnant girls mostly in their early teens because the mere mention of contraceptives in the community comes with a negative reaction.
“I can go into the shop and buy paracetamol without caring who sees me. But even grown-ups even go to buy condoms, he asks the attendant; give me the bitters, they give him; give me paracetamol, they give him and then he is looking around to observe if anyone is watching. He asks is there any change, then give me condoms. But the main one was the condom. When you get to the pharmacy or shop and go straight to buying condoms, the attendant is judging you and you are also judging them. However, in the market, the market woman is very assertive. This is the same society.”
Dr Issah added that another challenge which affected contraceptive up-take in adolescents is poor targeting with communication materials and mesages. Almost all characters used in the commercials on contraceptives were adults, creating the perception that young people are outside the bracket of people who should be talking about or using contraceptives. However, the Service has realized this and is working to target them. This is because when they receive the messages early in life and adopt in, they hold on to it and are able to transfer the knowledge and experience to others especially, younger ones.
“You see, if you target it now, you don’t need to target them when they’re older. It is said that you can’t teach an old dog new tricks. So, it went just down the drain. But once you do it for the adolescent, it is an investment, because you don’t need to spend any more money. They just carry that experience into adulthood.”
The question however remains if parents will consent to having their children aged 10 to 19 access family health services. Some parents I spoke to were skeptical about allowing this. The first parent said;
“I believe a child has no business with contraceptives. I may however consider those that are 16 years and above. With the society we live in, its quite difficult to get teenagers within that age group not being sexually active. So, if I realize my child is hitting 16 years, I may consider it”
The second parent said ;
“Yes and no. A ten-year-old is too young to receive any information but I would educate my child in their late teens.”
For the third parent, she expressed worry about side effects and the fact that a child with that kind of information may explore and abuse the contraceptives. She said ;
“Considering the side effects of contraceptive, I don’t think it is right to introduce it to a child. Also, some of them may abuse it. If I teach my child, she may just misuse it.”
The Director of Family Health Dr Kofi Issa in response to these concerns said such parental restrictions rather push adolescents to seek alternative information which may be detrimental to their well-being. He indicated that research has shown that giving adolescents the right information on their sexual reproductive health, rather makes them informed and protected.
“All these parental restrictions here and there when the law says otherwise, is what normally pushes people to look for alternative sources of information. If something is not discussed in the open and is driven underground, you find that it leads to complications. People say yeah, if you give them the information, then you open the floodgates. Research has proven that those who would have actually been taking advantage of this information would be empowered to know how to structure their lives”
During my interactions for the story, a few issues stood out for me. These are misconceptions, fear of being judged and culture. I reached out to the UNFPA which has vast experience in working with adolescents on how these issues can be tackled to improve contraceptive uptake in the 10 to 19 population. The Country Director Dr. Wolford Ochan called for the need to understand the forces that drive resistance to contraceptives as well as the key players in the lives of adolescents. These key players he said include parents, teachers, and religious leaders who could collaborate to achieve results.
“We need to understand clearly who are the key players in the life of young people at home who act as gatekeepers, at school, in the church, in the spaces where young people come. We also need to know who the adversaries are. They may not necessarily be in opposition. They may disagree with you on the family planning service education, but actually agree with you on the education of the girl child, which should go hand in hand and compliment reproductive health education. Then you also need to know the neutrals and reach them quickly to start saying that look, we can support this initiative of creating the environment.”
While commending efforts by government to improve adolescent reproductive health, Dr. Wilfred Ochan said it must show more commitment
by investing in procuring contraceptives for this vulnerable population. Currently, the UNFPA and its partners including USIAD and the West Africa Health Organization, WAHO, procure up to 90 percent of contraceptives for the country. He added that while government is investing in training health professionals and infrastructure for storage of Family Planning commodities, it must consider playing a major part in procuring commodities, especially at a time when donor support is dwindling.
“The government has already signed on to a commitment called the Compact for Family Planning where it has committed to spend an amount of money to be able to procure from partners. Now, of course, we can always do more with the budget. And of course, you can always push to the limit that we can also do because when the donor funding and all this right now ends, government will have to take up the cost gradually.”
As part of this year’s family planning week, which includes World Contraception Day observed on the 26th of September each year, Ghana Health Service is seeking to change misconceptions especially those associated with adolescent contraceptive uptake as well as encourage domestic financing for Family Planning commodities. National Program Manager of family planning, Dr. Claudette Diogo shed more light saying the theme for this year’s celebration, My Choice, My Freedom is encouraging
collaboration with partners. She said the Service is having weeklong activities and events where there will be provision of free services. They will also have information sessions, and a number of market activation in markets and communities just to create awareness, demystify family planning and actually address the issues of misconception.
Abstinence is clearly not working. And as a nation, we cannot continue to be play ostrich while a younger population is stifled by unwanted pregnancies, which could have been avoided. It is time to have an open national conversation on contraceptive use for teens.