Family Planning for Health and Development

Family planning plays an important role in the reproductive health and rights of women. Access to contraception helps empower women and adolescents, increases investment in children, and contributes to poverty reduction and overall development. A reduction of 0.5 in the fertility rate has been shown to lead to a 5.6 percent increase in GDP per capita over 20 years. A decrease in unplanned pregnancies also leads to a lower risk of health complications, maternal and child deaths, and malnutrition in children.

Securing access to family planning is a critical component of building human capital in most developing countries, but policymakers need to make sure every cedi spent of limited public resources generates the largest possible benefit in economic and social terms. Ghana Priorities, a collaboration between the National Development Planning Commission and the award-winning think tank Copenhagen Consensus, seeks to provide inputs to this debate.

Using the method of cost-benefit analysis, 28 teams of economists have studied more than 80 initiatives over the last year to find the best policies in areas ranging from health to education, from sanitation to employment. The results of these studies are now being published for the benefit of all Ghanaians.

To inform the debate on how to improve reproductive health, Prof. Eugenia Amporfu, Dr. Eric Arthur and Dr. Jacob Novignon from the Kwame Nkrumah University of Science and Technology and Dr. Brad Wong of Copenhagen Consensus studied two key interventions: extending Ghana’s current family planning program for adult women and including compulsory sexual health education for boys and girls at the junior high school (JHS) and senior high school (SHS) levels.

Since 2015, Ghana has had a successful family planning program that has helped increase the use of contraceptives from 32% to 38% among unmarried women and from 22% to 30% with married women. The researchers studied an extension of this policy, increasing the targets for contraception prevalence to 50% and 40% for these two groups of beneficiaries, respectively.

This would result in a total of nearly 72,000 unintended pregnancies avoided every year for unmarried women and 81,000 unintended pregnancies avoided for married women.  In the long run, this would mean 138 neonatal deaths and 74 maternal deaths averted for unmarried women and 235 neonatal deaths and 126 maternal deaths for married women. The lowered fertility rate would also have an important impact on the economy, through a proportional increase of around 3% of GDP per capita over 20 years.

The total cost of the intervention is GH￠ 1,012 million for an intervention targeting 3.2 million unmarried women over 8 years and GH￠ 988 million for an intervention targeting 4.2 million married women over 6 years. The benefits are GH￠ 30,000 million and GH￠ 33,000 million, respectively. Targeting married women brings the number of births down by a larger amount, which leads to a higher demographic dividend and therefore an even higher return on investment. Every cedi spent would produce social and economic good worth 29 to nearly 34 cedis.

Teen mothers and their children are at a higher risk of health complications, and less likely to continue with their education. In Ghana, the teenage childbearing rate is 75 births per 1,000 girls, higher than the global average of 44 births. Nearly all sexually active, adolescent and unmarried females want to avoid pregnancy within the next two years, but 62% have an unmet need for family planning and the number of unintended pregnancies during JHS is estimated to be over 56,000. For this reason, the researchers also analysed an intervention on compulsory, comprehensive, and universal reproductive health education.

Sexual and reproductive health education already forms part of the curriculum in Ghana, but it is not compulsory and the coverage of topics is minimal. Drop-out rates are also considerable. The intervention proposed in the study includes a revision of the curriculum, training of school-based health coordinators, and education on birth control methods such as contraceptives and abstention for one cohort of adolescents through JHS and SHS. The intervention would avoid over 10,000 unintended pregnancies at JHS level and nearly 4,500 at SHS level.

An effective compulsory, comprehensive sexual education would delay pregnancy to an age when it is physically safer to have children, which reduces the medical costs of birth, fistula, caesareans, and abortions, and infant and maternal mortality. Approximately 9 maternal deaths and 118 infant deaths would be averted per cohort thanks to the intervention. Continued education would also provide increased income worth GH￠ 670 per year of JHS and GH￠ 900 per year of SHS completed, lasting for the women’s entire working lives. The total costs of this intervention were estimated at approximately GH￠ 127 million over a 7-year period and the benefits at GH￠ 285 million, meaning the intervention would provide a benefit around 2 times higher than the original investment.

In both cases, the health and economic benefits exceed the costs of the proposed initiatives. High fertility rates hamper economic growth and development, and intensive interventions that respond to women’s contraceptive needs would be a key element in reversing the high rate of unwanted pregnancies in Ghana.

This article was originally published in Ghana's newspaper of record - The Daily Graphic.