A qualitative analysis of the effect of a community-based primary health care programme on reproductive preferences and contraceptive use among the Kassena-Nankana of northern Ghana

Abstract

BackgroundIn 2000, Ghana launched the Community-based Health Planning and Services (CHPS) initiative to improve access to health and family planning services. This initiative was based in part on research, known as the Navrongo Project, conducted in the Kassena-Nankana district (KND) between 1994 to 2003 which demonstrated significant impact on fertility and child mortality. This paper examines current contraceptive perceptions in communities that were exposed to the Project’s service models over the 1994 to 2003 period, and the post-experimental policies of the CHPS era.MethodsQualitative study was conducted in the KND of Ghana from June to September, 2012, by convening 8 male and 8 female FGD panels as well as 8 in-depth interviews of community leaders. Data collection was stratified by original experimental cell of the Navrongo Project to permit appraisal of social effects of contrasting experimental conditions. Inductive content analysis was performed with QSR Nvivo 10 to identify predominant themes.ResultsWhile findings show that exposure to community-based services was associated with enhanced approval of birth spacing and limitation, this view is grounded in perceptions that childhood survival has improved. Nonetheless, concerns were expressed about contraceptive side effects, prominently permanent sterility. Strategies for male outreach and community engagement originally introduced during the Navrongo Project have not been sustained with CHPS scale-up. The apparent atrophy of attention to the needs of men may explain the resistance of some males to the notion of female reproductive autonomy and the practice of some women to adopt contraception in secret. Despite this apparent programmatic dearth of male engagement, there is evidence to suggest that social impact of the original male engagement strategy persists in communities where male mobilization was combined with doorstep provision of family planning care during the Navrongo Project.ConclusionCommunity-based services fostered attitudinal change towards family planning in a traditional sub-Saharan African setting. Sustained exposure to primary health care that have improved the survival of children has made the use of contraception more acceptable. Efforts should be embedded in primary health care programmes that address concerns about child survival while also consigning sustained priority to the information needs of men.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1325-6) contains supplementary material, which is available to authorized users.

Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

“…Health equity and childhood survival are improved in localities where CHPS is functioning [10]. Yet, despite this evidence of potential benefits, coverage is often incomplete or flawed [24][25][26][27][28][29] and NHIS implementation lapses often constrain financial access [30][31][32].…”

Context-specific Factors and Contraceptive Use: A Mixed Method Study among Women, Men and Health Providers in a Rural Ghanaian District

“…Religion, place of residence (rural/urban), educational status, age, parity and social economic status are among common predictors of family planning use in different settings. Many studies in Ghana have provided wide-range predictors and determinants of family planning use across several population groups [19][20][21][22][23] . However, some studies in sub-Saharan Africa (SSA) show that different factors influence fertility and family planning interventions differently [24][25][26][27] .…”

Unmet reproductive health care needs among rural Ghanaian women

“…Community level evidence on reproductive services uptake such as family planning using the "Zurugelu Approach" in Ghana shows that introducing and sustaining reproductive change requires attention to the needs and concerns of not only women (Dalaba et al, 2016). In particular, the involvement of the male spouse and the hospital staff effectively promotes family planning and counselling services (Dalaba et al, 2016). But how exactly is the Ghanaian health system responding to the changing reproductive needs of women through information and counselling services?…”

“…Religion, place of residence (rural/urban), educational status, age, parity and social economic status are among common predictors of family planning use in different settings. Many studies in Ghana have provided wide-range predictors and determinants of family planning use across several population groups (Abekah-Nkrumah & Abor, 2016;Atuahene, Afari, Adjuik, & Obed, 2016;Blanc, 2001;Dalaba et al, 2016;. However, studies in SSA and West Africa show that different factors influence fertility and family planning interventions differently (see Chapter 2).…”

“…Fertility preferences and intentions on the timing of child bearing and the desired number of children appear to drive reproductive decisions (Miller & Pasta, 1995). Community level evidence on reproductive services uptake such as family planning using the "Zurugelu Approach" in Ghana shows that introducing and sustaining reproductive change requires attention to the needs and concerns of not only women (Dalaba et al, 2016). In particular, the involvement of the male spouse and the hospital staff effectively promotes family planning and counselling services (Dalaba et al, 2016).…”