Barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy in Ghana: an exploratory qualitative study

Abstract

ObjectivesThis study explored the perceived barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals (‘professionals’), grassroots workers and adolescent girls in Ghana.Design and settingWe employed an exploratory qualitative study design involving interviews with professionals, grassroots workers and adolescent girls in the Central Region of Ghana.ParticipantsThis study involved 15 professionals employed in government or non-governmental organisations, 15 grassroots workers and 51 pregnant/parenting and non-pregnant adolescent girls.Data analysisThematic analysis was conducted deductively using the ecological framework for understanding effective implementation.ResultsEighteen themes mapped to the five domains of the ecological framework emerged. Perceived barriers included gender inequality, family poverty, stigma, community support for early childbearing and cohabitation, inadequate data systems, lack of collaboration between stakeholders and lack of political will. Effective implementation of community by-laws, youth involvement, use of available data, and collaboration and effective coordination between stakeholders were the perceived facilitators.ConclusionPolitical leaders and community members should be actively engaged in the implementation of adolescent sexual and reproductive health policies and programmes. Gender empowerment programmes such as education and training of adolescent girls should be implemented and strengthened at both the community and national levels. Community members should be sensitised on the negative effects of norms that support child marriage, gender-based violence and early childbearing.

Knowledge and awareness of policies and programmes to reduce adolescent pregnancy in Ghana: a qualitative study among key stakeholders

“…These participants may also have represented a better-informed sub-set of the population. Content analysis reported in this paper is purely descriptive but more detailed findings conceptually based on implementation science are reported elsewhere [ 16 ].…”

“…In Ghana, national policies have aimed at reducing adolescent pregnancy [ 6 , 15 ]. These policies have been useful in reducing adolescent pregnancy through mainstreaming SRH information and gender-sensitive and responsive health services [ 16 ]. Notable among these is the Adolescent Health Service Policy and Strategy which seeks to enhance the health status and quality of life of adolescents and young people in Ghana [ 17 ].…”

“We have nice policies but…”: implementation gaps in the Ghana adolescent health service policy and strategy (2016–2020)

“…Several studies have explored different aspects of policies and interventions for adolescent health that may help explain gaps in policy implementation; however, most focused on only specific aspects of adolescent health. These included analyses of barriers and facilitators of implementation of policies for reducing adolescent pregnancy in Ghana ( 15 ), barriers to access and provision of adolescent sexual and reproductive health services ( 16–18 ), care-seeking behaviors and how that affects the provision of mental health ( 19 ), barriers to low uptake of contraception ( 20 ), and awareness of rights with regards to reproductive health ( 21–24 ). Thus, the literature contains a somewhat fragmented narrative that covers particular interventions or challenges rather than convey a comprehensive analysis of a holistic national policy to understand how and why the policy was implemented within its specific context.…”