ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF

FAMILY PLANNING.

Presented at the KNUST Annual Scientific Conference

26TH AUGUST 2010 by Dr. Gloria J. Quansah AsareDirector, Family Health Division

Content

• MDGs• Current Country Status (Health Related MDGs)• FP• FP & MDGs• Conclusion• Way Forward• References

Millennium Development Goals

• Millennium Development Goals are a UN framework for global development

• There are a total of 8 MDGs and 4 goals are directly related to health:

1. End Poverty & Hunger2. Universal Education3. Gender Equality4. Child Health5. Maternal Health6. Combat HIV/AIDS7. Environmental Sustainability8. Global Partnership

MDG 1: End Poverty & Hunger

• Goal: eradicate extreme poverty & hunger• Target: to halve, between 1990-2015 the

proportion of people who suffer from hunger• Indicators: - prevalence of underweight children under five

years of age

MDG 4: Child Health

• Goal: reduce child mortality• Target: to reduce, by 2/3, between 1990-2015

under-5 mortality rate• Indicators: - Under-five mortality rate - Infant mortality rate - Proportion of 1 year-old children immunised

against measles (increase by 2/3)

MDG 5: Maternal Health

• Goal: reduce maternal mortality Target: to reduce by 3/4 between 1990-2015 maternal

mortality ratio Indicators: - Maternal mortality ratio - Adolescent birth rate - Unmet need for family planning(Increase) - Proportion of births attended by skilled health personal -Contraceptive prevalence rate -Antenatal care coverage

MDG 6: Combat HIV/AIDS, Malaria and Other Diseases

• Goal: combat HIV/AIDS, Malaria and other diseases Target: have halted by 2015 and begun to reverse the spread

of HIV/AIDS Indicators: - HIV prevalence among population aged 15-24 years - Condom use at last high-risk sex - Proportion of population aged 15-24 with comprehensive

correct knowledge of HIV/AIDS

MDG 6: Combat HIV/AIDS, Malaria and Other Diseases cont.

• Goal: combat HIV/AIDS, Malaria and other diseases Target: achieve, by 2010, universal access to treatment for

HIV/AIDS for all those who need it Indicators: - Proportion of the population with advanced HIV infection

with access to antiretroviral drugs

MDG 6: Combat HIV/AIDS, Malaria and Other Diseases cont.

• Goal: combat HIV/AIDS, Malaria and other diseases Target: have halted by 2015 and begun to reverse the

incidence of malaria and other major diseases Indicators: - incidence and death rate associated with Malaria - Proportion of children under five sleeping under insecticide-treated bed nets - Proportion of children under 5 with fever who are treated with appropriate

anti-malarial drugs - Incidence, prevalence and death rates associated with tuberculosis - Proportion of tuberculosis cases detected and cured under directly observed

treatment short course (DOTS)

INTERVENTIONS & CURRENT STATUS

MDG 1: End Poverty & HungerINTERVENTIONS

• Nutrition education • Promotion of

complementary feeding• Promotion of good eating

habits• Promotion of exclusive

breastfeeding• Rehabilitation of

undernourished children• Food supplementation

15.4

12.4

25.4

22.324.3

21.4

0

5

10

15

20

25

30

1998 2003 2008

year

% o

f u

nd

er 5

ch

ildre

n

Prevalence of Underweight Children Under 5 years (weight-for-age -2 std.

devs) 1998 - 2008

MDG 4: Child Health Interventions

• Promotion of exclusive breast feeding

• Promotion of early introduction of complementary feeding + breastfeeding

• School health services• Vitamin A supplementation• Immunisation• Growth promotion and

nutrition• Curative care for minor

ailments• IEC

119.4107.6 111.2

8070.8

39.88

0

20

40

60

80

100

120

140

1993 1998 2003 2008 2015

year

Deat

hs/1

,000

Under-5 Mortality, 1993 - 2008

MDG 4: Child HealthInfant Mortality, 1993 - 2008

66.4

56.7

64.3

50

0

20

40

60

80

1993 1998 2003 2008

year

Dea

ths/

1,00

0

Source: DHS-Ghana, 1988, 1993, 1998, 2003 , 2008

50.6

60.9

68.8

79.9

0

10

20

30

40

50

60

70

80

90

1993 1998 2003 2008

year

pro

po

rtio

n o

f ch

ild

ren

1-y

r

Proportion of 1 year-old children immunised against

measles, 1993 - 2008

MDG 4: Child Health• Challenges– High Neonatal mortality rate– Traditional/ Cultural practices– Limited access to services– Poor utilization of services– Health seeking behaviours

• Way forward– Improve skills – Improve Community actions – Operatios Research

MDG 5: Maternal Health Interventions

• Services being provided– nutrition education,– Iron folate supplementation– Tetanus immunisation – Education on breastfeeding and care of the new born– IPT– VCT and PMTCT – education to improve capacity of family and community members in home based, life saving skills – Family planning services– comprehensive abortion care services as permitted by law

• Increased – access to Essential, comprehensive and basic obstetric care– access to blood transfusion services – coverage, content and quality of antenatal and post natal services– proportion of deliveries conducted by skilled attendants

• Promote– the prevention of unsafe abortion and post abortion care– the prevention &management of reproductive tract infections– the prevention and management of harmful traditional practices e.g. FGM– The management of cancers of the reproductive system

Package of Services

– Safe Motherhood• Emergency Obstetrics

care• Essential Newborn Care• PMTCT• MIP

– Family Planning– Comprehensive Abortion

Care Services– IE &C

MDG 5: Maternal Health

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

0

100

200

300

400

500

600

700

800

740

590540 560

483451

185

YEAR

PE

R 1

00 0

00 L

B

Maternal Mortality Ratio, 1990 – 2015 Projections

Source: WHO, 2008

GAP

MDG 5: Maternal HealthMedically Assisted Deliveries

1993 – 2008

44 44.347.1

57

0

10

20

30

40

50

60

1993 1998 2003 2008

year

% o

f del

iver

ies

Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008

Antenatal Care (at least 1 visit) 1988 – 2008

87.5

91.9

95.4

82

84

86

88

90

92

94

96

1998 2003 2008

year

% o

f w

om

en r

ecei

vin

g a

t le

ast

1 vi

sit

(fro

m h

lth

pro

f)

MDG 5: Maternal HealthAge-Specific Fertility Rate: 15-

19, 1993 – 2008

Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008

2022

2524

0

5

10

15

20

25

30

1993 1998 2003 2008

year

% o

f m

arri

ed w

om

en u

sin

g a

ny

met

ho

d

Contraceptive Use: Any Method 1988 – 2008

116

88

74

66

0

20

40

60

80

100

120

140

1993 1998 2003 2008

birth

s/1,

000 w

omen

ages

15-1

9

year

MDG 5: Maternal HealthUnmet Need for Family Planning, 1993 – 2008

Success!

38.6

33.534 34

30

31

32

33

34

35

36

37

38

39

1993 1998 2003 2008

year

% o

f w

om

en w

ith

un

met

nee

d

Source: DHS-Ghana, 1988, 1993, 1998, 2003 ,2008

* Unmet Need figures are derived from both the number of women who want to delay childbirth or have no more children and the number that are not using contraceptive methods.

MDG 5: Maternal Health• Challenges– 3 Delays• Decision Taking, Reaching Facility, Receiving Care

– Limited geographical access by some clients– Human resources; ageing midwives, and their numbers – Inadequate EmOC equipment

• Way Forward – Collaboration with civil society organisations, NGOs,

Communities and other MDAs– Training in midwifery– Improve communication (mobile telephony)

MDG 6: HIV - Interventions• Counselling and testing services• Prevention of Mother to Child Transmission• Management of STIs• Condom Promotion: provision of condoms to Social marketing

agents• Safe blood transfusion

– Provision of HIV test kits for all health institutions– Screening of blood

• HIV exposure prevention in health facilities• Health promotion and demand creation• Treatment care and support

– Improve quality of treatment services– Increase access to ART – Strengthening care and support services for PLHIV

MDG 6: HIV

2.3

2.9

3.43.6

3.1

2.7

3.2

2.6

2.2

2.6

1.9

2.5 2.6

1.9

0

0.5

1

1.5

2

2.5

3

3.5

4

2000 2001 2002 2003 2004 2005 2006 2007 2008year

Pre

vale

nce

Rat

e

General Population

Ages 15-24

HIV Prevalence Rates, 2000 – 2008

Source: NACP

3156

13,249

23,614

197

1804 1913

0

5000

10000

15000

20000

25000

2003 2004 2005 2006 2007 2008year

# of

per

sons

on

AR

T

Number of Persons on ART, 2003 – 2008

MDG 6: HIVCondom use at last high-risk sex (with a non-marital,

non-cohabitating partner), 2003 & 2008

43.9

44

28.1

25.4

0 5 10 15 20 25 30 35 40 45

percentage

Male

Female

2008

2003

2003

2008

Source: DHS-Ghana 2003 & draft 2008

MDG 6: HIV% of population (15-24 years) with comprehensive correct

knowledge of HIV/AIDS, 2003

45.45

38.15

34 36 38 40 42 44 46

Percentage of persons

Male

Female

Source: DHS-Ghana 2003

MDG 6: Malaria Interventions

• Improvement of malaria case management in health facilities e.g. ACTs,

• Promotion of home-based care of malaria with emphasis on symptoms detection and seeking early treatment

• Promotion of the use of insecticide-treated nets for children under-five and pregnant women

• Provision of intermittent preventive treatment for pregnant women

• Promotion of indoor residual spraying (IRS)

• Larviciding

3.5

21.8

41.1

0

5

10

15

20

25

30

35

40

45

2003 2006 2008

year

% o

f chi

ldre

n

Proportion of children under 5 sleeping under insecticide-

treated bed nets, 2002 – 2008

MDG 6: MalariaMalaria Case Fatality Rate Under 5,

2002 – 2008

60.762.8

60.8

43

0

10

20

30

40

50

60

70

1998 2003 2006 2008

year

% o

f chi

ldre

n

Proportion of children under 5 with fever who are treated

with appropriate anti-malarial drugs, 1998 – 2008

MDG 6: TB Interventions

• DOTS quality expansion programme– Provision of infrastructure for supervised treatment in some district hospitals.

• Public –Private Mix (PPM) DOTS• Integration of TB and HIV prevention, care and support activities • Community based TB Care

– system of case holding and defaulter tracing with active community participation.

– Enablers package• TB in prisons• Advocacy , communication, social mobilization

– Promote behavioural change communication to support TB control • Monitoring, supervision and evaluation

02000400060008000

10000120001400016000

Year

No.

of c

ase

Tuberculosis Case Detection 1997-2008

45.850.6

55.350.3

5660.5

66.971.7 72.6

76.1

84.7

54.249.4

44.749.7

4439.5

33.128.3 27.4

23.919.3

0102030405060708090

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Rat

e (%

)Treatment Success Adverse outcome

Tuberculosis Treatment Outcome: Treatment Success Vrs Adverse Outcome, 1997-

2007

MDG 6: HIV/ AIDS

• Challenges– Delays in reporting– Human Resource: Multi tasked personnel – Procurement delays– Delays in initiating care (CT,PMTCT and ART)

• Way forward– All regions to be resourced to carry ART training to

increase access to HAART– Increase access to CT, STI services

MDG 6: Malaria

• Challenges– Delay in in the approval of anti malaria drug policy

• Some hospitals do not adhere to new anti malaria policy• Existence of several mono therapies in the system

– Acceptability and utilisation of some brands of LLINs– Improvement in diagnosis and prescription

• Way Forward– Improvement in drug regulation – Treatment of other materials other than bed nets– Scale up Indoor Residual Spraying– Improve diagnostic capacity of including laboratory support

• Scale up use of rapid diagnostic test kits

MDG 6: Tuberculosis • Challenge– Low case detection rate

• Way Forward– Address reasons for low case detection rate through monitoring,

supervision and research– Develop standard operating procedures for TB case detection– Conduct national TB prevalence survey to assess magnitude of

TB problem– Involve ex TB patients in Tb control activities to improve case

detection rate– PPM DOTS expansion

Family Planning

• Family planning services include methods and practices to space births, limit family size and prevent unwanted pregnancies.

• Fertility by choice, and not by chance is a basic requirement for women’s health.

• Fertility regulation is also a major element in aiding safe motherhood strategy. – reduces the number of unwanted pregnancies– decrease in the total exposure to risk of

pregnancy – decrease in the number of unsafe abortions.

Goal

• The goal of family planning is to assist couples and individuals of all ages to achieve their reproductive goals and improve their general reproductive health.

Eligibility

All individuals and couples including adolescents are eligible for family planning services.  

Family planning methods available in Ghana

Short term• Condoms (male and female)• Spermicides• Oral Contraceptive pills

(Combined & Mini-pill)• Injectables – (3

monthly)• Injectable (Monthly)• Lactational Amenorrhoea

Method (LAM)

Long Term(Reversible)• Intra Uterine Device• Implants• Natural Family Planning

Method

(Permanent /Irreversible)

• Tubal Ligation ♀ • Vasectomy ♂

• Emergency Contraception

“Planning for Progress and Development” 1969 Population Policy

FP was seen essentially as an instrument for

•attaining specified demographic targets and •socio-economic development objectives.

“Population Growth in excess of 2 % per year is among the structural factors inhibiting the achievement of a wide range of development objectives” (UN Population Division)

Ghana Population Policy, 1969

Post –ICPD, 1994

• Global Consensus that National Development aspirations were best achieved through Comprehensive Reproductive Health Programmes including FP.

• Benefits of FP extend beyond slowing pace of Population Growth – National RH Service Policy & Standards– Adolescent Health & Development Programme – Road Map for Repositioning Family Planning etc.

Population Targets & Performance

Year TFR CPR

Projected Achieved Projected Achieved

1988(DHS) 6.7 5.0%1993(DHS) 5.5 10.5%

1998(DHS) 4.4 13.0%

2003(DHS) 4.4 19.0%

2008(DHS) 4.0 17.0%

2000 5.0 15%

2010 4.0 28%

2020 3.0 50%

TFR and use of any and modern contraceptive methods, Ghana 1988-2008

Unmet Need for FP

Unmet need refers to women who do not want to get pregnant for the next two to three years (spacing) or women who do not want to have any more children (limiting) but are not using any method.

•Unmet need is 34%

•10% higher in Rural area

Unmet Need for FP

1113 12

16

25

22

34

38

27

0

5

10

15

20

25

30

35

40

Urban Rural National

% U

nmet

Nee

d

total

limiting

spacing

Some Challenges

• Decreasing Contraceptive Prevalence rate – 19% to 17% (GDHS 2003, 2008)

• Persistently High Unmet Need for FP 34-35%• Rumours, Myths & Misconceptions about contraceptives• Contraceptive Security issues – Reduced or Dwindling Funding – Procurement of contraceptives– Programme activities particularly demand generation (IE&C,

BCC)– Sub optimal integration of FP with other services

A Pivotal Service in RH

Family Planning• A component of Reproductive Health• Also a component of Safe motherhood• Cuts across most components of RH– Post Abortion Care, Comprehensive Abortion Care– STI/HIV/AIDS Prevention and Management– Infertility Prevention and Management – Adolescent and Male Services– Gender-based Violence

FP Benefits All!

• Women• Children• Men• Families• Communities• Nations• The Earth

For Children Lower risk of:• Child death• Infant death• Neonatal death• Fetal death• Stunting and underweight• Small for gestational age• Low birth weight• Preterm birth

For MotherLower risk of :• Maternal death• Puerperal endometritis• Premature rupture

membranes• Anemia• Third trimester bleeding

Conde-Agudelo A., Effect of Birth Spacing on Maternal and Perinatal Health: A Systematic Review and Meta-Analysis. Rutstein, S. Johnson & Conde-Agudelo A. Systematic Literature Review and Meta-Analysis of the Relationship between Interpregnancyor Interbirth Intervals and Infant and Child Mortality. Reports submitted to CATALYST Consortium, October 2004, Conde-Agudelo, A. and Belizan, J.M. Maternal morbidity and

mortality associated with interval: Cross sectional study. British Journal (Clinical Research Ed.) 321 (7271): 1255-1259. Nov. 18, 2000.

Evidence of longer birth intervals effects on health

Family Planning is Pivotal to SRH&

Relevant in All 8 MDGs!

FP and MDG’s

FP

1. Poverty

2 Education

3Gender

4 Child Health5

Maternal Health

6 HIV, Malaria,

Other

7Environment

8 Partnership

FP & MDGs

MDG1: Poverty Eradication• With exception of a few oil

rich states,no country has pulled itself out of poverty while maintaining high fertility

• E.g. Thailand, South Korea and Taiwan all lowered fertility before achieving economic success

MDG2&3: Education & Gender

• # of school age children double every 20 years, undermining quality

• Girls tend to have educ stopped or shortened

• “If you educate a woman, you education a nation.”– Dr. J.K. Aggrey

FP

1. Poverty

2. Education

3. Gender

4. Child Health

5. Maternal Health

6. HIV, Malaria,

Other

7. Environment

8. Partnership

FP & MDGs

MDG4: Child Health• Closely spaced children lead

to increase in child deaths• # of child deaths averted if

unmet need for FP in Ghana were met:– 200,000 over 10 years =– 20,000 per year =– 55 child deaths per day

MDG5: Maternal Health• Risk of maternal death

increases if woman is:– Too old, too young– Has many children or closely

spaced children• # of maternal deaths

averted if unmet need were met:– 4000 over 10 years =– 400 per year =– >1 per day

FP

1. Poverty

2. Education

3. Gender

4. Child Health

5. Maternal Health

6. HIV, Malaria,

Other

7. Environment

8. Partnership

FP & MDGsMDG6: Combat HIV/AIDS, Malaria and Other Diseases

• Rapid pop growth negatively impacts overstretched health systems

• Promotion and access of male and female condoms thru FP programs protect against HIV/AIDS & STIs

MDG7: Environmental Sustainability

• Rapid pop growth negatively pressures:– Forests, biodiversity– Coastal and marine

ecosystems, fisheries– Surface water from agric and

mining pressures– Flooding in urban areas due

to rapid in-migration

FP

1. Poverty

2. Education

3. Gender

4. Child Health

5. Maternal Health

6. HIV, Malaria,

Other

7. Environment

8. Partnership

FP & MDGs

MDG 8: GLOBAL PARTNERSHIPS

• Foster Partnerships at all levels• FP has the potential of fostering partnerships and also

thrives in partnerships for Advocacy, Service Delivery, Research, IEC, Coordination, Integration, etc. at all levels.– Internaltional– National– Public Private Partnership– All Stakeholders – Men, women, youth, Religious Organizations,

MDA.s , Private Sector,

• FP should be Everybody’s Business!!!

FP

1. Poverty

2. Education

3. Gender

4. Child Health

5. Maternal Health

6. HIV, Malaria,

Other

7. Environment

8. Partnership

Way Forward

Strengthened Partnerships in:• Repositioning Family Planning• Advocacy • Ensuring Increased Government Funding & Support for

Contraceptive Commodities & Services• Improved Service Delivery• IE&C

– Family Planning Week– Re Launch “Life Choices Campaign”

• Media Support • Research and Dissemination of Information is Crucial!

Conclusions

• Ghana can do a lot more towards achieving the health MDGs by 2015 if resources are committed.

• FP has the potential to hasten Ghana’s Development efforts.1. Ensure FP is a centrally important component of the

medium term health plan and features in all poverty reduction strategies in the country.

2. Ensure budget support.3. Appeal to development partners for additional support to

help buttress our efforts.• Reposition FP as a development tool and a choice in Life to

attain goals.

53

References• UNFPA Fact Sheet. http://www.unfpa.org• ICF Macro. 2010. Ghana Trend Report: Trends in Demographic, Family Planning, and Health

Indicators in Ghana. 1960-2008: Trend Analysis of Demographic and Health Surveys Data. Calverton, Maryland, USA: ICF Macro.

• Report of Hearings by the All Party Parliamentary Group on Population, Development and Reproductive Health. January 2007. Return of Population Growth Factor: Its Impact upon the Millennium Development Goals.

• USAID Health Policy Initiative. July 2009. “Achieving the MDGs: The contribution of family planning Ghana.” Futures Group International.

• Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International. 2009. Ghana Maternal Health Survey 2007. Calverton, Maryland, USA: GSS, GHS, and Macro International.

• The Case for Including Family Planning on the National Health Insurance Scheme (NHIS) and Increased Budgetary Allocation for Contraceptives by Government. Position Paper. PPAG and Partners Advocacy 2010

• Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. 2009. Ghana Demographic and Health Survey 2008. Accra, Ghana.

• Vice President’s Keynote Address at Launching of Life Choices Campaign, Accra August 2010

Thank You for Your Interest!

Presented by:Dr. Gloria Quansah Asare

( Director Family Health Division)Ghana Health Service

“Family Planning for a Better Life”