How far has Ghana moved forward the agenda of promoting Adolescent Sexual and Reproductive Health and Rights?

By G.D. Zaney


Reproductive Health (RH) is defined by the International Conference on Population and Development (ICPD) Programme of Action (PoA), as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes.”



The definition was accompanied by a call on all countries to promote greater partnerships in the implementation of innovative programmes aimed at making quality RH services accessible and affordable to all by the year 2015.


It was in September 1994, in Cairo, Egypt, when representatives from 179 countries participated in discussions to finalize a PoA on population and development for implementation, lasting a period of 20 years.


The primary recommendations of ICPD PoA were the call to link the provision of sexuality education and Sexual and Reproductive Health (SRH) services; build awareness, acceptance and support for youth-friendly Sexual and Reproductive Health (SRH) education and services; address gender inequity in terms of beliefs, attitudes and norms; and target the early adolescent period (10-14 years).


Member countries were, therefore, required under the ICPD PoA to strive to meet the educational and service needs of adolescents to enable them to deal in a positive way with their sexuality.


In addition, ICPD PoA also underscored the importance of accessibility to reproductive health services through primary health care systems to individuals of all appropriate ages, including adolescents as soon as possible and not later than the year 2015.


As part of an enhanced approach to reproductive health and rights, PoA advocated making family planning universally available by the year 2015, provided estimates of the levels of national resources and international assistance that would be required and called on governments to make these resources available.


In 2012, the Commission on Population and Development (CPD) also made a policy statement on Adolescent Sexual and Reproductive Health Rights (ASRHR), the key elements of which included the right of young persons to Comprehensive Sexual Education (CSE); the right to decide on all matters affecting their sexuality; right to access SRH services, including the right to abortion, where legal, and the protection, and promotion of the rights of young persons to control their sexuality, free from violence, discrimination and coercion.


Why is the health of adolescents considered as critical as to receive the attention it is being accorded? One may ask.


The answer is not farfetched. Adolescents face peculiar health risks which are not only detrimental to their immediate future, but also for the rest of their lives.


Indeed, adolescent health constitutes a large proportion of the global disease burden while higher maternal mortality and morbidity rates, and the increased risk of induced abortions—largely illegal and unsafe— are known to be the direct results of early childbearing.


Recent studies have also shown that as a result of pregnancy and childbirth, diseases affecting adolescents constitute 23 per cent of the general disease burden.


The studies reveal that young women aged 15 to 19 years give birth to an estimated 16 million children annually while girls aged between 12 and 15 in low-income countries give birth to 2.5 million children every year, and that of the estimated 22 million unsafe abortions that are registered every year, 15 per cent have been found to occur among women aged 15 to 19 years while 27 per cent are registered among those aged 20 to 24 years.


Other implications for adolescent health include gender-based violence which increases the risk of negative SRH issues such as unintended pregnancies, Human Immuno-deficiency Virus (HIV) infection, alcohol abuse, mental health disorders and Female Genital Mutilation (FGM).


World Health Organization (WHO) estimates indicate that an estimated 3.3 million girls are at risk of undergoing FGM   in Africa, every year, one million young persons aged 15 to 24 are infected with HIV while globally, young women comprise over 60 per cent of all young people living with HIV, with the corresponding number in sub-Saharan Africa as high as 72 per cent.


Ghana, therefore, had no choice but to respond to the call by ICPD POA and the policy statement of the CPD on ASRHR by developing and implementing interventions to make quality SRH services accessible and affordable.


A report by the National Development Planning Commission which was strategically selected to co-ordinate the ICPD review process in Ghana indicates that over the past 20 years, Ghana has made significant progress in the implementation of the ICPD PoA, with far-reaching improvements in institutional mechanisms as well as policy frameworks for women's empowerment, the promotion of gender equality and equity, health care, including family planning and reproductive health services, and the prevention of Sexually Transmitted Infections (STIs).


The report indicates that access to health care and services, and geographical coverage, especially in the rural areas, have also increased through the expansion of Community-based Health Planning and Services (CHPS).


According to the report, there has also been the continuous expansion of functional CHPS zones in all Regions in Ghana, increasing from 868 in 2009 to 1,675 in 2011, bringing primary health care and reproductive health services closer to the people, as a result.


Furthermore, the report shows, the maternal mortality ratio in Ghana has shown a consistent decline since 1990 to 350 deaths per 100,000 live births in 2010 and was projected to fall to 185 deaths per 100,000 live births by 2015.


To further reduce this before 2015, several mechanisms, including the implementation of the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA), an initiative of the African Union Commission, were initiated to curb the continent's high rate of pregnancy-related deaths.


Family planning centres, the report reveals, have also been set up to counsel people on family planning and the prevention of sexually transmitted STIs while the Ghana Health Service (GHS) also conducts annual reviews of its operations to manage performance and determine where new or improved strategies are required for better maternal health outcomes and service delivery.


The report mentions the Planned Parenthood Association of Ghana (PPAG) as having, over the years, expanded its operations to cover a whole range of SRH services and delivered services and programmes through 1,356 service points including 11 permanent clinics, 54 mobile clinics and over 1,000 Community-Based Service Points (CBSPs).


In terms of the development of health infrastructure, the report says, government began the construction of fifteen (15) polyclinics costing €37 million euros.


Additionally, the report adds, Government launched the MDG5 Acceleration Framework (MAF) in 2011 to guide national interventions to accelerate the reduction of maternal mortality in the country.


It is important to note that the gains have not been made by Government alone and that the private sector has also contributed to improve access to health care services— one example of which is the Reducing Maternal Morbidity and Mortality (R3M) programme in Ghana whose objectives are to support government to achieve a 39 per cent contraceptive prevalence rate and reduce maternal mortality resulting from unsafe abortion.


Indeed, the R3M partners have provided Long Acting and Permanent Methods (LAPM) to 106,126 women, comprehensive abortion care services to 133,291 clients as a result of which 254,000 unintended pregnancies, 1250 maternal deaths and 161,000 unsafe abortions were averted.


Currently, the health sector seeks, notwithstanding the challenges, to improve upon SRH services by expanding the coverage of existing reproductive health programmes and strengthen governance and administration through systems structuring, planning as well as performance monitoring at all levels.


The health sector is also committed to the reduction of inequalities in health outcomes across regions through bridging the gaps of geographical and financial access, ensuring increased access of the population in hard-to-reach areas to maternal and SRH services in order to address the needs of diverse sub-populations.


In addition, the health sector also seeks to expand the cadre of providers, train more staff to deliver services, ensure better monitoring of staff and undertake initiatives to improve Emergency Obstetric and New-Born Care (EmONC).


While the health sector continues to play its mandated role in the promotion of ASRHR, others are also making strenuous efforts in that direction in view of the fact that the challenges of recognizing and fulfilling the reproductive and sexual rights of all young people, regardless of sexual orientation and gender identity, and ensuring access to health education and services, including safe and legal abortion, remain as formidable as ever.


The 7th Africa Conference on Sexual Health and Rights, which took place in Accra on the 8th of February to the 12th of February 2016, was, indeed, one of such efforts which are in consonance with the recommendations of ICPD.


President Mahama who delivered the key note address at the opening ceremony of the 7th Africa Conference on Sexual Health and Rights, reassured Ghanaians of the commitment of the Government of Ghana to working in collaboration with other African leaders for the total reduction of the incidence of HIV and AIDS on the continent which form part of ASRHR.


Ghanaians are equally reassured at the conference of the personal commitment of Dr Mrs Lordina Mahama, President of the Organisation of African First Ladies Against HIV/AIDS (OAFLA) and the commitment of OAFLA as an organization, in ensuring the removal of all the barriers— maternal mortality, early and forced marriages, teenage pregnancy, HIV and AIDS— impeding the full potential of the youth.


Certainly, these efforts cannot be in vain. The goal may look distant, but it, surely, is within reach.


All stakeholders should, therefore, be guided and encouraged by the words of Dr Babatunde Ahonsi, Country Representative, United Nations Fund for Population Activities (UNFPA), who accurately describes the conference as part of a long-term process of building and deepening the discourse and moving forward, after 2015, of the agenda of addressing the challenges of policy gaps in promoting SHRs—and this is to say: this agenda requires relentless and painstaking efforts as well as tremendous financial investment.


The writer is an officer of the Information Services Department.



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