Family Planning - An African Village's Position

Is family planning an effective way to increase population? Nana Bristiam Atorsah II believes so. He is chief of the Nawuri, a 4,000-member tribe made up primarily of subsistence farmers in Ghana's Northern Region.

Atorsah is eager to help “regrow” a community that suffered considerable losses during tribal conflict in 1991, but he also wants to protect his people against the high rates of maternal and infant mortality that besiege sub-Saharan Africa. "By encouraging the use of modern contraceptives for birth spacing of two to three years, we're helping to improve our health and economic well-being. This does much more to increase the size of our tribe than simply promoting larger families," the chief explained. Recent studies in developing countries have shown infant mortality can be reduced by up to 24 percent and under-5 mortality by up to 35 percent in families whose children are born at least three years apart.

At 18 percent, Ghana's contraceptive prevalence rate is the second highest in West Africa (behind Cape Verde). Knowledge of contraception is believed to be nearly universal and supplies consistently keep up with demand. Nonetheless, the percentage of Ghanaian women who have expressed a desire for family planning but are not using a modern method is estimated at 35 percent.

The pock-marked dirt roads leading in and out of Kpandai, where Nana Atorsah and a large concentration of his tribe members live, are difficult enough to navigate in the dry season. And, during the Northern Region's May-to-September rainy season, necessary detours tack extra distance and time onto planned travels. Despite such conditions, personnel at the Kpandai Health Centre and the nearby Oti River Hospital report they rarely have even short-term stock-outs of contraceptives. They use the Ghanaian Ministry of Health's paper-based logistics management information system to track commodity usage and estimate upcoming requirements, which are then forwarded to the regional medical storage facility at Salaga for regularly scheduled fulfillment.

Despite a smooth flow of reproductive health supplies and the strong influence that Nana Atorsah carries as a chief, sharing the family planning message among the Nawuri has been a challenge. Help came from a group of local women who developed a dance to communicate the benefits of birth spacing to the community. A defining moment of the pantomime features a father (played by a woman) being wrestled to the ground by his children as they beg him for food.

Promoting the use of contraceptives as a way to improve maternal and child health through birth spacing is a fairly recent phenomenon in Ghana, particularly in the way the Nawuri women are doing it through dance. But the effort to sustain family planning continues, faced with today’s challenge of maintaining support as the fight against HIV/AIDS and other priorities create competition for available funding.