W ANTED F ERTILITY R ATES

Mother’s age at birth

<20 41.7 57.3 1.0 100.0 631

20-24 66.6 31.9 1.5 100.0 1,403

25-29 75.7 20.9 3.4 100.0 1,699

30-34 74.6 16.0 9.4 100.0 1,404

35-39 73.4 10.1 16.5 100.0 907

40-44 64.6 6.5 28.8 100.0 271

45-49 57.1 0.5 42.4 100.0 42

Total 69.2 23.6 7.3 100.0 6,358

6.5 W

F

R

The wanted fertility rate measures the potential demographic impact of avoiding unwanted births.

It is calculated in the same manner as the total fertility rate but excludes unwanted births from the numerator. A birth is considered wanted if the number of living children at the time of conception is less than the ideal number of children reported by the respondent. The gap between wanted and actual fertility shows how successful women are in achieving their reproductive intentions. This measure also may be an underestimate to the extent that women may not report an ideal family size lower than their actual family size.

The total wanted fertility rates shows in Table 6.6 represent the levels of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been avoided. Overall, Ghanaian women have 0.6 children more than their ideal number of 3.6 children. This implies that the total fertility rate (TFR) is 17 percent higher than it would be if unwanted births were avoided.

The gap between wanted and observed fertility rates is larger among women in rural areas (0.8 children) than among women in urban areas (0.3 children). By region, the gap is largest among women residing in the Central and Brong Ahafo region (0.9 children) and smallest among women in Western and Greater Accra regions (0.3 children each).

The gap between wanted and observed total fertility rates decreases with education. Women with no education have 0.7 children more than they want, compared with 0.3 children among women with a secondary or higher education. There is an inverse relationship between wanted fertility rates and wealth.

The gap between wanted and actual fertility rates ranges from 0.2 children among women in the highest wealth quintile to 1.0 child among women in the second wealth quintile.

There has been a slight increase in the wanted fertility rate from 3.5 children in 2008 to 3.6 children in 2014.

Table 6.6 Wanted fertility rates

Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Ghana 2014

Background characteristic

Total wanted fertility rates

Total fertility rate Residence

Urban 3.1 3.4

Rural 4.3 5.1

Region

Western 3.3 3.6 Central 3.8 4.7 Greater Accra 2.5 2.8

Volta 3.6 4.3

Eastern 3.4 4.2 Ashanti 3.5 4.2 Brong Ahafo 3.9 4.8 Northern 6.2 6.6 Upper East 4.5 4.9 Upper West 4.5 5.2

Education

No education 5.5 6.2 Primary 4.1 4.9 Middle/JSS/JHS 3.6 4.2 Secondary+ 2.3 2.6

Wealth quintile

Lowest 5.5 6.3

Second 4.5 5.5

Middle 3.2 3.9

Fourth 3.1 3.5

Highest 2.6 2.8

Total 3.6 4.2

Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2.

Family Planning • 79

FAMILY PLANNING 7

amily planning has been a priority for the government of Ghana for many years. It is highlighted as a key factor in population management and national development outlined in the current Ghana Shared Growth and Development Agenda II: 2014-2017 (NDPC 2014). Important policy documents have been written to guide the implementation of the country’s national family planning programme.

These documents include the National Population Policy, the Reproductive Health Service Policy and Standard, the 2000 Adolescent Reproductive Health Policy, the Reproductive Health Commodity Security Strategy (2011-2016), the Draft National Condom and Lubricant Strategy and Market Segmentation Analysis for family planning, among others (MoH 2011).

The goal of family planning is to assist couples and individuals of reproductive age to achieve their reproductive goals and improve their general reproductive health. The objectives of Ghana’s family planning programme are (1) to provide information, education, and counselling to individuals and couples, enabling them to decide freely and responsibly when to start childbearing and how to space the children they choose to have; (2) to provide affordable contraceptive services and make available a full range of safe and effective methods; and (3) to provide information on how to manage reproductive tract infections (RTIs) and sexually transmitted infections (STIs), including HIV and AIDS (GHS 2014).

Despite the high importance placed on family planning activities by national policies, strategies, and plans, adequate funding for the family planning programme remains a challenge, thereby affecting progress towards the set targets. In response, the government of Ghana has passed a law to include family planning in the National/District Health Insurance Scheme (N/DHIS). This will enhance the advocacy efforts of stakeholders in the area of reproductive health and family planning from the public and private sectors, civil society, nongovernmental organisations (NGOs), and development partners. However, the implementation of the law is yet to be realised.

This chapter presents information on knowledge of various contraceptive methods and discusses past and current prevalence. For users of rhythm or calendar method (periodic abstinence), knowledge of the ovulatory cycle is examined; for those relying on sterilisation, the age at the time of the procedure is assessed. Also discussed are the source of modern contraceptive methods, informed choice,

F

Key Findings:

• Knowledge of contraception is universal in Ghana.

• Twenty-seven percent of currently married women use contraception; 22 percent use a modern method.

• The three most popular modern methods used by married women are injectables (8 percent), implants (5 percent), and the pill (5 percent).

• Use of modern methods has more than quadrupled in the past 25 years, rising from 5 percent in 1988 to 22 percent in 2014.

• The government sector remains the major source of contraceptives in Ghana, providing them for 64 percent of current users, an increase from 39 percent in 2008.

• Overall, one in four contraceptive users discontinued using a method within 12 months of starting its use. Six percent of episodes of discontinuation occurred because of side effects or health concerns.

• Thirty percent of currently married women have an unmet need for family planning services, with 17 percent having an unmet need for spacing and 13 percent having an unmet need for limiting.

discontinuation rates and reasons, unmet need for family planning, nonuse of contraception, and intent to use contraceptive methods in the future. In addition, information is provided on exposure to family planning messages through the media and contact with family planning providers. These topics are of practical use to policymakers in formulating efficient and effective family planning strategies and policies.

Although the main focus of this chapter is on women, results from the male survey are also presented because men play an important role in the realisation of reproductive goals. Comparisons are also made, where feasible, with findings from previous surveys to evaluate trends over the past years in Ghana.