**_Regina_** _McNanara_ **_et_** _al._

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# II. Ghana Registered Midwives Association Family Planning Program

# _Backgrouund_

Ghana was the first of the African colonies to realize political independence and one of the first to officially declare that its high fertility was an impediment to social and economic development and to set goals for lower growth rates. These goals have not been achieved. The annual growth rate from 1960 to 1970 was about 3.0 percent; the United Nations Department of International Economic and Social Affairs estimated the 1990 population at 15 million and the growth rate at 3.2 percent (United Nations, 1990). In 1990, there were almost three million more Ghanians than was reported from the 1984 census.

Ghana promulgated its official population policy in 1969 and the National Family Planning Programme (GNFPP) was established a year later. The Secretariat charged with coordination of activities in both public and private sectors was located within the Ministry of Finance and Economic Planning. Participating agencies included five other government ministries and the Central Bureau of Statistics as well as the Christian Council of Ghana and the Planned Parenthood Association of Ghana (PPAG), private sector agencies which had been offering family planning services since the 1960s.

According to reports of the University of Ghana Population Impact Project, the population policy was retained through successive administrations over the next 20 years, but with erratic political commitment. Lack of adequate knowledge about population issues, poor institutional coordination, a limited number of trained personnel, insufficient institutional support and inadequate government funding are a few of the problems cited (Benneh et al., 1989). Historical accounts are replete with references to poor institutional coordination, tension, structural confusion and frustration (Kwafo, n.d.; Nabila, n.d.). Yet some progress was made. By 1974, family planning services were offered in 135 clinics throughout the country; over half were Ministry of Health (r-OH) facilities and the others were PPAG, the Christian Council and private or military hospitals and clinics. By 1986, approximately 330 clinics offered family planning services (Nabila, 1986). Contraceptive social marketing programs were attempted in 1971 and 1978, and a current program started in 1986.

Economic deterioration in Ghana, beginning in the early 1970s and reaching the lowest point in 1983, severely damaged the country's health service infrastructure. An exodus of skilled labor, poor morale among the health workers who remained, high prices and lack of petrol, paper, and other basics for supply and communication, &ll brought MCH and family planning services close to a moribund state. There was little international donor assistance during these devastating years to maintain existing services or to encourage initiatives in program development.

The 1971 and 1978 social marketing efforts foundered on lack of funds and management expertise, although their demise is attributed also to ambivalence in official circles concerning use of the media for family planning messages, especially those that describe contraceptive methods. On several occasions, all social marketing promotions through the mass media were halted, at least in part because of political apprehension about support for family planning in a country where high fertility is valued. Nevertheless, Ghanaians have had extensive exposure to