Innovative Strategies Reduce Fertility in Ghana

(excerpts from the Population Council site)

"In the early 1990s, surveys conducted in Ghana showed that people's desire for family planning was largely unfulfilled, despite two decades of policies aimed at making inexpensive family planning services available. Research also showed that mortality in remote rural areas was substantially higher than in urban communities. In response to this situation, the Ghanaian Ministry of Health designed the Community Health and Family Planning experiment at its Navrongo Health Research Centre (NHRC), a field station in rural northern Ghana. The Population Council provided research support and administered funding for this experiment. Many respected observers had stated that improving access to family planning services in rural sub-Saharan Africa would have little or no effect on fertility because kinship networks, family structures, and marriage customs favor large families. Recent results from the Navrongo experiment have provided an altered perspective on the issue..."

Two experimental strategies were developed. In one strategy, Ministry of Health nurses live and work in community-constructed health centers and provide health and family planning services door to door. In the other strategy— known as zurugelu, which means "togetherness" in the local language—door-to-door services are provided by local volunteers and supported by community leaders. These leaders also host community gatherings, known as durbars, that foster community dialogue about health and reproductive matters.

"The study is being conducted in four geographic regions in the Kassena-Nankana District. People in Area 1 are exposed to the zurugelu strategy. Residents of Area 2 receive care from nurses. In Area 3, people benefit from contact with both the zurugelu and nurse outreach strategies. In these three experimental areas and in Area 4, the comparison area, residents have access to Ministry of Health fixed-location clinics..."

It was reported that the initial results of the experiment suggest that in a traditional African society provision of primary health services in the local community and intensive social mobilization can make a difference in fertility and ideas and beliefs about reproduction. The researchers found that when nurse outreach and zurugelu were combined, married women's knowledge of contraceptives improved significantly more than when these two strategies were used separately.