Impact of social and monetary costs on family planning behavior in a rural impoverished locality of northern Ghana
Methods: A qualitative study comprised of 16 male and female community-member focus groups, and 68 in-depth interviews of community leaders, frontline workers, and managers was conducted in Ghana's Upper East Region between June and September 2012.
Results: Women were positive about fertility regulation owing to perceptions that more children are surviving and expenses associated with raising children are rapidly increasing. Male reluctance to regulate fertility nonetheless remains high. In response to this preference gender gap, women often practice contraception covertly, employing tactics that mask their actions such as visiting nurses at irregular hours and locations, denying use among kin, and avoiding modalities that could betray use. Monetary service fees complicate surreptitious use because women have constrained autonomy to finance services, obligating them to negotiate with men or elder women for resources for fees when they would prefer to keep such matters secret.
Conclusion: Women offset social costs of family planning with complex strategies that combine contraceptive secrecy with dependence upon workers to defer payment of fees. Contraceptive use would be facilitated by mitigating the interplay of social and monetary costs by promoting family planning via male social networks, diminishing psycho-logistical costs by delivering care to women in non-clinical settings, and removing fees for services and supplies.
Learning Areas:Planning of health education strategies, interventions, and programs
Social and behavioral sciences
Identify the social and monetary costs of family planning, as well as the strategies that both women and programs pursue to enable women to implement their preferences.
Keyword(s): Family Planning, Barriers to Care
Qualified on the content I am responsible for because: I worked on this project for the entirety of its duration, first as a study coordinator in Ghana, and then as a data analyst and writer in New York.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.