2001 ANNUAL REPORT
Appraising reproductive behavior change in Ghana

The Population Council is carrying out two studies that are providing new insights into factors influencing fertility in Ghana. 

A nurse provides home-based health services as part of the ongoing study conducted through the Navrongo Health Research Centre.

An experiment that began in 1996 is being conducted in collaboration with the Navrongo Health Research Centre, a Ministry of Health field station in rural northern Ghana. Council senior associate James F. Phillips has provided technical assistance to Ghanaian colleagues in testing the relative effects of two strategies for delivering health care to rural residents. In the experiment’s design, these approaches are implemented independently, jointly, and not at all, producing four study areas. In one strategy, nurses provide health and family planning services door-to-door. In the other strategy, community leaders support the provision of health services by sponsoring volunteer services. 

Where community mobilization was implemented and where community mobilization was combined with doorstep delivery of services by nurses, fertility fell significantly more than in the comparison area where only clinic- based services were provided. The combined approach also had a significantly greater effect than community mobilization alone. The success of this experiment has led the government of Ghana to begin implementing the combined approach nationwide. 

In the second Council study, senior associates John B. Casterline and Mark R. Montgomery and other Council colleagues are collaborating with researchers at the University of Cape Coast in southern Ghana. This study is exploring social diffusion, the influence exerted by one person’s knowledge, attitudes, and behaviors—in this case about contraceptive use—on the choices made by others. The experiment is designed to estimate the magnitude of these diffusion effects. 

The study involves six rounds of survey data collection in which field workers ask women and men about their own contraceptive use and the related knowledge, attitudes, and behaviors of their closest associates. Thus far, with four rounds of data analyzed, the results indicate that the adoption of modern contraception is strongly affected by exposure to the attitudes and behaviors of associates. 

The findings from both of these studies assist the government of Ghana in implementing effective reproductive health programs. Furthermore, the projects are helping to strengthen the capacity of Ghanaian researchers to conduct additional comprehensive investigations.