|
|
| ||
|
Winter 1997, Vol. 3, No. 1 Family Planning As recently as 1994, modern contraceptives were a rarity in Kassena-Nankana, a rural district of northern Ghana. That year, three villages in the district became the site of a family planning pilot project; 15 months later, more than 250 women in these villages were practicing contraception. What factors distinguished this group of "contraceptive innovators" from women who adhered to traditional reproductive practices? This question is the subject of a new Population Council paper (see Source), which presents findings from Phase I of the Community Health and Family Planning Project, an experimental program run by the Navrongo Health Research Centre (a Ghanaian Ministry of Health field station) with technical assistance from the Council. The project is testing programmatic strategies that are culturally adapted to a traditional, rural African society. Initial results of this experiment belie a basic premise of most family planning programs and research: that contraceptive adoption is a result of individual initiative. "A lot of our thinking in the family planning field is based on the idea that we are working with individuals; but women in this society do not view themselves as individuals," observes James Phillips, the lead author of the paper and the Council's primary liaison to the Navrongo project. Women in Kassena-Nankana may have their private views and preferences, but they "are not free to act on their motives as individuals with personal needs," the paper states. Instead, women defer to their husbands, corporate (i.e., extended) family, and community leaders before taking action. As a result, they rarely adopt contraception unless they perceive that their husbands and other community members support this decision. Spousal and social support for family planning is, in fact, the most powerful predictor of contraceptive adoption in this locale. "Characteristics of individuals, such as personal preference to limit or space childbearing, literacy of husbands or wives, or other indicators of demand for family planning, are less important determinants of contraceptive innovation than are indicators of husband's support, spousal communication, or social interactions about family planning," the paper reports. Data show that a woman is three times more likely to adopt contraception if she has discussed family planning with her husband or the head of her compound, and four times more likely to adopt if she has "consistent recall of spousal dialogue." Even discussing family planning with someone outside the compound increases a woman's odds of becoming a contraceptive innovator. Family planning programs in Asia, Latin America, and other regions have succeeded by identifying women's contraceptive needs and preferences, then providing services to meet this demand. "Even in Bangladesh, where the corporate family and community are very important, women have a powerful sense of personal agency when it comes to family planning," Phillips observes. "They have preferences that they feel they can act on when services are made available to them." But in an African setting like Kassena-Nankana, "traditional institutions limit the utility of models predicated on individual agency," Phillips says. In this cultural milieu, "family planning strategies that aim to mobilize individual agency...will be less effective than approaches that foster a sense of collective participation of extended families," the paper states. The Navrongo project has met this cultural challenge by supplementing door-to-door service delivery to individuals with initiatives that promote social support for family planning through traditional cultural channels (for more on this design, see "Fostering reproductive change in a traditional African society: An experiment in northern Ghana" in the June 1995 issue of Population Briefs). This dual approach is now being tested throughout the Kassena-Nankana District in a scaled-up version of the three-village pilot project. The Navrongo research team hopes this experiment will yield a programmatic strategy that allows women to adopt contraception on their own behalf, and that fosters community support for family planning in traditional African settings. Source Outside funding |
