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MEDIA CENTER Can Family Planning Services Reduce Fertility in Rural West Africa? NEW YORK (12 July 2002) — Can improved access to family planning services reduce fertility in rural West Africa, where traditional religious customs and kinship networks reinforce the desire for many children? According to a new study, family planning programs-if they are integrated into a comprehensive health-care system, convenient to clients, respectful of preferences, and responsive to community needs-can indeed lower fertility rates, even in a rural traditional setting that is widely viewed as being incompatible with family planning program success. The study appears in the June issue of Studies in Family Planning, a quarterly peer-reviewed journal published by the Population Council. Noting that fertility levels in Sahelian West Africa are double the levels observed in other developing regions of the world, Cornelius Debpuur and his colleagues set out to assess the relative impact of different types of program strategies in rural northern Ghana. Fertility was reduced by one birth in the first three years of exposure to the component of the program that combined accessible health care with community involvement. The authors analyzed demographic data gathered by the Navrongo Health Research Centre's Navrongo Community Health and Family Planning Project. Since 1994, Navrongo researchers have worked with Ghana's Ministry of Health to change the country's primary health-care program from a passive clinical system to an active community-outreach program. Specifically, paramedical workers who were once assigned to underused clinics were redeployed to villages and equipped with outreach transportation. They were instructed to canvass communities and seek clientele for the public program. At the same time, researchers mobilized support for community health and family planning services by engaging existing councils of elders and traditional networks. Navrongo was selected because the northern regions of Ghana are widely assumed to be unfavorable settings for family planning success. The study area lies in the most impoverished region of Ghana, on the border of Burkina Faso, where animist religious practices predominate and traditional forms of village government and social organization endure. Although some exposure to outside ideas and influences arises from trade and migration, the study district remains isolated and remote. Despite the social institutional constraints to contraceptive use, most women expressed a preference for some degree of fertility control, researchers found. Their findings indicate a need for further research concerning the social costs of contraception and on the ways that these costs can be mitigated by community-action programs. Cornelius Debpuur is Rockefeller Fellow, Navrongo Health Research Centre, Ministry of Health, Navrongo Upper East region, Ghana. James F. Phillips is Senior Associate and Elizabeth F. Jackson is Research Coordinator, Policy Research Division, Population Council. Alex Nazzar is Scientist, Health Research Unit, Ghana Health Service. Pierre Ngom is senior Fellow, Africa Population and Health Research Centre, Nairobi, Kenya. Fred N. Binka is Associate Professor, University of Ghana, School of Public Health.
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