Reducing Maternal Morbidity and Mortality (R3M) in Ghana

The R3M program provides technical and financial support to increase access to family planning and comprehensive abortion services in three regions of Ghana.

The Issue

Over the past two decades, maternal mortality has begun to decline globally, though progress has remained too slow to achieve targeted reductions for 2015. Although the Government of Ghana has made impressive gains, access to maternal health services is still limited, particularly for the majority of the population who live in urban slums and rural communities. There remains a sizable unmet need for family planning services and a low contraceptive prevalence rate. Although legally available, access to safe abortion services remains a challenge. Taken together, these factors demonstrate the need for extensive and strategic policy and program efforts.

The Progress

Since 2006, a consortium of five organizations (EngenderHealth, Ipas, Marie Stopes International, Population Council, and the Willows Foundation) has supported the Ghana Health Service in implementing the “Reducing Maternal Mortality and Morbidity” (R3M) program. R3M provides financial and technical assistance to enable the government to significantly expand women’s access to modern family planning (FP) and comprehensive abortion care (CAC), initially in 17 pilot districts in 2007 and then expanded to total coverage of the Greater Accra, Eastern, and Ashanti regions.

The objectives of R3M are to:

  • Make FP services (especially long-acting and permanent methods) and CAC routinely available in the program districts and, ultimately, at all levels of the health system in Ghana;
  • Support the Government of Ghana in achieving its contraceptive prevalence goal of 39% by 2015;
  • Reduce mortality and morbidity due to unsafe abortion in the three focus regions and contribute to the achievement MDG5 for Ghana.

The Population Council coordinates the work of program partners to ensure all activities are mutually reinforcing and cost-effective. The Council also coordinates operations research to inform policy, conducts advocacy activities, and provides districts with technical and financial support to improve infrastructure and the standard of care for family planning and CAC services.

The Impact

What has R3M achieved?

R3M continues to raise awareness of the importance of family planning and CAC in safeguarding maternal health and is generating greater public awareness of and support for these services. Best practices continue to be evaluated and support provided for the expansion and possible replication of R3M to other regions.

Increased the number of skilled service providers

  • By the end of 2012, R3M trained 38 CAC trainers and 320 midwives and physicians to provide safe CAC services. An additional 233 house officers, residents, and consultants received comprehensive updates and clinical skills in CAC; and 637 health workers were trained to provide long-acting and permanent contraceptive methods.

Trained key opinion leaders and allied professionals about CAC and reproductive health

  • Nearly 200 professionals (including all senior police officers; Queen Mothers; three Parliamentary Select Committees; and the then Attorney General and Minister of Justice) were sensitized to the medical, legal, and social aspects of safe abortion and family planning.

Provided FP and CAC services directly to women

  • Almost half a million women received modern family planning methods, with 116,872 opting for long-acting or permanent methods as of December 2012.
  • More than 122,545 women accessed high-quality, safe CAC services.
  • More than 60% of interviewed and registered women received counseling and 15,800 received referral services. The contraceptive prevalence rate in this population tripled within four years from 11% to 34%.

Improved attitudes toward CAC and reproductive health services

  • Following considerable consultation and intensive advocacy, substantial proportions of key opinion leaders, police officers, service providers, and the general public understand and accept the broader provisions of the law to safeguard the lives of women in need of abortion.

Demonstrated the importance of collaboration to change attitudes toward CAC and FP

  • Years of partnership have allowed consortium partners to work according to a supportive organizational model that recognizes partners as complementary equals, while allowing them to retain professional and administrative autonomy.
What is the Council’s contribution toward overall R3M achievements?

Coordination for effective program implementation

  • Since 2006, the Council has provided the essential leadership to promote and ensure that the brand name “R3M” lives up to its label. Effective coordination has stimulated a consolidated approach to the collection, management, and timely sharing of information on maternal morbidity and mortality as well as meeting program-related goals.

Revised curriculum for journalism and law schools

  • The curricula of the Faculty of Law of the Ghana Law School and the Ghana Institute of Journalism are being revised to include more guidance on comprehensive abortion care and how it relates to maternal health.

Improved quality of services through provision of client-friendly facilities

  • The infrastructure of more than 70 Ghana Health Service FP and CAC units was upgraded.
  • Seven new FP and CAC units were constructed; and two new reproductive health centers were built at Korle Bu Teaching Hospital and La General Hospital to serve as centers of excellence for training health workers in FP and CAC.

Health assistants clinical and medical schools

  • The Council led the development of training protocols and a handbook for a new category of health workers known as Health Assistants Clinical (HAC) in Atibie and Mampong midwifery schools and medical schools.
  • The Family Planning and Comprehensive Abortion Handbook for Medical Students and House Officers was developed as a pocket reference for students.

Support to pre-service training institutions

  • The Council provided support to the MoH/GHS and Nurses and Midwives Council (NMC) to improve the quality of teaching and learning in 14 midwifery training schools and two teaching hospitals. In collaboration with other partners, the Council trained nurses, midwives, medical students, and OB/GYN interns in CAC and FP, including intrauterine devices and implant insertion and removal, with special emphasis on long-acting and permanent methods.

In 2013, Council staff attended a Civil Society Organizations meeting with the President, His Excellency John Dramani Mahama, during which he committed to being a vocal advocate and publicly speaking about maternal mortality and family planning and advancing these topics as priorities among sectorial ministries.

Fact Sheets (1)