In my first article on the series ‘Testimonies from Kigali, Lessons for Ghana’ I promised to write another of my numerous lessons I gleaned from the 5^th International Conference on Family Planning, held from the 12^th -15^th of November 2018, at the Kigali Convention Centre, Rwanda. I am by this article honouring that promise to my distinguished readers this New Year.

I was supported by my organization, Marie Stopes International Ghana (MSIG) to go to Kigali and present a joint poster with a very respected senior colleague, on Ghana’s progress towards Comprehensive Sexuality Education (CSE) in schools. As the Adolescent/Youth Focal Person of my organization, I was tasked to also listen, observe, ask and copy anything which could aid our quest to reach more sexually active adolescents and young people with comprehensive sexual and reproductive health information and contraceptive services. This would in turn help reduce the incidences of unintended pregnancies and  consequent complications among our young ones. My participation in the breakout sessions were therefore very biased; I was almost always in a session on adolescents and young people.  After a few sessions on adolescent contraception, I conceived this idea of putting my thoughts into writing for our Health Managers and Government Leaders in Ghana to consider, as we work together to improve the health of our girls.

Teenage Pregnancy must be viewed as a Public Health Emergency with a Red Flag

After attending my first two sessions on adolescents and family planning, my eyes were opened to the great disservice we are doing to our young girls as a people. A recent article I read had this quote by Alexander Yakovlev, a Soviet Politician and Philosopher: ‘‘A litmus test of any government, however it may describe itself, is its treatment of children’’  I even prefer to say that ‘the litmus test of any country, however, it may describe itself, is its treatment of women, especially its girls.’’

I think that if a country sits down for 32 out of every 100 of its girls who are 19years old to become teenage mothers, drop out of school and struggle to survive in the informal sector; and 20 out of every 100 of its girls to be married off before their 16^th birthday, then there is really a complex socio-cultural and public health emergency in that country. Yet that is the case of our beloved Ghana, where 140 out of every 1000 (15-19yrs olds) girls are pregnant teenagers.

A recent UNFPA conceptual framework on adolescent sexual and reproductive health I came across seemed to suggest that, the real difference between women who make it in life and those who do not make it, comes down to their access to sexual and reproductive health information and services during adolescence. The evidence is that when girls are given comprehensive sexual information - including information on how to stay chaste, contraception, safe abortion and the issue of gender within that age window - they have greater chances of delaying sexual debut and birth until a later time in their twenties when they have good education and are relatively more empowered economically to fend for themselves and dependents.  It is not that we do not know these facts as a people; we have always known them, and they have informed the numerous policies we have developed, which we rarely implement and evaluate.

Ghana’s teenage pregnancy rate of 14.2% according to our 2017 Maternal Health Survey is one of the highest among lower middle income countries. In developed countries, this figure is only 1.5%.  Abortion as a pregnancy outcome amongst our adolescent girls which stands at 19% is also one of the highest among our middle income classmates. Whilst I respect the efforts we have made to address teenage pregnancies, such as the formulation of a 5-year strategy to combat the menace by the Ministry of Children, Gender and Social Protection, the Ghana Adolescent Health Service Policy and Strategy by the Ghana Health Service, and several other strategies by current and previous Governments, I am still of the firm opinion that we have not raised the health alert of teenage pregnancy to the level it deserves in public health. Until we begin to see teenage pregnancy as a Public Health Emergency which requires monetary investment to fund the wonderful strategies we have developed to reduce it to the bearest minimum, we are just paying lip service to the main threat to the well-being of our girls. It is clearly not enough to formulate a policy; we need to implement it, and that requires deliberate investment of financial and human resources. This is where we are lacking as a people.

Godfred Bonnah Nkansah

Our 2017 Maternal Health Survey showed that 9% of our girls have ever had sex by age 15. The figure, however, shoots up to 47% by age 18. Fifty percent (50%) of our young girls have ever had sex by 18.4yrs. Meanwhile, even among those who are married within this age range (15-19yrs), only 17% are on modern contraception to either delay or space their births.  Only 32% of those not married within this same age range who are sexually active are on modern contraception. Our adolescent unmet need for contraception, which in the lay man’s vocabulary refers to the proportion of adolescent girls who are in sexual unions, and have no plans of getting pregnant within the next two years, but are not on any form of contraception is 51%. It is one of the highest in the lower middle income belt.  Simply put, our adolescents are having sex without contraception. The results then are obvious; we are going to continue having a lot of them having unintended pregnancies, unsafe abortions, dropping out of school, having repeated pregnancies, experiencing maternal and child mortalities or dropping off into a poorly rewarding informal economy where she is unable to compete due to her limited skills. She also becomes the victim of unending sexual and gender based abuses. This is the threat we are faced with if we do not raise the red flag against teenage pregnancy.

Sexual and Reproductive Health Services such as Family Planning must be a core part of our Poverty Alleviation Strategy.

As a country, we can never truly eradicate poverty in all forms if we continue to pay lip service to the sexual and reproductive health of the adolescent girl. Whilst we have committed to the spirit of the Sustainable Development Goals, which is to leave no one behind, I fear greatly for our girls, especially those out of school, who are out there in the informal economy, and who are hustling for hand to month remunerations every day. We seem to have forgotten about them almost entirely in our reproductive health programming.

In Kigali, I saw that countries had rolled out integrated HIV/STI and family planning services targeting girls, because those countries had realized adolescent girls are amongst the main drivers of rapid population growth, and needed to be supported with family planning services to help expand their reproductive health choices. They had also worked hard to tie contraception to career aspirations of girls, and are helping them to know how contraception can help them complete their apprenticeship, schools, vocational training and help lift them up from poverty. Their poverty alleviation programmes therefore include voluntary family planning, because evidence has shown that the poor are most vulnerable to unintended pregnancies. Governments are therefore aggressively helping their poor, including their girls to understand the need to delay, space and limit births. The poor girl is told how access to contraception can help her complete school and also delay birth until she was ready.

I think this is the direction we should be going as a nation. We need to pursue a deliberate all-out war against adolescent pregnancies: it must be a priority on our development goal list. If we don’t, we are denying the young girls their right to good life. I have always argued that adolescent pregnancy is a failure of public health. Somebody who was supposed to have given out comprehensive information to that girl did not do it because, perhaps she/he assumed the girl was too young to have such information. As for the men, I do not trust that they will ever be able to zip their flaps and wait until our girls are mature enough to marry them as custom demands. It has never happened anywhere in Ghana, and I therefore would not attempt any such campaign. The real opportunity therefore is in arming the adolescent girl with all the sexual and reproductive health information and services she needs to face the men when they make advances towards her.

I believe the greatest investments in our day must be in the empowerment of our women and girls. We must give them the opportunity to live better lives than their parents are living today, by rescuing them from perhaps the biggest threat to their greatness – unintended pregnancy! We must reduce the expensive conferences and start going into the slums, the brothels, the villages and  schools to provide sexual and reproductive health information and services to every girl, especially those who are sexually active. We need not be overly religious about this. We must agree that teenage pregnancy is a menace - it is a thief which continues to rob our lovely girls of opportunities in life – and decide to stop it at all cost.

Government must lead the way  in showing greater responsibility for our Girls

Government must lead the charge of investing in the SRH of the girl child and then coalesce support from partners to complement its investments. We cannot continue to depend on donors to fund our teenage pregnancy initiatives as has been the case for years uncountable. We need to begin to see clear lines in our annual budgets going to all the ministries, departments and agencies which have mandates connected with our girls, and even NGOs with proven capacities to help reach our girls with SRH services. Government must also see research into adolescent SRH as very crucial and invest in it. All that I learnt from Kigali, some of which I am sharing here, were borne out of research. It provides the evidence for policies, strategies and programme implementation. 

I do not as yet know of any Government funded programme in adolescent sexual and reproductive health in Ghana. All the programmes we have seen in the last 10 years have been donor funded: Talk of the AYA project, the Ghana Adolescent Reproductive Health Project, the ‘No Yawa’ Project, and the ASK Alliance Project, which delivered massive results by way of education and contraception amongst our girls, were all funded by donors. I know the strategies are there in the books. I have been honoured to have had the opportunity to have represented my organization on various working groups which developed some of the policies. We have always been excellent at developing policies and strategies. Our bane has always been funding their implementation.

I believe in the Ghana beyond aid vision of the current administration. I believe it is the way to go. Weaning ourselves off donor dependency is crucial; we must do whatever it takes to make that happen. This must be looked at beyond partisan politics. We need to start making the domestic financing of our public health interventions, especially sexual and reproductive health a major priority.

You do not need a rocket scientist or a soothsayer to tell you the future of a nation. You can always tell by the level of investment the nation makes in the health (especially the sexual and reproductive health) and education of its youth. In my opinion, the most significant indicator of the future of a country is always the girls of that country. Like our great statesman, Dr. James Emmanuel Kwegyir-Aggrey (1875-1927), said, if you educate a woman – including education on her sexual and reproductive health- you educate a whole nation. Let us give the young girl in my father’s village the opportunity to build a nation! She deserves it too.

Godfred.Bonnah-Nkansah@mariestopes.org.gh/godfredphanet@gmail.com

The writer is the Advocacy Manager and Adolescent Focal Person for Marie Stopes International Ghana, an international NGO headquartered in the UK, and with presence in 37 countries, specialised in the provision of sexual and reproductive health services.