Why Do Family Planning Providers Restrict Access to Services? An Examination in Ghana

Context In 1969, Ghana became one of the first African countries to adopt a population p o l i c y. Acceptance of family planning was s l o w, however, and 20 years later, in 1988, the prevalence of modern contraceptive use had reached only 5%. Between 1988 and 1998, though, the use of modern contraceptive methods nearly tripled, fro m 5% to 13%. At the same time, the total fertility rate dropped from 6.4 to 4.5 lifetime births per woman.3 To improve quality of care and clients’access to family planning and other re p roductive health services, Ghana recently developed and disseminated National Repro ductive Health Service Protocols (with technical assistance from INTRAH a n d P R I M E ) .4 A few years before, Ghana also had formulated new service delivery policies and standards. All of those guidelines— uniform rules to which all family planning service delivery points should adhere — a re designed to remove medical barriers and replace diff e rences between clinical practices with uniform, quality services. Written ru l e s may also protect providers, many of whom fear being blamed by dissatisfied clients or their partners. John Stanback is senior re s e a rch associate, Family Health International, Research Triangle Park, NC, USA. K.A. Tw u m-Baah is deputy government statistician, Ghana Statistical Service, Accra, Ghana. Support for the re s e a rc h on which this article is based was provided by the U.S. Agency for International Development. Why Do Family Planning Providers Restrict Access to Services? An Examination in Ghana