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Addressing Men’s Concerns About Reproductive Health Services and Fertility Regulation in a Rural Sahelian Setting of Northern Ghana: The “Zurugelu Approach”

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Critical Issues in Reproductive Health

Part of the book series: The Springer Series on Demographic Methods and Population Analysis ((PSDE,volume 33))

Abstract

Convenient, nonclinical, community-based services that use community organization, structure and institutions has emerged as the core strategy to expand access to contraceptive technologies in sub-Saharan Africa. When experimental projects in Asia revealed that this approach, collectively termed “community-based distribution” (CBD), can enhance the quality, appropriateness and impact of family planning programs, lack of convenient access to contraceptives was viewed as the primary barrier to the practice of family planning rather than societal barriers. This paper presents findings from the long term observation of a factorial trial of alternative strategies for CBD, testing the relative effects of professional nurse based strategies versus combining nurse with volunteer roles that target the needs of men. Quantitative and qualitative results attest to the importance of activities that address the needs and concerns of men. Strategies that lacked this focus had no impact, even when CBD made comprehensive family planning services fully accessible.

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Notes

  1. 1.

    The “Integrated Management of Childhood Illness (IMCI)” approach was intended to improve health by training workers to recognize treatment needs of a wide range of health problems and engage parents and communities in improving recognition of illness and appropriate actions (see WHO (2008)).

  2. 2.

    Community engagement components of the Zurugelu approach were designed to sustain access to basic pharmaceutical supplies. Volunteer recruitment and management procedures were adapted from the recommendations of the UNICEF sponsored “Bamako Initiative” which sought to translate social institutions into resources that organize primary healthcare (Knippenberg et al. 1990). Family planning themes and activities were added to Bamako mandated health service strategies.

  3. 3.

    The term “durbar” refers to an event, convened by chiefs and elders, to assemble family heads for making announcements, building consensus, and gauging community reactions to some event or activity of collective interest. Employed extensively in northern Ghana as an important mechanism for community governance, durbars were utilized in the CHFP to promote health awareness and build understanding of project activities (Tindana et al. 2007).

  4. 4.

    This approach represented the view promoted by the World Bank at the time which advocated the use of paid, professional nurses to improve the range and coverage of community health care (World Bank 2003).

  5. 5.

    Figure 4.2 is adapted from the “Easterlin Synthesis Framework” (Easterlin and Crimmins 1985; Easterlin et al. 1988).

  6. 6.

    See for example, Taylor et al. (1976) and Ringheim et al. (2011).

  7. 7.

    The High Impact Rapid Delivery program was launched in the Upper East Region of Ghana in 2003 as a follow-on to the UNICEF Accelerated Child Survival Program. Although the official aims and clinical components of both programs were similar to CHFP, these initiatives did not provide for the posting of nurses to communities and family planning was not a focus of volunteer training and deployment (Nakamura et al. 2011). Ghana Health Service progress reports on the High Impact Rapid Delivery program make no mention of family planning (see, for example, Ghana Health Service 2010).

References

  • Adongo, P. B., Phillips, J. F., Kajihara, B., Debpuur, C., & Binka, F. N. (1997). Cultural factors constraining the introduction of family planning among the Kassena-Nankana of northern Ghana. Social Science & Medicine, 45(12), 1789–1804.

    Article  CAS  Google Scholar 

  • Akazili, James et al. 2003. Panel survey report. Community health and family planning project (CHFP). Documentation note 48. Navrongo, Ghana.

    Google Scholar 

  • Bawah, A. A., Akweongo, P., Phillips, J. F., & Simmons, R. (1999). Women’s fears and men’s anxieties: The social impact of family planning in northern Ghana. Studies in Family Planning, 30(1), 54–66.

    Article  PubMed  CAS  Google Scholar 

  • Bertrand, J. T., Mangani, N., Mansilu, M., McBride, M. E., & Tharp, J. L. (1986). Strategies for family planning service delivery in Bas Zaire. International Family Planning Perspectives, 12(4), 108–115.

    Article  Google Scholar 

  • Bertrand, J. T., McBride, M. E., Mangani, N., Baughman, N. C., & Kinuani, M. (1993). Community-based distribution of contraceptives in Zaire. International Family Planning Perspectives, 19(3), 84–91.

    Article  Google Scholar 

  • Binka, F. N., Nazzar, A., & Phillips, J. F. (1995). The Navrongo community health and family planning project. Studies in Family Planning, 26(3), 121–139.

    Article  PubMed  CAS  Google Scholar 

  • Binka, F. N., Ngom, P., Phillips, J. F., Adazu, K., & MacLeod, B. B. (1999). Assessing population dynamics in a rural African society: The Navrongo Demographic Surveillance System. Journal of Biosocial Science, 31, 373–391.

    Article  Google Scholar 

  • Binka, F. N., Bawah, A. A., Phillips, J. F., Hodgson, A., Adjuik, M., & MacLeod, B. (2007). Rapid achievement of the child survival Millennium Development Goal: Evidence from the Navrongo Experiment in northern Ghana. Tropical Disease and International Health, 12(5), 578–593.

    Article  Google Scholar 

  • Bledsoe, C. H., Banja, F., & Hill, A. G. (1998). Reproductive mishaps and Western contraception: An African challenge to fertility theory. Population and Development Review, 24(1), 15–47.

    Article  Google Scholar 

  • Bongaarts, J., & Bruce, J. (1995). The causes of unmet need for contraception and the social content of services. Studies in Family Planning, 26(2), 57–75.

    Article  PubMed  CAS  Google Scholar 

  • Bongaarts, J., & Sinding, S. W. (2009). A response to critics of family planning programs. International Perspectives on Sexual and Reproductive Health, 35(1), 39–44.

    Article  PubMed  Google Scholar 

  • Caldwell, J. C., & Caldwell, P. (1988). Is the Asian family planning program model suited to Africa? Studies in Family Planning, 19(1), 19–28.

    Article  PubMed  CAS  Google Scholar 

  • d’Cruz-Grote, D. (1996). Prevention of HIV infection in developing countries. Lancet, 348(9034), 1071–1074. Retrieved June 12, 2013, from http://www.thelancet.com/journals/a/article/PIIS0140-6736(95)11031-3/fulltext

  • Dasgupta, M., Bongaarts, J., & Cleland, J. (2011, June 1). Population, poverty, and sustainable development: A review of the evidence (Policy Research Working Paper No. 5719). Washington, DC: World Bank.

    Google Scholar 

  • Debpuur, C., Phillips, J. F., Jackson, E. F., Nazzar, A. K., Ngom, P., & Binka, F. N. (2002). The impact of the Navrongo project on contraceptive knowledge and use, reproductive preferences, and fertility. Studies in Family Planning, 33(2), 141–164.

    Article  PubMed  Google Scholar 

  • Doctor, H. V. (2010). Has the Navrongo Project in northern Ghana been successful in altering fertility preferences? African Population Studies, 22(1), 88–106.

    Google Scholar 

  • Doctor, H. V., Phillips, J. F., & Sakeah, E. (2009). The influence of changes in women’s religious affiliation on contraceptive use and fertility among the Kassena-Nankana of northern Ghana. Studies in Family Planning, 40(2), 113–122.

    Article  PubMed  Google Scholar 

  • Dube, H. M. B., Marangwanda, C. S., & Ndhlovu, L. (1998). An assessment of the Zimbabwe family planning programme: Results from the 1996 Situation Analysis Study. Harare: Zimbabwe National Family Planning Council and Nairobi: Africa Operations Research and Technical Assistance Project II, The Population Council. Unpublished report.

    Google Scholar 

  • Easterlin, R. A., & Crimmins, E. M. (1985). The fertility revolution: A supply–demand analysis. Chicago: University of Chicago Press.

    Google Scholar 

  • Easterlin, R. A., Wongboonsin, K., & Ahmed, M. A. (1988). The demand for family planning: A new approach. Studies in Family Planning, 19(5), 257–269.

    Article  PubMed  CAS  Google Scholar 

  • Foreit, J. R., Gorosh, M. E., Gillespie, D. G., & Gary Merritt, C. (1978). Community-based and commercial contraceptive distribution: An inventory and appraisal. Population Reports. Series J, 19(March), 1–29.

    Google Scholar 

  • Frank, O., & McNicoll, G. (1987). An interpretation of fertility and population policy in Kenya. Population and Development Review, 13(2), 209–243.

    Article  Google Scholar 

  • Freedman, R. A. (1987). The contribution of social science research to population policy and family planning program effectiveness. Studies in Family Planning, 18(2), 57–82.

    Article  PubMed  CAS  Google Scholar 

  • Ghana Health Service Regional Health Directorate, Upper East Region. (2010, January–June). High impact rapid delivery progress report. Bolgatanga: Regional Health Administration, Ghana Health Service. Unpublished report.

    Google Scholar 

  • Ghana Statistical Service (GSS), & Macro International. (1994). Ghana demographic and health survey, 1993. Calverton: Macro International.

    Google Scholar 

  • Ghana Health Service. (2010). High impact rapid delivery progress report. Bolgatanga, Ghana.

    Google Scholar 

  • Goldberg, H. I., McNeil, M., & Spitz, A. (1989). Contraceptive use and fertility decline in Chogoria, Kenya. Studies in Family Planning, 20(1), 17–25.

    Article  PubMed  CAS  Google Scholar 

  • Knippenberg, R., et al. (1990). The Bamako initiative: Primary health care experience. Children in the tropics: Review of the International Children’s Centre. Children in the Tropics. Retrieved June 14, 2013, from http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED319533&ERICExtSearch_SearchType_0=no&accno=ED319533

  • Kols, A. J., & Wawer, M. J. (1982, November–December). Community-based health and family planning. Population Reports. Series L, 3(10), L77–L111.

    Google Scholar 

  • Kruger, R. A. (1988). Focus groups: A practical guide for applied research. Beverly Hills, CA: Sage.

    Google Scholar 

  • Luck, M., Jarju, E., Nell, M. D., & George, M. O. (2000). Mobilizing demand for contraception in rural Gambia. Studies in Family Planning, 31(4), 325–335. Retrieved June 12, 2013, from http://doi.wiley.com/10.1111/j.1728-4465.2000.00325.x

  • Munyakazi, A. (1989). L’experience des abakangurambaga en communes Gatonde et Kihado de la préfecture Ruhengeri. [The experience of the abakanguambaga in Gatonde communities of Ruhengeri prefecture] Imborezamuryango, Office National de la Population (Rwanda No. 15, August 14–20). Unpublished report.

    Google Scholar 

  • Musau, S. N. (1997, January). Family life education project, Busoga Diocese, Uganda: Cost analysis report. Arlington: Partnership for Child Health Care, BASICS. Unpublished report.

    Google Scholar 

  • Nakamura, H., Ikeda, N., Stickley, A., Mori, R., & Shibuya, K. (2011). Achieving MDG 4 in Sub-Saharan Africa: What has contributed to the accelerated child mortality decline in Ghana? PLoS One, 6(3), e17774. doi:10.1371/journal.pone.0017774.

    Article  PubMed  CAS  Google Scholar 

  • National Population Council. (1994). A draft population policy. Accra: Ministry of Finance and Planning.

    Google Scholar 

  • Nazzar, A., Adongo, P. B., Binka, F. N., Phillips, J. F., & Debpuur, C. (1995). Developing a culturally appropriate family planning program for the Navrongo Experiment. Studies in Family Planning, 26(6), 307–324.

    Article  PubMed  CAS  Google Scholar 

  • Ngom, P., Binka, F. N., Phillips, J. F., Pence, B., & MacLeod, B. (2001). Demographic surveillance and health equity in sub-Saharan Africa. Health Policy and Planning, 16(4), 337–344.

    Article  PubMed  CAS  Google Scholar 

  • Nicholas, D. D. (1978, October 16). The Danfa family planning program. Paper presented at the 106th annual meeting of the American Public Health Association, Los Angeles.

    Google Scholar 

  • Phillips, J. F., Greene, W. L., & Jackson, E. F. (1999). Lessons from community-based distribution of family planning in Africa. New York: The Population Council.

    Google Scholar 

  • Phillips, J. F., MacLeod, B. B., & Pence, B. (2000). The Household Registration System: Computer software for the rapid dissemination of demographic surveillance systems. In: Demographic research (Vols. 2–6). Rostock: Max Planck Institute for Demographic Research. http://www.demographic-research.org/volumes/vol2/6/default.htm

  • Phillips, J. F., Bawah, A. A., & Binka, F. N. (2006). Accelerating reproductive and child health programme impact with community-based services: The Navrongo experiment in Ghana. Bulletin of the World Health Organization, 84(12), 949–955. Retrieved http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2627578&tool=pmcentrez&rendertype=abstract

  • Phillips, J. F., Jackson, E. F., Bawah, A. A., MacLeod, B., Adongo, P., Baynes, C., & Williams, J. (2012). The long term fertility impact of the Navrongo Experiment in rural northern Ghana. Studies in Family Planning, 43(3), 175–190.

    Article  PubMed  Google Scholar 

  • Ringheim, K., Gribble, J., & Foreman, M. (2011). Integrating family planning and maternal and child health care: Saving lives, money, and time. Washington, DC: Population Reference Bureau.

    Google Scholar 

  • Robey, B., Rutstein, S. O., & Morris, L. (1993). The fertility decline in developing countries. Scientific American, 269(6), 60–67.

    Article  PubMed  CAS  Google Scholar 

  • Ross, J. A., & Frankenberg, E. (1993). Findings from two decades of family planning research. New York: Population Council.

    Google Scholar 

  • Ross, J. A., Lauro, D. J., Wray, J. D., & Rosenfield, A. G. (1987). Community based distribution. In R. J. Lapham & G. B. Simmons (Eds.), Organizing for effective family planning programs. Washington, DC: National Academy Press.

    Google Scholar 

  • Rutenberg, N., & Watkins, S. C. (1997). The buzz outside the clinics: Conversation and contraception in Nyanza Province, Kenya. Studies in Family Planning, 28(4), 290–307.

    Article  PubMed  CAS  Google Scholar 

  • Shoenmaecker, R. I., Lesthaeghe, R., & Tambashe, O. (1981). The child-spacing patterns and the postpartum taboos in tropical Africa. In H. Page & R. Lesthaeghe (Eds.), Child-spacing in tropical Africa-traditions and change (pp. 25–72). London: Academy Press.

    Google Scholar 

  • Taylor, C. E., Newman, J. S., & Kelly, N. U. (1976). The child survival hypothesis. Population Studies, 30(2), 263–278.

    PubMed  CAS  Google Scholar 

  • Tindana, P. O., Singh, J. A., Tracy, C. S., Upshur, R. E. G., Daar, A. S., Singer, P. A., Frohlich, J., & Lavery, J. V. (2007). Grand challenges in global health: Community engagement in research in developing countries. PLoS Medicine, 4(9), e273. doi:10.1371/journal.pmed.0040273.

    Article  PubMed  Google Scholar 

  • World Bank. (2003). Making services work for poor people, The 2004 world development report. New York: Oxford University Press.

    Book  Google Scholar 

  • World Health Organization. (2008). A systematic review of the effectiveness of shortening integrated management of childhood illness guidelines training. Final report. Geneva: World Health Organization.

    Google Scholar 

  • Zinanga, A., Bouzidi, M., & Korte, R. (1990). Community-based distribution programme in Zimbabwe. In Family planning for life: Experiences and challenges for the 1990s. Papers presented at the Conference on Management of Family Planning Programmes, Harare, Zimbabwe, 1–7 October 1989 (pp. 37–44). London: International Planned Parenthood Federation. Retrieved June 14, 2013, from, http://www.cabdirect.org/abstracts/19901884586.html;jsessionid=624368FA4B81168991A7123BA3973D12

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Acknowledgements

 This research was funded by grants to the Mailman School of Public Health, Columbia University from the William and Flora Hewlett Foundation and the Doris Duke Charitable Foundation. The Navrongo Community Health and Family Planning Project was supported by grants to the Population Council from the United States Agency for International Development, the Finnish International Development Agency, and the Mellon Foundation. The Navrongo Demographic Surveillance System was supported by grants to the Ghana Health Service from the Rockefeller Foundation.

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, School of Public Health, University of Ghana, Legon, Accra, Ghana

    Philip Baba Adongo Ph.D.

  2. Heilbrunn Department of Population and Family Health, Columbia University, Mailman School of Public Health, New York, NY, USA

    James F. Phillips Ph.D. & Colin D. Baynes MPH

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  1. Philip Baba Adongo Ph.D.
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  2. James F. Phillips Ph.D.
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  3. Colin D. Baynes MPH
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Correspondence to Philip Baba Adongo Ph.D. .

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  1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA

    Andrzej Kulczycki

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Adongo, P.B., Phillips, J.F., Baynes, C.D. (2014). Addressing Men’s Concerns About Reproductive Health Services and Fertility Regulation in a Rural Sahelian Setting of Northern Ghana: The “Zurugelu Approach”. In: Kulczycki, A. (eds) Critical Issues in Reproductive Health. The Springer Series on Demographic Methods and Population Analysis, vol 33. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6722-5_4

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