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

  • Philip Baba Adongo
  • James F. Phillips
  • Colin D. Baynes
Part of the The Springer Series on Demographic Methods and Population Analysis book series (PSDE, volume 33)


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.


Family Planning Total Fertility Rate Family Planning Service Family Planning Program Community Health Nurse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



 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.


  1. 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.CrossRefGoogle Scholar
  2. Akazili, James et al. 2003. Panel survey report. Community health and family planning project (CHFP). Documentation note 48. Navrongo, Ghana.Google Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. Caldwell, J. C., & Caldwell, P. (1988). Is the Asian family planning program model suited to Africa? Studies in Family Planning, 19(1), 19–28.PubMedCrossRefGoogle Scholar
  13. d’Cruz-Grote, D. (1996). Prevention of HIV infection in developing countries. Lancet, 348(9034), 1071–1074. Retrieved June 12, 2013, from
  14. 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
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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
  19. Easterlin, R. A., & Crimmins, E. M. (1985). The fertility revolution: A supply–demand analysis. Chicago: University of Chicago Press.Google Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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
  22. Frank, O., & McNicoll, G. (1987). An interpretation of fertility and population policy in Kenya. Population and Development Review, 13(2), 209–243.CrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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
  25. Ghana Statistical Service (GSS), & Macro International. (1994). Ghana demographic and health survey, 1993. Calverton: Macro International.Google Scholar
  26. Ghana Health Service. (2010). High impact rapid delivery progress report. Bolgatanga, Ghana.Google Scholar
  27. Goldberg, H. I., McNeil, M., & Spitz, A. (1989). Contraceptive use and fertility decline in Chogoria, Kenya. Studies in Family Planning, 20(1), 17–25.PubMedCrossRefGoogle Scholar
  28. 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
  29. 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
  30. Kruger, R. A. (1988). Focus groups: A practical guide for applied research. Beverly Hills, CA: Sage.Google Scholar
  31. 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
  32. 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
  33. 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
  34. 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.PubMedCrossRefGoogle Scholar
  35. National Population Council. (1994). A draft population policy. Accra: Ministry of Finance and Planning.Google Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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
  39. 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
  40. 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.
  41. 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
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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
  44. Robey, B., Rutstein, S. O., & Morris, L. (1993). The fertility decline in developing countries. Scientific American, 269(6), 60–67.PubMedCrossRefGoogle Scholar
  45. Ross, J. A., & Frankenberg, E. (1993). Findings from two decades of family planning research. New York: Population Council.Google Scholar
  46. 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
  47. 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.PubMedCrossRefGoogle Scholar
  48. 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
  49. Taylor, C. E., Newman, J. S., & Kelly, N. U. (1976). The child survival hypothesis. Population Studies, 30(2), 263–278.PubMedGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. World Bank. (2003). Making services work for poor people, The 2004 world development report. New York: Oxford University Press.CrossRefGoogle Scholar
  52. 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
  53. 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,;jsessionid=624368FA4B81168991A7123BA3973D12

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Philip Baba Adongo
    • 1
  • James F. Phillips
    • 2
  • Colin D. Baynes
    • 2
  1. 1.Department of Social and Behavioral Sciences, School of Public HealthUniversity of GhanaAccraGhana
  2. 2.Heilbrunn Department of Population and Family HealthColumbia University, Mailman School of Public HealthNew YorkUSA

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