Contraceptive Use in Ghana : The Role of Service Availability, Quality and Price Book

Ghana was among the first sub-Saharan African countries to adopt a population policy, in 1969. Today, the mean distance to a source of family planning is about three miles, including public and private health facilities and private pharmacies. These services also offer several modern contraceptive methods, for a fee. Secondary enrollment rates for girls have risen to 31 percent, among the highest in sub-Saharan Africa. However, population is still growing rapidly, fertility is high and contraceptive use is low. In this paper, individual women are linked to the characteristics of the nearest pharmacy, health facility and source of family planning to assess the relative importance of socioeconomic background and the availability, price and quality of family planning services on contraceptive use and fertility. The source of data is the 1988-89 Ghana Living Standards Survey (GLSS). The results suggest that raising levels of female schooling will also raise contraceptive use and lower fertility, particularly in rural areas. Distance to services remains a binding constraint for contraceptive use among the entire sample and for the urban sample of women; the distance to services in rural areas is still high, while in urban areas where demand for smaller families is greater, distance is a binding constraint even though average distances are smaller. The number of methods offered at a health facility is associated with lower fertility but has no apparent relation with current contraceptive use. The presence of admission fees at the nearest health facilities has no relation with contraceptive use, while the availability of spermicides raises use. Service characteristics have little relationwith fertility and sometimes in unexpected directions, leading to the suspicion that some of the services are placed according to patterns of demand. Measures of the quality of services show no consistent effect on the demand for contraception or on fertility. This may be because of low variation in quality, because the important quality aspects were not measured by the GLSS, or because other factors, such as distance and price, are the binding constraints to increased use of modern methods at present.