ABSTRACT
Reproductive health has always been a critical factor for all spheres of development be it social, economic and even cultural. This study highlights the contributions of international development partners, particularly the United Nations Population Fund (UNFPA) in providing reproductive health services in Ghana. Data for the study was from primary sources mainly interviews and secondary sources including journal articles, internet sources, reports, books etc. This study sheds light on the instrumental efforts of the UNFPA in reproductive health programming in Ghana. Key findings indicate that international development partners have been instrumental in increasing awareness of reproductive health and rights issues in Ghana, additionally UNFPA has been a major supplier of contraceptives in the country as well as funded a lot of reproductive health initiatives. The study identifies some challenges encountered in the provision of these services, majority of which is low funding both locally and globally as well as requisite training for health workers. This study recommends that government carefully considers domestic resource mobilization to be able to provide these services considering dwindling donor support as well increased capacity building initiatives for health workers to be able to discharge their duties efficiently. With proper planning and management, reproductive health can be of immense benefits to nations, hence it deserves all the necessary attention.
CHAPTER ONE
RESEARCH DESIGN
Introduction
In 2012, at the United Nations (UN) Rio +20 summit, nations devoted themselves to developing a new set of goals to replace the Millennium Development Goals (MDGs) that were due expiration in 2015. There have been several interventions by international/global organizations to curb the social, economic, political and health challenges facing the world’s population. One of the examples of the global framework for development was the MDGs. The MDGs was a fifteen-year development agenda made up of seven major goals from the year 1999 to 2015 1. The operation of the MDGs ended in 2015 and was replaced with the sustainable development goals.
The new goals, the Sustainable Development Goals (SDGs), were universally applicable and to build on the MDGs with anticipated targets projected to be achieved by 2030. The predominant objectives of the SDGs as settled upon by states at the Rio +20 summit can be described as poverty eradication, sustainable lifestyles for all and an unchanging and robust planetary life-support system2.
At a UN sustainable development summit held in New York in 2015, the new goals, the SDGs were adopted by the General Assembly. Each goal, with its associated target and indicators to measure its success.3 The SDGs in total are made up of seventeen (17) goals and one hundred and sixty-nine (169) targets.
The SDGs build upon the MDGs to address the “unfinished business” in the MDG era and mainly seek to provide a universal framework for collaboration to tackle the three scopes of sustainable
development highlighting: “the right to development for every country, human rights and social inclusion, convergence of living standards across countries, and shared responsibilities and opportunities.”4
Goal three of the SDGs seeks to “ensure healthy lives and promote well-being for all at all ages”. Target seven states that, “by 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes”.
Health is essential to human development, in as much as health influences development, development also has an influence on health. The SDGs acknowledge that social and economic developments are affected by diverse health challenges, as such, investments in health and other areas of development are mutually reinforcing.5
Sexual health as an area of health has evolved in the last fifty years in the international discourse on health. The earliest deliberations on sexual health by the World Health Organisation began as early as 1974 and promoted a positive perspective on human sexual behaviour with particular attention to pleasure, improvement of personal relationships and the right to information, further deliberations resulted in the need to link it with notions of reproductive health.6
Reproductive Health (RH) as a concept was developed at a UN sponsored population conference, the International Conference on Population and Development (ICPD) in Cairo in 1994. This was a pivotal moment in the global discourse on the significance of RH and rights, the goals of the ICPD programme of action (PoA) signed by 179 countries were “to attain worldwide access to safe, affordable and effective reproductive healthcare and services including those for young
people including promoting a gender viewpoint and to shed light on reproductive health from a rights-based approach”7.
The conference resulted in universal acceptance of reproductive health and rights and placed comprehensive sexual and reproductive health and rights, choice, women’s empowerment at the center of global agenda. It was agreed at the Cairo conference that; “couples and individuals have the right to freely and responsibly decide the number, spacing and timing of their children, and to have the information and means to do so, also choices vis-à-vis reproduction should be made free from discrimination, coercion and violence”.8
According to the ICPD PoA paragraph 7.2,
Reproductive health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. It also includes sexual health, the purpose of which
is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.9
Reproductive rights are regarded as human rights which encompass universal access to RH throughout a person’s life, and states are bound by legal obligations according to the dictates of international human rights laws to ensure that every person enjoys these rights without inhibition. The commitments by governments and the United Nations system overall to RH and reproductive rights are culled from the general principles of equality and human dignity as established by the universal declaration of human rights.
Historically, Ghana’s first population policy was adopted 1969, which was later revised and a new one adopted prior to the 1994 Cairo conference in response to emerging issues in SRH.
Consequently, several policies were adopted in response to growing recognition for reproductive rights, notable among them being the 2000 National Adolescent Reproductive Health Policy. 10
As explained by Adanu et al, SRH is very vital to the development of a nation, hence, policies and programs aimed at improving SRH have been fused into health interventions and development frameworks for a lot of countries. SRH initiatives are a major focus of the Ministry of Health’s scope of work and are assessed through demographic and health surveys.11
In Ghana, apart from the Ministry of Health (MOH), several international development partners are committed to ensuring that RH services are available and accessible for all people in line with international mandates. For the purposes of this paper, the contributions of United Nations Population Fund (UNFPA) will be assessed.
UNFPA is the United Nations sexual and reproductive healthcare agency, which supports reproductive health care for people, providing services for more than eighty percent (80) of global population. The UNFPA’s support to the MOH/ Ghana Health Service (GHS) begun in 1986. Their services include training health workers in RH activities, sexually transmitted STIs, HIV/AIDS, family planning, etc., procurement of equipment and supplies for RH activities in the country and fellowship training abroad for capacity building abroad and in-country. It also funds some NGO’s as well as the national population council and the Ghana education service in executing population centered programmes and activities respectively.
