The Fertility Impact of Achieving Universal Health Coverage in an Impoverished Rural Region of Northern Ghana

James F. Phillips , Columbia University
Elizabeth F. Jackson, Columbia University
Ayaga A. Bawah, University of Ghana
Patrick Asuming, University of Ghana

Pervasive unmet need for family planning persists throughout Ghana, despite longstanding policies aiming to provide universal family planning coverage (UFPC). The Community-based Health Planning and Services initiative (CHPS) for achieving universal health coverage (UHC) is also Ghana’s core UFPC strategy. In four years, the Ghana Essential Health Interventions Program (GEHIP) expanded CHPS population coverage from 20 percent to 100 percent, positioning its strategies as the framework for CHPS reforms for achieving UHC. Baseline and terminal surveys are analyzed to test the hypothesis that achieving UHC with the GEHIP model is tantamount to achieving UFPC. GEHIP exposure was associated with increased contraceptive use, but also increased unmet need. Multivariate spline regression analyses show that GEHIP exposure was associated with only modest fertility decline. Achieving UFPC requires beyond UHC activities that support the family planning information and service needs of men and women in ways that offset social barriers to contraception.

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 Presented in Session 27. Examining the Role of Population and Reproductive Health Policies and Practices