Curtailing Unplanned Pregnancies Through National Health Insurance Scheme

Worldwide, about 800 women die everyday due to complications during pregnancy and childbirth-about 287,000 women in 2010 lost their lives to pregnancy related cases. In developing countries, like ours, conditions related to pregnancy and childbirth constitutes the second leading causes (after HIV/AIDS) of death among women of reproductive age. This is according to the World Health Organisation (WHO). Some of the causes of these deaths are; severe bleeding, infections, unsafe abortions, and hypertensive disorders.

Out of about 136 million women who give birth each year, worldwide, about 20 million of them experience pregnancy-related illness after birth. As if that is not enough, about 16 million girls aged 15 and 19 give birth each year, accounting for more than 10% of all births. In developing countries, complications from pregnancy and childbirth are the leading causes of death among girls in their teen age.

On the more serious note, about 21 million unsafe abortions are carried out, mostly in developing countries every year, resulting in 47,000 maternal deaths worldwide.

From the lenses of Public Health practice, I think that many of these maternal deaths could have been prevented if information on Family Planning and contraceptives were available, accessible, and affordable, and put into practice.

If about 10% of all pregnancies or births in a year occur among people in their teen age, what it simply means is that, those pregnancies were not intended in anyway. The aspect that calls for more public health concern is that the number of unsafe abortions carried out among teenagers each year, outnumber the number of deliveries to these teen group. What it implies is that; the cases of maternal mortality would keep increasing if unsafe abortions are also on the increase.

A simple survey I conducted on teens, who have suffered teenage pregnancy in some deprived communities here in Ghana, revealed that; about 98% of these young girls have little or no information on the myriad of contraceptives we have today. A chunk of these teens also relied on the natural family planning method; which turn to fail these teens in most cases because most of them are not able to interpret their physiological changes in relation to their ovulation period and or menstrual cycle.

If a developing country like Ghana can lose thousands of its human resource capital to preventable cause of death (unsafe abortion and unplanned pregnancy), then it needs to be treated with much urgency just as any other national development agenda.

Here in Ghana, the regional compilation of the 2013 figures on maternal mortality revealed that, a total of 1,012 institutional deaths were recorded across the country in 2013 compared to 889 deaths in the preceding year. This is according to the District Health Information Management (DHMIMS2) data compiled on March 30, 2014 and made available by the Ghana Health Service. Meanwhile, one of the targets of the millennium Development Goals (MDGs) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. So far, the vehicle for driving home the above objective/target has been driving at either first gear or on deflated tyres. Since 1990, the global maternal mortality ratio has declined by only 3.1% annually instead of the 5.5% rate needed to achieve MDG 5; aimed at improving maternal health.

The simple inference that could be drawn from the proliferation of unplanned pregnancies among teens is that, these teens have sex unprotected. What this means is that there could be high rate of sexually transmitted infections among these age group. Substantiating the above claim, the World Health Organization reported that young people aged 15-24 accounted for an estimated 45% of new HIV infections worldwide in 2007.

To address the above menace, we need massive Public Health awareness/ education among all women and men in fertility age, particularly, women in our hard-to-reach farming and fishing communities and girls in junior and senior high schools. The education in the junior high school level should be intensified. This is because the rate of teen pregnancy is more alarming among this group as compared to teens in the senior high school level.

Education and awareness creation alone may not be enough to achieving the goal of reducing the number of unsafe abortions, unplanned pregnancies and maternal mortality. Rather, the host of modern contraceptives should be made available and affordable to men and women in fertility age.

Figures from the National Health Authority (NHIA) indicate that nearly more than half of Ghanaians are enrolled on the National Health Insurance Scheme. It will be much more prudent to include Family Planning methods as part of the services rendered by NHIS. This development, in my candid opinion, will be the most effective and efficient way of making it affordable and achieving the pre-determined behaviour change expected.

In the same development, I would want to argue that our country (Ghana) would better be managed and developed if deliberate effort is directed at child spacing among married couples. The uncontrolled childbirth among a chunk of married couples, particularly in rural communities goes a long way to increasing our population pool against the scarce resources available. If childbirth among couples in our rural communities who cannot afford three (3) square meals a day is not controlled, we will still be under developed. If more of our uncontrolled birth children are born to parents who cannot give them proper education and parenting, the already existing unskilled human resource-base would keep widening at the expense of the skilled human resource.

This should therefore be a national wakeup call to the government, NHIA and other relevant stakeholders to initiate a collective will to considering the inclusion of Family Planning services to the services rendered by the NHIS. It would be a great investment towards sustainable human resource capital for the development of our dear nation, Ghana.

Gbolu Samson
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+233 241115660