Ghana.

• Position: Reproductive & Sexual Health Rights in Cameroon, Egypt, Ghana, Malawi and Rwanda: An Advocacy and Communications Approach - Report

1.0 BACKGROUND AND INTRODUCTION

Reproductive and sexual rights are intrinsically linked with and indivisible from other human rights and are accepted internationally as a precondition for sustainable development. Participation in the reproductive and sexual decision-making process enables women to participate actively in and enjoy developmental rights related to education and productive labour. The whole process is part of the development continuum which embraces all aspects of the lifespan of women from the womb to the tomb.

This research aims to provide the evidence for African NGOs and CSOs to influence national legal and policy frameworks to provide protection and promote SRHR in Ghana. This research will assess the Government of Ghana's implementation of the International Conference on Population and Development (ICPD) and other relevant international and regional instruments.

The findings will provide some guidance to improve the negotiation capacity of young Ghanaian women, with regard to their SRHR by exposing and thereby deconstructing existing customary and religious barriers that undermine autonomy and choice as manifest in sexual coercion and violence.

1.1.1 Demographic Facts about Ghana

Population in 2000 20,212 Population in year 2015 ('000) 29,820 Sex ratio (/100 females) 99.1 Age distribution (%): Age 0-14 43.1 Youth (1 5-24.) 19.9 Age 60 + 4.9 Annual population growth rate (%) 2.7 Total fertility rate (/woman) 4.7 Life expectancy at birth (years) Males 60.3 Females 63.8 Both sexes 62.0 GNP per capita (U.S. dollars, 1998) 390 Thresholds * Births with skilled attendants (%)1/ 44 [greater than or equal to] 60 Contraceptive prevalence rate (%)2/ 20 [greater than or equal to] 55 Proportion of population aged 15-24 living with HIV/AIDS (%)3/ 2.39 [less than or equal to] 10 Adolescent fertility rate (per 1,000 women aged 15-19)4/ 113.1 [less than or equal to] 65 Infant mortality rate (per 1,000 live births)5/ 66 [less than or equal to] 50 Maternal mortality ratio (per 100,000 live births)6/ -- [less than or equal to] 100 Adult female literacy rate (%)7/ 53 [greater than or equal to] 50 Secondary net enrolment ratio (%)8/ -- [greater than or equal to] 100 * UNFPA Document DP/FPA/2000/14 and Approved By the Executive Board in Decision 2000/19. Similar indicators are used to track progress in sexual and reproductive health. 1.1.3 Research Methodology

A literature review to examine background information and documentation on SRHR in Ghana including the implementation of the ICPD preceded qualitative research.

Interviews were conducted with respondents from various institutions which provide services or monitor services for women in various spheres, exploring their scope of involvement in provision of SRHR.

For the qualitative aspects of the research a participatory interview approach guided by a questionnaire was used. The questionnaire gauged the understanding of various sectors of the population of SRHR and their understanding of the exercise of these rights. It sought to assess gender based barriers to negotiation including cultural and religious barriers. Interviewees were selected through purposive sampling. Questionnaires were administered in 6 different regions of the country spanning the various cultural and religious diversities, professions and age groups.

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The towns visited were (from North to South) Tamale in the Northern Region, Kumasi in the Ashanti region, Koforidua and Somanya in the South Eastern regions, Cape Coast in the Central Region, Takoradi in the Western region and Accra (the capital of Ghana) in the Greater Accra Region. The survey targeted both men and women from all social spheres urban and rural and interviews were carried out on a one-to one basis. The resultant information was analyzed and is presented.

2.0 FINDINGS

2.1. Assessing Progress on Implementation of SRHR in Ghana

2.1.1 Institutional Surveys

MINISTRY OF WOMEN AND CHILDREN'S AFFAIRS (MOWAC)

MOWAC's achievements include the establishment of gender desk officers (GDO's) in all Ministries, Departments and Agencies (MDA's) and some districts; affirmative action to achieve parity in girl-child education; sensitization programmes to create health awareness for women on SRHR; family planning and safe motherhood.

As challenges, MOWAC itself identifies socio-cultural constraints, behavioral and attitudinal changes and lack of sex-aggregated data for decision making. In reality, the impact of this Ministry has not been optimal. For instance, the number of women in decision-making is minimal. Women account for less than 10% of people in public office with only two women in Cabinet, 7% of assembly members are women, 16% of women in Council of State and only 19 women (9%) in the 200-member parliament. Few women are represented on public boards and commissions. Gender Officers have not been able to effectively influence policy-making. There are no concrete policy measures put in place to ensure that structural inequalities between women and men are taken into account in promoting the participation in policy decisions4. The mandate of MOWAC is to initiate/formulate policies and promote gender mainstreaming across all sectors that will lead to the achievement of gender equality and empowerment of women, survival, development and growth of children as well as ensuring the protection of the rights of women and children. An honest appraisal of its achievements in six years indicates that its mandate has not been achieved. It has never included the promotion of SRHR within its objectives, concentrating mainly on micro-credit provision to women.

The Government of Ghana has adopted the Affirmative Action Policy Guidelines which include increasing to 40 per cent the representation of women in key positions in public service and in national executive or policy-making institutions. This has not translated into reality and most boards and institutions fall short of these targets.

In Ghana as in many developing countries, a disproportionate share of the burden of poverty is borne by women which undermines their health and well-being. There are twice as many illiterate women as there are men. Women's' education positively affects their participation in the labor force; improves the living standards of the family; increases the use of health care services; reduces child mortality and improves children's nutrition and education. In line with the ICPD Programme of Action and the solemn declaration on Gender Equality in Africa, the government of Ghana has identified three areas under its gender equality, equity and empowerment strategy. These are: the empowerment of women and the enhancement of the status of women in the society; the welfare of the girl child; and emphasizing male responsibilities and participation in family life issues.

In empowering women, the government has, on paper, sought to establish transparent m'echanisms to ensure the equitable representation of women in all aspects of the nation's economic, political and socio-cultural development. Priority has also been said to be given to measures aimed at reducing poverty, ill health and illiteracy among women. MOWAC has however emphasized the role of micro credit in the empowerment of women, yet this in the long term tends to impoverish them even further as they remain on the borderline for poverty.

Government has made efforts to eliminate discriminatory practices against women, particularly, practices involved with opportunities for promotion, equal pay and access to credit. It has also organized many educational seminars in the rural areas across the country to educate women on empowerment issues including SRHR and the elimination of exploitation, abuse, harassment and violence against women. These efforts however are not self sustaining and the momentum quickly dies down.

In an attempt to ensure the welfare of the girl child in education, the government appointed a Minister for Primary, Secondary and Girl-Child education to ensure the provision of equitable educational opportunities for the girl-child. Admission of girls into tertiary institutions has been increased under the Education Reform Policy. Some NGOs have instituted special scholarship schemes to support the needs of talented but poor children as well as educational needs of girls to complement government efforts. Fee-free education at the primary level and a new school feeding programme has helped to increase general enrolment figures.

THE NATIONAL POPULATION COUNCIL (NPC)

The NPC is the body set up before the ICPD by the government of Ghana to monitor population activities in the country. Ghana had a National Population Council, first inaugurated in the early 1990's but its national policies were revised in 1994 after the ICPD to reflect the international consensus. Subsequently the Government put in place the needed policy and structures for action on the PoA. The Parliament of Ghana has an active committee on population and development and is an active member of The Forum of African and Arab Parliamentarians for Population and Development.

The Council revised its strategies after the 1994 ICPD and formulated a national population policy framework. It outlined three areas for action namely...