DOCUMENT RESUME

ED 088 667 SE 010 517

AUTHOR Gaisie, S. K.; And OthersTITLE Country Profiles, Ghana.INSTITUTION Columbia Univ., New York, V.Y. International Inst.

for the Study of Human Reproduction.; PopulaticnCouncil, New York, N.Y.

SPONS AGENCY Ford Foundation, New York, N.Y.PUB DATE Oct 70NOTE 12p.

EDRS PRICE MF-$0.75 HC-$1.50DESCRIPTORS Demography; *Developing Nations; *Family Planning;

National Programs; Population Distribution;Population Growth; *Population Trends; SocialSciences

IDENTIFIERS *Ghana

ABSTRACTA profile of Ghana is sketched in this paper.

Emphasis is placed on the nature, scope, and accomplishments cfpopulation activities in the country. Topics and sub-topics include:location and description of the country; population (size, growthpatterns, age structure, urban/rural distribution, ethnic andreligious composition, migration, literacy, economic status, futuretrends); population growth and socio - economic development(relationships to national income, size of the labor force,agriculture, social welfare expenditures); history of populaticnconcerns; population policies; population programs (objectives,organization, operations, research and evaluation); private effortsin family planning; educational and scientific efforts in population;and foreign assistance for family planning activities. (RH)

Country ProfilesMWWM

O

GHANA

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Issued by The Population Council

and The Internotional Institute

for the Study of Human Reproduction,

Columbia University

U.S. OE PARTMENT OF HEALTH,EDUCATION &WELFARENATIONAL INSTITUTE OF

EOUCATIONHIS DOCUMENT HAS BEEN REPRO

DUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIGINAING IT POINTS OF VIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRESENT OFFICIAL NATIONAL INSTITUTE OFEDUCATION POSITION OR POLICY

THIS profile was prepared by S. K. Gaisie, Demographic Unit, Universityof Ghana, and S. B. Jones, Principal Assistant Secretary, Ministry ofFinance and Economic Planning, with the collaboration of Dr. J. C.Caldwell of the Population Council and Gordon W. Perkin, M.D., of theFord Foundation.

Location and DescriptionGhana lies in the hot, moist lowlandsof West Africa. Cocoa, timber, indus-trial diamonds, bauxite, manganesedioxide, coffee, and gold make Ghanaone of the richest countries in tropicalAfrica (1960 per capita income wasestimated at US$170; 1968 per cap-ita income, US$235). However, thewealth is not evenly distributed geo-graphically. Cocoa and timber, bothin the South, accounted for over 70per cent of the country's exports inthe late 1950's and early 1960's. Thesavannah country in the North has nosuch cash-export products. This di-chotomy is reflected in many socialand economic aspects of the popula-tion. The southern three-fifths of thecountry contain four-fifths of the pop-ulation. The population in the Southis better educated, subject to lowermortality, more likely to live in towns,more likely to know about contracep-tion, and less likely to be predomi-nantly concerned with the growing ofsubsistence crops, than the populationin the North. These differences areacknowledged by present developmentefforts which concentrate on the lessdeveloped areas of the country in or-der to achieve a more uniform stand-ard of living.

By tropical African standards Ghanais highly urbanized, one-quarter of theCI THE POPULATION COUNCIL. INC.. 1970

population being in centers with over5,000 inhabitants in 1960 (a reason-able criterion because in centers over5,000 more than half the work force isoutside agriculture).

Ghana achieved independence in1957, and was the first tropical Afri-can colony to do so. The overthrow ofan authoritarian government in 1966left the military administration andmuch of the populace anxious to find.pragmatic solutions to Ghana's prob-lems of development. The first na-tional election, held in August 1969,resulted in a popular, majority gov-ernment.

The Population

SIZE AND GROWTH PATTERNS

One of the most significant features ofGhana's population is its rate ofgrowth. In 1921 the country had apopulation of just over 2 million, andby the first quarter of 1960 the popu-lation had reached 7.1 million; thus, itmore than tripled in the short periodof 40 years. Although data for theearly part of the century are not reli-able, the figures indicate that Ghana'spopulation increased at an averageannual rate of 2.8 per cent between1921 and 1960. According to censusdata this rate increased to over 4 percent per annum in the period between

October 1970

1948 and 1960. Estimates, however,indicate that the plausible rate ofnatural population growth during thisperiod was actually between 2.7 and 3per cent per annum. Population esti-mates for 1970 and 1980 are 9.5 mil-lion and 13.6 million persons, respec-tively. These figures reflect a doublingof the population in only 20 years.Preliminary census figures for 1970,which have been released, indicate atotal population count of 8.5 million.(This figure has not been adjusted.)

Ghana's crude birth rate is currentlyestimated to be between 47 and 52 per1,000. The total fertility rate is be-tween 6.5 and 7.5. The crude deathrate and infant mortality rate wereestimated at 23 per 1,000 and 160 per1,000 live births respectively in 1960.Maternal mortality was estimated atabout 10-12 maternal deaths per 1,000deliveries. The life expectancy at birthwas probably about 40 years in 1960.These vital rates are based on retro-spective data collected in 1960, andalthough they indicate the existenceof a comparatively high death rate inGhana, this rate has been decliningrapidly as a result of the widespreadapplication of preventive and curativemedicine. Preliminary data from anational fertility survey completed in1970 suggest that by 1968 the crudedeath rate had fallen to about 17 per1,000, representing an average de-cline of three-quarters of a point eachyear since 1960. The rate of naturalincrease thus ranged between 3.0 and3.5 per cent per annum between 1967and 1969.

REDISTRIBUTION

In 1960 nearly 12 per cent of allGhanaians lived outside the regions inwhich they were born. The GreaterAccra, Ashanti, and Brong Ahafo re-gons attracted more people than theylost to the other regions during the

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intercensus period 1948 1960. Duringthis same period the Northern andUpper regions, and the Volta regionlost about 157,000 and 95,000 peoplerespectively. These inter-regional mi-grations indicate that in Ghana aselsewhere, people are moving from theless developed parts of the countryto the more economically advancedareas.

URBAN RURAL DISTRIBUTION

Centers with over 5,000 inhabitantsincluded 23.1 per cent of the popula-tion in 1960 and probably close to 30per cent by mid-1969. Three majorcenters with more than 100,000 in-habitants (Accra-Tema, Kumasi, andSekondi-Takoradi) comprised 7.7 percent of the population in 1960 andprobably 10 per cent in mid-1969.Accra-Tema and Sekondi-Takoradiare the most important centers ofsocial change. The great majority ofthe town population is distributedalong the coast and in the cocoa-growing areas in the South.

RELIGIOUS AND ETHNIC COMPOSITION

In 1960, 43 per cent of the populationwere Christian, 38 per cent tradition-alist, 12 per cent Muslim, and 7 percent reported no religion. The tradi-tional sector is declining fairly rapidlyand remains more important in theNorth than elsewhere. Among i,heChristian population at least two-thirds are Protestants. Religious divi-sions are not marked and are unlikelyto create fertility differentials.

The great bulk of Ghana's popula-tion continues to be of indigenousAfrican origin. There are small minor-ity groups of Europeans, Lebaneseand Syrians, and other Asians; how-ever, the proportion of Africans amongthe Ghanaian population has neverfallen below 99 per cent since 1921.

Although the 1960 population cen-sus revealed that 12.3 per cent of thetotal Ghana population were foreign-ers, about 96 per cent of the foreign-born immigrants hailed from thenearby African countries of Togo,Upper Volta, and Nigeria. There is nodoubt that the number of foreignershas decreased considerably as a resultof the enforcement of immigrationlaws by the present government. Un-fortunately, the number of foreignerswho left the country since the Alien

Compliance Order of 2 December1969 is not known.' .

ECONOMIC STATUS

In 1960, 83 per cent of the males and54 per cent of the females over 15years of age were working. Of theemployed, 64 per cent of the malesand 58 per cent of the females were inagriculture or fishing. Throughout theSouth, more than half the rural laborforce was employed in a form of farm-ing in which cash sales were impor-tant, with this proportion falling toless than one-fiftieth in the North.

LITERACY

In 1960, 21 per cent of the populationover ten years of age had been toschool, and the proportion probablyincreased to over 30 per cent by mid-1969. Male school enrollments andliteracy rates are about twice those offemales but fall to under one-and-a-half times the female rates in theyoungest age groups. At present liter-acy rates are probably above 50 percent in the major towns, about 33 percent in the rural South, and less than10 per cent in the North.

FUTURE TRENDS

The most recent population projec-tion,2 assuming unchanged fertility,showed a 1970 population of 9.5 mil-lion, a 1980 population of 13.6 million,a 1990 population of 19.7 millio-y anda 2000 population of 28.9 million. Thisprojection also showed that if fertilityfell by 50 per cent between 1975 and2010, the population at the end of thecentury would be about 24.4 million.Constant fertility would lead to a rate

I The socio-economic implications of thesudden departure of large numbers of aliensfollowing the enforcement of the Alien Com-pliance Order of December 1969 are recog-nized. Studies are underway to determineboth the short term and the long term effectson the economy and on the rate of populationgrowth. However, many of the aliens wereself-employed and it is likely that the shortterm effect on unemployment will not be sig-nificant. Furthermore, Caldwell has shown inhis projections that fertility rather than immi-gration is the principal determinant of long,,..:-n population growth in Ghana. The agestructure of the population is also unlikely tobe significantly affected by the departure oflarge numbers of aliens since the evidencesuggests that they were producing children atalmost the same rate as the indigenous popu-lation and in most cases the alien worker leftGhana accompanied by his dependents.

S. K. Gaisie, Dynamics of PopulationGrowth in Ghana.

2

of natural increase of about 4 per centper annum by the end of the century.The average rate of growth would in-crease from about 3.0 per cent in 1960to 3.6 per cent between 1970 and 1975and would exceed 4 per cent in theyear 2000. A linear decline in fertilityby a total of 50 per cent between 1975and 2015 would decrease the averagerate of growth to 2.7 per cent by theyear 2000. The population of Ghanawould double every 30 years or every17 years on the assumptions of de-clining and sustained fertility respec-tively. Urban population projections'indicate that half the population willbe living in towns by 1987, with Ac-cra's population exceeding 1.5 million.

SOCIAL-ECONOMIC GROUPS ANDATTITUDES

The several surveys conducted amongurban and rural communities provideinformation on family planning knowl-edge, attitudes, and practices (KAP)in Ghana. Studies done in 1965 and1966 indicate that 94 per cent ofGhanaian women wanted four or morechildren. Between 25 per cent and 33per cent of the rural respondents andabout 50 per cent of the urban sampledid not want the large family tradi-tional in Africa. In the urban areasabout 85 per cent of the women withpost-secondary or university trainingand in the rural areas 21 per cent ofwomen with no schooling preferred"small" families (less than seven chil-dren). About 50 per cent of the unedu-cated rural women but less than 10per cent of the urban women with nopost-primary schooling favored afamily of more than seven children.

The results of these surveys alsoindicate that knowledge of somemethod of contraception is relativelywidespread; however, many of thetraditional methods are ineffectiveand the use of the more modern meth-ods is still very limited.

In Accra 11 per cent of all womenknew of some method of birth control.Among women with secondary educa-tion 28 per cent knew of a method;among women with middle school, 19per cent did. Among the urban elite 65per cent of women with secondaryeducation and 44 per cent of thosewith less than secondary education

3 J. C. Caldwell, "Population Prospects andPolicy" in A Study of Contemporary Ghana,Vol. II, edited by Birmingham et al.

were familiar with some method. In1965 and 1966 when these surveyswere conducted, organized familyplanning clinics were virtually non-eN:stent in the country and conse-quently none of the urban male andfemale elites knew of the intrauterinedevice (IUD) and only 2 per cent ofeach sex group possessed some knowl-edge about oral contraceptives (in-cluding tablets and other mediciuesfor female hygiene).

It was observed that 23 per cent ofthe rural respondents, 65 per cent ofthe urban male elite, and 54 per centof the urban female elite wanted toknow more about family planning.

The results of the KAP studies indi-cate that the knowledge of, attitudestoward, and practice of family plan-ning vary according to the educationalbackground of the respondents, urbanor rural residence, and area of birth.The recently completed national fer-tility survey is likely to show a sub-stantial increase in the proportion ofrespondents familiar with both theoral contraceptive and the IUD.

Relationship of PopulationGrowth to Social and EconomicDevelopment

RELATIONSHIP TO NATIONAL INCOME

It has been calculated that, with netexternal investment at zero, per cap-ita income would fall between 1960and 1985 by 8 per cent with constantfertility, but would rise 9 per centwith fertility declining by 1. per centper annum and 24 per cent withfertility declining by 2 per cent perannum! It has recently been arguedthat the only economic alternative tofertility decline is massive externalinvestment and that this is a riskylong-term policy.

RELATIONSHIP TO SIZE AND QUALITYOF THE LABOR FORCE

Approximately 40 per cent of Ghana'stotal population and about 75 per centof the adultsabout 3.5 millioncomprise the active labor force. In thelong run the growth of the labor forceis determined by the rate of popula-tion growth; to the extent that thisrate can be checked an over-rapidgrowth of the labor force will also beavoided.

The labor force has been growing

1 John C. Caldwell, ibid.

more rapidly than the opportunitiesfor gainful employment. During thenext five years about 800,000 personsof working age will be added to thelabor force, bringing the total to about4.3 million. Allowing for deaths andretirements, at least 130-140 thousandnew workers from all sources, includ-ing immigration, may be expected toenter the job market each year. Mostof the new workers will be youngpeople, many drifting from rural tourban areas, more and more of themwith some education. Mounting un-employment is a critical problem.

The distribution of the labor forceamong the nation's industries pro-vides an index of the dimensions ofGhana's employment problems andthe level of industrial development.About two million persons-55-60 percent of the labor forceare engagedin agriculture and related pursuits,including an estimated 55-60,000 inforestry and 65,000 who obtaintheir livelihood from fishing. Proba-bly 400-500,000 persons are em-ployed in very small establishments,in petty trade (mostly women), inmotor transport and maintenance, indomestic and personal services, and inother individualized occupations. Out-side these categories there are morethan 490,000 employees in privateestablishments with five or moreworkers, according to a count by thesocial security system. About 100,000are employed in public services, in-cluding more than 50,000 teachers.These are included among roughly600,000 personsabout 17 per cent ofthe labor forcewho work for wagesand salaries in the more highly organ-ized enterprises and activities of bothpublic and private sectors. These esti-mates leave a residual of about 400,000which includes some who are fully orpartially self-employed, and the un-employed.

The modern sectors of employment,whose output is crucial for the growthof the national product, supply jobsto only about 10 per cent of the laborforce. Recorded employment in estab-lishments with ten or more workershas shown little recent change. Theprivate establishments in this group,whose expansion is unlikely to exceed10 per cent per annum in value outputfor the next five years, now employonly a few more than 100,000, and anyaggregate expansion in their employ-

3

ing capacity will be small as comparedwith the number of employables whowill reach working age each year.

Projectkrqs show that the indige-nous labor force will increase at therate of 2.8 per cent annually between1965 and 1970 and at the rate of 3.7per cent per annum in the period fol-lowing 1970. At these rates the num-ber of workers will reach 8.7 million in1995 and 18.6 million in 2015. Onassumption of declining fertility therate would be reduced to 3.5 per centbetween 1990 and 1995 and to 3.0 percent per annum after 1995, thus in-creasing the labor force from 8.6 mil-lion in 1995 to 15.6 million in 2015.

Declining fertility can have littleeffect on the supply of labor for 15years. Thereafter, however, the laborforce would grow less rapidly and itwould be less difficult to improve itsquality and stem the growth of un-employment. Meanwhile an increasingnumber of women would be gainfullyoccupied since a smaller number ofthem would be nursing babies andlooking after small children thanwould have been the case if fertilityhad remained high.

RELATIONSHIP TO AGRICULTURE

The bulk of the nation's labor forcefor many years will find employmentin agriculture and closely related ac-tivities. For the immediate future theelasticity of employment opportunityand the levels of manpower utilizationin agriculture will depend mainly onthe success of the government's pro-grams in inducing rising productivity,expanding markets, and providingneeded supports to improve the eco-nomic position of farmers.

Projections for a five-year periodenvisage an annual increase of thegross domestic product (GDP) in theagricultural sector within the range of3-5 per cent. At the same time thepopulation will increase at an annualrate of 3 per cent or more.

The, distinction between the size ofthe labor force and the concept ofemployment in agriculture is a hazyone since there is no way of estimatingthe intensity of employment (i.e. thedegree of underemployment) amongthe farming population. It may bereasonably assumed that even themarginal workers in the agriculturalsector engage in some amount of use-ful work at various times over the

period of a yearthe amount of workbeing dependent on weather and cropconditions.

If the spread of better farmingmethods and the improvement of phy-sical inputs are delayed or limited inscope, then the increase in agriculturalproduction will depend on puttingmore land under cultivation thus re-quiring larger quantities of labor andtending to curb the excessive migra-tion of rural dwellers to the towns.Under the most favorable conditionsagricultural employment cannot beexpected to absorb more than thenatural increase in the farm laborforce, which will be in the order of50-60,000 per year, and the actualabsorption may be far less.

As modernized agriculture isachieved, fewer and fewer people willbe engaged directly in farm produc-tion, while more and more will findwork in the assembly, storage, trans-port, distribution, processing, andfinancing of farm products, in supplyof tools and materials, and in relatedactivities.

Estimates indicate that agricultureaccounted for about 50 per cent of theGDP is 1961 and that there has beenno significant change in this propor-tion since 1955. The local food con-sumption also accounted for about athird of the GDP between 1955 and1962.

Th vural population was slightlyover 5 .iillion in 1960 and in compari-son with the urban population wasdeclining by 1 per cent per annum.With constant fertility it would be 8,3million in 1985 and 10.7 million in2000; with fertility declining by 1 percent per annum it would be 7.8 millionin 2000; with fertility declining by 2per cent per annum it would be 7.3million in 1985 and 7.0 millionin 2000.

RELATIONSHIP TO PUBLIC EDUCATION

Ghana's educational establishmenthas expanded at a spectacular rate,more rapidly than the economy and atgreat cost. Public outlays for educa-tion rose from NO34.45 million in1961-62 to Ng81. million in 1967-68,which was then 20.5 per cent of totalgovernment expenditure.

Enrollment in primary schools morethan doubled between 1960-61 and1964-65, rising from 441,000 to a high

N01.00 is roughly equivalent to US$1.00.

of 1.4 million. It has leveled off atslightly more than one million sincethe military coup. Middle schoolshave expanded each year, increasingenrollment by some 160 per cent, from145,000 in 1960-61 to 382,000 in1968-69, while enrollment in second-ary schools has tripled from 16,500 to46,500. The three universities havenearly quadrupled enrollment since1960-62, expanding from 1,378 to5,053 in the school year just ended.

About 'd per cent of those of pri-mary and middle-school ages are nowin school.

There were 1.8 million children ofschool age in 1960. This number willincrease to 4.6 million in 1985 withconstant fertility, or 4.1 million if fer-tility is reduced by 1 per cent perannum, and 3.7 million if fertilitywere to decline by 2 per cent perannum. To have all children in schoolby 1985 would require a five-fold in-crease in school facilities between 1960and 1985 with constant fertility; withfertility falling by 1 per cent perannum, an increase of 4.6 times; andwith fertility falling by 2 per cent perannum, just over four times as manyschoolrooms and teachers as existed in1960.

RELATIONSHIP TO PUBLIC HEALTH

Public health measures are among themajor factors that have contributedin recent years to reductions in thecrude death rate by as much as three-quarters of a point per year. Conse-quently with constant fertility therate of natural increase will probablyreach 4 per cent by 2000. The Govern-ment's development program calls forthe phased extension of health serv-ices. Thus mortality is likely to con-tinue to decline, particularly in ruralareas where preventive health meas-ures are being introduced as quicklyas facilities and personnel becomeavailable.

Ghana currently spends overUS$2.65 per capita on health services.The cost of the National FamilyPlanning Programme could largely bemet from the savings in increasedhealth expenditures resulting fromfewer babies. Alternatively with re-duced fertility the per capita healthexpenditures could be increased, pre-sumably contributing to a furtherimprovement in the health of thepopulation.

4

Development of a PopulationPolicy

Concern about Ghana's high rate ofpopulation growth first arose after therelease in late 1961 of the 1960 censustotal population figure showing thatthe population had increased by two-thirds since the 1948 census, an aver-age annual rate of increase of 4.2 percent. The Bureau of Census pointedout that some of the increase was fromimmigration and that the 1948 censuswas probably defective. The Bureauthen erred on the cautious side byassuring the planners that the growthrate was only 2.5 per cent per annurn,although subsequent analyses haveshown that it was undoubtedly higherthan this.

President Nkrumah believed thatthe high population growth rate couldbe accommodated by the economy hewas building, but in 1963, in theSeven-Year Development Plan, theGhanaian planners warned that thehigh rate of growth would put seriousstrains on the economy. In 1965the President established an Inter-Departmental Committee to considera population policy for Ghana.

Definite steps toward formation ofa population program were initiatedby the 1966-1969 Military Govern-ment, which was left saddled withlarge national debts. The Commis-sioner of Economic Affairs was thedriving force in population reform.Formerly Chairman of the EconomicCommittee of the National LiberationCouncil, Mr. E. N. Omaboe had beena director of the study sponsored bythe Ghana Academy of Sciences andthe Ford Foundation, which resultedin a report published in 1966 and1967 as "A Study of ContemporaryGhana." The study drew attention tothe economic savings that could beachieved by reducing the growth rate.

The Two-Year Development Plan,published in the summer of 1968, con-tained a brief reference to the Govern-ment's intention to establish familyplanning services. During that sameyear the newly created Ghana Man-power Board advised that the rate ofpopulation growth must be retardedor the needs of mounting numberswould blunt the drive for accelerateddevelopment and thwart the efforts toattain higher levels of employmentand welfare. After preliminary studiesthe Manpower Board prepared a

broad statement of national popula-tion policy. The statement was ap-proved by the National LiberationCouncil, and was published in March1969 as an official policy paper, "Pop-ulation Planning for National Progressand Prosperity,"6 the major policyrecommendations of which follow:

I. A national population policyand programme are to be devel-oped as organic parts of socialand economic planning and de-velopment activity. Details ofprogrammes are to be formu-lated through the collaborativeparticipation of national andregional entities, both publicand private, and representativesof relevant professions anddisciplines.

IL The vigorous pursuit of furthermeans to reduce the still highrates of morbidity and mortalitywill be an important aspect ofpopulation policy and pro-grammes.

HI. Specific and quantitative popu-lation goals will be establishedon the basis of reliable demo-graphic data and the determina-tion of demographic trends. Tothis end steps will be taken tostrengthen the statistical, re-search, and analytical facilitiesand capabilities of the Govern-ment and of public and privateeducational and scientific organ-izations.

IV. Recognizing the crucial impor-tance of a wide understanding ofthe deleterious effects of unlim-ited population growth and ofthe means by which couplescan safely and effectively controltheir fertility, the Governmentwill encourage and itself under-take programmes to provide in-formation, advice, and assist-ance for couples wishing to spaceor limit their reproduction.

roles for women; and to examinethe structure of Governmentperquisites and benefits and ifnecessary change them in suchways as to minimize their pro-natalist influences and maximizetheir anti-natalist effects.

VI. The Government will adopt pol-icies and establish programmesto guide and regulate the flowof internal migration, influencespatial distribution in the inter-est of development progress, andreduce the scale and rate of im-migration in the interests ofnational welfare.

VII. Provision will be made to estab-lish and maintain regular con-tact with the development andexperience of population pro-grammes throughout the worldthrough intensified relationshipswith international public andprivate organizations concernedwith population problems.

The March 1969 statement firmlyestablishes a population policy whichcommits the Government to providethose who wish to restrict their familysize with the mean: for doing it.

During the fall of 1969 Ghana re-turned to civilian rule with the elec-tion of a popular majority govern-ment. In January 1970 the Govern-ment considered the machinery pro-posed for Ghana's family planningprogram and gave its approval to theestablishment of the program. In addi-tion the cabinet authorized the neces-sary funds to finance the program.

National Family PlanningProgramme

The following section describes theorganization and structure of Ghana'sNational Family Planning Programmewhich was approved by tha Govern-ment in January 1970.

GOALS AND OBJECTIVES

The principal objective of the Na-tional Family Planning Programme isto reduce the rate of populationgrowth in Ghana. Every effort will bemade to assure public access to, andacceptance and continuation of, con-traceptive use. Preliminary planningtargets have been based on an esti-mate of the effort needed to keep thepresent rate of population growthfrom increasing in light of a fallingdeath rate. These targets were basedon the following assumptions:

(a) That the crude death rate coulddecline by as much as one pointper year and that for each fall ofone point in the death rate a com-parable fall in the birth rate mustoccur to maintain a constant rateof growth.

(b) That as many as one-third of fam-ily planning acceptors and thesame proportion of continuingusers from previous years woulddiscontinue contraception in agiven year.That one birth would be pre-vented for each group of fourusers of effective methods duringa year.

It is probable that the death ratemay not decline as rapidly as pre-dicted. In that event a program of themagnitude envisaged would not onlykeep the rate of population growthfrom increasing but could also initiatea modest decline in the annual rate ofincrease. It is also recognized that thepreliminary planning targets are onlyan approximate.,estimate of the effortrequired and are to be further refinedon the basis of program experienceand additional demographic data asthey become availabl, .

The planning targets that havebeen calculated on the basis of theseassumptions are indicated in Table 1.

(c)

These programmes will be edu-cational and persuasive, and notcoercive.

TABLE 1. Planning Targets for Increasing the use of Contraceptives,Ghana(Figures are in thousands)

V. Ways will be sought to encour-age and promote wider produc- Users at Acceptors

Totalnumber of

usersUsers dis-

continuing Users at Estimatedtive and gainful employment for Fiscal start of during during during end of birthswomen; to increase the propor- year year year year year year preventedtion of girls entering and com- FY1970 54 54 18 36 3pleting school; to develop a FY1971 36 78 114 38 76 19wider range of non-domestic FY1972 76 96 174 58 116 29

FY1973 116 118 234 78 156 396 Summarized in Studies in Family Plan- FY1974 156 144 300 100 200. 50

ning, No. 44, August 1969.

5

FIGURE 1. Organization Chart, Ghana National Family Planning Programme, December 1969

Ministry of Finance andEconomic Planning

.."Ministry of Information

National Family Planning Ministry of Youth andMinistry of Health Council Rural Development

Ministry of Laborand Social Welfare

Executive Director

Executive Committee

Evaluation andResearch Unit

Training Unit AdministrativeFiscal, Purchasingand Supply Unit

Service Division

GovernmentServices Unit

Hospitals

HealthCenters

I

PrivateServices Unit

Planned ParenthoodAssociation of Ghana

Private HospitalsPhysicians Midwives

Commercial Outlets

If the acceptor targets are achievedand the assumptions regarding dis-continuation are correct, there will beabout 200,000 continuing users at theend of the fifth year. This representsapproximately 10 per cent of the ex-pected female population in the child-bearing ages.

ORGANIZATION AND RESPONSIBILITIES

The Office of the Director and theSecretariat for the National FamilyPlanning Programme are a part ofthe Ministry of Finance and EconomicPlanning which includes the Govern-ment machiner:4 for development plan-ning. The National Family PlanningCouncil is the advisory body throughwhich the involvement of a widerange of public and private organiza-tions are mobilized. The Council is

Information andEducation Division

Personal ContactUnit

Health Education

Social WelfareDevelopment Workers

Cinema Units

Local Organizations

Teachers

Nurses and Midwives

not an operating agency. All Govern-ment ministries and private and vol-unteer agencies whose activities arerelevant to family planning are repre-sented on the Council.

Administrative continuity betweenCouncil meetings is provided by aseven member Executive Committee.The Ministries of Finance and Eco-nomic Planning, Health, Labor andSocial Welfare, Information, andYouth and Rural Development, thoseMinistries most directly involved withthe implementation of the program,are represented on the ExecutiveCommittee. The Executive Commit-tee is responsible for directing thedevelopment of the program. The fulltime director of the program reportsto the Minister of Finance and Eco-nomic Planning.

Two operating divisions are being

6

Mass Media Unit

Press

Radio

Television

Outdoor Publicity

Cinema

established, one concerned with theprovision of family planning servicesand the other responsible for informa-tion and education.,The Service Divi-sion plans and coordinates the activi-ties of the two units of the division,the Government Services Unit andthe Private Services Unit (Figure 1).The Information and Education Divi-sion, headed by a professional in masscommunications, plans and coordi-nates the activities of the two units ofthat division, the Personal ContactUnit and the Mass Media Unit. TheHealth Education Division of theMinistry of Health, the Ministry ofLabor and Social Welfare, the Min-istry of Youth and Rural Develop-ment, and the Ministry of Informa-tion will all be directly involvedwith the information and educationprcgram.

Three staff units directly respon-sible to the director are also beingestablished. The Administration, Fis-cal, Purchasing, and Supply Unit willprepare budgets, handle and accountfor program funds and be responsiblefor the ordering, storing, maintaining,and distributing supplies and equip-ment. The Training Unit has overallresponsibility for planning and coordi-nating training programa for all cate-gories of personnel involved in theprogram. The Evaluation and Re-search Unit will report at regular in-tervals on the results of the totalprogram and be responsible for plan-ning sample surveys on continuity ofuse of contraceptives and other ques-tions of vital importance to the pro-gram's administrators.

The program will use existing in-stitutions, facilities, and personnel inboth the public and private sectors.The Ministry of Health has majorresponsibility for the provision ofcontraceptive services, for patient ed-ucation, and for training of technicalpersonnel involved in the service pro-gram. The Ministry of Informationhas major responsibility for mass in-formation and education. The Minis-tries of Youth and Rural Develop-ment, and Labor and Social Welfarewill be involved with education andrecruitment. The Ministry of Educa-tion and the Ministry of Agriculture(the Extension Services Division)will participate in the information andeducation program. The Planned Par-enthood Association of Ghana pro-vides contraceptive services and willcontinue to play an important role intraining workers and in public infor-mation. The support and active in-volvement of a number of additionalagencies, institutions, and professionalassociations will also be enlisted.

PROGRAM PLAN

A detailed plan for the education ofthe population and for the phasedextension of services is being preparedduring the early months of the pro-gram. The initial phase of the serviceprogram will concentrate on estab-lishing family planning services in thelarger Government hospitals. Thesehospitals are well-distributed geo-graphically and can serve as trainingcenters for medical and paramedicalpersonnel. The initial training efforthas begun with the preparation of job

descriptions and task-oriented train-ing materials for the several catego-ries of personnel who will be involved.In as much as professional people,especially those working in the healthprofessions, are in very short supplyin Ghana, every effort will be made toassure that those working in the pro-gram will be assigned tasks and re-sponsibilities according to their capa-bilities and training. Consistent withthis policy, specially trained nursesand midwives are expected to providea significant proportion of the avail-able services.

An intensive and sustained infor-mation campaign, emphasizing bothmass media and person-to-personcommunications will be developed toparallel if not precede the establish-ment of contraceptive services.

SUPERVISION

Supervision of the family planningwork will be planned and coordinatedby the staff of the National FamilyPlanning Programme but will be pri-marily the responsibility of the re-spective ministries. For example theMobile Cinema Vans operated by theMinistry of Information are to besupervised by that Ministry eventhough they will be participating infamily planning educational work.Rural development workers who willbe actively involved in patient recruit-ment will be supervised by their supe-riors in the Ministry of Youth andRural Development.

INCENTIVES

Incentive schemes to improve staffeffectiveness and to increase accept-ance of contraceptives and their con-tinued use are to be developed, testedand, where practicable, implemented.A preliminary trial of a nonmonetarycommodity incentive has already beencarried out by the Planned Parent-hood Association. Field workers of-fered interested clients a coupon thatcould be exchanged for one two-poundtin of powdered milk if the womancame for family planning servicewithin ten days. Patient returns in-creased from around 11 per cent dur-ing the control week to over 20 percent during the weeks the free milkwas offered. During the final week ofthe study the field workers were alsooffered an incentivesix tins of pow-dered milk for the worker referring

7

the most new patients, four for thesecond, and two tins for the workerplacing third. Patient acceptances in-creased to over 30 per cent of thosereferred and the total number of newpatients was more than double that ofthe weeks when only the patient in-centive was offered. The results ofthis preliminary trial suggest that inGhana a combination of patient andworker incentives may significantlyincrease the proportion of interestedpatients who come for service therebyreducing the cost per new patientrecruited?

PERSONNEL

The program plan recommends thatthe director of the program and theheads of the two major divisions andthree staff units shown in figure 1, befull time officers. Initially some ofthese positions are likely to be filled bystaff seconded from other Ministries.

TRAINING

The Ministry of Health will be respon-sible for conducting training coursesfor medical and paramedical person-nel engaged in technical aspects of theprogram. The facilities and staff ofKorle Bu Hospital (Ghana MedicalSchool), particularly its Departmentof Obstetrics, will play a major role inclinical training.

The Ministry of Youth and RuralDevelopment is planning to conducttraining courses for the more than 600rural development workers. The re-gional training centers operated bythis ministry will be used.

Programed instruction manuals de-veloped in Thailand have been testedin Ghana and are being adapted priorto their introduction as an integralpart of the training scheme. ThePlanned Parenthood Association willcontinue to provide training for itsfield workers. All training activitieswill be coordinated by the TrainingUnit of the National Family PlanningProgramme.

INFORMATION AND EDUCATION

The Information and Education Divi-sion has responsibility for stimulating,coordinating, and helping to designand operate programs for general in-

7 A preliminary report on this study, byGordon W. Perkin, appears in Studies inFamily Planning, 57: 12-15, September 1970.

struction. The goals of the divisionare: to provide the knowledge neededby couples to regulate their fertility;to acquaint people with the values ofresponsible parenthood; to inform thepublic about, the goals and achieve-ments of the National Family Plan-ning Programme; and to keep Gov-ernment officials and the public in-formed about the importance of familyplanning for economic development.The Personal Contact Unit is respon-sible for helping to design, produce,test, and distribute printed and audio-visual materials and for stimulatingtheir use in person-to-person andsmall group discussions. The HealthEducation Division of the Ministry ofHealth will be an important partnerin this endeavor. The Mass MediaUnit is responsible for 'mounting andsustaining an information campaign,using all available media, to promotewidespread knowledge about popula-tion growth and awareness of therespectability, availability, conven-ience, and safety of family planning.This unit will both produce programsand materials, and contract with ap-propriate private and public agenciesfor their production and dissemina-tion. The Ministry of Information, itsstaff, and mobile cinema vans are tobe a key part of the mass media effort.

The National Family Planning Pro-gramme has adopted an inverted redtriangle as the national family plan-ning symbol. The triangle will beprominently displayed on all litera-ture, posters, clinics, and vehicles, andworn by family planning workers. Itwas introduced during Family Plan-ning Week in August 1969.

EVALUATION AND RESEARCH

The Evaluation and Research Unitwill be responsible for collecting, tab-ulating, interpreting, and reportingpromptly at regular intervals, servicestatistics generated by the program.Special sample surveys may be jointlyorganized with competent local insti-tutions. One of the first responsibili-ties of this unit is to design and test aclinic record-card and reporting formsthat will be used throughout the pro-gram. The Demographic Unit at theUniversity of Ghana, the Institute forStatistical, Social and Economic Re-search, and the Central Bureau ofStatistics will be important collabora-tors in the evaluation effort.

ADMINISTRATION AND SUPPLY

The Administration and Supply Unitis responsible for budget preparation,financial control, and the ordering,storing, distribution, and maintenanceof all supplies and equipment. Thisunit will also administer any incentivesystem that may be adopted.

PROGRAM BUDGET

The precise amount of local funds tobe allocated to the National FamilyPlanning Programme for its first fullyear of operation has yet to be de-cided. The budget that has been pro-posed is equivalent to about US$0.04per capita for the first complete yearof the program.

Foreign assistance requirements willincrease over the first three years ofthe program as clinics are established,staff trained, and the need for newvehicles and foreign training met. Inlater years, the bulk of foreign assist-ance will probably be needed for thepurchase of contraceptive supplieswith the requirements for equipmentand foreign training decreasing as theprogram becomes fully operational.

Current Prevalences of BirthControl Practice

Oral contraceptives are now availablein the private sector but their highprice, about NO1.60 per cycle, haslimited their use to the highly-motivated middle class. It is estimatedthat between 10,000 and 12,000 cyclesof oral contraceptives are sold throughthe private sector each month. Con-doms are also available but the levelof sales is not known. The IUD isavailable from Planned Parenthoodclinics, Korle Bu Hospital, and a num-ber of private physicians. About 7,000women have received family planningservices through the Planned Parent-hood and church-related clinics. Vas-ectomy is almost unknown, and tubec-tomy is neither popular nor readilyavailable. In light of the continuinghigh fertility, the large family size,and the limited access to modern con-traceptives, it is likely that less than 5per cent of fertile Ghanaian womenare using a modern method of familyplanning at the present time.

The Ghanaian abortion law statesthat "any act which is done, in goodfaith and without negligence, for thepurpose of medical or surgical treat-

8

ment of a pregnant woman is justifi-able, although it causes or is intendedto cause abortion or miscarriage, orpremature delivery, or the death ofthe child." On 25 June 1969 the crimeof abortion was reduced from a firstdegree felony with a minimum ten-year prison sentence to a second de-gree felony subject to an indetermi-nate sentence not to exceed ten yearsor a fine. As in other countries Ghana-ian women frequently resort to abor-tion which is not difficult to obtain,particularly in the urban centers.

Indigenous Supporting Resourcesand Institutions

GHANA MANPOWER BOARD

The Ghana Manpower Board cameinto existence in January, 1968.Chaired by the Commissioner of Eco-nomic Affairs, its broad functionswere defined by Decree to include"review . . . (of) the policy of theGovernment on population and mi-gration and advice on measures to betaken to ensure the fullest utilizationof the human resources of the coun-try." Executive and technical servicesare provided by the Ministry of Fi-nance and Economic Planning. Prep-aration of the national populationpolicy for Government approval wasthe first major undertaking of theboard. The board was also responsiblefor developing the plan of organiza-tion and proposed machinery for theNational Family Planning Programmedescribed earlier. The board has con-tinuing responsibility for developmentand guidance of national populationpolicy in all of its aspects and willmaintain a general surveillance of thefamily planning program and its rela-tionship to national development.

MINISTRY OF HEALTH

The Ministry of Health is responsiblefor the provision, integration, and de-velopment of health services through-out the country. The Ministry has 13technical divisions, including Mater-nal and Child Health and sevenadministrative support divisions. TheDirector of Medical Services is re-sponsible for the day to day opera-tions of the Ministry. Ghana is dividedinto nine regions with a total of 49districts. Each regional health pro-gram is administered by a RegionalMedical Officer of Health who super-

vises both preventive and curativeservices in the region. There are 42Government Hospitals with about6,000 beds. Both district and regionalhospitals exist, with more specializedservices available at the regional level.There are another 71 hospitals, withslightly under 4,000 beds, operated bymission groups, mines, other indus-tries, and private practitioners.

There are 49 health centers-40rural and 9 urbandesigned to pro-vide both preventive and curativeservices. Each health center is di-rected by a health center superin-tendent (medical assistant) and has apotential staff of up to six clinicalnurses, two midwives, one publichealth nurse, two community healthnurses, a nutrition officer, a sanitaryinspector, and laboratory and dis-pensary assistants. In the rural areasthe health centers are located in thesmall towns where there are no hospi-tals. Each serves a health area ofabout 150,000 population. The Min-istry of Health plans to increase thenumber of rural health centers staffedwith physicians who would supervisefour or five rural health posts. At pres-ent there are only 11 rural healthposts in operation. The developmentplan calls for one fully staffed andoperating health area (health centerand four or five health posts) in eachregion by 1973.

It is the Government's intention toextend the preventive and curativehealth services as quickly as possibleto the two-thirds of the Ghanaianpopulation not at present effectivelycovered.

About 75 per cent of all deliveries inGhana take place at home and aresupervised by untrained attendants.Of the remaining 25 per cent about 12per cent take place in Governmenthospitals and health centers, 7 percent in mine and mission hospitals, and6 per cent in private maternity homes.Almost all supervised deliveries withthe exception of complicated casesare the responsibility of the midwives.An average of 18,000 deliveries perannum takes place in the three largestGovernment hospitals. This repre-sents slightly more than 4 per cent ofthe total annual number of births.

Health personnel. There are about550 physicians in Ghana. Of these 349are on the staff of the Ministry ofHealth. Two-thirds of the doctors on

the Ministry of Health staff arcGhanaian with the proportion of ex-patriate physicians continuing to de-cline as Ghanaian graduates fromboth Ghana Medical School and over-seas institutions enter Governmentservice.

The Ministry of Health has justover 3,500 nurses and 550 midwiveson its staff. About 25 per cent of thenurses have also received training inmidwifery. In addition to the Govern-ment midwives there are nearly 800registered private midwives who op-erate private clinics. The number ofuntrained practicing midwives is notknown.

The nursing schools graduate about130 State Registered Nurses each yearfrom the three-year course. Qualifiedregistered nurses are graduated fromschools located in the smaller regionalhospitals and mission hospitals. Mid-wives receive two and a half yearstraining after ten years of school.

The Ministry of Health recognizesthat the number of physicians is notsufficient to mount a vigorous familyplanning program particularly in therural areas where health facilities aswell as physicians are very thinly dis-tributed. To help compensate for theshortage of physicians a group ofsenior nurse-midwives are to receivean intensive eight-week trainingcourse as family planning nurses. Thecourse will emphasize clinical experi-ence and will train the nurse-midwifespecialist to operate family planningclinics under medical supervision. Itis expected that this specially trainedgroup will provide many of the familyplanning services available throughthe national program.

CENTRAL BUREAU OF STATISTICS

The Demographic and Social Statis-tics Division of the Central Bureau ofStatistics is responsible for collectingand publishing basic demographicdata. Census-taking was first intro-duced into the country by the Colo-nial Government in 1891 and fromthen on a census was taken every tenyears until 1941 when World War Hinterrupted the sequence. It was notuntil 1948 that another census wastaken. From the point of view ofmethodology and scope the early at-tempts to collect population datamay be called "counts" rather than"censuses."

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The 1960 census marked the begin-ning of a considerable improvement incensus-taking in the country, particu-larly with respect to techniques, ob-jectives and scope. The improvementsreflected the positive attitude of theGovernment toward demographic andsocio-economic data as tools for plan-ning and administration. The 1960census was a complete enumeration ofthe population in Ghana as of mid-night, 20 March 1960. The question-naire contained, in addition to name,11 other items: address at time of enu-meration, sex, age, place of birth,country of origin, tribe, school attend-ance, type of economic activity, in-dustry, occupation, and employmentstatus. Two months after the census aPost-Enumeration Survey was carriedout on a sample of about 5 per cent ofthe total population. The main objec-tives of the survey were to measurecoverage and content errors and toinquire into additional topics thatcould not be covered in the maincensus. Among the items covered werehousehold size and structure, internaland external migration, religion, liter-acy, secondary occupation, economiccharacteristics of the unemployed, de-gree of employment, marital statusand form of marriage (whether con-sensual or formal; if formal, whetherunder Traditional Law or BritishCode, etc.), number of wives, localityof residence of husband, fertility andmortality. Five complete volumes andseveral special reports have beenpublished.

The 1970 census began on 1 March1970. A field test and a trial censuswere conducted in September 1968and in March 1969 respectively. The1970 census will collect almost thesame basic information as obtained in1960 but there will be some majorchanges in the post-enumeration sur-vey. It has been decided by the 1970Census Advisory Committee thatsince information on fertility and mor-tality is being collected by the Demo-graphic Unit at the University ofGhana, questions on these topicsshould be omitted from the post-enumeration survey so that a moreintensive investigation of other itemsLan be carried out.

REGISTRATION DEPARTMENT

This department, which records suchfacts as births, deaths, and migration,

is located in the Ministry of LocalGovernment and will become impor-tant as the registration system is ex-tended and improved.

THE DEMOGRAPHIC UNIT

Demography was first introduced inthe Sociology Department of the Uni-versity of Ghana in 1959. In 1966 aseparate Demographic Unit was setup within the department as a centerfor demographic research and instruc-tion. The 1960 post-enumeration sur-vey data on fertility and mortalityhave been analysed and released bythe unit. Demography co..tirs for B.A.and B.S. (Honors) sociology studentsare being conducted by the researchfellows of the unit. This unit has justcompleted a national fertility survey.

A family survey conducted in 1961covered such items as type of house-hold, family structure, sanitation, kin-ship patterns, and fertility. Between1962 and 1964 a survey program whichincluded the following studies wasundertaken with Populatio Councilassistance: Rural-Urban MigrationSurvey; Internal Migration Survey;Population Attitudes in Economic-ally Superior Urban Areas: and Pop-ulation Attitudes in Rural Areas.

The "Ghana Fertility Survey" wasconducted in 1965. This survey sought,among other things, information onfertility, marital history, exposure tointercourse, and attitudes toward,knowledge about and use of methodsof family limitation. In 1966 a "Mi-gration Survey" was conducted in theEastern Region and Accra CapitalDistrict.

The Demographic Unit is presentlyengaged in a national demographicsample survey Housnlize andcomposition, fertility, mortality, mar-ital history of women, record of preg-nancies, internal migration, attitudetoward family size, and knowledge,attitude, and practice of family plan-ning are among the major topics beinginvestigated.

In 1967 a multipurpose survey ofthe Eastern Region of the country wasconducted that provided some infor-mation on people's attitudes towardfamily planning, as well as estimates offertility and mortality. Thus since 1961there has been continuing research ondemographic topics, including fertilitycontrol, and a large number of publica-tions have been produced.

UNIVERSITY OF GHANA MEDICALSCHOOL

Ghana Medical School graduated itsfirst class of 40 physicians in 1969.The Medical School recognizes theimportant responsibility of physiciansin the field of family planning. TheDepartment of Obstetrics operates afamily planning clinic at Korle BuHospital and has undertaken the clini-cal evaluation of several contraceptivedrugs and devices. This clinic has re-cently joined the International Post-partum Programme and will play animportant role in training physicians,nurses and midwives in the technicalaspects of family planning. The De-partment of Preventive and SocialMedicines has developed plans for amajor five-year community medicineproject. Family planning research andservice will be an integral part of thisprogram.

PRIVATE AGENCIES

The Planned Parenthood Associationof Ghana. The Planned ParenthoodAssociation of Ghana (PPAG) wasformed in March 1967 and began pro-viding contraceptive services early in1968. The association has expandedrapidly; it employs full-time fieldworkers and now has clinics operatingin each of the major urban areas.More than 5,000 patients have re-ceived service in the clinics operatedby PPAG. The association cooperateswith the Department of Obstetrics atKorle Bu where its busiest clinic isheld. PPAG will continue to play animportant role in the developing na-tional program. Training, patient re-cruitment and education, and directclinic services will continue to beimportant parts of the PPAG pro-gram. The association is affiliated withthe International Planned ParenthoodFederation (IPPF) and has continuedto receive almost all of its financialsupport from this agency. In additionthrough an Agency for InternationalDevelopment (AID) grant to IPPF,over US$200,000 will be available forcontraceptive supplies in the fiscalyear FY1969. These supplies will besent through the Planned ParenthoodAssociation for the National FamilyPlanning Programme. PPAG's oper-ating budget increased from aboutUS$50,000 in 1968 to over US$110,000in 1969. A major increase is also likelyin 1970 as the association's program is

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extended into a number of rural areasand the number of full-time fieldworkers is further increased.

Christian Council. The ChristianCouncil of Ghana provides familyplanning services at five centers andsupplies a number of church-relatedhospitals. About 1500 women receivedcontraceptive services during 1968.The council is also active in family lifeeducation. Assistance has been re-ceived from IPPF and Church WorldService.

Assistance from InternationalAgencies

THE POPULATION COUNCIL

The Population Council helped de-velop and continues to support thedemography program and the Demo-graphic Unit at the University ofGhana. Total support to this unit willreach US$300,000 by 1972. The post-partum program at Korle Bu Hospitalalso receives support from the Coun-cil. It is expected that additional post-partum programs will also qualify forsupport during the year. Advisoryservices, particularly in demography,and fellowships for foreign traininghave also been provided.

AGENCY FOR INTERNATIONALDEVELOPMENT (AID)

AID has provided US$163,000 to sup-port the Demographic Unit's nationalsample survey. During FY1969 aboutUS$100,000 was also committed tosupport a variety of activities relevantto family planning including severalawards for training in the UnitedStates. Preliminary funding for acommunity health and family plan-ning project, to be undertaken by theDepartment of Preventive and SocialMedicine at Ghana Medical School,was approved in FY1969. It is pres-ently envisaged that this five-yearproject would receive technical assist-ance through a contract with the Uni-versity of California, Los Angeles.

During the first few years of thenational program it is expected thatAID will be asked to provide a majorshare of the contraceptive supplies.Fellowships for training in the UnitedStates in population-related fields willalso be available. Local currency gen-erated by sale of American foodstuffsmay be available to the NationalFamily Planning Programme.

FORD FOUNDATION

A Ford Foundation financed. advisoryteam from Harvard University is in-volved with economic planning inGhana. The Manpower Board, re-sponsible for the development of thepopulation policy and for designingthe National Family Planning I'ro-gramme, has also had advisory assist-ance. A resident population adviser ispresently assisting with the implemen-tation of the national program. Addi-tional short-term consultants havebeen provided on request from theGovernment. A number of travel andstudy awards have enabled severalkey groups of Ghanaians to visit fam-ily planning institutions in othercountries. Distribution of the Govern-ment Population Policy has beenfacilitated by financial assistance fromthe Ford Foundation.

INTERNATIONAL PLANNEDPARENTHOOD FEDERATION (IPPF)

IPPF is continuing to provide finan-cial support to the Planned Parent-hood Association. IPPF has also givensome support to the Christian Counciland a modest research grant to theMedical School. The Planned Parent-hood Association has received short-term technical assistance from IPPFin planning and developing its pro-gram. Total IPPF assistance to theseorganizations during 1968 and 1969 isin excess of US$100,000 excluding sub-stantial commodity assistance. IPPF'srepresentative for West Africa is lo-cated in Accra.

OTHER

The private agencies and MissionHospitals offering family planningservices have received some contra-ceptive supplies from Pathfinder Fundand Church World Service.

Evaluation of PopulationActivities

FACILITATING FACTORS

The farsighted, comprehensive, Gov-ernment population policy adopted inMarch 1969 clearly sets forth thedimensions of the population problemand establishes the broad principlesunder which contraceptive servicesand other policy recommendationswill be implemented.

Locating the National Family Plan-ning Programme in the Ministry ofFinance and Economic Planning with

its Director a senior official in thatMinistry assures the program of visi-bility, and of sufficient strength andstatus to work effectively with othergovernment ministries and privateagencies.

The Ministry of Finance and Eco-nomic Planning's overall responsi-bility for population planning helps toassure that important factors in addi-tion to family planning will be consid-ered in implementing the populationpolicy. Stricter immigration policies,increasing employment opportunitiesfor women, and several fertility disin-centives have already been considered.

Incorporating the National FamilyPlanning Programme as a part of theGovernment's development machin-ery suggests that population growthwill be considered as one of the impor-tant variables in the developmentprocess that may be influenced byplanning.

The decision to make full use ofexisting personnel, facilities, and in-stitutions in both the public and pri-vate sectors will minimize duplicationof effort and should encourage thebest use of scarce resources.

The Demographic Unit at the Uni-versity of Ghana and the CentralBureau of Statistics have played keyroles in providing data that contrib-uted to the development of the March1969 population policy.

The Medical School is accepting itsresponsibility in population and fam-ily planning and will be an increas-ingly important resource as the pro-gram develops.

The Planned Parenthood Associa-tion of Ghana supports the govern-ment program and will continue toplay a significant role in the NationalFamily Planning Programme.

A number of government minis-tries, especially Health, Information,Youth and Rural Development, La-bor, and Social Welfare, will be im-portant participants in the actionprogram.

The initial favorable reaction to thegovernment policy and the machinerythat has been designed to implementit suggest the development of a flex-ible, innovative and ultimately suc-cessful program.

A number of highly qualified andcommitted professionals are availableto the program.

There has been no indication of any

11

significant political, religious, or eth-nic opposition to the National FamilyPlanning Programme.

A number of international agencieshave expressed interest in assisting theNational. Family Planning Programme.

Those associated with the planningand development of the program haveshown a willingness to take advantageof successful experience from othercountries.

LIMITING FACTORS

Traditional values associated withlarge families and high fertility con-tinue to be widely held.

The shortage of medical and para-medical personnel, particularly in therural areas, will increase the difficul-ties of extending the current methodsof family planning to the many areaswhere health facilities have yet to bedeveloped.

Continuing high levels of infantmortality may inhibit the widespreadacceptance of family planning as cou-ples may be reluctant to limit familysize while the risks of death for chil-dren already born remain high.

The continuing decline in the deathrate means that a major effort will benecessary just to keep the annual rateof natural growth from increasing.

In view of the economic problemsfacing the country the National Fam-ily Planning Programme will requiresubstantial foreign assistance for theforeseeable future.

SummaryThis profile has summarized the popu-lation trends and current status offamily planning in Ghana. A far-sighted and comprehensive popula-tion policy has been adopted and aNational Family Planning Programmewhose secretariat is located in theMinistry of Finance and EconomicPlanning is being implemented. Fulluse will be made of existing facilitiesand personnel in both private andpublic sectors. The University ofGhana's Demographic Unit and theMedical School are contributing tothe program. Excellent cooperationexists between the various Ministriesand private agencies involved in theprogram. The willingness to adoptsuccessful experience from other coun-tries enhances the prospects of theprogram's success. However, the con-tinued popularity of large families, the

low prevalence or contraceptive prac-tice and a rapidly declining death ratesuggest that a major program effortwill be required just to keep the pres-ent high rate of population growthconstant.

ReferencesAddo, N. 0. "Demographic Aspects

of Manpower and Employment inGhana." The Economic Bulletin ofGhana, Vol. XI, No. 3, pp. 3 34.(Reprints).

Birmingham, Walter, 1. Neustadt, E. N.Oraaboe (eds.). "Some Aspects of So-cial Structure." A Study of Contenzpo-rary Ghana, Vol. II. (London: Allenand Unwin, and Chicago: Northwest-ern University Press, 1967).

Brass, W., A. J. Coale, P. Demeny, et al.The Demography of Tropical Africa(Princeton University Press, 1968).

Caldwell, John C. African Rural-UrbanMigration: The Movement to Ghana'sTowns (Canberra: Australian NationalUniversity Press and New York:Columbia University Press, 1969).

----. Population Growth and FamilyChange in Africa: The New Urban Elitein Ghana (Canberra: Australian Na-tional University Press, 1968).

Caldwell, John C. and C. Okonjo, (eds.).The Population of Tropical Africa(London: Longman); Green and Co.,1968).

Gaisie, S. K. Dynamics of PopulationGrowth in Ghana (Ghana PublishingCorporation, Accra-Tema, May 1969).

Kpedepko, G. M. K., "The Eastern Re-gion Demographic Survey." TechnicalPublication Series of the Institute ofStatistics (New Times Press, Accra,1969).

"Working Life Tables for Malesin Ghana." Journal of the AmericanStatistical Association, Vol. 64, No.325. March 1969, pp. 102-110.

Republic of Ghana. Population Plan-ning for National Progress and Prosper-ity. Ghana Population Policy (GhanaPublishing Corporation, Accra-Tema,Ghana, March 1969).

. Two Year Development Plan(Ghana Publishing Corporation, Accra-Tema, Ghana, July, 1968).

. First Annual Report of the GhanaManpower Board (Ghana PublishingCorporation, Accra-Tema, Ghana,1968).

. 1960 Population Census of GhanaSix volumes, special reports. From1962. (Central Bureau of Statistics,and Ghana Publishing Corporation,Accra-Tema, Ghana).

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University of Ghana, Demographic Unit.Proceedings of the Conference on Popu-lation Growth and Economic Develop-ment in Ghana, 1968 (University ofGhana Press, Accra, 1969).

University of Ghana, Demographic Unit.1968-1969 Demographic Sample Sur-vey (unpublished data).

This is part of an information serviceprovided by The Population Counciland The International Institute forthe Study of Human Reproduction,Columbia University.

Other Country Profiles published todate are:Hong Kong (November 1969)Iran (December 1969)Korea, Republic of (April 1970)Malaysia (July 1970)Mauritius (September 1970)Pakistan (March 1970)Philippines, The (June 1970)Sierra Leone (September 1969)Taiwan (February 1970)Thailand (May 1969)Turkey (January 1970)United Arab Republic (August 1969)