Abstract
BackgroundIn most resource poor countries, particularly sub-Saharan Africa, modern contraceptive use and prevalence is unusually low and fertility is very high resulting in rapid population growth and high maternal mortality and morbidity. Current evidence shows slow progress in expanding the use of contraceptives by women of low socioeconomic status and insufficient financial commitment to family planning programs. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008.MethodsWe constructed a database using the Women’s Questionnaire from the Ghana Demographic and Health Survey (GDHS) 1988, 1993, 1998, 2003 and 2008. We applied regression-based Total Attributable Fraction (TAF); we also calculated the Relative and Slope Indices of Inequality (RII and SII) to complement the TAF in our investigation.ResultsEquality in use of modern contraceptives increased from 1988 to 2008. In contrast, inequality in fertility rate increased from 1988 to 2008. It was also found that rural–urban residence gap in the use of modern contraceptive methods had almost disappeared in 2008, while education and income related inequalities remained.ConclusionsOne obvious observation is that the discrepancy between equality in use of contraceptives and equality in fertility must be addressed in a future revision of policies related to family planning. Otherwise this could be a major obstacle for attaining further progress in achieving the Millennium Development Goal (MDG) 5. More research into the causes of the unfortunate discrepancy is urgently needed. There still exist significant education and income related inequalities in both parameters that need appropriate action.
Highlights
Since the introduction of Millennium Development Goal 5 (MDG 5), the global community has seen some positive trends in maternal health, changes are unevenly distributed [1,2,3,4]
There was a parallel decrease in non-use of modern contraceptive methods (Table 1)
Women with average income levels had the highest reduction in the prevalence of non-use of modern contraceptive methods, followed by those with low income and high income levels (Table 2)
Summary
Since the introduction of Millennium Development Goal 5 (MDG 5), the global community has seen some positive trends in maternal health, changes are unevenly distributed [1,2,3,4]. Studies that investigate inequality in health should examine the multiple dimensions of inequality that exist within countries such as age, residence (rural or urban), gender, marital status and educational level [17] based on the different human rights challenges, policy needs, and opportunities within a country. This is because the health gaps between these groups may be as significant as the gap between the rich and poor [17]. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008
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