Ghana has often been the first country in Sub-Saharan African to commit itself to progressive policy changes and, in the early 1990s took steps to develop a strong adolescent reproductive health police. Several government ministries collaborated with national organizations and international donor representatives to draft that policy.

In 1969, the government of Ghana issued a population policy focusing entirely on family planning. The policy was not a success, and in 1992 then – President Jerry Rawlings established the National Policy addressing a broad range of youth issues, including early pregnancy, marriage and gender inequality. Perhaps the most impressive aspect of the document, however, is the definition of the institutional framework through which the policy will be implemented.

Ghana’s National Reproductive Health Service Policy, completed soon after the 1994 ICPD, mandates comprehenssive reproductive healthcare, including counseling and sex education, for all Ghanaians without respect to age. It also calls for the active discouragement of female genital cutting, and outlines provisions of adolescents and reproductive health. However, disapproval of youth sexual activity poses an important challenge to youth reproductive health efforts, Ghana is a multi-ethnic society. Society with substantial proportions of Christians, Muslims and practitioners of indigenous beliefs. The relative lack of tension among religious groups in Ghana prevents this diversity from becoming a major political factor in national debate over reproductive health policy. Nonetheless, adults across religious groups tend to judge youth sexual activity harshly, adversely affecting the openness of policy dialogue.

A thoughtful adolescent reproductive health policy has existed in draft form since 1996. Its approval is seen largely as a formality since most stakeholders have already agreed to it.

The Adolescent Reproductive Health Policy reflects the spirit of the ICPD programme of Action, referring explicitly to the right of young people to information, services and involvement in planning and provides guidelines for government and non-governmental agencies implementing programs across sectors with specific targets for youth wellbeing. Percentage reductions in early marriage, childbirth and dropping out of school, and increases in exposure to sex education, out-of-school programs, youth-friendly services and girls’ schooling. A secondary focus is on the institutions and parents, caretakers, teachers, religious leaders, service providers and policy makers who influence the upbringing of youth. Several important coalitions have played a role in the development of the Adolescent Reproductive health policy.

Religious organizations were also involved from the outset, and the government took care to inform people and seek their approval; an adolescent reproductive health needs assessment and forum were conducted nationally in 1997 to stimulate regional discussions and address objections.

Government initiative, the coordination efforts of the National Population Council, and donor pressure also added policy development across sectors.

Ghana’s openness to constructive involvement of International donors in the policy development process is unusual. As a member of parliament stated “We as a nation need partners and we welcome help

”. Remarkable in many of Ghana’s policy document is the acknowledgement of the broad range of policies, laws and programs that forms the context for youth sexual and reproductive health.

A 1996 Adolescent Reproductive Health Summit in Accra identified the government agencies that oversee activities relating to young people. Participants also identified gaps needing to be addressed and the need for a coalition of advocates who could lobby at the highest levels of government.

Challenges and Responses:
Efforts to implement these policy changes have been slow and face obstacles resulting from the effects of decentralization, a lack of resources, gender inequities and a reluctance to acknowledge youth sexual activity. Ghana’s decentralization process call for replication of many departments, including reproductive health, at the district level but the transition has not been smooth.

With twice the per income of some of its West African neighbours, Ghana nonetheless depends significantly on International financial and technical support for health and development programs. Though the country is deeply committed to basic education and has increased its education budget several fold since 1987, the costs of schooling have implications for youth development and reproductive health. Families unable to pay school fees for all children most often send sons and not daughters to secondary school, pushing some girls into sexual relationships with older men to pay their expenses.

A lack of funding has limited the development of youth-friendly centres and clinics, and some donors are uncomfortable supporting income-generation for youth as part of a reproductive health program – yet many youth cannot afford nominal clinic costs.