Total fertility rate trends in Ghana according to different dimensions of inequality from 1993 to 2014 | BMC Women’s Health


The last few decades have been marked by a dramatic decline in fertility rates around the world. In 2019, the global fertility rate stood at 2.5 births per woman, indicating a decline from 2.8 births per woman in 2000 [1]. In sub-Saharan Africa, this decline has been much slower [2]. For example, while the total fertility rate (TFR) in SSA only decreased from 6.57 births per woman in 1950 to 4.62 births per woman in 2019, the TFR of Asia and the Latin America has declined sharply, from 5.83 and 5.83 births per woman in 1950 to 2.15 and 2.04 births per woman in 2019 respectively [3, 4]. This is essential, given the alarming impacts of rapid and uncontrolled population growth on the well-being of nations. [5]. Although the high population may have some virtue, for example; increase in the workforce, its negative consequences seem to outweigh the positive ones [6]. For example, with rapid population growth, there is pressure on social amenities as well as unemployment, which has negative implications for the growth and development of low- and middle-income countries like Ghana. In South Africa, for example, rapid population growth and a sharp increase in the school-age population are reported to have undermined efforts to improve the quality of education, and in Mozambique it is estimated that only 30 % of population has access to health services due to rapid population growth [7].

To offset the negative implications of rapid and high population growth, low- and middle-income countries around the world are putting in place measures to try to curb rapid and uncontrolled population growth. This involves putting in place policies and interventions. In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development emphasizing universal access to a full range of reliable and safe family planning methods to help people decide responsibly and freely. the number and spacing of their children. [1]. The international community has therefore sought to expand the use of contraceptives, counselling, information dissemination and other family planning services as one of the tools to control rapid and uncontrolled population growth. [2, 8, 9]. Increased use of these services and programs has led to improvements in health-related outcomes, such as reductions in maternal and child mortality, unwanted and high-risk pregnancies, and improvements in economic and educational outcomes, particularly for girls and women.

Although fertility rates in most high-income countries are declining, programs and interventions do not appear to be working in many SSA countries, as the fertility rate is either stable or declining at a rapid pace. slower, or increasing. [8, 10,11,12]. For example, in Ghana, TFR is reported to have fluctuated over 2 decades [13, 14]. Despite the introduction of numerous government policies, programs and interventions such as the 2004 National Population Policy, the Ghana Population and AIDS project (1996–2000), the 2002 Free Compulsory Universal Basic Education (FCUBE) Contraceptive Social Marketing project ( 1987–1990), Ghana Family Planning and Health Program (1990-1996) and Free High School Programs, ISF has not seen a major decline and the trend in recent years remains unclear.

Research has found some association between fertility and other variables such as level of education [15]unmet need for family planning [15] and the use of contraceptives [16] and the 2019 World Fertility Policy Paper also illustrated that variations in fertility trends between countries are associated with the trend of growth in national wealth, education expenditure and income inequality [1]. Perhaps these variables could also play a critical role in Ghana’s GFI trend.

According to the Ghana Demographic and Health Survey (GDHS) [14]there have been fluctuations in the fertility rate in the country, and the World Bank has also reported that Ghana’s TFR is declining at a much slower rate [14]. The rate of decline since 1980 has fallen sharply. For example, between 1980 and 1990 the rate of decline was 0.937, between 1990 and 2000 the rate of decline was 0.776, between 2000 and 2010 the rate of decline was 0.553 and finally, between 2010 and 2019 the rate of decline was by 0.457 [17]. This implies that even though the TFR in Ghana has been declining over the years, the rate of decline has also declined sharply. These are in the background of several interventions that Ghana has implemented over the past 3 decades to curb rapid population growth, such as FCUBE in 2002, Free SHS in 2017, introduction of community health nursing to scale up the provision of family planning services in 1960, the introduction of contraceptive import subsidies in 2002, and the adoption of the National Population Policy in 2004.

To better understand the situation of TFR in Ghana and what needs to be done to ensure a stable and sustainable decline, it is necessary to first look at the trend of TFR over a longer period while taking into account certain dimensions of inequality. Therefore, this study was conducted to examine trends in the total fertility rate along different dimensions of inequality between 1993 and 2014. The results of such a nationally representative study will help formulate and strengthen programs, strategies and interventions to control the rapid and uncontrolled population growth in Ghana.

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