Professor Richard M. K. Adanu - Inaugural lecture 2014/2015

Her Right Not a Favour: The Future of Women's Health in Ghana

Professor Richard M. K. Adanu

Women's health is a concept that embraces the complete World Health Organization definition of health. This concept looks at the well-being of women through the lenses of accepted societal and cultural practices as well as through the lens of gender issues. Women's health is closely related to reproductive health, which began its rise to prominence in 1994 after the International Conference on Population and Development in Cairo. Reproductive health, unlike what many people think, is however not only about the health of women. There are issues in reproductive health that concern both men and women, hence the terms Women's Reproductive Health and Men’s Reproductive Health. Women's Health has many different aspects which can be addressed by the clinician, the public health specialist and the gender advocate among others. This lecture will examine women’s health from these three perspectives.

Women's health in Ghana has been studied in different ways and some of these studies will be highlighted. The main source of information for the lecture is the Women’s Health Study in Accra, a representative cross-sectional study which has conducted two waves of the measurement of disease burden among women in Accra. Emphasis will be placed on the following: maternal health, family planning, abortion, cervical cancer screening and non-communicable diseases.

Ghana's maternal mortality was recently reported to be 380 per 100,000 live births by the WHO, UNICEF and World Bank in their regular report on trends in maternal mortality. Even though Ghana does not appear to be likely to meet the Millennium Development Goal target for maternal mortality, there has been a 50% reduction in maternal deaths between 1990 and 2013. Despite the increasing use of maternal health services by women in the country and improving maternal health indicators, there are still some issues to consider regarding the quality of care provided to pregnant women in Ghana.

The level of use of modern family planning methods in Ghana has always been stated to not be in congruence with the total fertility rate of 4. The hidden piece of the family planning puzzle in Ghana has still not been discovered but data from the Women's Health Study in Accra suggests that some new approaches in investigating fertility control be explored. While many women in Ghana have used a family planning method at one point, there are relatively high rates of discontinuation of modern methods. The concerns that women have regarding family planning could be addressed by improving the quality of family planning care and having a more community based focus in family planning counselling. The use of effective family planning prevents a woman from being exposed to the risk of maternal mortality so it is very important to address questions of family planning in women who have suffered maternal morbidity.

The failure of family planning results in unwanted pregnancies which in turn increase the risk of unsafe abortion and abortion related deaths. Induced abortion continues to be a controversial and polarizing issue. Despite this, it is not possible to discuss women's health without facing the legal, social, cultural and clinical faces of induced abortion which is the third leading cause of maternal mortality in Ghana. Methods of assessing abortion rates were tested in the Women's Health Study in Accra and issues relating to the 'commodification of abortion' were also identified.

Barrier methods of family planning serve as protection against sexually transmitted infections. One infection which is prevented by these methods is infection with Human Papilloma Virus which has been shown to be the cause of cervical cancer. Cervical cancer is therefore a preventable cancer which continues to be responsible for the deaths of women in Ghana. There are known screening tests, which are available in Ghana, for the early stages of cervical cancer. The level of knowledge and use of such tests will be discussed in this lecture. 

Going beyond Women's Reproductive Health, The Women's Health Study in Accra looked at non-communicable diseases. The relatively high levels of obesity and hypertension that were discovered serve as a major source of concern in the area of women's health in Ghana. 

Women in Ghana and the rest of the world are major players in developmental issues. The contribution of women to society goes way beyond childbearing and child minding. Women are major contributors to the economy of their countries. In many cases women are found to be shouldering responsibilities that have traditionally been seen as 'male roles'. Women as a whole however do not have much of a say in determining the legal, political, social, clinical and other decisions that have a direct bearing on their health. Every single Ghanaian has a role to play in ensuring good health of our women. In light of the large contribution that women make to advance our country, it is our moral obligation to ensure that our women are healthy. Our efforts at improving women's health must never be seen as a favour that society is providing to women. Women in Ghana, all over Africa and the rest of the world have an undeniable right to good health and all of us need to ensure that this right is upheld.

Submitted by Public Affairs