Maternal Health & SRHR Projects Deliver Lasting Change in Ghana

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1 October 2016 In this Issue 1. Maternal and Child health project to benefit 30,000 women 2. The World Starts With Me Changed My Life- A 15yrs Old Girl 3. The Result of Knowledge, Attitude and Practices (KAP) Survey on SRHR in Basic Schools in Ghana Maternal Health & SRHR Projects Deliver Lasting Change in Ghana

2 Maternal and Child Health Project to Benefit 30,000 Women in Ghana contribute to the Ghana Health Service efforts at reducing maternal and child mortality in Ghana. What is T4MCH? T4MCH is an innovative maternal and child health project which seeks to reach out to mothers, their male partners and community members through different types of technologies such as electronic charting, phone messaging, and knowledge sharing sessions using PowerPoint Presentations and vital maternal and child health information videos. Target Audience Savana Signatures, an ICT for Development (ICT4D) organization based in Ghana, Salasan Consulting and Mustimuhw Solutions both in Canada with funding support from Global Affairs Canada have begun the implementation of the Technology for Maternal and Child Health (T4MCH) project. The project is aimed to The T4MCH project seeks to reach expectant mothers both old and young, men and young adults.

3 The project is expected to reach 30,000 women. In addition to its major activities, T4MCH also will feature interesting and some unique approaches to Nkwanta South and the Kadjebi Districts in the Volta Region) of Ghana. The project is expected to benefit 30,000 women in the 9 districts within 4-years of implementation period. It is estimated that 11 per cent of female deaths in Ghana occur during childbirth. These deaths, the Programme Manager, SRHR of Savana Signatures, Abdul-Rashid Imoro said could be prevented through the following solutions: Abdul-Rashid Imoro speaking at a community Sensitization programme gender equality, research, communications and monitoring and evaluation all of which seek to empower women through technology and access to timely information about maternal health care. The project is being implemented in 33 health facilities in 9 districts (Sagnarigu, Mamprugu Mouduri, Sawla Tuna Kalba and North Gonja districts in the Northern Region, Jirapa, Wa West and Wa East in the Upper West Region and The T4MCH project will encourage women to patronise health facilities while pregnant instead of relying solely on traditional birth attendants, he said. He said, T4MCH project sought to address the indifference of some expectant mothers towards Antenatal Care (ANC) attendance which, he described as necessary for pregnant women and unborn babies. It is during ANC that complications and infections during pregnancy could be detected and treated. If we have more women attending ANC and accessing medical care during pregnancy, the rates of maternal

4 and infant deaths will drastically be reduced in Ghana, he said. Savana Signatures and its partner organizations Salasan Consulting and Mustimuhw Solutions are working closely with the officials of Ghana Health Service (GHS), health professionals, community and women leaders, women and men in the selected districts and health facilities to ensure that the project delivers lasting change to maternal and infant deaths. The project implementation team have sought the commitment of stakeholders to ensure a successful implementation of the project. Use of Mobile Technology T4MCH is a 4-year project which is expected to end in The project will use mobile messaging in the form of voice calls to deliver vital maternal and child health information to non-literate women in their preferred local language and SMS in English to literate women. The T4MCH will use an integrated approach to reducing maternal and infant mortality. This will be done through the introduction of technological innovation in maternal and child service delivery as well as developing the capacity of health staff to use ICTs in new and innovative ways to deliver service to women. The project will mainstream gender by reaching out to men including adolescents and increase awareness and agency for mothers and their families in the chosen 3 regions of Ghana. Imoro said, the project would also work to improve relationships between women and health care providers to guarantee better health care for expectant mothers. We hope to deliver lasting change to maternal and infant mortality in Ghana by encouraging, educating and building the capacity of health workers to improve the quality of health care service delivery to women and new-borns at the project health facilities in Ghana, he said.

5 The World Starts With Me Project Changed My Life - A 15 -Years Old Girl "I thought it will not benefit me in any form to belong to this club besides I am always warned not to delay coming home after school", she said. Gifty comes from a Christian home. Based on their religious beliefs, Gifty s parents follow a pattern of life. My parents will not like to see me associating myself with others perceived to be bad children They think I may be influenced to adopt their bad behaviors, she said. It was difficult for Gifty to join the WSWM club whose activities take place after school. Gifty Bensah Bensah Gifty is 15 years old and a form three (3) student at Ho Dome R/C Junior High School. Initially, she does not want to be part of a school club that teaches sexuality and child rights lessons. What then is the WSWM? The World Starts With Me (WSWM) is a computerbased, rights-based, Comprehensive Sexuality Education programme designed for in- and out-ofschool youth between the ages of 12 and 19 years. The WSWM has 14 lessons curriculum that combines Sexual Reproductive Health and Rights (SRHR) education with building IT skills and creative expression.

6 The project is being implemented by Savana Signatures in 14 schools in the Northern and Volta Regions of Ghana and supported by RFSU. Gifty is among other peer educators of the WSWM project who are assisting their peers to access SRHR information and linking them to service providers in the Ho Municipality. We organize community and school sensitizations or exhibitions for students and parents. We hope to get every young person talking about sexuality and making the right decisions regarding their reproductive health, she said. When my parents finally learned more about the WSWM project that it does not encourage young people to engage in sexual intercourse, rather it prepares young people to avoid behaviors that could affect their physical, economic, emotional and educational development they encouraged me to continue the campaign on SRHR to benefit more young people. This project is unique and participatory that activates and build young people s confidence. Having been impressed by the positive impact of the WSWM, Gifty s parents have compromised their family values a bit. Now, I am allowed to participate in and discuss issues about sexuality. My parents are happy that I have gained in-depth knowledge about sexuality, Gifty said. Before joining the club, I was not happy with my physiological makeup particularly my height. My friends used to mock at my height which used to disturb me a lot but not anymore, she said.

7 She will always isolate herself from her peers in school to avoid being mocked at. Because of this, I will not mingle in school, I was always sad, she said. The most significant change I realized after participating in the WSWM project is that I no longer feel shy in discussing sexuality issues with my peers, she said. she added I can now mention sensitive parts of the human body such as the vagina, penis, and breast easily. She appealed to Savana Signatures to not only increase the number of the WSWM clubs but expand to cover the entire student body in Ho Dome R/C JSS. Gifty likes the methods used to facilitate the WSWM 14 lessons and hope that all her school teachers will join and adopt the facilitation style. What I like most about the WSWM project is that, you learn through games. It was difficult mentioning these things before I join the WSWM project, she said. Gifty now opens up to her class teacher, parents and friends anytime she is menstruating. I am feeling good about myself now. The knowledge I gained from the WSWM project is guiding me against teenage pregnancy and peer pressure. Many of my friends who are not part of the club are expressing interest in joining too, she said. Gifty in a group photo with the WSWM facilitators, GES officials and Savana Signatures staff in Ho

8 The style of facilitation combined with games makes learning interesting and fun. The WSWM is a life changer, she said. Gifty has fallen in love with her books and aspiring to Madam Edith, Gifty s teacher be among the top brilliant students in her school. She wants to be a great woman in the near future. Havor Victory, member of the WSWM club Jerome Aborhor, Member of the WSWM club

9 RHR. I have learned to accept myself the way Photo: The Result of Knowledge, Attitude and Practices (KAP) Survey on Sexual and Reproductive Health and Rights in Basic Schools in Ghana

10 What is the state of Sexual and Reproductive Health and Rights (SRHR) among teachers and young people in basic schools in Ghana? To find an answer to this question, Savana Signatures in 2015 used a Knowledge, Attitude and Practices (KAP) to gauge teachers and young people s knowledge, attitude and practices of sexual and reproductive health and rights in some basic schools. (WSWM) project being implemented in those schools. The WSWM is a computer-based, rights-based, Comprehensive Sexuality Education programme designed for in and out-of-school youth between the ages of 12 and 19 years. The WSWM has 14 lessons curriculum that combines Sexual Reproductive Health and Rights (SRHR) education with building IT skills and creative expression. The project is being implemented by Savana Signatures in 14 schools in the Northern and Volta Regions of Ghana and supported by RFSU. The survey was carried out in ten (10) selected Junior High Schools (JHS) in the Northern region. The survey was not only to gauge the respondents knowledge, attitude and practices of SRHR but also evaluate the impact of the World Starts With Me In Ghana, SRHR lessons are restricted in school and at homes. This is mainly because of cultural and religious influence. This turns to put young people at risk. They are mostly expose to new sexual transmitted infections, teenage pregnancies and HIV.

11 80 students and 12 teachers in the ten selected schools constituted the survey population. Sexuality education for young people The survey revealed that, 92% of the teachers were in support of sexuality education been taught in schools whereas the remaining 8% were indifferent as to whether or not sexuality education should be taught in schools. Those in support of sexuality education added that sexuality was something positive and enjoyable and should be taught to young people. Comparing this to the baseline study, there has been a 28% increase in the number of teachers who think sexuality education should be taught in schools (from 64% for baseline to 92%). Fig 3: Sexuality is positive and enjoyable 50% 40% 30% 20% 10% 0% 42% totally agree 50% agree 8% neither agree nor disagree Attitude in sexuality education The right of young people to make sexuality decisions We sought to find out if it is appropriate for young people to make their own decisions about their sexuality.

12 agree 50% totally agree 50% 92% of SRHR peer educators agreed that young people have the right to make decisions on their sexuality. Sexual behaviours 100% of the respondents (teachers and students) supported the view that young people should stay away from sexual behaviours until they are ready for it. However, the baseline survey indicated that 94% of the teachers and peer educators supported this view. Source: Savana Signatures project survey, 2015 Assertiveness of young people to sexuality and sexual intercourse The survey revealed that, 92% of the teachers were of the view that when young people engage in sexual intercourse both the girl and the boy should be willing; this represents an improvement from the 76% that was recorded in the baseline study. The remaining 8% did not take a stand on the issue. Fig 4: Involvement of young people in sexual behaviours

13 Fig 5: Assertiveness 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 50% Practice of SRHR 42% 8% totally agree agree neither agree nor disagree permissible, but this mid project survey on the other hand revealed that all the teachers (100%) now believe that sexual intercourse among young people should necessarily be consensual. Use of contraceptives by girls Figure 6 below shows that 72% of teachers agreed that girls should be allowed to take contraceptives such as oral pills when engaging in sexual intercourse; this is an improvement from the 67% that was recorded during the baseline survey. But 18% of them disagreed with the use of contraceptives; another 10% had no particular interest for or against the use of concentrative by girls during sexual intercourse. Consensual sexual intercourse among young people During the baseline study, it was revealed that 3% of the teachers did not believe that sexual intercourse among young people should necessarily be consensual, implying that forced sex should be

14 Axis Title Fig 6: Contraceptives usage parenting and STIs including HIV and AIDS. This shows a 16% increase from the 84% that was recorded during the baseline survey. Young people, relationship and sex neither agree nor disagree totally disagree agree 10% 18% 56% A total of 92% (60% for the baseline) of teachers and peer educators believed that young people (male and female) can be friends without engaging in sexual activities whereas 8% of them were of the view that it is difficult for opposite sex to be friends without indulging in sexual activities. Pre-mature sex: Reality or Perception? totally agree 16% 0% 20% 40% 60% Axis Title Condom use Figure 7 shows a mixed reaction among teachers and peer educators about pre-mature sex among young people. The survey found 66% (54% during the baseline survey) of teachers acknowledging the reality of re- All the teachers (100%) established the need for condom use by young people during sexual intercourse, to prevent unwanted pregnancies, early

15 mature sex among young people whilst 34% of the teachers thought otherwise. Abortion; permissible or not Fig 7: Pre- mature sex; reality or perception Prevalence of same sex relationship Whereas 26% (72.7% for the baseline survey) believed same sex sexual relationship was Western, 66 % did not believe so, and 8% were indifferent (see table 3). 35% 30% 25% 20% 15% 10% 25% 34% 25% Abortion Here, the teachers had a divided view, 33% (9% for baseline survey) of them said abortion should be permitted, at the same time 33% of them did not subscribe to abortion. 34% of them on the other hand were indifferent on this issue. 5% 0% 8% 8%

16 SRHR knowledge attitude and practice: among students Demographic characteristics of students 80 JHS students were interviewed from 10 schools for this survey. Out of this number, 42% of them were females and 58% of them males (fig 9). female 42% male 58% The study targeted students within the age bracket years, but the study revealed that some of the JHS 1 students interviewed were between years (8%). Majority of the students (64%) were between years of age. The study also found that 40 students (50%) lived with their parents and receive care from them, 33% of them lived with only one parent who could be either the mother or father, while 2 students (3%) said they lived on their own. Fig 9: Sex Distribution of Students JHS Students Knowledge Of SRHR Same sex relationship The study revealed that 99% (98% for baseline survey) of the students were totally not in support of homosexuality; they went further to say that homosexuality was a disease. 1% of the students supported homosexuality. The focus group discussions revealed that most students have heard about homosexuality but they really do not know what it entails, this probably explained why 1% of them supported it.

17 Knowledge of HIV/AIDS/STIS Table 4 shows an improvement in student s knowledge of HIV/AIDS/STIS, from 43% that was recorded during the baseline survey to 89%. 89% of the students indicated that unprotected sex could likely result in HIV/AIDs/STIs infections. no 11% yes 89% A significant 11% did not believe they could be infected by sexually transmitted diseases through unprotected sex. In addition, 80% (52% for the baseline) of the students believed that HIV/AIDS was a big threat to their personal health while 18% did not believe that it was a threat to their health as can be seen in figure Fig 10: HIV/AIDS a threat Preventing Sexually Transmitted Infections The students suggested various methods of preventing HIV/AIDS infection. 61% of the students suggested condom use and contraceptives (an improvement from the 39% recorded in the baseline survey), while 32% suggested faithfulness and abstinence. There were others; 7% who suggested measures such as non-penetration sex, taking HIV test before sexual intercourse and bathing immediately after sexual intercourse.

18 Attitude towards SRHR: JHS Students Ideal age for sexual intercourse Perhaps in view of the age range of the students, majority of them 74% (57.5% for the baseline) believed that the ideal age for one to engage in sexual intercourse for the first time should be from 20 years and above (table 5). There was however another 9% who felt one could commence engaging in sexual intercourse between 16 and 20 years. Perception of Students about each other The study revealed that 20% of the students were of the view that when a young girl dresses in revealing clothes and miniskirts she is inviting rape on herself. On the other hand, 70% (58% from baseline survey) of the students were of the view that when a girl wears revealing clothes and miniskirts it does not mean she is asking to be raped. On the issue of whether or not boys and girls can be friends without having sexual intercourse, 94% of the students (63% from baseline survey) said young people of the opposite sex can be friends without necessarily engaging in sexual intercourse, where as 6% of the said it was totally impossible for a boy and a girl to be friends without having sex. The students also believe that a boy or a girl has the right to say no to sexual intercourse and therefore should not be forced to engage in sexual intercourse. Whereas 91% of the students were of the view that a boy or a girl should not be forced to have sexual intercourse against their will, 8% (16% for the baseline survey) of them said it was ok to use minimal force if a partner does not consent to sexual intercourse. Pregnancy among young people On the issue of pregnancy, 97.5% (76% for the baseline survey) of the students believed that they could get pregnant by engaging in sexual intercourse without the use of condoms. 2.5% did not believe in the use of condoms. Those who supported the use of condoms considered getting pregnant at a teenage age as a serious problem. From table 6, 84% (24% from the baseline survey) of the students did not believe that having anal sex was a safe way of preventing oneself from

19 contracting sexually transmitted infection. However, 16% of the students view anal sex as a way of preventing oneself from contracting sexually transmitted infection. Sexual conversations among young people The survey generally revealed that young people do not discuss sex, STIs/HIV and pregnancy-related issues with adults, including parents. The survey revealed in figure 11 that 33% (77% for the baseline survey) students were much more confident about engaging in sexual conversations among themselves. The percentage of students who now engaged in sexual discussions with their parents increased from 5% during the baseline survey to 31% and their teachers 18%. They were however slightly comfortable discussing their sexual issues with health personnel (14%). See fig 11: Sexual Conversations 35% 30% 25% 20% 15% 10% 5% 0% 31% 18% 14% 33% 4% Refusal and negotiation skills N/R friends 1% health workers peereducators teachers parents Whereas 38% (27% from the baseline survey) of the students said they could negotiate with their partners not to engage in sexual intercourse, 30% (25% from the baseline survey) indicated they could negotiate for safe sex by insisting on the use of condom. There were however 19% who indicated powerlessness to convince their own friends about sexual decisions and another 13% were undecided

20 about whether or not they could negotiate safe sex or refuse to have sex when demanded from their peers and other friends. Young people and sexual intercourse In addition, 32%(28% from baseline survey) indicated they would report to their teacher if sexual demands were persistent from peers; 27% (19% for the baseline survey) said they would inform their parents and 5% said they would report to the police. There were 15% of them who indicated they would physically fight peers and friends who pester them for sex and 14% indicated they would shout for help when sexual demands are persistent. There was another 7% who said they would break up their relations with friends who come up with persistent sexual demands. Whereas 26% of students said they had friends who engaged in sexual intercourse, 63% (74% from baseline survey) said they either did not know about it or had no friends who engaged in sexual intercourse. In respect of abstinence from sex, there were 69% (41% from baseline survey) students who said they had friends who abstained from sex intercourse but

21 (23%) students either did not have such friends or did not know of those who abstained from sex. Condom Use The majority of them (61%) had no knowledge of any friends who engaged in sexual intercourse and frequently use condoms. It has been revealed that young people find it easy to purchase condoms after learning lessons from the WSWM. 68% (15% from the baseline survey) students indicated they could confidently purchase and use a condom, while 31% said they could not do so. The rest of them (1%) said they did not have a stand on condom purchase and use. In terms of knowledge of friends who use condom, only 26% (9% from baseline survey) of students indicated knowledge of their friends who use condoms. Beware!! HIV/AIDS is Real Practice Safe Sex, Use Appropriate Contraceptives

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