|Addressing the teenage pregnancy menace: Pharmacists to the rescue|
Addressing the teenage pregnancy menace: Pharmacists to the rescue
Okyere, Harry Amoaning (BPharm, MPH, MPSGH)
Highlights of Ghana Maternal Health Survey (GMHS)
The Ghana Statistical Service (GSS) conducted the second Ghana Maternal Health Survey (GMHS) from 15 June through 12 October 2017 with a nationally representative sample of 27,000 households involving 25,062 women between the ages of 15-49. This 2017 GMHS updates information from the 2007 survey and it is a complement to the Ghana Demographic and Health Surveys (GDHS).
Report of the 2017 survey shows significant improvements in some important reproductive health indicators over the past decade. For example, fertility in Ghana has been declining since the 1980s, from 6.4 children per woman in 1988 to 4.6 children per woman in 2007. If fertility were to remain constant at current levels, a woman from Ghana would bear an average of 3.9 children in her lifetime, according to the survey.
In the same vein, under-5 mortality rates have declined over time, from 80 deaths per 1,000 live births 10-14 years before the survey (2003-2007) to 52 deaths per 1,000 live births in the 0-4 years prior to the survey (2013-2017). While antenatal care attendance did not have much room to improve from 96% in 2007, the proportion of births and stillbirths taking place in a health facility increased from 54% to 97%, and the proportion attended by a skilled provider increased from 55% to 97%.
Teenage pregnancy remains a public health challenge
Of particular importance is the persistent high rate of adolescent motherhood in the country. At the time of the GMHS, 14% of adolescent women age 15-19 had begun childbearing: 12% had already had a live birth and 3% were pregnant with their first child. The proportion of teenagers who have begun childbearing increases dramatically with age from 3% of those aged 15 to nearly one-third (32%) of those aged 19. It is therefore clear from the aforementioned that teenage pregnancy remains an important public health challenge in Ghana. It is closely linked to a myriad of adverse socio-economic issues which includes persistent poverty, school failure, child abuse and neglect, health and mental health issues.
Even though significant progress has been achieved in the quest to promote sexual and reproductive health, improve maternal mortality and control population growth in Ghana; it appears that we are missing an important subset of individuals, specifically the adolescent female population. The Global Strategy for Women’s and Children’s Health, launched by the UN Secretary General in September 2010, stresses the importance of addressing the health and welfare of adolescent girls, especially towards achieving MDG-5 related to maternal mortality reduction. This advocacy is of paramount importance because recent estimates and research findings pertaining to adolescents and their reproductive health are very alarming; adolescents who are 15–19 years of age are twice as likely to die during pregnancy or childbirth compared to women over 20 years of age; adolescents under 15 years of age are five times more likely to die during pregnancy or childbirth. The higher prevalence and increasing incidence of unplanned pregnancy among adolescents also may reflect multiple barriers to accessing quality Reproductive Health Services, including ability to pay, lack of transportation, and discomfort with facilities and services designed for adults, as well as concerns about confidentiality and stigmatization especially within the religious and cultural context of Ghana.
The adolescent population represents about 22.4 percent of the entire Ghanaian population, and more than half this figure are females. Even though few health centers provide family planning and reproductive health services in the country, many of such centers are located in more affluent communities and are not easily accessible to the rural folks and poorer communities that probably need it most. Moreover, such centers are not designed for everyone, and for cultural reasons, the adolescent girl may not be comfortable in accessing services from these centers, for fear of being judged or stigmatized, coupled with cost implications.
How Community Pharmacists can be empowered to help
One strategy with great potential to improve the prevention and management of unintended pregnancy for adolescent women is the integration of Adolescent Reproductive Health, including behavioural modifications, contraception and abortion services into community-based pharmacies. Community-based pharmacists are optimally positioned to improve the prevention and management of unintended pregnancies by offering comprehensive contraception and abortion care.
Community pharmacists interact with adolescents frequently and are therefore well positioned to engage this vulnerable population in conversations about their sexual and reproductive health. Pharmacists can be trained to provide scientific-based modeled Reproductive Health Education, contraception services, safe medical abortion for early pregnancies and referral services where necessary. Traditionally, pharmacists’ role in reproductive health have been the supply of post coitus hormonal contraceptives and the condoms. However, pharmacists have been included in various sexual health care programs elsewhere that include empowering pharmacists to provide progesterone depot injection (Washington State project). Administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) by pharmacists in a pharmacy setting was found to be feasible.
Empowerment should begin in pharmacy schools
A strong advocacy should be mounted for the integration of basic Reproductive Health Services programme into the training curriculum of pharmacy schools. Pharmacy graduates must be properly trained and possess the skills to care for the unmet needs of the public in this sensitive area. Establishment of sexual/reproductive education programs and sexual health clinics that incorporate pharmacists as educators should be considered. Studies have shown that many individuals are comfortable with their pharmacists taking on other roles besides dispensing. We therefore need to exploit this unique feature about community-based pharmacies.
Evidence exists to suggest that Pharmacists are receptive to contraception and abortion training and service provision. Efforts to support delivery of these services to female adolescent population could include enhanced clinical training and interventions at the community based pharmacies to increase access to Reproductive Health services.
1. 2017 Ghana Maternal Health Survey (GMHS) report; available at http://www.statsghana.gov.gh/GMHS.html