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Chapter 1 Introduction CHAPTER 1 INTRODUCTION 1.1 Geography, History and Economy Geography Ghana is centrally located in the West African sub-region and has a total land area of 238,539 square kilometres. The topography of Ghana shows that it is generally a low-lying country. The only range of hills lies on the eastern border with the Republic of Togo and the west of the Volta River along the Akwapim- Kwahu area. Along the coast is savannah grassland that is criss-crossed by several rivers and streams that are navigable by canoe. In the west and central parts of the country is heavily forested terrain that is sub- divided by hills, rivers and streams. To the north of the country lies the undulating savannah drained by the Black and White Volta Rivers. The climate of Ghana is tropical, but rainfall and temperatures vary by distance from the coast, and elevation. The rainy season in the northern parts of Ghana begins in March and lasts until September, while two rainy seasons are recorded in the southern half of the country—April to July, and September to October. The average annual temperature is about 26o Celsius (79oFahrenheit). History Until 1957, the country was called the Gold Coast; a name given to it by the early Europeans, because of the abundant gold traded on the coast. Due to the belief of ties between the people of this country and the ancient empire of Ghana which was situated in the Sahelian region of Senegal, Mauritania and Mali, the country was given the name Ghana when it gained independence from the British on 6th March 1957. It became a republic in the British Commonwealth of Nations on 1st July 1960. Ghana has had its share of political turbulence with the military taking over the reigns of power on four occasions over the four decades of independence. Today, Ghana is one of the most politically stable and peaceful countries in Africa, having successfully gone through a transition from military rule to multi-party democracy in 1993. Ghana operates a parliamentary system of government based on multi-parties; and has an elected President. The country has a three tier local government. There are 10 administrative regions, representing the first level of administration, and these are subdivided into districts, totalling 110. In line with the country’s decentralised policy, the district represents the basic unit of planning and political administration. Below the districts are the unit committees. Economy The structure of the economy has not changed significantly in recent years. The primary sector continues to dominate in terms of its contribution to output, employment, revenue, and foreign exchange earnings. Agriculture is the main economic activity, and currently accounts for about 51 percent of the Gross Domestic Product (GDP), and employs about 60 percent of the labour force (Ghana, 1994). Tourism is however, fast becoming a very important foreign exchange earner. 1 The economy recorded its worst performance during the decade prior to 1984, but has made a dramatic recovery with the institution of the Economic Recovery Programme (ERP) in 1983. Since 1984, the real national income has grown at an average annual rate of 5.3 percent, compared to a decline of 1.3 percent during the 1976-1983 period (Ghana, 1994). 1.2 Demographic Profile When Ghana gained independence in March 1957, its population was barely 6 million. The first post- independence population census conducted in 1960 recorded the number of people in the country at 6.7 million, giving an inter-censal growth rate of 4.2 percent between 1948 and 1960 (Ghana, 1994). By 1970 the population of Ghana had increased to 8.6 million with an annual rate of increase of 2.4 percent. The last census in 1984 put the country’s population at 12.3 million with an inter-censal growth rate of 2.6 percent. The mid-year population of Ghana for 1999 is estimated at 18.3 million thus indicating a tripling of the population between 1957 and 1999, or a doubling of the 1970 population in just 26 years. With a substantial proportion of its population below fifteen years of age, Ghana’s population is relatively young. The 1984 Census showed that 45 percent of the population was under the age of 15 with 51 percent aged 15-64. A more recent study, the 1997 Core Welfare Indicators Questionnaires (CWIQ) Survey, showed a slight drop in the proportion of the population under 15 years to 42 percent while those age 65 and over increased to 5 percent (GSS, 1998) Although fertility has been declining, current levels have been a source of worry for policy makers and planners. The total fertility rate ranged between 6 and 7 for the period between 1960 and 1988. It dropped to 5.5 in 1993, but this is considered rather high (GSS, 1994). There is evidence to indicate that the death rate in Ghana has been steadily declining over the years as a result of a combination of several factors such as improvement in public health, sanitation, medical facilities, increasing education, and modernisation in general. The infant mortality rate (IMR), dropped from 133 per 1,000 in 1957 (MOH, 1996) to 77 per 1,000 in 1988 (GSS and IRD, 1989), and 66 per 1,000 in 1993 (GSS and MI, 1994). Life expectancy at birth has increased from about 45 years in 1960 to 57 years in 1998 (MOH, 1996). However, there still exist wide variations between regions, between urban and rural populations, and between different cultural and religious groups. The pattern of morbidity has virtually remained unchanged over the years, and the general populace seems to be afflicted largely with the same diseases such as malaria, upper respiratory infections and water- borne diseases. An underlying cause of the persistence of these diseases is the widespread prevalence of poor nutrition, poverty, inadequate housing, and lack of access to potable water in many communities. Ghana’s population is predominantly rural. In 1960 only 23 percent of the population lived in urban areas, increasing to 29 percent in 1970, 32 percent in 1984, and 34 percent currently. Thus, 66 percent of the country’s population reside in rural communities and are mainly employed in primary production (Ghana, 1994 and GSS and MI, 1998). 1.3 Population and Reproductive Health Programmes Ghana adopted a population policy in 1969. One of the major long-term objectives of this policy was to reduce the population growth rate from nearly 3.0 percent in 1969 to 1.7 percent by the year 2000 (Ghana, 1994). By 1993, seven years to the target date, the 1969 policy had made only modest gains, for instance, the growth rate was estimated at between 2.8 and 3.0 percent and this was considered to be quite high (GSS and MI, 1994). Besides, there were new issues and concerns, which needed to be taken into 2 account. The 1969 population policy was therefore revised in 1994 to take into account emerging issues like HIV/AIDS, population and the environment, and concerns about the elderly and children, and also to develop new strategies that would ensure the achievement of the policy objectives. The revised edition reviewed all policy goals and set new targets within the framework of a national development strategy. One of the major targets in the new policy is the reduction of total fertility rate (TFR) to 5.0 by the year 2000, to 4.0 by 2010 and to 3.0 by 2020. This is to be achieved by attaining a contraceptive prevalence rate (CPR) of 15 percent by the year 2000, 28 percent by 2010 and 50 percent by 2020. The new target for population growth rate is 1.5 percent by 2020. The attainment of these policy goals is recognised as integral components of the national strategy to accelerate the pace of economic development, eradicate poverty and enhance the quality of life of all citizens, as outlined in the Vision 2020 Plan of Action. It is expected that these goals would propel Ghana into a middle income earning country by the year 2020 (Ghana, 1995). The National Population Council (NPC) and its secretariat were established in 1992 as the highest statutory body to advise the government on population-related issues, and to facilitate, monitor, co-ordinate, and evaluate the implementation of population programmes. In December 1994, Parliament accorded the NPC statutory recognition by enacting an act to regulate its affairs. Ghana collaborates with the United Nations Fund for Population Activities (UNFPA), the United States Agency for International Development (USAID), and other donor agencies to implement a number of population-related activities. Both UNFPA and USAID support the Government of Ghana's efforts to address the high population growth rate, low contraceptive prevalence rate, reproductive/sexual health, HIV/AIDS and other sexually transmitted diseases (STDs), and maternal and child health. Strategies focus on policy coordination and implementation, service delivery, and demand generation. In its policies and programmes for the redirection and intensification of population activities, Ghana has incorporated the ideals and recommendations of the International Conference on Population and Development (ICPD) held in Cairo in September 1994, the World Summit on Poverty and Social Development held in Copenhagen in April 1995, and the Fourth World Conference on Women held in Beijing. The Ministry of Health is vigorously pursuing policies aimed at ensuring good health for all citizens by the year 2000. Emphasis has been on making primary health care delivery systems available and accessible to all communities by the target date. 1.4 Objectives and Organisation of the Survey The 1998 Ghana Demographic and Health Survey (GDHS) is the latest in a series of national-level population and health surveys conducted in Ghana.
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