Household Cost of Accessing Contraceptive Services among Women in Urban Communities: A Case Study of Planned Parenthood Association of Ghana Clinics

Abstract

Attempts to increase the number of Family Planning (FP) users have been plagued with several access barriers. Cost is still a major barrier in the health systems in most developing economies. In these countries, healthcare financing is heavily reliant on out-of-pocket payment for certain health services. Ghana’s revised National Health Insurance Act, 2012 (Act 852) mandates the Minister of health to include coverage of relevant clinical methods of contraceptive services in the list of NHIS benefits. However, implementation of this policy has not seen much progress, and contraceptive services continue to be paid out-of-pocket in most public and private facilities across the country. The level of direct and indirect cost, in the context of the consumer, has a major influence on their ability to access services. This study, through a facility-based cross-sectional design used both qualitative and qualitative approaches, explored the household cost of accessing contraceptive services among women in urban communities in Ghana. "Household Perspective" was used to assess the costs incurred by women and their households when accessing contraceptive services at PPAG clinics. This perspective provided valuable insights into the financial burden faced by individuals seeking contraception and helped identify areas where interventions or policy changes may be needed to reduce these costs and improve access to family planning services in urban communities. Direct costs were estimated as medical cost and non medical cost. Indirect costs were estimated by measuring the reported lost time by clients. Intangible costs were described using a Likert scale to measure the likely effect of accessing contraceptive services on clients in the areas of fear, pain, social relationship, stigmatization /discrimination. According to this study, the average direct cost of contraceptive service is GHS18.4, comprising of GHS 8.5(46.4%) of direct Medical Cost and GHS 9.8% (53.6%) of direct non-medical cost. Also, clients lost an average of 52.13 minutes owing to traveling and waiting time; costing them average of GHS 3.8 of productivity. Most respondents (71.2%) indicated that they consulted their partners before taking a decision to access contraceptive services. Also, 94% of respondents indicated that their decision to access contraception will not have a negative effect on their relationship. The study found that the direct and indirect costs associated with contraceptive services are relatively high when compared to daily minimum wage and the prevailing economic conditions. These findings align with the results of recent studies on the same topic. This information indicates that the financial burden of accessing contraceptive services, including both the actual cost of the services themselves (direct costs) and other associated expenses like transportation or time off work (indirect costs), is significant. Additionally, the fact that these findings are consistent with recent studies implies that this is not an isolated issue but rather a recurring trend observed in multiple studies. These findings have important implications for policymakers, healthcare providers, and organizations involved in sexual and reproductive health, as they highlight the potential barriers that individuals may face when seeking contraceptive services and the need for strategies to reduce these costs or make services more accessible.