Addressing Men’s Concerns About Reproductive Health Services and Fertility Regulation in a Rural Sahelian Setting of Northern Ghana: The “Zurugelu Approach”

Convenient, nonclinical, community-based services that use community organization, structure and institutions has emerged as the core strategy to expand access to contraceptive technologies in sub-Saharan Africa. When experimental projects in Asia revealed that this approach, collectively termed “community-based distribution” (CBD), can enhance the quality, appropriateness and impact of family planning programs, lack of convenient access to contraceptives was viewed as the primary barrier to the practice of family planning rather than societal barriers. This paper presents findings from the long term observation of a factorial trial of alternative strategies for CBD, testing the relative effects of professional nurse based strategies versus combining nurse with volunteer roles that target the needs of men. Quantitative and qualitative results attest to the importance of activities that address the needs and concerns of men. Strategies that lacked this focus had no impact, even when CBD made comprehensive family planning services fully accessible.