Health system solutions to barriers to family planning access in rural Northern Ghana

Background: Navrongo Health Research Centre trial in northern Ghana demonstrated effective community-based primary health care, prompting the Ministry of Health to launch Community-based Health Planning and Services (CHPS) initiative to scale up its strategies. While CHPS has expanded access to maternal and child health services, it has not replicated Navrongo’s success in family planning (FP). This paper explores social and gender factors underlying the decline in CHPS’s FP focus and identifies strategies to restore its emphasis on male social engagement. Methods: A diagnostic implementation study employed community-based participatory research across 3 rural Northern Region communities. Reactions from community stakeholders, health workers, and leaders were analyzed to identify factors contributing to weak FP implementation. Results: Barriers to FP include male ambivalence, women’s fears of spousal and social conflict, restrictive norms limiting youth and women’s access to services, and constraints on women’s reproductive autonomy. These social factors contribute to worker hesitation toward FP promotion, exacerbated by vertical programming and health insurance policies emphasizing facility-based care over community outreach. Unlike Navrongo, CHPS lacks strategies for male engagement or social mediation to reduce spousal discord. Conclusion: Improving contraceptive uptake requires aligning health system actions with social structures that shape male identity and influence reproductive decisions. Training should integrate experiential, community-based approaches that equip frontline workers to promote FP within local social and institutional contexts.