On the first day that I entered Planned Parenthood Association of Ghana, the sticker on the door that greeted me said “ABSTINENCE 100% effective against teenage pregnancies an STIs.” From that moment on, the differences between reproductive and sexual health in the US and in Ghana were clear to me. Other posters that were in the waiting room of the clinic only enforced abstinence as the dominant form of contraception. One big poster said that “Abstinence does not make you kolo! It pays to wait,” (Kolo means outcast or someone who isn’t part of society) with a smiling school girl on it. However, when in conversation with other workers in PPAG, their personal views do not align with the propaganda of abstinence that is shown all across the main waiting area of the clinic. Obviously, as physicians, midwives and nurses, they are the ones that counsel women, and men, who come to the clinic for sexual and reproductive health. They are tasked with the job of explaining how different contraceptives work and insert them if needed. So, where does this emphasis on abstinence come from?
These past two weeks, we (the PPAG interns) gave presentation on teenage pregnancy to different schools. We were given little to zero information on how we should approach the presentation, what we should include, what we should not or how to talk about teenage pregnancy to 12-17-year old’s. The night before the presentation, we sat around and discussed all of these questions, but we just kept coming back to our own predisposed ideas of how sex education and teenage pregnancy should be taught, which was different to what was culturally sensitive to Ghana. After hours of talking, we came up with what we thought was a pretty solid and unbiased talk on teenage pregnancy which discussed the causes, the different paths a woman can take if they do become pregnant at a young age, and ways to prevent teenage pregnancy. We talked about a broad range of contraceptive methods that included abstinence, condoms, IUD’s and emergency contraception. Though we focused on abstinence and condoms, we tried to explain the importance of women choosing contraceptives (IUD’s, pill, etc.) but do not think it was understood properly; especially when we were told to take out the information that we said about hormonal contraceptives and emergency contraception.
This past week, we observed one presentation that a PPAG member gave. This presentation was vastly different from ours. The only contraceptive method that she talked about was abstinence and she conveyed it in a very forceful, almost using a scaring tactic, manner. All of the end-results of teenage pregnancy were death. Death was brought up multiple times during the presentation, both by the students and the presenter. If you get an abortion, you may die. If you get pregnant, your two options are to either carry out the term or die. You may get pregnant, have the baby, but can only raise the baby in poverty and then it will die. Simply listening to the presentation at home, I was shocked at the constant repetition of death and abstinence. This presentation reminded me of the 40 seconds of sex education in the movie “Mean Girls,” where the teacher says, “Don’t have sex, because you will get pregnant and die!” but this time it went on for 35 minutes.
Having worked with the presenter for weeks, I know that her personal views do not reflect what she is telling these young children. But, why is she preaching something she does not believe in? The cultural and social boundaries in Ghana refrained her from telling the children the full extent of how to combat teenage pregnancy, something that she does every day to women who come seek her counsel. But then again, how does she expect women and these girls in the future to come to PPAG and seek counselling for birth control options if she is not instilling this knowledge on to girls at an earlier age? Additionally, with Ghana’s commitment to Family Planning 2020, which aims to ensure comprehensive sexual health education, how can Ghanaians’ perspectives on sex and sex education change? Will committing to FP2020 push social and cultural boundaries that are not yet ready to be challenged? I do not have the answers and I am not sure who would, but, working at PPAG helped me understand the difficulties of sex education in countries where the family planning narrative is dominated by discourse on overpopulation and population control. One thing that I do hope changes is the connotations of death with teenage pregnancy that sex educators are conveying to children.
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