Context-specific Factors and Contraceptive Use: A Mixed Method Study among Women, Men and Health Providers in a Rural Ghanaian District

Martin Amogre Ayanore, Milena Pavlova, Wim Groot

Abstract

Suitable options for improving women‘s access to effective, safe and context-specific contraceptive methods must be explored to curtail rising unmet needs for contraceptive use in rural Ghana. The study aimed to outline context-specific factors associated with contraceptive use, access on demand and future use intentions among women in one district of Ghana. Using mixed method approach, quantitative data (n=720) was collected among women aged 18-28. Focus group discussions and in-depth interviews were also conducted among women (n=30) aged 18-49 and men (n=10) respectively. IDIs were conducted among 3 midwives. Women who received focused counseling on contraceptive use were twice likely to have ever used (OR=2 95% CI 1.163-3.467) or be current users (OR=2, 95% CI 1.146-4.010) of contraceptives. Male partner support can drive cultural sensitivities towards accepting use of contraception (OR=34.5, CI% 19.01-64.22). Covert use is still preferred by most in the study. Services delivered on good provider-relational grounds and convenient clinic hours encourage contraceptive use among women. Male targeting for improving contraceptive service use must first identify context-specific preferences of the woman, since covert use is highly valued. Ascertaining the prevalence of covert use and how community systems can address this for improved contraceptive uptake is further recommended. (Afr J Reprod Health 2017; 21[2]: 81-95).

Full Text:

PDF

References

WHO. Sexual health, human rights and the law. World Health Organization; 2015.

Casterline JB and Sinding SW. Unmet need for family planning in developing countries and implications for population policy. Population and development review. 2000;26(4):691-723.

UNICEF, and WHO. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF. In: UNFPA and The World Bank estimates. Geneva: World Health Organization; 2012.

Ashford L. Unmet need for family planning: Recent trends and their implications for programs. Population Reference Bureau; 2003.

Darroch JE, and Singh S. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: An Analysis of National Surveys. The Lancet. 2013;381(9879):1756-1762.

Campbell M, Sahin-Hodoglugil NN, and Potts M. Barriers to Fertility Regulation: A Review of the Literature. Studies in family planning. 2006;37(2):87-98.

Asekun-Olarinmoye E, Adebimpe W, Bamidele J, Odu O, Asekun-Olarinmoye I, and Ojofeitimi E. Barriers to use of modern contraceptives among women in an inner city area of Osogbo metropolis, Osun state, Nigeria. International journal of women's health. 2013;5:647.

Smith R, Ashford L, Gribble J, and Clifton D. Family planning saves lives. 2009.

Tsui AO, McDonald-Mosley R, and Burke AE. Family planning and the burden of unintended pregnancies. Epidemiologic reviews. 2010:mxq012.

Sedgh G, Singh S, Shah IH, Åhman E, Henshaw SK, and Bankole A. Induced abortion: incidence and trends worldwide from 1995 to 2008. The Lancet. 2012;379(9816):625-632.

Mosha I, Ruben R, and Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC public health. 2013;13(1):523.

GSS, GHS, and ICF Macro. Ghana Demographic and Health Survey. Accra, Ghana: GSS,GHS, ICF Macro; 2014.

Blanc AK, and Grey S. Greater than expected fertility decline in Ghana: untangling a puzzle. Journal of Biosocial Science. 2002;34(04):475-495.

Johnson FA, and Madise NJ. Targeting women at risk of unintended pregnancy in Ghana: Should geography matter? Sexual & Reproductive Healthcare. 2011;2(1):29-35.

Adanu RM, Seffah JD, Hill AG, Darko R, Duda RB, and Anarfi JK. Contraceptive use by women in Accra, Ghana: results from the 2003 Accra Women's Health Survey. African journal of reproductive health. 2009;13(1):123-133.

Asamoah B, Agardh A, and Östergren PO. Inequality in fertility rate and modern contraceptive use among Ghanaian women from 1988-2008. International Journal for Equity in Health. 2013;12(1):37.

Teye JK. Modern Contraceptive Use among Women in the Asuogyaman District of Ghana: Is Reliability More Important than Health Concerns? African journal of reproductive health. 2013;17(2):58.

GSS, GHS, and ICF Macro. Ghana Demopgraphic and Health Survey 2008. Accra Ghana: GSS, GHS, and ICF Macro; 2009.

Blanc AK. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Studies in family planning. 2001;32(3):189-213.

Eliason S, Baiden F, Quansah-Asare G, Graham-Hayfron Y, Bonsu D, Philips J, and Awusabo-Asare, K. Factors influencing the intention of women in rural Ghana to adopt postpartum family planning. Reprod Health. 2013;10(1):34.

Dalaba MA, Stone AE, Krumholz AR, Oduro AR, Phillips JF, and Adongo PB. A qualitative analysis of the effect of a community-based primary health care programme on reproductive preferences and contraceptive use among the Kassena-Nankana of northern Ghana. BMC Health Services Research. 2016;16(1):1-8.

Abekah-Nkrumah G, and Abor PA. Socioeconomic determinants of use of reproductive health services in Ghana. Health Economics Review. 2016;6(1):1-15.

Atuahene MD, Afari EO, Adjuik M, and Obed S. Health knowledge, attitudes and practices of family planning service providers and clients in Akwapim North District of Ghana. Contraception and Reproductive Medicine. 2016;1(1):1.

Do M, and Kurimoto N. Women's empowerment and choice of contraceptive methods in selected African countries. International perspectives on sexual and reproductive health. 2012:23-33.

Darroch JE. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Contraception. 2013;87(3):259-263.

Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, and Innis J. Family planning: the unfinished agenda. The Lancet. 2006;368.

DeRose LF, Dodoo NA, and Patil V.Fertility desires and perceptions of power in reproductive conflict in Ghana. Gender & Society. 2002;16(1):53-73.

Adongo PB, Phillips JF, Kajihara B, Fayorsey C, Debpuur C, and Binka FN. Cultural eactors constraining the introduction of family planning among the Kassena-Nankana of Northern Ghana. Social science & medicine. 1997;45(12):1789-1804.

Yakong VN, Rush KL, Bassett-Smith J, Bottorff JL, and Robinson C. Women‘s experiences of seeking reproductive health care in rural Ghana: challenges for maternal health service utilization. Journal of Advanced Nursing. 2010;66(11):2431-2441.

Crissman HP, Adanu RM, and Harlow SD. Women's sexual empowerment and contraceptive use in Ghana. Studies in family planning. 2012;43(3):201-212.

Debpuur C, Phillips JF, Jackson EF, Nazzar A, Ngom P, and Binka FN. The impact of the Navrongo Project on contraceptive knowledge and use, reproductive preferences, and fertility. Studies in family planning. 2002;33(2):141-164.

GSS. 2010 Population and Housing Census Final Report. Accra,Ghana.2012.

Meij J, De Craen A, Agana J, Plug D, and Westendorp R. Low-cost interventions accelerate epidemiological transition in Upper East Ghana. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009;103(2):173-178.

Borkan JM. Mixed Methods Studies: A Foundation for Primary Care Research. Annals of Family Medicine. 2004;2(1):4-6.

Kish L. Timing of surveys for public policy. Australian Journal of Statistics. 1986;28(1):1-12.

Ross JA, and Winfrey WL. Contraceptive use, intention to use and unmet need during the extended postpartum period. International family planning perspectives. 2001:20-27.

Ross J, and Hardee K. Access to contraceptive methods and prevalence of use. Journal of biosocial science. 2013;45(06):761-778. 38. DeRose LF, Dodoo FN, Ezeh AC,and Owuor TO. Does discussion of family planning improve knowledge of partner's attitude toward contraceptives? International family planning perspectives. 2004:87-93.

Jewkes R, Abrahams N, and Mvo Z. Why do nurses abuse patients? Reflections from South African obstetric services. Social science & medicine. 1998;47(11):1781-1795.

D'Ambruoso L, Abbey M, and Hussein J. Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana. BMC Public Health. 2005;5(1):140.

Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, and Innis J. Family planning: the unfinished agenda. The Lancet. 2006;368(9549):1810-1827.

Adebayo SB, Gayawan E, Ujuju C, and Ankomah A. Modelling geographical variations and determinants of use of modern family planning methods among women of reproductive age in Nigeria. Journal of biosocial science. 2013;45(01):57-77.

Ononokpono DN, Odimegwu CO, Imasiku E, and Adedini S. Contextual determinants of maternal health care service utilization in Nigeria. Women & health. 2013;53(7):647-668.

Corroon M, Speizer IS, Fotso JC, Akiode A, Saad A, Calhoun L, and Irani L. The role of gender empowerment on reproductive health outcomes in urban Nigeria. Maternal and child health journal. 2014;18(1):307-315.

Izugbara C, Ibisomi L, Ezeh AC, and Mandara M. Gendered interests and poor spousal contraceptive communication in Islamic northern Nigeria. Journal of Family Planning and Reproductive Health Care. 2010;36(4):219-224.

Rottach E, Schuler SR, and Hardee K. Gender perspectives improve reproductive health outcomes: new evidence. 2009.

Metcalfe QMR. Understanding women‘s empowerment and maternal mortality in the Ugandan context: effects of mitigative intervention strategies [M.A thesis.]: Arts & Social Sciences: School for International Studies, Simon Fraser University; 2010.

Cleland J, and Shah IH. The contraceptive revolution: focused efforts are still needed. The Lancet. 2013;381(9878):1604-1606. 49. Eliason S, Baiden F, Yankey BA, and Awusabo–Asare K. Determinants of unintended pregnancies in rural Ghana. BMC Pregnancy Childbirth. 2014; 14: 261.

Van de Walle E. Fertility transition, conscious choice, and numeracy.demography. 1992;29(4):487-502.

Refbacks

  • There are currently no refbacks.