Family Planning in Rural Ghana: a Mixed-Methods Study

Background: Family planning provides women, men, and adolescents the ability to prevent or postpone childbearing. Family planning is a cost-effective strategy for reducing high-risk pregnancies, unsafe abortions, and allowing for birth spacing. This study was conducted in rural Ghana with three goals: 1) to estimate the prevalence of modern family planning use and unmet need for modern contraceptives, 2) to identify factors associated with unmet need for modern family planning, and 3) to understand women’s experiences and behaviors related to modern family planning use. Methods: This explanatory mixed-methods study collected 281 household surveys and 33 in-depth interviews of women 18-49 years old from the Amansie West District of Ghana. Measures of interest included: demographics, pregnancy history, pregnancy status, pregnancy intentions and attitudes, knowledge and perceived availability of modern contraceptives, modern contraceptive use, perception or partner’s attitude toward family planning, depression, autonomy, partner communication, freedom from coercion and partner support. Unmet need was defined as women of fertility age, that reported not having a hysterectomy, who were not currently pregnant, were sexually active in the last three months, did not wish to become pregnant in the next few months and were not using a modern family planning method. Met need was defined as women of fertility age, that reported not having a hysterectomy, were not currently pregnant, were sexually active in the last 3 months, did not wish to become pregnant in the next few months and were using a modern family planning method. Descriptive statistics were used to describe the demographic characteristics and family planning use. Cronbach’s alpha test was performed to measure the internal consistency of the measures described previously. Two-sample t-tests were used to test for significant differences between the met need and unmet need for modern contraceptives populations for continuous variables. Categorical variables were tested for statistically significant differences using a chi-squared test. The interviews explored community and individual perspectives of family planning, barriers to use, experiences with family planning use, and reasons for using or not using family planning. Results: The prevalence of met need and unmet need for modern family planning use were found to be 14.9% and 33.1%, respectively. About half (52%) of the sample were found to have no current or near future need for family planning. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. A fear of side effects was the most reported barrier to modern family planning use, 31.7% (n=89). Qualitative interviews found a fear of side effects to stem from rumors concerning consequences that occur when a woman is unable to menstruation, experienced by many women using modern contraceptives. Conclusion: This study highlights the discrepancy between the knowledge of modern family planning and perceived availability that may account for unmet need for modern family planning. Furthermore, the data illustrated the impact of rumors and misconceptions on the use of family planning and revealed that many of the predicted barriers to family planning use may no longer be as relevant.