Misperception and Myths About Contraceptive Use in Ghana
Misperception and Myths About Contraceptive Use in Ghana
Objective Ghana, like the rest of West Africa, has very low contraceptive prevalence and is one of a few nations that reports declines in contraceptive use over time based on two of the most recent national surveys. Fear of side effects is a leading cause of non-use of contraception, based on national surveys. The objective of this study was to gain a more holistic understanding of why Ghanaian women are not using contraception.
Methods We used focus groups with vignettes to elicit normative beliefs about contraception. We recruited 91 women from three different clinics within Legon Hospital in Accra, Ghana: the antenatal clinic, the student clinic and the child welfare clinic. Focus groups were homogeneous with regard to age group and union status.
Results We found that women were most concerned with the menstrual irregularities caused by hormonal methods. In addition, women believed strongly that the hospital was the best place to get contraception as blood tests were needed to match women with the appropriate method. Knowledge of how methods worked and of basic reproductive biology was low.
Conclusions Poor knowledge of how to use modern methods combined with myths and misinformation should be the targets of programmes to increase modern contraceptive prevalence in Ghana.
While in many low- and middle-income countries there has been an increase in contraceptive prevalence, in West Africa contraceptive uptake has been remarkably slow. Multiple studies have highlighted the importance of and need to address misinformation and side effects as a reason for contraceptive non-use. In the last decade, few family planning programmes have addressed concerns about contraceptive side effects despite evidence from a variety of settings showing that these concerns are real barriers to many women's uptake and/or continuation of contraception.
Ghana is a low-income country, undergoing a significant fertility transition. Ghana's total fertility rate has declined from 6.4 in 1988 to 4.0 in 2008. In addition, while modern contraceptive use among married women increased from 4.2% in 1988, use declined between 2003 (18.7%) and 2008 (16.6%). Declines were seen across methods including oral contraceptives (8% in 2003 to 5% in 2008) and condoms (down to only 2% in 2008 from 18% in 2003 – a 16% drop).
Based on unprompted and prompted reports of knowledge of contraceptive methods, awareness has slipped with women reporting knowledge of an average of 7.8 modern methods as compared to an average of 8.6 methods in 2003. Overall, Ghana's levels of modern contraceptive use relative to its fertility decline are puzzling; even when the contraceptive prevalence was rising in the past, the pace of the fertility transition was substantially faster than expected, given contraceptive use levels.
Fear of side effects, especially those perceived to impair fertility, remain the leading cause of non-use of modern contraception in Ghana based on the Demographic and Health Survey (DHS) and other sources. Fear of side effects increased in importance as a reason for non-use from 18% in 1998 to 26% in 2003 and 2008. In 2008, 16% of non-users said they do not intend to use in the future because they are opposed to using family planning (up from 5.8% in 2003). In 2008, 2% of women cited lack of knowledge of methods as a reason for non-use. Although the proportions remained under 10%, the proportion of women who cited "inconvenience" and "interferes with body's normal process" rose between 2003 and 2008. In this study, we used in-depth qualitative methods with women attending three hospital clinics in Accra, Ghana to gain a more holistic understanding of the reasons why women are not using contraception.
Abstract and Introduction
Abstract
Objective Ghana, like the rest of West Africa, has very low contraceptive prevalence and is one of a few nations that reports declines in contraceptive use over time based on two of the most recent national surveys. Fear of side effects is a leading cause of non-use of contraception, based on national surveys. The objective of this study was to gain a more holistic understanding of why Ghanaian women are not using contraception.
Methods We used focus groups with vignettes to elicit normative beliefs about contraception. We recruited 91 women from three different clinics within Legon Hospital in Accra, Ghana: the antenatal clinic, the student clinic and the child welfare clinic. Focus groups were homogeneous with regard to age group and union status.
Results We found that women were most concerned with the menstrual irregularities caused by hormonal methods. In addition, women believed strongly that the hospital was the best place to get contraception as blood tests were needed to match women with the appropriate method. Knowledge of how methods worked and of basic reproductive biology was low.
Conclusions Poor knowledge of how to use modern methods combined with myths and misinformation should be the targets of programmes to increase modern contraceptive prevalence in Ghana.
Introduction
While in many low- and middle-income countries there has been an increase in contraceptive prevalence, in West Africa contraceptive uptake has been remarkably slow. Multiple studies have highlighted the importance of and need to address misinformation and side effects as a reason for contraceptive non-use. In the last decade, few family planning programmes have addressed concerns about contraceptive side effects despite evidence from a variety of settings showing that these concerns are real barriers to many women's uptake and/or continuation of contraception.
Setting
Ghana is a low-income country, undergoing a significant fertility transition. Ghana's total fertility rate has declined from 6.4 in 1988 to 4.0 in 2008. In addition, while modern contraceptive use among married women increased from 4.2% in 1988, use declined between 2003 (18.7%) and 2008 (16.6%). Declines were seen across methods including oral contraceptives (8% in 2003 to 5% in 2008) and condoms (down to only 2% in 2008 from 18% in 2003 – a 16% drop).
Based on unprompted and prompted reports of knowledge of contraceptive methods, awareness has slipped with women reporting knowledge of an average of 7.8 modern methods as compared to an average of 8.6 methods in 2003. Overall, Ghana's levels of modern contraceptive use relative to its fertility decline are puzzling; even when the contraceptive prevalence was rising in the past, the pace of the fertility transition was substantially faster than expected, given contraceptive use levels.
Fear of side effects, especially those perceived to impair fertility, remain the leading cause of non-use of modern contraception in Ghana based on the Demographic and Health Survey (DHS) and other sources. Fear of side effects increased in importance as a reason for non-use from 18% in 1998 to 26% in 2003 and 2008. In 2008, 16% of non-users said they do not intend to use in the future because they are opposed to using family planning (up from 5.8% in 2003). In 2008, 2% of women cited lack of knowledge of methods as a reason for non-use. Although the proportions remained under 10%, the proportion of women who cited "inconvenience" and "interferes with body's normal process" rose between 2003 and 2008. In this study, we used in-depth qualitative methods with women attending three hospital clinics in Accra, Ghana to gain a more holistic understanding of the reasons why women are not using contraception.