Hormonal contraceptive use in Ghana: the role of method attributes and side effects in method choice and continuation

Sarah Keogh, Guttmacher Institute Easmon Otupiri, Kwame Nkrumah University of Science and Technology Philicia Castillo, Guttmacher Institute Doris W. Chiu, Guttmacher Institute Chelsea Polis, Guttmacher Institute Emmanuel K. Nakua, Kwame Nkrumah University of Science and Technology Suzanne Bell, Johns Hopkins University

First published on Contraception:

| DOI: https://doi.org/https://doi.org/10.1016/j.contraception.2021.05.004
Abstract / Summary
To understand the barriers and facilitators of hormonal contraceptive use among Ghanaian women, in order to help improve contraceptive counseling and reduce the high rates of unintended pregnancy.
Study design
We conducted a nationally representative community-based survey of 4139 women aged 15-49 in 2018, and used descriptive statistics and logistic regression to examine correlates of current hormonal method use, preferred method attributes and their association with method choice, and the role of side effects in hormonal method discontinuation.
Hormonal method use (vs. contraceptive non-use) was associated with younger age, higher parity and education, but not with union status, wealth or residence. Preferences for key method attributes were associated with choosing particular methods. Most valued attributes were effectiveness at preventing pregnancy, and low risks of harming health and future fertility. These last two concerns are echoed in the second most common reason for discontinuation (health concerns). While menstrual changes were a common concern, leading some respondents to discontinue hormonal contraceptives, many were willing to endure these effects. In contrast, having experienced long-term health issues as a perceived result of hormonal method use more than halved the odds of current use. Contraceptive counseling on menstrual changes, other side effects, and impacts on future fertility had not been universally provided.
Ghanaian women value hormonal methods for their effectiveness against pregnancy. However, concerns about side effects (particularly bleeding changes), future fertility impairment, and long-term health issues led some women to discontinue hormonal methods. Counseling on these issues was reportedly inadequate.