Utilization of Reproductive Health Services among Adolescents in Ghana: Analysis of the 2007 and 2017 Ghana Maternal Health Surveys

Abstract

Introduction: Adolescents aged 10 and 19 years constitute about 1.2 billion of the global population. In Ghana, adolescents form about a quarter of the population. The developmental changes that occurs during adolescence predisposes them to some health risks. In all regions in the world, young people are reaching puberty earlier; this influences them to engage in sexual activity at a younger age while delaying marriage. This increases the risk of exposure to HIV and other sexually transmitted infections, unwanted pregnancies with attendant issues like unsafe abortion. Many adolescents in Ghana underuse Sexual Reproductive Health (SRH) services primarily due to the stigma attached to adolescent sexual activities. Aim: This study examined the utilization of SRH services among adolescents aged 15-19 years in Ghana over a ten-year period. Methods: The study utilized data from the 2007 and 2017 Ghana Maternal Health Survey (GMHS) on 2,056 and 4909 adolescents respectively. Data was analyzed using STATA 15 version. The extracted data was presented using frequency tables. The Pearson’s chi-squared test was used to assess the relationship between the independent variables and utilization of SRH services. Logistic regression was fitted to examine the determinants of SRH utilization. Odds ratio and their 95% confidence intervals were used to assess the strength of association. A P-value of 0.05 was used to determine statistical significance. Results: The mean (SD) age of the respondents was 16.8 ±1.4 for both 2007 and 2017 study. Percentage of respondents with no education declined from 10.0% in 2007 to 5.5 in 2017. Age at first sex is highest among 15-17year old in both 2007 and 2017 [ 15(24.7/26.0), 16(21.4/23.4) & 17(17.7/18.4)]. Among respondents who were using contraception and had ever had sex declined from 28.3% to 22.5% over the ten years period however modern contraception use had increased from 44.9% to 71.8% over the same period. The 2007 bivariate and multivariate analysis showed that ever had sex, age at first sexual intercourse and ever given birth showed association with utilization of . The 2017 bivariate analysis showed that age, educational level, region, residence, ever had sex, age at first sexual intercourse, ever given birth, knowledge about abortion and knowledge about source of family planning had significant relationship with utilization. The logistic regression analysis showed that age, ever given birth, educational level, ever had sex, age at first sexual intercourse and knowledge about source of family planning were significant. When all the variables were adjusted, age, ever had sex, age at first sexual intercourse, ever given birth, educational level and knowing source of family planning showed significant association with utilization. Test of proportion on utilization of sexual and reproductive health (SRH) services between 2007 and 2017 showed a significant decline among those currently using family planning. However there has been significant increase among respondents who used modern methods. There was no significant change in the utilization of abortion services over the period. Conclusion: Utilization of family planning methods has significantly declined between 2007 and 2017. However modern family planning methods utilization has increased significantly between 2007 and 2017. Sexual activities are important determinants of utilization of SRH.