Yeboah et al. BMC Public Health (2023) 23:1925 BMC Public Health https://doi.org/10.1186/s12889-023-16795-1 R E S E A R C H Open Access Use of any contraceptive method among women in rural communities in the eastern region of Ghana: a cross-sectional study Isaac Yeboah1, Martin Wiredu Agyekum2*, Joshua Okyere3, Ronald Osei Mensah4, Mary Naana Essiaw1, Hilda Appiah1, Andrew Kweku Conduah1, Seth Nana Kwabena Koduah5 and Aaron Kobina Christian6 Abstract Background In Ghana, there is an increase in contraceptive use for traditional and modern methods in rural areas. This study seeks to examine the prevalence and determinants of current use of any contraceptive method among women of reproductive age in the rural Eastern Region of Ghana. Methods A community-based cross-sectional study was conducted among women of reproductive age in the rural Eastern region of Ghana. A structured questionnaire was used to interview women in rural Lower Manya and Upper Manya Krobo districts of Eastern region who were selected using a simple random sampling technique. The data were analysed using Stata version 16. A Binary logistic regression was used to examine the determinants of current use of any contraceptive use (traditional and modern methods). Results The prevalence of contraceptive use was 27.8%. In the adjusted analysis of binary logistic regression, contraceptive use was significantly lower (aOR = 0.24; 95%CI = 0.10–0.56; p = 0.001) among respondents aged 41–49 years compared to those aged 18–35 years. Contraceptive use was significantly lower among migrants (aOR:0.53; 95%CI:0.28–0.99; p = 0.048) compared with non-migrant. Conclusion The prevalence of any contraceptive use among rural women was low. Government and other stakeholders need to create awareness about contraception in the rural areas of Eastern region of Ghana and that would help increase contraceptive methods utilization. In addition, family planning programs should target migrants to design an intervention to increase contraceptive use in rural areas. Keywords Prevalence, Determinants, Contraceptives, Rural, Communities, Eastern, Region, Ghana *Correspondence: 3Department of Population and Health, University of Cape Coast, Cape Martin Wiredu Agyekum Coast, Ghana mwagyekum@uew.edu.gh 4Centre for Languages and Liberal Studies, Takoradi Technical University, 1Institute of Work, Employment and Society, University of Professional Takoradi, Ghana Studies, Accra, Ghana 5Commonwealth Senior High School, Lartebiokoshie, Accra, Ghana 2Institute for Educational Research and Innovation Studies (IERIS), 6Regional Institute for Population Studies, University of Ghana, Legon, University of Education, Winneba, Ghana Ghana © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Yeboah et al. BMC Public Health (2023) 23:1925 Page 2 of 7 the best of our knowledge. Contraceptive prevalence Text box 1. Contributions to the literature (35.6%) for any method in the Eastern region is high, [7] • Research has shown that the use of any contraceptive but the associated factors, especially in the rural areas, method is increasing in rural areas of sub-Saharan Africa. For are unknown. This is because there are no studies exam- policy makers, the use of any contraceptive method even in ining the prevalence and determinants of contraceptive the rural areas is heterogenous and context specific. use for any method (that is either traditional or modern • Although we found that the study areas contraceptive prevalence level was similar to national rural prevalence methods) in the rural Eastern Region of Ghana. Hence, level, the factors associated with the use of any contracep- it is very imperative that we understand the factors asso- tive method in our study area provide policy makers insights ciated with contraceptive use among rural women in the into real-world. Eastern region of Ghana to help policymakers to design • These findings contribute to gaps in the literature where an appropriate intervention to help increase contracep- less is known about the contraceptive behaviour of rural tive use. Therefore, this study seeks to examine the preva- women in Eastern region of Ghana. Therefore, policy makers should provide contraceptive interventions targeted at lence and factors associated with use of contraceptives migrant in rural Eastern region. among women living in rural communities in the East- ern region of Ghana. We hypothesized that the use of any contraceptive method is associated with social and Background demographic factors. Globally, about 190  million out of 1.9  billion women within the reproductive age (15–49 years) who want to Methods avoid pregnancy do not use any contraceptive method. It Study setting is estimated that 23.7% of women in sub-Saharan Africa Ghana is basically an agrarian economy with the agricul- who want to avoid pregnancy do not use any contra- tural sector made up of predominantly smallholder farm- ceptive method; a term referred to as “unmet needs for ers. The agricultural sector employs about 58% of women. family planning” [1]. In Ghana, about 30% of married The study was conducted in the rural farming communi- women have an unmet need for family planning [2]. ties of two Manya Krobo districts (Upper Manya Krobo The high unmet need is associated with the non-use of districts and Lower Manya Krobo district) in the East- contraceptives which leads to unwanted pregnancy and ern Region of Ghana. The region has the highest unmet consequently adverse related pregnancy outcomes such need of 35.1% in Ghana and by extension, those in the as abortion and mortality [3]. Evidence shows that con- rural areas have higher unmet needs than the urban traceptives are very essential and remain a global inter- areas. The districts are in the semi-equatorial climate vention for preventing unwanted pregnancy and related belt, with annual rainfall ranging from 900 to 1,500 mil- maternal morbidity and mortality [4, 5]. Even though limetres. The majority of the population in Upper Manya contraceptive awareness is very high in SSA, most Krobo reside in rural areas (69%) while about 1 out of 4 women do not use contraceptives [6]. of the population (24.2%) in Lower Manya Krobo reside In sub-Sahara Africa, contraceptive use is a complex in rural centers [29]. Both districts have about fourteen individual choice that is influenced by a variety of con- communities. textual factors including socio-demographic, cultural, economic factors and partner influence [7–17]. However, Study design cultural, socio-demographic and economic factors tend The study design was a cross-sectional household sur- to influence contraceptive use in rural areas in SSA [18– vey collecting information on women empowerment 20]. In addition, unavailability of contraceptive services, and some individual and household outcomes. Pri- limited knowledge among both women and their part- mary data was collected using a structured interviewer- ners and perceived side effects of modern contraceptive administered questionnaire that was adopted from methods could also influence the decision for women to standard questionnaires including Pro-WEAI (Women’s use contraceptives most especially in rural areas [21, 22]. Empowerment in Agriculture Index). The Pro-WEAI According to the 2017 Ghana Maternal and Health questionnaire covered a range of topics such as social Survey, the contraceptive prevalence rate was 25% for all and demographic information, role in household deci- methods. Although there is a preponderance of empiri- sion-making around production and income, access to cal studies on the prevalence and determinants of contra- productive capital, access to financial services, time allo- ceptive use in Ghana, most of these studies have mainly cation, group membership, physical mobility, reproduc- focused on modern contraceptive use [16, 23–26]. There tive history of respondents. Hence, the current analysis are few studies on the determinants of contraceptive is part of a larger cross-sectional household survey col- use for any method in rural Ghana [27, 28] and none of lecting information on women’s empowerment and their these studies is in the rural Eastern Region of Ghana to Yeboah et al. BMC Public Health (2023) 23:1925 Page 3 of 7 nutritional outcomes (e.g., overweight and/or obesity), of living children, age at first pregnancy, number of preg- health and household outcomes. nancies and number of child loss were also assessed. Study population and sampling and sample size Ethics statement Households with women were identified by using a The study’s ethical protocol was approved by the Nogu- 2-stage sampling procedure, in which 4 primary units chi Memorial Institute of Medical Research Institutional (communities) were selected with probability propor- Review Board, University of Ghana, Legon (NMIMR tional to size, and secondary units (women) were selected IRB Number: 020/19–20). Informed consent for volun- using the random-walk method commonly used in EPI tary participation was obtained from participants before cluster surveys to identify participants [30, 31]. The being interviewed. Additionally, the purpose of the study sample size for this study was based on determining the including the general objectives, benefits, and risks of prevalence of overweight/obesity among women in the taking part in the study was explained to the partici- Eastern region. The formula below was used to deter- pants before they consented to be part of the study. Par- mine the sample size.  ticipation was voluntary and remunerative (participants were given soap after the interview). Confidentiality was Z2P (1− P ) upheld throughout the study. The study was conducted in n = d2 accordance with the relevant guidelines and regulations specified by the Ethics Committee. where n = Sample size, Z = Z statistic for a level of confidence: Z = 1.96 for level of confidence of 95%, Measurement of variables P = Expected prevalence or proportion: The prevalence The main dependent variable for this study is the cur- of overweight/obesity reported in the 2014 Ghana’s rent use of any contraceptive method. Respondents were demographic and health survey was 38.5%. This figure is asked if they were using any family planning method to expected to be rising. We assumed an overweight/obe- prevent pregnancy. The question posed was ‘Are you cur- sity prevalence of 50%. This gives a minimum required rently doing something or using any method to delay or sample of 385. Finally, an additional 10% of the sample avoid getting pregnant’? Those who were using a method, was added to account for missing data or non-respond- either modern or traditional method to prevent preg- ing respondents. Thus, the final target sample size was nancy were classified as “yes” whiles those who were not 435. For the main study, we interviewed women who had using anything to prevent pregnancy were classified as ever and never had sex. For the purpose of this study, the “no”. sample unit was restricted to women who were sexually The independent variables for the study are age, marital active in the last 12 months preceding the survey. This status, educational attainment, migration status, number led to the reduction in the sample size for this study from of pregnancies, desire for another child, number of living 435 to 281. children, district, type of household, head of household and occupation. The age of respondents was classified Data collection procedure as “18–35 years”, “36–40 years”, and “41–49 years”. Mari- The data was collected between June and July 2021. Data tal status of respondents was categorised as “currently collection was conducted in four communities within the married”, “cohabiting” and “currently not married”. Edu- two districts. These communities are Sekesua, Mensah cational attainment was classified as “no education”, Dawa, Oborpah and Yoguse. These were communities “primary”, “Junior High School (JHS)”, and “Senior High with most agricultural activities. Training was conducted School (SHS) or higher”. Migration status was classified for field enumerators on data collection processes, con- as “migrant” and “non-migrant”. Number of pregnan- fidentiality, study objectives and rationale of the project. cies was recategorized as “1–3”, “4–5” and “6 and more”. After the training, the study instrument was piloted to All the women interviewed in this study have ever been assess its clarity and suitability. Respondents were asked pregnant. Likewise, the number of living children. There- to sign an informed consent form before the interviews fore, there was no zero-category number of pregnancies were conducted. Random selection of households that and living children. The number of living children was practice agricultural activities as main occupation was classified as “1–3”, “4–5” and “6 and more”. Age at first used as a sampling strategy. Using an interviewer-admin- pregnancy was categorized as “<18 years” “18–24 years” istered questionnaire, data were collected on socio- and “25 years and above”. Access to health facility was demographic variables such as age, educational level, classified as “yes” and “no”. In addition, head of household marital status, household wealth status, and current con- was categorized as “self”, “husband” and “other relatives”. traceptive use. Reproductive history: parity and number Lastly, occupation was recategorized as agricultural self- employed and other activities. Yeboah et al. BMC Public Health (2023) 23:1925 Page 4 of 7 Table 1 Characteristics of participants (n = 281) Table 2 Prevalence of contraceptive use by background Characteristics Category Frequency (%) characteristics Any Contraceptive use Yes 78(27.8) Characteristics Category Contracep- X2 (p No 203(72.2) tive use value) Age 18–35 112(39.9) Yes (%) 36–40 75(26.7) Age (n = 281) 18–35 36.6 10.9 41–49 94(33.5) 36–40 29.3 (0.004) Marital Status Currently Married 121(43.1) 41–49 17.0 Cohabiting 118 (42.0) Marital Status Not married 16.7 3.0(0.220) Not currently married 42(14.9) Currently married 29.8 Educational Attainment No education 82(29.2) Cohabiting 29.7 Primary 68 (24.2) Educational No education 25.6 0.5 (0.915) JHS 63 (22.4) Attainment Primary 29.4 SHS or Higher 68 (24.2) JHS 30.2 Migration Status Migrant 98(34.9) SHS or Higher 28.6 Non-migrant 183(65.1) Number of 1–3 28.7 0.4 (0.780) Number of Pregnancies 1–3 101(35.9) Pregnancies 4–5 25.3 4–5 99(35.2) 6 or more 29.6 6 or more 81(28.8) Number of living 1–3 28.4 0.4 (0.787) Number of living children 1–3 134(47.7) children 4–5 28.6 4–5 112(39.9) 6 or more 22.9 6+ 35(12.5) Migration Status Migrant 30.6 0.6(0.434) Age at first pregnancy < 18 years 45(16.0) Non-migrant 26.3 18–24 years 196 (69.8) Head of Household Self 13.5 6.5(0.038) 25+ 40 (14.2) Husband/Partner 31.2 Access to health facility Yes 181 (64.4) Other Relative 28.6 No 100 (35.6) Occupation Agricultural- self 26.9 0.4 (0.497) Head of Household Self 52(18.5) employed Husband 215(76.5) Other 31.5 Other Relatives 14(5.0) Access to health Yes 27.6 0.0 (0.946) Occupation Agricultural-self employed 227(80.8) facility No 28.0 Other 54(19.2) Age at first < 18 years 26.7 2.6 (0.264) Source: Pro-WEAI Data, 2021 pregnancy 18–24 years 30.1 25+ 17.5 Data analysis The bivariate result is presented in a row percentage. Source: Pro-WEAI, 2021 The characteristics of the study sample were described using percentages and frequencies. The association using any contraceptive method to prevent pregnancy. between the current use of any contraceptive methods Almost 40% of the women were aged 18–35 years with and women’s characteristics were tested using cross- a little over a quarter (26.7%) and one-third (33.5%) were tabulation and chi-square. A multivariate binary logistic aged 36–40 years and 41–49 years respectively. Most of regression analysis was performed to examine the fac- the participants were married (43.1%), have no education tors associated with the current use of any contraceptive (29.2%) and were non-migrants (65.1%). More than over method. A binary logistic regression was used because one-third (35.9%) of the women had 1–3 pregnancies. the dependent variable was a dichotomous variable. The Similarly, about 7 in 10 women (76.5%) live in households model accounts for controlled variables, hence produces with husbands as the head of the household. Majority of an adjusted odds ratio.  The analyses were performed the respondents (80.8%) are in agriculture as their main using Stata version 16 and statistical significance was set occupation. at the 5% alpha level (p < 0.05). Association between current use of any contraceptive Results method and background characteristics Description of background characteristics According to Table  2, contraceptive use by those aged From Table 1, there was a marked difference in the preva- 18–35 years was 36.6%. Among study participants who lence of the current use of any contraceptive method. were currently married, 29.8% were currently using The results show that 27.8% of women who were sexu- any contraceptive method and 30.2.% of those who had ally active and within their reproductive age were using attained JHS education were also using any contracep- any contraceptive method while 72.2% women were not tive method. It was noted that 30.6% of the women who Yeboah et al. BMC Public Health (2023) 23:1925 Page 5 of 7 were non-migrant were currently using any contracep- Factors associated with the current use of any tive method. It was observed that current contraceptive contraceptive method use was 29.6%, and 28.6% and among participants with 6 Table 3 presents the crude and adjusted odds of the cur- or more pregnancies, and those with 4–5 living children rent use of contraceptives. The results show that the respectively. Contraceptive use among households’ heads odds of current use of any contraceptive method were with husband/partners and other relative as head of the lower (aOR = 0.24; 95%CI = 0.10–0.56; p = 0.001) among household was 31.2% and 28.6% respectively (Table 2). those aged 41–49 years compared to those aged 18–35 years. Migrants were less likely (aOR:0.53; 95%CI:0.28– 1.01; p = 0.048) to use any contraceptive method than non-migrants. Table 3 Factors associated with contraceptive use among study participants Discussion Age Ad- p 95%CI This study examined the prevalence and determinants justed value of the current use of any contraceptive method in the Odds Ratio rural Eastern region of Ghana. The study is relevant as Age it highlights the prevalence and determinants of the cur- 18–35 (ref ) rent use of any contraceptive method in the rural Eastern 36–40 0.52 0.099 0.24 1.13 region of Ghana. Previous studies on contraceptives have 41+ 0.24 0.001 0.10 0.56 focused on modern contraceptives in the urban areas Marital Status and the entire country with few studies in rural areas [27, Not married (ref ) 28]. However, few studies in rural areas do not incorpo- Married 1.38 0.644 0.35 5.41 rate contraceptives for any method. Therefore, it is very Cohabiting 0.91 0.889 0.25 3.37 important we understand the use of contraceptives for Educational Status any method in the rural Eastern region of Ghana to help No education (ref ) inform policymakers on the need to improve contracep- Primary 0.89 0.780 0.41 1.97 tive interventions. JHS 0.96 0.924 0.42 2.19 The overall prevalence of contraceptive use was 27.8%, SHS or Higher 0.75 0.491 0.32 1.72 which is very low despite the government of Ghana’s Number of living child intervention and strategies to increase the use of family 1–3 (ref ) planning in Ghana. Though the prevalence rate is low, 4–5 1.02 0.961 0.40 2.61 it is close to the national prevalence rate (25%) reported 6 or more 0.62 0.481 0.16 2.34 by the Ghana Maternal and Health Survey in 2017 [7]. Head of Household This difference could be attributed to low access to infor- Self (ref ) mation about family planning and contraception use. Husband/Partner 2.94 0.082 0.87 9.92 Also, the prevalence rate in this study is higher than Other Relatives 2.34 0.273 0.52 10.65 what has been recorded in other studies. Achana et al., Migration Status [32] reported 13% contraceptive prevalence rate in the Non-migrant (ref ) Upper East rural areas in Ghana, 16.8% was reported in Migrant 0.53 0.048 0.28 0.99 rural Osun State in Nigeria [33], 13.7% in rural Zambia No. of Pregnancies [34] and 20% in rural Ethiopia [35]. On the other hand, a 1–3 (ref ) contraceptive prevalence rate (43%) higher than what was 4–5 1.33 0.563 0.51 3.51 reported in this study was recorded in Zambia [36]. The 6 or more 2.30 0.161 0.72 7.35 low prevalence of contraceptive use in this study com- Occupation pared with other studies could be a result of the timing Other (ref ) and settings of the study. Though in this study, about 7 Agric-self employed 0.78 0.501 0.38 1.60 out of 10 women had formal education, factors such as Age at first pregnancy fear of side effects of modern contraceptives, myths sur- < 18 years (ref ) rounding contraceptive use, partner opposition, the 18–24 years 1.35 0.456 0.61 3.01 25+ 0.88 0.821 0.28 2.78 dominance of men in reproductive decision-making Access to health facility due to the patriarchal system and limited access to fam- Yes (ref ) ily planning products/services could hinder the use of No 1.17 0.614 0.64 2.14 contraceptives [8, 27, 37]. Also, most of the communi- Abbreviations: ref -reference category; CI- Confidence Interval Source: Pro- ties in this study were remote areas hence there were few WEAI, 2021 healthcare facilities to provide family services to clients. Yeboah et al. BMC Public Health (2023) 23:1925 Page 6 of 7 We found that age was significantly associated with Limitation of study the current use of contraceptives. The results show that This study has a number of limitations. First, use of women who were 41–49 years were less likely to use any contraception was dichotomous, so we were unable to contraceptive method than those who were 18–35 years. determine the depth or accuracy of the use of specific This implies that adolescents and youth were more likely contraceptive method women reported they used. Addi- to use contraceptives to prevent pregnancy than adults. tionally, numerical problems with the data prohibited us The findings of the study corroborate other studies that from including all contraceptive methods in the analy- reported that age is very significant in the use of contra- sis. Second, the analysis would be strengthened by the ceptives [35, 38, 39]. In rural areas, majority of the ado- inclusion of more measures at the couple’s level beyond lescent and youth (18–35 years) are sexually active and demographics, knowledge of and attitudes towards con- may understand the consequences of engaging in unpro- traception. Finally, there are limitations due to the study tected sex. Hence, they are likely to use contraceptives to design. Because of the cross-sectional nature of this protect themselves from unwanted pregnancies or spac- study, the results should be interpreted with caution as ing births [39]. In addition, the few women who may be causality assumptions cannot be made. Despite these single may not want to give birth out of wedlock, hence, limitations, these data provide a sample of rural women may be serious about family planning to regulate their to inform the literature on factors influencing contracep- sexual activities. In this study, the odds of contraceptive tive use. Moreover, the limitations of the small sample decreases with an increase in age. Though sexual activ- size and lack of qualitative part are recommended for ity for women in their thirties tends to be high, most of further studies. them are concerned about giving birth and may reduce contraceptive use. Therefore, they will engage in unpro- AcknowledgementsThis original study was supported by grant from IDRC and SSHRC from the tected sex to prevent unwanted pregnancy. However, in Canadian Queen Elizabeth II Diamond Jubilee Scholarships (QES). The content the later age groups, there is a decrease in sexual activity is solely the responsibility of the authors and does not necessarily represent as age increases [38]. This, therefore, reduces contracep- the official views of the funders. We also thank Dr. Aaron Kobina Christian, Principal Investigator for the original study for giving us access to use the data tives use. and also agreeing to be part of the co-authors. Migration status was found to be significantly associ- ated with contraceptive use in the rural areas in Eastern Author contributionsIY conceived and conceptualized the study; IY analyzed the data; IY, MWA, Ghana. The findings show that migrants are less likely to JO and ROM wrote the original manuscript; IY, MNE, HA, AKC, MWA, JO, ROM, use contraceptives than non-migrants. This study, how- SNKK and AKC revised the manuscript. All authors have read and approved ever, contradicts findings from a similar study [40] which the final manuscript. found that women who migrate, whether from rural to Funding urban areas, rural to rural areas or between urban cen- The authors have received no specific funding for this work. ters, are more likely to use contraceptives than non- Data Availability migrant rural women. In this study, the probable reason Data will be available upon request from the corresponding author. could be that women migrate alone due to economic reasons and may not have their partners around. This Declarations could reduce their sexual activity or make them sexually inactive hence not using any contraceptives to prevent Ethical approvalThe study’s ethical protocol was approved by the Noguchi Memorial pregnancy. However, there may also be a further study Institute of Medical Research Institutional Review Board. Informed consent using qualitative method to provide in-depth knowledge for voluntary participation was obtained from participants before being as to why migrants in rural areas are less likely to use interviewed. Additionally, the purpose of the study including the general objectives, benefits, and risks of taking part in the study was explained to the contraceptives. participants before they consented to be part of the study. Participation was voluntary and remunerable. Confidentiality was upheld throughout the study. Conclusion The study was conducted in accordance with the relevant guidelines and regulations specified by the Ethics Committee. This study indicates that the prevalence of contraceptive use is 27.8%. The factors associated with contraceptive Consent for publication use in the rural Eastern region of Ghana includes ado- Not applicable. lescent and young women and non-migrants. The find- Competing interests ings suggest the need to promote use of contraceptives The authors declare that they have no competing interests. through reliable supply of contraceptives. Family plan- Received: 20 June 2023 / Accepted: 19 September 2023 ning programs should target migrants to design an inter- vention to increase contraceptive use in rural areas. Yeboah et al. BMC Public Health (2023) 23:1925 Page 7 of 7 References 22. Thummalachetty N, Mathur S, Mullinax M, DeCosta K, Nakyanjo N, Lutalo 1. Teshale AB. Factors associated with unmet need for family planning in sub- T, Brahmbhatt H, Santelli JS. Contraceptive knowledge, perceptions, and saharan Africa: a multilevel multinomial logistic regression analysis. PLoS ONE. concerns among men in Uganda. BMC Public Health. 2017;17(1):1–9. 2022;17(2):e0263885. 23. Wulifan JK, Mazalale J, Kambala C, Angko W, Asante J, Kpinpuo S, Kalolo A. 2. Ghana Statistical Service (GSS). Ghana Health Service (GHS), ICF International. Prevalence and determinants of unmet need for family planning among mar- Ghana demographic and health survey 2014. Maryland: GSS, GHS, and ICF ried women in Ghana-a multinomial logistic regression analysis of the GDHS, International;: Rockville; 2015. 2014. Contracept Reproductive Med. 2019;4(1):1–4. 3. Dejene H, Abera M, Tadele A. Unmet need for family planning and associated 24. Beson P, Appiah R, Adomah-Afari A. Modern contraceptive use among factors among married women attending anti-retroviral treatment clinics in reproductive-aged women in Ghana: prevalence, predictors, and policy dire Dawa City, Eastern Ethiopia. PLoS ONE. 2021;16(4):e0250297. implications. BMC Womens Health. 2018;18(1):1–8. 4. Aryanty RI, Romadlona N, Besral B, Panggabean ED, Utomo B, Makalew 25. Asamoah BO, Agardh A, Östergren PO. Inequality in fertility rate and modern R, Magnani RJ. Contraceptive use and maternal mortality in Indonesia: a contraceptive use among ghanaian women from 1988–2008. Int J Equity community-level ecological analysis. Reproductive Health. 2021;18(1):1–9. Health. 2013;12(1):1–2. 5. Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: 26. Eliason S, Awoonor-Williams JK, Eliason C, Novignon J, Nonvignon J, Aikins M. the unfinished agenda. The Lancet. 2006;368(9549):1810–27. Determinants of modern family planning use among women of reproductive 6. Prata N, Bell S, Fraser A, Carvalho A, Neves I. Partner support for family plan- age in the Nkwanta district of Ghana: a case–control study. Reproductive ning and modern contraceptive use in Luanda. Angola Afr J Reproductive Health. 2014;11(1):1–0. Health. 2017;21(1):35–48. 27. Biney AA, Wright KJ, Kushitor MK, Jackson EF, Phillips JF, Awoonor-Williams 7. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. Ghana JK, Bawah AA. Being ready, willing and able: understanding the dynamics of maternal health survey 2017. Accra, Ghana: GSS, GHS, and ICF; 2018. family planning decision-making through community-based group discus- 8. Agyekum MW, Henry EG, Kushitor MK, Obeng-Dwamena AD, Agula C, Opoku sions in the Northern Region. Ghana Genus. 2021;77(1):1–23. Asuming P, Toprah T, Agyei-Asabere C, Shah I, Bawah AA. Partner support and 28. Geelhoed DW, Nayembil D, Asare K, Van Leeuwen JS, Van Roosmalen J. women’s contraceptive use: insight from urban poor communities in Accra, Contraception and induced abortion in rural Ghana. Tropical Med Int Health. Ghana. BMC Womens Health. 2022;22(1):1–0. 2002;7(8):708–16. 9. Negash WD, Eshetu HB, Asmamaw DB. Predictors of modern contracep- 29. Ghana Statistical Service. Ghana 2021 Population and Housing Census. Popu- tive use among reproductive age women in high fertility countries in lation of regions and districts: General Report Volume 3A, Accra, Ghana 2022. sub-saharan Africa: evidence from demographic and health surveys. BMC 30. Russo G, Miglietta A, Pezzotti P, Biguioh RM, Bouting Mayaka G, Sobze MS, Womens Health. 2022;22(1):1–0. Stefanelli P, Vullo V, Rezza G. Vaccine coverage and determinants of incom- 10. Kushitor M, Henry EG, Obeng-Dwamena AD, Agyekum MW, Agula C, Toprah plete vaccination in children aged 12–23 months in Dschang, West Region, T, Shah I, Bawah AA. Covert Contraceptive Use amongst the urban poor Cameroon: a cross-sectional survey during a polio outbreak. BMC Public in Accra, Ghana: experiences of health providers. Reproductive Health. Health. 2015;15(1):1–1. 2022;19(1):1–2. 31. WHO. Training for mid-level managers (MLM). Module 7: the EPI coverage 11. Agula C, Henry EG, Asuming PO, Obeng-Dwamena A, Toprah T, Agyekum survey [Internet]. Geneva, Switzerland: World Health Organization; 2019. p. MW, Shah I, Bawah AA. Postpartum contraceptive initiation and use: evidence 18. from Accra, Ghana. Women’s Health. 2022;18:17455057221141290. 32. Achana FS, Bawah AA, Jackson EF, Welaga P, Awine T, Asuo-Mante E, Oduro A, 12. Ekholuenetale M, Owobi OU, Shishi BT. Socioeconomic position in modern Awoonor-Williams JK, Phillips JF. Spatial and socio-demographic determi- contraceptive uptake and fertility rate among women of childbearing age in nants of contraceptive use in the Upper East region of Ghana. Reproductive 37 sub-saharan countries. World. 2022;3(4):858–75. Health. 2015;12(1):1–0. 13. Andualem G, Aklilu A, Belay G, Feyisa W, Alemnew F. Factors associated 33. Olalekan AW, Olufunmilayo AO. A comparative study of contraceptive use with utilization of modern postpartum family planing methods during the among rural and urban women in Osun State, Nigeria. Int J Trop Disease extended postpartum period among mothers who gave birth in the last 12 Health. 2012;2(3):214–24. months at Injibara town, Northwest, Ethiopia: a cross-sectional study. Contra- 34. Sserwanja Q, Musaba MW, Mutisya LM, Mukunya D. Rural-urban correlates of cept Reproductive Med. 2022;7(1):1–1. modern contraceptives utilization among adolescents in Zambia: a national 14. Adde KS, Ameyaw EK, Mottey BE, Akpeke M, Amoah RM, Sulemana N, cross-sectional survey. BMC Womens Health. 2022;22(1):1–0. Dickson KS. Health decision-making capacity and modern contraceptive 35. Fenta SM, Gebremichael SG. Predictors of modern contraceptive usage utilization among sexually active women: evidence from the 2014–2015 among sexually active rural women in Ethiopia: a multi-level analysis. Chad Demographic and Health Survey. Contracept Reproductive Med. Archives of Public Health. 2021;79(1):1–0. 2022;7(1):1–9. 36. Lasong J, Zhang Y, Gebremedhin SA, Opoku S, Abaidoo CS, Mkandawire T, 15. Atiglo DY, Biney AA. Post-Abortion Contraceptive Use among Girls and Zhao K, Zhang H. Determinants of modern contraceptive use among married Women in Ghana. Women’s Reproductive Health 2022 Jun 8:1–4. women of reproductive age: a cross-sectional study in rural Zambia. BMJ 16. Loll D, Fleming PJ, Manu A, Morhe E, Stephenson R, King EJ, Hall KS. Repro- open. 2020;10(3):e030980. ductive autonomy and modern contraceptive use at last sex among young 37. Bawah AA, Akweongo P, Simmons R, et al. Women’s fears and men’s anxieties: women in Ghana. Int Perspect Sex Reproductive Health. 2019;45:1–2. the impact of family planning on gender relations in Northern Ghana. Stud 17. Nyarko SH. Prevalence and correlates of contraceptive use among female Fam Plann. 1999;30:54–66. adolescents in Ghana. BMC Womens Health. 2015;15(1):1–6. 38. Rohmah N, Yusuf A, Hargono R, Laksono AD, Sujoso AD, Ibrahim I, Marasa- 18. Debebe S, Limenih MA, Biadgo B. Modern contraceptive methods utilization bessy NB, Pakaya N, Seran AA, Adriyani R, Walid S. Barrier to contraceptive use and associated factors among reproductive aged women in rural Dembia among childbearing age women in rural Indonesia. Malaysian Family Physi- District, northwest Ethiopia: Community based cross-sectional study. Int J cian: The Official Journal of the Academy of Family Physicians of Malaysia. Reproductive Biomed. 2017;15(6):367. 2021;16(3):16. 19. Ganle JK, Obeng B, Segbefia AY, Mwinyuri V, Yeboah JY, Baatiema L. How 39. Apanga PA, Adam MA. Factors influencing the uptake of family planning intra-familial decision-making affects women’s access to, and use of maternal services in the Talensi District, Ghana. Pan Afr Med J. 2015;20(1). healthcare services in Ghana: a qualitative study. BMC Pregnancy Childbirth. 40. Ochako R, Askew I, Okal J, Oucho J, Temmerman M. Modern contraceptive 2015;15(1):1–7. use among migrant and non-migrant women in Kenya. Reproductive Health. 20. Letamo G, Navaneetham K. Levels, trends and reasons for unmet need for 2016;13(1):1–8. family planning among married women in Botswana: a cross-sectional study. BMJ open. 2015;5(3):e006603. 21. Tibaijuka L, Odongo R, Welikhe E, Mukisa W, Kugonza L, Busingye I, Nabukalu Publisher’s Note P, Ngonzi J, Asiimwe SB, Bajunirwe F. Factors influencing use of long-acting Springer Nature remains neutral with regard to jurisdictional claims in versus short-acting contraceptive methods among reproductive-age women published maps and institutional affiliations. in a resource-limited setting. BMC Womens Health. 2017;17(1):1–3.