See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/265382655 A Comparative Qualitative Study of Misconceptions Associated with Contraceptive Use in Southern and Northern Ghana Article  in  Frontiers in Public Health · September 2014 DOI: 10.3389/fpubh.2014.00137 CITATIONS READS 12 197 7 authors, including: Philip Adongo Philip Teg-Nefaah Tabong University of Ghana University of Ghana 71 PUBLICATIONS   1,451 CITATIONS    20 PUBLICATIONS   124 CITATIONS    SEE PROFILE SEE PROFILE Thomas Bavo Azongo James F Phillips University for Development Studies Columbia University 17 PUBLICATIONS   23 CITATIONS    183 PUBLICATIONS   3,851 CITATIONS    SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: The Navrongo Community Health and Family Planning Project View project Strategies to Encourage Repeat Donations in Ghana View project All content following this page was uploaded by Philip Adongo on 07 September 2014. The user has requested enhancement of the downloaded file. ORIGINAL RESEARCH ARTICLE PUBLICHEALTH published: 05 September 2014doi: 10.3389/fpubh.2014.00137 A comparative qualitative study of misconceptions associated with contraceptive use in southern and northern Ghana Philip B. Adongo1*, PhilipT.-N.Tabong1,Thomas B. Azongo2, James F. Phillips3, Mallory C. Sheff 3, Allison E. Stone3 and PlacideTapsoba4 1 Department of Social and Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana 2 School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana 3 Department of Population and Family Health, Mailman School of Public Health, Columbia University in the City of New York, New York, NY, USA 4 The Population Council, Accra, Ghana Edited by: Evidence from Ghana consistently shows that unmet need for contraception is pervasive Will R. Ross, Washington University with many possible causes, yet how these may differ by cultural zone remains poorly under- School of Medicine, USA stood. This qualitative study was designed to elicit information on the nature and form of Reviewed by: Daniel Shea Gerber, University of misconceptions associated with contraceptive use among northern and southern Ghana- Massachusetts Amherst, USA ians.Twenty-two focus group discussions (FGDs) with married community members were Franklin Asiedu-Bekoe, Ghana Health carried out. Community health officers, community health volunteers, and health care man- Service, Ghana agers were also interviewed using a semi-structured interview guide. FGDs and in-depth Will R. Ross, Washington University School of Medicine, USA interviews were recorded digitally, transcribed verbatim, and analyzed using QSR Nvivo 10 *Correspondence: to compare contraceptive misconceptions in northern and southern Ghana. Results indi- Philip B. Adongo, Department of cate that misconceptions associated with the use of contraceptives were widespread but Social and Behavioral Sciences, similar in both settings. Contraceptives were perceived to predispose women to both pri- University of Ghana, School of Public mary and secondary infertility, uterine fibroids, and cancers. As regular menstrual flow was Health, P. O. Box LG 13, Accra, Ghana e-mail: adongophilip@yahoo.com believed to prevent uterine fibroids, contraceptive use-related amenorrhea was thought to render acceptors vulnerable to uterine fibroids as well as cervical and breast cancers. Contraceptive acceptors were stigmatized and ridiculed as promiscuous. Among northern respondents, condom use was generally perceived to inhibit erection and therefore capable of inducing male impotence, while in southern Ghana, condom use was believed to reduce sensation and sexual gratification.The study indicates that misconceptions associated with contraceptive use are widespread in both regions. Moreover, despite profound social and contextual differences that distinguish northern and southern Ghanaians, prevailing fears and misconceptions are shared by respondents from both settings. Findings attest to the need for improved communication to provide accurate information for dispelling these misconceptions. Keywords: misconceptions, contraceptives, family planning, unmet need, Ghana INTRODUCTION all pharmaceuticals, all contraceptive methods have one or more Estimates suggest that sexual and reproductive conditions account known side-effects. for 18.4% of the global burden of disease, of which 32.0% is Despite these known side-effects, several other complex reasons among women aged 15–44 years (1). Contraception and family are cited by women when interviewed about perceptions of risk planning are integral components of reproductive health, and and reasons for non-use (4). Of these factors, some have no obvi- have demonstrated positive effects on women’s health. Moreover, ous link to side-effects, such as lack of concern over the possibility family planning promotion has the potential to reduce poverty, of pregnancy, perceived invulnerability to pregnancy, and forget- maternal and child mortality, high risk pregnancy, and abortion fulness (5). Other factors are correlates rather than direct causes, (2). Because of this importance, universal access to reproductive such as low socio-economic status, low educational attainment, or health services is identified as one of the targets of the United cultural barriers to contraceptive use (6). Poor access, cost, or clin- Nations Millennium Development Goals (3). The World Health ical restrictions are also cited as barriers to this use (7). However, Organization has acknowledged the priority need for family plan- misconceptions about family planning and the effects of contra- ning services that enables couples to implement preferences to ceptives on women’s health, future fertility, and birth outcomes space or limit childbearing. Yet research in many settings has are further mentioned as reasons for non-use (8). demonstrated that couples often eschew family planning out of Contraceptive use in West Africa has been lower than lev- concern for its detrimental effects. Indeed, as is the case with els reported in East and Southern Africa, despite longstanding www.frontiersin.org September 2014 | Volume 2 | Article 137 | 1 Adongo et al. Comparing misconceptions in contraceptive use attention from foreign aid programs and national policies (9). verbal consent as an indication for their willingness to participate. In 2004, Ghana projected that it would achieve a contraceptive Verbal consents were recorded digitally and those who gave ver- prevalence rate (CPR) of 28% by 2010 and of 50% by 2020. The bal consent were asked to recommend an independent person to attainment of these goals was recognized as integral to the coun- serve as witness to the process. Participants who gave written con- try’s economic development national strategy as outlined in the sent were asked to either append their signature or thumbprint Vision 2020 Plan of Action (10). However, records indicate that on informed consent forms as an indication of their agreement Ghana’s current contraceptive acceptance rate is 23%, five per- to take part in the study. In order to ensure confidentiality and centage points below the expected projection. Several factors may anonymity, codes were used to identify participants in both in- be responsible for Ghana’s inability to achieve this target, notably depth interviews and FGDs. Names and locations of communities barriers in contraceptive use that have often been cited as one of were also kept confidential. the reasons impeding the achievement of fertility regulations (11). Semi-structured in-depth interview guides were designed by Understanding these barriers is important for providing program- the researchers and used to collect the data. These interview guides ing guidance on the provision of family planning services. This were designed in English and translated into Akan, Kassim, and qualitative descriptive study was therefore designed to elicit from Nankana by language experts using back-to-back strategy. In back- community members misconceptions associated with the use of to-back strategy, independent language experts first translated the contraceptives, and compare and contrast these between southern primary instruments in English into the various local languages. and northern Ghana. Knowledge of these perceptions in different Another group of language experts proficient in both English and regions is important for the design of programs targeting false the local languages retranslated the versions from the local lan- impressions. guages back to English. The two versions are then compared to ensure consistency. Inconsistencies were resolved through a dis- MATERIALS AND METHODS cussion between the language experts and an independent referee. STUDY AREAS Local research assistants were recruited, trained, and deployed to The study was conducted in two districts each in northern and their linguistically relevant communities. Training for interview- southern Ghana. Sefwi Bibiani-Ahwiaso Bekwai (SBAB) district ers included a combination of classroom work and mock interview in Western region and Komenda-Edina-Eguafo-Abrem (KEEA) exercises. municipal area in the Central region comprised localities of the Twenty-two FGDs were held in northern and southern Ghana; southern zone, whereas Kassena-Nankana east (KNE) and west 11 FGDs for male groups, and 11 with female homogenous com- (KNW) districts in the Upper East Region of Ghana comprised the munity members. All participants were married with children. localities in the northern Ghana. The 2010 Population and Hous- Focus group discussants consisted of 6–8 people seated in a semi- ing Census reported the populations for the SBAB and KEEA as circle with the moderator and note-taker sitting in front of the 123,272 and 144,705, respectively. The same report indicated that discussants. During FGDs, each participant was given the oppor- the population of KNE and KNW was 109,944 and 70,667, respec- tunity to give their contribution on a particular question before tively (8). The Ghana Demographic and Health survey further proceeding to another question. In many instances, there was con- noted that the contraceptive prevalence for modern contracep- sensus in responses. The sampling of the respondents was carried tive methods among married women between the ages of 15 and out to ensure that both urban and rural residents were repre- 49 years was 14% for the Upper East Region, 17% in the Central sented in all study areas. In addition, community health officers, Region, and 13% in the Western Region (12). KNE and KNW volunteers, and health managers were purposefully recruited and were selected because of an ongoing community health family interviewed using a semi-structured interview guide. Both IDIs planning model, which was being piloted to determine the impact and FGD lasted for between 30 and 90 min and were conducted of the program on fertility in northern Ghana. SBAB and KEEA within communities. were also selected because the districts received support from a USAID grant through the Population Council of Ghana to imple- DATA PROCESSING AND ANALYSIS ment Community-based Health Planning and Services (CHPS). Both FGDs and IDIs were audiotaped using a digital audio- The CHPS strategy, among other objectives, aims to increase recorder, and complemented with written interview notes on community members’ access to reproductive health and family paper. The study coordinators crosschecked all the data received planning. for completeness and accuracy on a daily basis. Content analy- sis was used to analyze the qualitative data based on emerging STUDY DESIGN themes and sub-themes in line with the study objectives. The This study was a descriptive qualitative study using in-depth inter- researchers designed an initial codebook, which was accepted by views, focus group discussions (FGDs), and expert opinions. These all researchers. Based on the codebook, coding of data was car- strategies were employed to elicit in-depth information on mis- ried out using QSR Nvivo 10©, a computer program for analyzing conceptions regarding the use of contraceptives in the selected qualitative data sets. Trend analysis of the FGDs and IDIs for each districts and understand the reasons for these misconceptions. topic was used to identify the major issues for each of the study themes and sub-themes. The trend analysis was also employed DATA COLLECTION to facilitate comparison of the views of participants within and Ghana Health Service Ethics Review Committee approved the pro- among the different study areas. Descriptive narratives supported tocol for the study. Participants in the study gave either written or by illustrative quotes are used in results. Frontiers in Public Health | Public Health Education and Promotion September 2014 | Volume 2 | Article 137 | 2 Adongo et al. Comparing misconceptions in contraceptive use RESULTS not get cancers because they never used contraceptives. Although CONTRACEPTIVE USE AND CHANGES IN WEIGHT no scientific evidence supports the claim, respondents in north- The majority of women, who use contraceptives, do not gain or ern Ghana perceived that the incidence of cancers was higher in lose weight; however, this was a main misconception found in this southern Ghana as a result of higher contraceptive prevalence in study. Weight changes occur naturally in life but because these those regions. changes in weight are so common, many women misconstrue this and attribute these changes to the use of contraceptives. Both Our ancestors were not getting cancers because they did not do family weight gain and loss were mentioned in northern and southern planning Ghana; weight loss was more pronounced in southern Ghana, — (man, IDI, northern Ghana) while respondents in northern Ghana were more inclined to So you see when our women go to the south, because they do FP there, attribute the use of contraceptives to weight gain. they end up getting [more] cancers than the women here in the north — (man, IDI, northern Ghana) My little sister went to do the implant and she changed drastically, that is at first, she was fat but after doing the family planning she grew TRADITIONAL VALUES lean. Because of what happened, my mother advised her to stop the FP Traditional values still play a major role in contraceptive uptake and as soon as she stopped using the FP, she regained her weight back and adherence, especially in northern Ghana, and emerged as — (woman, FGD, southern Ghana) a well-entrenched theme in northern Ghana. Respondents were Many people say it brings a lot of problems to them especially when asked to describe the norms and practices that might affect the it is incompatible with their blood and body. Some also say that it uptake of contraceptive services in the community to determine makes them put on a lot of weight how project interventions can be successful. The traditional belief — (woman, IDI, northern Ghana) that contraceptive use is synonymous to abortion emerged as a Both weight gain and loss were perceived as undesirable for drawback to contraceptive acceptance, traditional myths more women as it had the tendency to cause marital instability. pronounced in northern Ghana. They think that if you do family planning and grow very fat your It is believed that traditional people should not use contraceptives. husband will not like you again and will go out for another woman You need to give birth to the number of children the gods have given — (CHO, IDI, northern Ghana) to you — (man, IDI, northern Ghana) CONTRACEPTIVE USE AND CANCERS Another area of concern was the desire to beget more chil- Associating contraceptive use and many forms of cancers in dren, especially in northern Ghana. Respondents in that region women emerged as a well-entrenched theme. In both settings, alluded to changing perception of high fertility rates as ideal and community members believed that contraceptive use predisposed acceptable in the community; yet in northern Ghana, the belief women to cancers. In southern Ghana, the use of contraceptives that using contraceptives could offend their gods and ancestors allegedly predisposed women to uterine fibroids (myomas). prevents many couples from accepting contraceptives. . . .. I know another lady who did it (FP) and stopped menstruating, Some people hold the belief that when you use contraceptives you will later on it developed into fibroid and ended up in surgery offend the gods but this perception is gradually fading off — (man, FGD, southern Ghana) — (man, IDI, northern Ghana) Yes, they have misconceptions about family planning; when you do it (FP) blood will clot in your womb, so that it would turn into PERCEPTION OF CONTRACEPTIVE USE AND ILLNESS fibroid . . . they believe that a Jadelle that is implanted, can pene- Participants in both southern and northern Ghana cited the expul- trate through your heart and go somewhere that can result in death. sion or shifts to other parts of the body of Intrauterine Contracep- And the IUCD, some also think that when you insert it, IUCD would tive Device (IUCD) or implants as cause for concern. Community penetrate into your uterus and cause cancer — (CHO, IDI, southern Ghana) members believe that implants could dislodge and go missing in the body through the blood stream, causing discomfort. Apart from the perception that the use of contraceptives could predispose a woman to uterine fibroid in southern Ghana, in We have heard about people complaining that they are not feeling well northern Ghana, the use of contraceptive was further associated or they frequently fall sick when using contraceptives with other type of cancers, such as cervical and breast cancers. — (woman, FGD, southern Ghana) I personally did FP, I went for one month injection and I was con- The community members perceive that when a woman uses IUD with tinuously getting sick, I really suffered during that time so I stopped. time it moves from the original place to another part of the body to I am not someone who usually gets sick but it was not so during the cause cancers in various parts of your body such as the uterus and time I was using the FP method breast — (woman, FGD, southern Ghana) — (CHO, IDI, northern Ghana) Some people say that when they use the family planning, they feel Some respondents even attributed the high incidence of cancers dizzy in present times to the use of contraceptives. To some,ancestors did — (woman, FGD, southern Ghana) www.frontiersin.org September 2014 | Volume 2 | Article 137 | 3 Adongo et al. Comparing misconceptions in contraceptive use Like the way my sister is saying, for me what I heard is that when FP is not good for people who have not given birth before as they may some people do it they bleed and feel dizzy. For me, I have not done not be able to give birth in future some before but these are the kind of things that I hear — (man, IDI, northern Ghana) — (woman, FGD, southern Ghana) In the community people are speculating about the side effects of some PERCEPTION OF THE EFFECTS OF CONTRACEPTIVES ON PHYSICAL AND of the FP products, some say they get excruciating pain, others say INTELLECTUAL ABILITY OF CHILDREN they suffer in their heart and also dizziness which could let you faint, Evidence shows that contraceptive use does not cause birth defects, others also say they often suffer from high blood pressure when they nor will it harm the fetus if a woman becomes pregnant while use contraceptives taking contraceptives. However, northern community members — (CHO, IDI, northern Ghana) believed that the use of contraceptives is associated with birth Feelings of dizziness following the use of contraceptive could be defects. According to these respondents, women who have used a genuine complaint, which will require further investigation and contraceptives are more likely to give birth to children with defects counseling. In the absence of professional guidance, these adverse or intellectually impaired. effects may be amplified in the community as an effect all contra- Some people believe that if you use contraceptive, you will give birth ceptive users experience. Closely related to this is the perception of to an abnormal child vomiting after sex, which is attributable to the use of contraceptives — (man, IDI, northern Ghana) among communities in northern Ghana. Apart from the bleeding, others are also saying that when you are on Others say that they get stomach related problems. Some say that when it (FP) for a long period, when you become pregnant the child will not they practice FP and have sex with a man, they become nauseated and be intelligent, the child will not be that good in school and the child vomit will always fall sick — (CHO, IDI, northern Ghana) — (CHO, IDI, northern Ghana) In this community, they believe that people that use contraceptive give CONTRACEPTIVE USE AND INFERTILITY birth to children that are intelligent There is no scientific evidence linking the use of contraceptive to — (man, IDI, northern Ghana) infertility. However, this is a widely held perception that emerged as a well-entrenched theme in both southern and northern set- However, linking contraceptive use to birth effects was not tings. Communities in northern Ghana generally believed that common in southern Ghana as it was neither mentioned in IDIs contraceptive use was inappropriate for people who had not given nor FGDs. birth, and that their use could lead to permanent childlessness due CONTRACEPTIVES USE AND PROMISCUITY to loss of fecundity. Although this association did not emerge as a Associating the use of contraceptives to a promiscuous lifestyle prominent theme in southern Ghana, linking contraceptive use to emerged as a major theme, more predominant in southern a secondary cause of infertility was mentioned in both southern than in northern Ghana. The general belief in southern Ghana and northern Ghana. is that married women who want to engage in extramarital Some also say if you do it (FP) for a long time you will not give birth affairs employ contraceptives as a strategy to prevent unplanned but if you do it for a short period and you want to get pregnant you pregnancies. really suffer — (woman, FGD, southern Ghana) Women who want to cheat on their husbands (engage in extramar- ital affairs) are the people who use contraceptives, so that whenYes, they (misconceptions) are very common here because most of their husbands are not around, they can be sleeping with other men them have in mind that when you do it (FP), you will not give birth after all they cannot become pregnant for the husband to detect any again. With depo, when you do it, you do not bleed (menstruate), extramarital affairs because you do not bleed they think the blood accumulates in your — (man, FGD, southern Ghana) womb and will give you problems in future making it impossible for you have child . . .. Family planning makes women to go out to have sex with other — (man, IDI, northern Ghana) men, so they would not allow their wives to do it — (CHO, IDI, northern Ghana) With the IUCD, you know that one passes through your vagina, some people think that it might shift to your womb and that way you will With this perception, men resist any attempt of their wife to not be able to give birth again use contraceptives as this may indicate support for your wife to — (CHO, IDI, northern Ghana) engage in extramarital affairs. With the perception of the association between contraceptive use and primary infertility in northern Ghana, contraceptives were PERCEPTION OF CONDOM USE AND PENILE ERECTION viewed as unsuitable for women, who have never given birth if they The effect of condom use on penile erection has no anchor in were concerned about having children in future. science, yet respondents in northern Ghana believed that con- doms prevent them from erecting and sustaining an erection. . . . if you have not given birth before, you do not have to use The use of condoms, respondents believed, could lead to impo- contraceptive as you will not be able to give birth in future tency, especially when used frequently during sex and over a long — (CHO, IDI, northern Ghana) duration. Frontiers in Public Health | Public Health Education and Promotion September 2014 | Volume 2 | Article 137 | 4 Adongo et al. Comparing misconceptions in contraceptive use They say that when they use the condom, their penis is not able to are transferred to other geographical areas by people without in- erect depth knowledge of the subject matter. Therefore, there is need for — (CHO, IDI, northern Ghana) an increase in human resources with requisite knowledge on con- As for the use of condom, we do not have to talk about it, it is like traceptives. In the absence of qualified counseling and advice on eating a toffee with the wrapper . . . it is even difficult to sustain an the use of different contraceptive methods, clients are compelled erection when you are using condom to rely on friends and family members for information, which in — (man, IDI, northern Ghana) many cases may be clouded with misconceptions. Most of men in this community do not like using condom because they The fear and misconstructions in both northern and southern say it is always too tight on their penis making it difficult for them to Ghana appear to be linked to undesirable outcomes in the use erect of contraceptives by previous users. One is related to the inabil- — (CHO, IDI, northern Ghana) ity to fulfill the reproductive role, such are begetting a child or delays in return to fertility when contraceptives are stopped. This However, in southern Ghana, condom use was believed to is problematic given the high value that is placed on children in reduce sensation for the man, thereby reducing sexual pleasure. the community, and even more pronounced in northern Ghana where a man’s wealth is customarily measured by the number As for condom, let not talk about at all, you will not enjoy sex if you of biological children he has. These, entwined with severe social use condom consequences of emotional strain in a relationship, fear of aban- — (man, FGD, southern Ghana) donment, and general community stigma, fuel misconceptions creating an uncertain environment for future users. Early sexual VASECTOMY, SEXUAL, AND PHYSICAL WEAKNESS and reproductive health education may be appropriate to ensure Vasectomy has no effect on both the physical and sexual ability that individuals acquire knowledge early enough to distil between of men. However, this emerged as a misconception in southern misconceptions and adverse reactions. Couples-based counseling Ghana. For respondents there, vasectomy was capable of making is also highly recommended because of the role men play in the a man both physically and sexually weak. The physical weakness, reproductive health decision-making process. respondents believed, could make the man less productive and The perception of the association between contraceptive use therefore incapable of meeting the socio-economic needs of the and serious complications such as cancers or birth defects would family. This perception was firmly entrenched in the minds of both not only make it difficult for a woman to fulfill her reproductive men and women. Closely related to the perceived physical weak- role in a marriage, but also have perceived financial implications ness is the perception of a reduction in the man’s sexual ability. in terms of medical costs. In effect, women who cannot over- Many respondents believed this could lead to marital instability as come fear of spousal abandonment or neglect in case of method it could encourage women to engage in extramarital affairs in order complications may likely opt not to use contraception until their to the get the sexual gratification the man could no longer provide. spouse agrees to it. A recent study in southern Ghana revealed that spousal consent was still very relevant in contraceptive uptake Vasectomy will make the man weak and will not be able to perform among women (11). Programs should therefore be designed to very well his physical and sexual duties in the family target men to discredit these misconceptions. A man who receives — (woman, FGD, southern Ghana) correct information on the use of contraceptives is more likely to It is the women who do not allow their husbands to do it (vasec- positively influence his wife’s use and disabuse the myths. tomy) because they believe that it (vasectomy) will make the man If the use of the male condom is believed to prevent erection and both physically and sexually weak subsequent impotence, the situation could be used as an opportu- — (Health Manager, IDI, southern Ghana) nity to promote the use of female condoms. Previously launched Knowledge levels on vasectomy were generally low among female condoms did not achieve the desired results because of respondents in northern Ghana, and the procedure was per- low patronage (14) leading to the launch of the second-generation ceived as synonymous to castration in both settings and therefore female condom. Condom use is one of the key strategies espoused inappropriate for a man. by the National AIDS Control Program (NACP) as a result of its dual protection against pregnancy and sexually transmitted infec- DISCUSSION tions (STIs). The notion that condom use inhibits penile erection This descriptive qualitative study was designed to explore the therefore poses a challenge to this strategy and, more generally, misconceptions associated with the use of contraceptives, and to to the control of STIs in Ghana. More education is required on compare these similarities and differences in northern and south- this topic, and reproductive health advocates should act upon this ern Ghana. The study delineates that misconceptions associated observation to strengthen campaigns in favor of the use of the with contraceptive use are still widespread among community female condom as an alternative to male condom. With correct and members in both settings. These misconceptions are impediments consistent use, the female condom is as effective as other barrier to the advocacy to increase contraceptive prevalence, and in exten- methods and has no known adverse effects or risks (15, 16). sion, impediments to combating unwanted pregnancy and unsafe Oral contraceptives offer many non-contraceptive health ben- abortion (13). However, the study also reveals the need for innova- efits, including decreased risks of bone loss, benign breast disease, tive ways to dispel misconceptions in the community. The majority pelvic inflammatory disease, ectopic pregnancy, and rheumatoid of these misconceptions are spread by community members and arthritis (17). However, these benefits are often overshadowed www.frontiersin.org September 2014 | Volume 2 | Article 137 | 5 Adongo et al. Comparing misconceptions in contraceptive use by the myths this study revealed. Although some studies have Philip Baba Adongo, Philip T.-N. Tabong, Thomas B. Azongo, reported an association between oral contraceptives and breast Mallory C. Sheff, did the analysis and writing of the manuscript. cancer, the relative risk has been reported to be very small (18). All authors read and approved the final manuscript. However, contraceptive use does not predispose women to uter- ine fibroid. The use of oral contraceptives has instead proven ACKNOWLEDGMENTS to be effective in preventing endometriosis, ovarian cancers, and The authors will like to express their unconditional gratitude to colorectal cancer (18). USAID for providing funding for the implementation of CHPS Associating contraceptive use to women’s promiscuous lifestyle in study areas in southern Ghana. We are also grateful to the poses another challenge to the push to increase contraceptive participants and the research assistants who collected the data. uptake. With this perception, many women who are willing to REFERENCES use contraceptives may desist from usage or engage in con- 1. 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Practical means of engaging men, reaching AI. Contraceptive usage among abortion seekers in Nigeria. West Afr J Med women, and improving the climate of knowledge may require (2002) 21(2):112–4. markedly different approaches to dispel these barriers. Nonethe- 14. Naik R, Brady M. The female condom in Ghana: exploring the current state of less, ubiquitous misconceptions, evident in every focus group and affairs and gauging potential for enhanced promotion. Population Council [Inter- net]. (2008). [cited 2014 May 6]. Available from: http://medcontent.metapress.every interview, suggest that implementation research to clarify com/index/A65RM03P4874243N.pdf myths and concerns is urgently needed. 15. Kaler A. The future of female-controlled barrier methods for HIV preven- tion: female condoms and lessons learned. Cult Health Sex (2004) 6(6):501–16. AUTHOR CONTRIBUTIONS doi:10.1080/13691050410001701948 16. Minnis AM, Padian NS. Effectiveness of female controlled barrier methods inPhilip Baba Adongo, James F. Phillips, Placide Tapsoba, Allison preventing sexually transmitted infections and HIV: current evidence and futureE. Stone conceived and designed the study: Philip Baba Adongo, research directions. Sex Transm Infect (2005) 81:193–200. doi:10.1136/sti.2003. Placide Tapsoba, Allison E. Stone, participated in data collection; 007153 Frontiers in Public Health | Public Health Education and Promotion September 2014 | Volume 2 | Article 137 | 6 Adongo et al. Comparing misconceptions in contraceptive use 17. Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous Received: 01 July 2014; accepted: 22 August 2014; published online: 05 September 2014. sex hormones and breast cancer in postmenopausal women: reanalysis of Citation: Adongo PB, Tabong PT-N, Azongo TB, Phillips JF, Sheff MC, Stone AE and nine prospective studies. J Natl Cancer Inst (2002) 94:606–16. doi:10.1093/jnci/ Tapsoba P (2014) A comparative qualitative study of misconceptions associated with 94.8.606 contraceptive use in southern and northern Ghana. Front. Public Health 2:137. doi: 18. Casey PM, Cerhan JR, Pruthi S. Oral contraceptive use and the risk of breast 10.3389/fpubh.2014.00137 cancer. Mayo Clin Proc (2008) 83(1):86–91. doi:10.4065/83.1.86 This article was submitted to Public Health Education and Promotion, a section of the 19. Gyapong J, Addico G, Osei I, Abbey M, Kobinah DA. An Assessment of Trends journal Frontiers in Public Health. in the Use of the IUD in Ghana. Accra, Ghana: Population Council and USAID Copyright © 2014 Adongo, Tabong , Azongo, Phillips, Sheff, Stone and Tapsoba. This is (2003). an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, Conflict of Interest Statement: The authors declare that the research was conducted provided the original author(s) or licensor are credited and that the original publica- in the absence of any commercial or financial relationships that could be construed tion in this journal is cited, in accordance with accepted academic practice. No use, as a potential conflict of interest. distribution or reproduction is permitted which does not comply with these terms. www.frontiersin.org September 2014 | Volume 2 | Article 137 | 7 View publication stats