SCHOOL OF PUBLIC HEALTH 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA 
   
 
 
UNMET NEED FOR FAMILY PLANNING AMONG MARRIED 
WOMEN IN THEIR REPRODUCTIVE AGE IN THE SUNYANI 
WEST DISTRICT OF BRONG AHAFO REGION, GHANA 
 
BY 
PEARL AOVARE 
(10550781) 
 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY 
OF GHANA, LEGON, IN PARTIAL FULFILLMENT OF THE 
REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC 
HEALTH DEGREE 
 
 
SEPTEMBER, 2016
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DECLARATION 
I, Pearl Aovare, declare that apart from specific references which have duly been 
acknowledged, this work is the result of my own original research, and that this dissertation 
either whole or in part has not been presented elsewhere for another degree. 
 
 
 
……………………………     ……………………………… 
Pearl Aovare                              Date 
(Student) 
 
 
 
 
………………………………….    ………………………………… 
Prof Augustine Ankomah               Date 
(Supervisor)          
 
 
 
 
 
 
 
 
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DEDICATION 
I dedicate this work to my lovely and beautiful mother, Madam Vida Kuwolamo. She is a 
woman of substance and I am so grateful to have her for her inspirational talks that gave me a 
lot of courage to carry on, for the financial support and her interest in wanting me to build my 
capacities, “Akiele dede3 Nma”.I also dedicate this work to my kid sister Carllian for the 
patience and understanding she exhibited when our mummy was away and I had to take care of 
her while pursuing this course.    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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ACKNOWLEDGEMENTS 
My profound gratitude goes to the Almighty God for giving me another opportunity to increase 
my knowledge to serve my generation. 
It is difficult to choose the right words in adequate quantity to describe how grateful I am to my 
supervisor Professor Augustine Ankomah Head of Department of Population, Family and 
Reproductive Health, School of Public Health, Legon. I am extremely grateful to him for his 
kind supervision, his fatherly advice, useful comments, guidance, support and opportunities 
given me throughout the period of this research.  
To the married women who comprised my study population in Sunyani-West District, I would 
like to thank you heartily for the open contribution in sharing your private experiences on 
sexuality and contraception.  
For my data collection team, I thank you for enduring the scourging sun and long working 
hours during the data collection. In the same vein, I would like to thank my fellow programme 
mates especially Mrs Felicia Aperkor, George Asante, Farouk Abdul-Wasie, Justice Akakpo 
and Nafisatu Sulemana, I sincerely express my gratitude for your generous contributions and 
efforts in making the completion of this work a success. 
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ABSTRACT 
Background: 
The rapid global population growth has made it imperative for the prescription of effective 
solution that would help reduce the geometric growth and prevent its attendant conflicts, over-
population and poverty. One solution propounded by this study is meeting the unmet need of 
married women of reproductive age. The objective of this study was to explore the nature of 
unmet need and to identify the key factors that explain unmet need among women in their 
reproductive age in the Sunyani west district of Brong-Ahafo region. 
Methodology:   
This study was a descriptive cross-sectional study conducted among 300 married women in the 
Sunyani-West District. Participants were recruited using systematic stratified random selection 
method which involved filling out structured, interviewer-administered questionnaires. Data 
was analysed using descriptive statistics and logistic regressions on STATA version 13.0.  
Results  
The level of unmet need for family planning among married women in the Sunyani-West 
District was 32.3%. Married women in the age group of 15 - 24 are more likely to have unmet 
need than women above 35 years old, although the relationship was not significant. There is a 
high level of unmet need among married women with secondary education (44.4%) compared 
to those who have no education (20.0%). It is also informative that about one third (31.6 %) of 
respondents got their information from health workers while (25.6%) of respondents with an 
unmet need do not discuss Family Planning with their spouses. Educational status of a married 
woman was found to be a key determinant of unmet for family planning due to its level of 
significance in the study. 
         Keywords: Unmet need, family planning, Determinants, characteristics of unmet need, Africa. 
 
 
 
 
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TABLE OF CONTENTS 
DECLARATION ................................................................................................................... i 
DEDICATION ...................................................................................................................... ii 
ACKNOWLEDGEMENTS .................................................................................................iii 
ABSTRACT ......................................................................................................................... iv 
TABLE OF CONTENTS ...................................................................................................... v 
LIST OF TABLES .............................................................................................................viii 
LIST OF FIGURES ............................................................................................................. ix 
LIST OF ABBREVIATIONS ............................................................................................... x 
DEFINITION OF TERMS ................................................................................................... xi 
CHAPTER ONE ................................................................................................................... 1 
INTRODUCTION ................................................................................................................ 1 
1.1 Background .............................................................................................................................. 1 
1.2 Problem Statement ................................................................................................................... 4 
1.3Justification of the study ........................................................................................................... 6 
1.4 Objectives of Study .................................................................................................................. 7 
1.4.1 General Objective ............................................................................................................. 7 
1.4.2 Specific Objectives ........................................................................................................... 7 
1.4.3 Research questions ............................................................................................................ 7 
CHAPTER TWO .................................................................................................................. 8 
LITERATURE REVIEW...................................................................................................... 8 
2.1 Introduction.............................................................................................................................. 8 
2.2 Knowledge of contraceptives................................................................................................... 8 
2.3 Contraceptive use prevalence and pattern................................................................................ 9 
2.4 Unmet need prevalence and pattern ....................................................................................... 11 
2.5 Socio-demographic determinants of unmet need ................................................................... 12 
2.6 Socio-economic determinants ................................................................................................ 15 
2.7 Context determinants ............................................................................................................. 18 
2.8 Health provider determinants................................................................................................. 19 
2.9 Conceptual Framework of the study ...................................................................................... 19 
CHAPTER THREE ............................................................................................................. 24 
METHODOLOGY .............................................................................................................. 24 
3.1 Introduction............................................................................................................................ 24 
3.2 Study Design .......................................................................................................................... 24 
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3.3 Study Area ............................................................................................................................. 24 
3.4 Variables ................................................................................................................................ 25 
3.5 Ethical Consideration ............................................................................................................. 26 
3.5.1 Ghana Health Service Ethical Approval ......................................................................... 26 
3.5.2 Approval from study area ............................................................................................... 26 
3.5.3 Description of subjects involved in the study ................................................................. 26 
3.5.4 Potential risks/benefits .................................................................................................... 26 
3.5.5 Privacy/confidentiality .................................................................................................... 27 
3.5.6 Compensation ................................................................................................................. 27 
3.5.7 Data storage and usage ................................................................................................... 27 
3.5.8 Voluntary consent ........................................................................................................... 28 
3.5.9 Conflict of interest .......................................................................................................... 28 
3.5.10 Proposal and funding information ................................................................................ 28 
3.6 Study Instrument .................................................................................................................... 28 
3.7 Target population ................................................................................................................... 29 
3.8 Inclusion Criteria ................................................................................................................... 29 
3.9 Exclusion Criteria .................................................................................................................. 29 
3.10 Sample Size and Sampling Technique ................................................................................. 29 
3.10.1 Sampling size determination ......................................................................................... 29 
3.10.2 Sampling Technique ..................................................................................................... 30 
3.11 Quality control ..................................................................................................................... 32 
3.12 Data Handling ...................................................................................................................... 32 
3.13 Data Analyses ...................................................................................................................... 32 
3.14 Dissemination of findings .................................................................................................... 33 
3.15 Source of Data ..................................................................................................................... 33 
CHAPTER FOUR ............................................................................................................... 34 
RESULTS ........................................................................................................................... 34 
4.1 Background characteristics of Respondents .......................................................................... 34 
4.2 Spousal characteristics of respondents .................................................................................. 36 
4.3 Perception and Spousal communication on family planning ................................................. 37 
4.4 Contraceptive use ................................................................................................................... 38 
4.5 Associations between socio-demographic characteristics and unmet need for family 
planning. ...................................................................................................................................... 43 
4.6 Associations between household factors and unmet need for family planning ..................... 46 
4.7 Perception about family planning and unmet need for family planning ................................ 48 
4.8 Results of Logistic Regression .............................................................................................. 48 
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CHAPTER FIVE ................................................................................................................. 51 
DISCUSSION ..................................................................................................................... 51 
5.1 Introduction............................................................................................................................ 51 
5.2 Limitations of the study ......................................................................................................... 59 
CHAPTER SIX ................................................................................................................... 60 
CONCLUSIONS AND RECOMMENDATIONS ............................................................. 60 
6.1 Conclusions............................................................................................................................ 60 
6.2 Recommendations .................................................................................................................. 61 
REFERENCES .................................................................................................................... 64 
APPENDICES .................................................................................................................... 72 
APPENDIX 1 ...................................................................................................................... 72 
Informed Consent Form ...................................................................................................... 72 
APPENDIX 2: Questionnaire ............................................................................................. 75 
 
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LIST OF TABLES 
Table 4.1: Socio-Demographic Characteristics of respondents ....................................................... 35 
Table 4.2: Spousal characteristics of unmet need for family planning ............................................ 36 
Table 4.3: Perception and Spousal communication on family planning ......................................... 38 
Table 4.4:  Contraceptive use by Socio-Demographic characteristics of respondents .................... 40 
Table 4.5: Unmet need by socio-demographic characteristics ........................................................ 45 
Table 4.6: Unmet need by household factors................................................................................... 47 
Table 4.7: Unmet need by context factors ....................................................................................... 48 
Table 4.8: Unmet need and significant factors ................................................................................ 50 
 
 
 
 
 
 
 
 
 
 
 
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LIST OF FIGURES 
Figure 1.1: Conceptual Framework of the study ............................................................................. 21 
Figure 2.1: Based on: Westoff C.F and L. H. Ochoa (1991). Unmet Need and the Demand for 
Family Planning, DHS Comparative Studies No. 5. .................................................... 11 
Figure 3.1: Map of Ghana, indicating Sunyani-West District, Brong Ahafo Region. ..................... 25 
Figure 4.1: Pattern of modern contraceptive use among Respondents ............................................ 41 
Figure 4.2: The level of unmet need for family planning among married women living in Sunyani-
West District. ................................................................................................................................... 42 
 
 
 
 
 
 
 
 
 
 
 
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LIST OF ABBREVIATIONS 
AIDS              Acquired Immune Deficiency Syndrome 
CHPS  Community –Based Health Planning and Services 
CPR  Contraceptive Prevalence Rate 
DFID  Department for International Development 
DHS  Demographic and Health Survey 
GDHS  Ghana Demographic and Health Survey 
GHS  Ghana Health Service 
GSS  Ghana Statistical Service 
HIV                 Human Immune virus 
ICPD  International Conference on Population Development 
IUD  Intra Uterine Device 
MDGs  Millennium Development Goals 
NGO  Non-Governmental Organisation 
PBR  Population Reference Bureau 
UN  United Nation 
UNICEF United Nation International Children Emergency Fund 
UNPA  United Nations Population Fund 
WHO  World Health Organisation 
WORA  Women in their Reproductive Age 
  
 
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DEFINITION OF TERMS 
 Unmet need for family planning: The percentage of women of reproductive age, either 
married or in a union, who want to stop or delay childbearing but are not using any method of 
contraception for family planning. 
Total Fertility Rate (TFR): The average number of children a woman would have in her 
lifetime, assuming the current age-specific birth rates. 
Contraceptive Prevalence Rate (CPR): It is the percentage of women who are currently 
using, or whose sexual partner is currently using, at least one method of contraception, 
regardless of the method used. 
Contraceptives: Contraceptives refer to the various devices, drugs, agents, sexual practices, or 
surgical procedures used in preventing conception or impregnation (pregnancy). 
Geometric Growth:   Refers to the situation where successive changes in a population differ 
by a constant ratio (as distinct from a constant amount for arithmetic change) 
Family Planning:  It is a process that allows individuals and couples to anticipate and attain 
their desired number of children and the spacing and timing of their births 
Amenorrhea:  It is the absence of menstruation 
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CHAPTER ONE 
INTRODUCTION 
1.1 Background 
The world’s population growth has assumed geometric growth proportions over the last 
200 years, as it has increased from 1 billion to 7 billion and counting (Hunt & Colander, 
2011). This rapid growth has unpleasant consequences such as overpopulation in many 
countries (notably India and China), increase in the price of food and energy, high youth 
unemployment rate that led to sluggish economic growth and pervasive poverty, as well as 
poor health for women and children (Bongaarts, Cleland, Townsend, Bertrand, & Gupta, 
2012). Family Planning has provided an important option in stemming this woeful tide. It 
has proved not just necessary, but indispensably beneficial to society. Bongaarts et al. 
(2012) put it “The evidence is clear: family planning improves health, reduces poverty, 
and empowers women.” 
The increased diffusion of family planning in the mid-20th Century, and establishment of 
national population control program made it imperative to embrace new paradigm shifting 
ideas that tried to quantify contraceptive use especially in developing countries for policy 
and programmatic purposes (Casterline & Sinding, 2000). One of such ideas was that 
assessing the knowledge, attitudes and practice gap in family planning. Simplified, this 
idea posited the existence of a gap between a woman’s fertility preferences, and what she 
both knew and did to achieve such preference (Klijzing, 2000). As such, the concept of the 
unmet need for family planning developed, and despite strong criticism, has come to 
occupy a central role in assessing the success of family planning and maternal health 
interventions (Ashford, 2003). 
The United Nations defines unmet need for family planning as the percentage of women 
of reproductive age (15-49 years), either married or in a union (and as such perceived to be 
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sexually active), who want to stop or delay (women who want a child after two or more 
years) childbearing but are not using any method of contraception (United Nations 
Department of Economic and Social Affairs, 2014). It has also been defined as the 
condition of wanting to avoid or postpone childbearing but not using any method of 
contraception (Casterline& Sinding, 2000). 
In further describing women who are said to have an unmet need for family planning, 
Yadav (2013) explained that any pregnant married woman whose pregnancy is unwanted 
or mistimed or who became pregnant unintentionally due to non-use of contraceptives has 
an unmet need (Yadav, 2013). Also, a woman who uses contraceptives but becomes 
pregnant because of contraceptive failure has an unmet need; just as a recently-delivered 
mother who is amenorrheic but whose child was unplanned is also classified as having an 
unmet need for family planning (Yadav, 2013). 
Generally, unmet need is understood as unmet need for spacing and unmet need for 
limiting (Yawson, 2014). Unmet need for spacing implies that there are women of 
reproductive age in a marriage/union who desire to postpone their next birth by a specified 
length of time (i.e. 2 years) but are not using contraceptives (Beekle & McCabe, 2006; 
Yawson, 2014). While unmet need for limiting refers to women of reproductive age in a 
marriage/union who desire no additional children and who do not currently use a family 
planning method (GSS), (GHS), & ICF Macro., 2015b). 
Unmet need for family planning represents a topical issue in fertility and population 
studies because of its persistence despite a global advancement in adoption of family 
planning, and its position as both a source and consequence of global inequality in access 
to needed healthcare (Bhattathiry & Ethirajan, 2014; Yawson, 2014). 
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In tackling this problem of accessing health care, the 1994 International Conference on 
Population and Development (ICPD) held in Cairo reached a number of consensuses, one 
(principle 8) of which was to assure that everyone has access to reproductive and sexual 
health services including family planning (United Nations, 1994). This was agreed on to 
prevent unsafe abortion and the management of the consequences of abortion, sexually 
transmitted diseases and other reproductive health conditions. In November, 2008, the 
United Nations Population Fund (UNFPA) in their outlook made a case for family 
planning. With family planning, achieving the various MDG will be effective. It will help 
alleviate poverty and accelerate socioeconomic development, ensuring that all children go 
to school, promoting gender equality, reducing infant mortality, slowing the spread of 
HIV/AIDS and lastly it can help in protecting the environment (United Nations Population 
Fund - UNFPA, 2008). 
Ensuring better access to family planning has now become a global phenomenon in 
addressing those challenges. It is for these reasons that the Millennium Development Goal 
(MDG) 5 was made to include universal access to reproductive health with unmet need as 
an indicator of such (Indicator 5.6) (Bhutta et al., 2010; Bradley, Croft, Fishel, & Westoff, 
2012). Among the target areas are contraceptive prevalence rate and unmet need for 
family planning. In the MDG report on goal 5 in 2015, contraceptive prevalence among 
women aged 15 to 49, married or in a union increased from 55 percent in 1990 worldwide 
to 64 percent in 2015 (United Nations, 2015). Unmet need does not necessarily mean that 
family planning services are not available, it may also mean that women lack information 
or the quality of services on offer does not inspire the necessary confidence or that women 
themselves have little say in decision makings (Ferdousi et al., 2010). 
In Ghana, it is an undeniable fact that the unmet need for family planning is still high 
especially in the rural areas  (GSS) et al., 2015b). It is not to say that nothing has been 
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done about it. The health ministry and Ghana health service with NGOs have enrolled on 
many activities in order to reduce these unmet needs but much still has to be done. 
It has become clear that increased access to family planning will help reduce maternal 
mortality and child mortality. The 2012 London summit on family planning restated the 
interest and commitment to family planning with some attention devoted to unmet need. 
Some of the questions raised under the summit included:  “which women and girls have an 
unmet need for modern contraceptives? Can unmet need be eliminated solely by 
increasing access to contraceptives? Whose unmet needs are most pressing, and which 
strategies should be prioritized?”(UK Department for International Development - DfID, 
2012). 
The study will look at factors associated with the unmet need for family planning among 
women in the Sunyani-west district of Brong -Ahafo region. 
 
1.2 Problem Statement 
Globally, Africa is the region with the highest number of women with unmet need for 
family planning. It is estimated that 35 million women in sub-Saharan Africa (which is 25 
per cent of women of reproductive age who are married or in a union) who are in their 
reproductive years would prefer to avoid being pregnant, but are not using any method of 
family planning ( WHO, 2011, Msacky, 2012;). According to the preliminary report of the 
Ghana Demographic and Health Survey 2014, 30 percent of currently married women 
have an unmet need for family planning, while 42 percent of unmarried sexually active 
women have an unmet need for family planning  (GSS) et al., 2015b). 
This state of things has resulted in a situation where the total fertility rate remains above 4 
(4.2 to be exact), contraceptive prevalence rate is 27 percent. Thirty seven  percent of all 
child births in Ghana are unintended (unwanted or mistimed births), and unsafe abortions 
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account for about 12% of maternal deaths, with current maternal mortality ratio of 380 
maternal deaths per 100,000 live births ( GSS), (GHS), & ICF Macro., 2009; (Omane-
Adjepong, Oduro, & Annin, 2012; United Nations, 2013); Eliason, Baiden, Yankey, & 
Awusabo, 2014; United Nations Children Fund - UNICEF., 2015; . This dismal state of 
fertility persists despite efforts such as the CHPS – Community-based Health Planning and 
Services (Ensor & Cooper, 2004). 
There have been some attempts to understand the factors responsible for this high unmet 
need in Ghana. A prominent example of this is the Health Summit Report of 2011 by the 
Ministry of health in Ghana, which in trying to state some of the reasons given for the 
persistent drop in the family planning acceptor rate as including shortage of commodities, 
inadequate targeting of youth, socio-cultural reasons and cross cutting issue, also 
addressed workable solutions on tackling unmet need for family (Ghana Ministry of 
Health, 2011). 
It is vital to know the unmet need of communities because unmet need represents an 
important measure of the future demand for contraception, and how much fertility rates 
can be controlled if the stated unmet need is fully met. As such, it is very useful for 
programmatic and policy purposes as it highlights deficiencies in family planning 
expansion. 
However, there is a need for investigations that are local and sensitive to social contexts 
(especially in communities that are hardest hit by the low coverage of contraceptives) in 
order to build a holistic understanding of the problem, which can then be used to fashion 
effective and scalable solutions. 
One of such communities in Ghana is the Sunyani West district located in the Brong-
Ahafo region of Ghana, where the problem of poor family planning coverage is 
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particularly acute. For example, unplanned pregnancy has been high in the district with 
figures from 2014 showing that a total of 259 unwanted pregnancies, among those age 15-
19 years alone, were recorded between January and June (PeacefmOnline, 2014). This 
occurred under the circumstance of the regional family planning coverage being about 
32.8 percent, compared to a target of 60 percent in 2014 (Ghana News Agency, 2014). 
In spite of these obvious challenges, no major study has been conducted to identify the 
factors responsible for the unmet need for family planning among married women in the 
Sunyani west district of the Brong-Ahafo region. This study seeks to fill that gap in 
knowledge by identifying the factors which are associated with the unmet need for family 
planning in the district. 
1.3Justification of the study 
Meeting the contraceptive needs of women globally is not simply a health or women’s 
goal. It is essential to the development of economies and safeguarding the rights of every 
human. This study thus represents an effort to contribute knowledge to this worthy aim 
and improve lives. 
Practically, this study, through its findings, provided a theoretical based for the 
development of effective family health programs by policymakers that helped reduced the 
risk of having mistimed or unwanted births, induced abortion, or maternal deaths. It also 
advised policymakers on where resources can be focused on in existing programmes to 
increase their effectiveness. 
Finally, the findings, when well taken and implemented, provided comprehensive social, 
economic and psychological benefits for women, families, communities and the entire 
nation. 
 
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1.4 Objectives of Study 
1.4.1 General Objective 
The main objective of the study was to explore the nature of unmet need and to identify 
the key factors that explain unmet need among married women in their reproductive age in 
the Sunyani west district of Brong-Ahafo region. 
1.4.2 Specific Objectives 
The following made up the specific objectives; 
1. To estimate the level of unmet need for pregnancy mistimed or unwanted among 
married women in the Sunyani- west District 
2. To find the demographic characteristics of married women with unmet needs 
3. To determine the socio-economic and context factors associated with unmet need 
1.4.3 Research questions 
In this study, the researcher sought to answer the following research questions. 
1. What is the magnitude of unmet need for family planning? 
2. What are the factors associated with the occurrence of unmet need for family planning? 
 
 
 
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CHAPTER TWO 
LITERATURE REVIEW 
2.1 Introduction 
This chapter presented literature reviewed in relation to the objectives of this study. The 
literature reviewed includes journal articles, books, newspaper, relevant web pages as well 
as dissertations and theses. The literature was obtained from various sources, including 
data bases which includes Measure DHS, PubMed, Google scholar, Elsevier, Oxford 
journals, Cambridge journals and Online Wiley. Searches conducted on the internet were 
done using search terms such as “unmet need in Ghana”, “determinants of unmet need”, 
“and unmet needs in Africa” and “characteristics of women with unmet need”. It has 6 
(six) sections which outlines the prevalence and pattern of unmet need and contraceptive 
use globally, and the determinants of unmet need. 
2.2 Knowledge of contraceptives 
Tied to unmet need for modern contraceptive is an understanding of the knowledge and 
use of contraceptives. Importantly, despite the high fluctuations of birth rates there is still 
a low contraceptive prevalence in sub-Saharan Africa. Using contraceptives is largely 
based on having knowledge of its existence and the methods available. 
According to Longwe et al. (2013), knowledge of contraceptives is universal in the 
developed world and almost universal in the developing world (Huisman, 2012). Research 
has shown that globally, there is a high saturation of knowledge about contraceptive 
methods, with knowledge of at least one contraceptive in sub-Saharan Africa nations at 
about 85% method (Sedgh et al., 2007, Shane et al., 2007). This is also true in Ghana, 
where the 2014 Demographic and Health Survey found that 99% of women and men know 
of at least one method of contraceptive  (GSS), Ghana Health Service, & ICF Macro., 
2015a). The survey also showed that modern methods were more known than traditional 
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ones among women, with the male condom (96%), injectables (92%), the pill (91%), 
being the most known methods among women. 
This knowledge shows some considerable variability across different population 
demographics, with those in the rural areas knowing less than those in urban settings 
(Apanga & Adam, 2015). According to the 2014 GDHS report also, those with a higher 
level of education and income have more knowledge about contraceptives (GSS, 2014). 
This confirms studies conducted by Heinemann et al. (2005) and Myer et al. (2007) that 
education status is a predictor of the knowledge of contraceptive methods (Andalón, 
Williams, & Grossman, 2014; Heinemann, Saad, Wiesemes, White, & Heinemann, 2005; 
Myer, Mlobeli, Cooper, Smit, & Morroni, 2007). 
A study by Aryeetey et al. (2010) in the Ga East district of Greater Accra among women 
of ages 15-49 years further corroborates the association of education and knowledge 
(Aryeetey, Kotoh, & Hindin, 2011). The authors found that knowledge of any modern 
method of contraceptives was near universal at 99.7% of all respondents, with the number 
of modern methods known to women increased with increasing level of education 
(Aryeetey et al., 2011). 
2.3 Contraceptive use prevalence and pattern 
Knowledge does not however translate to use. The United Nations 2013 report on world 
contraceptive patterns shows that 63% of women of reproductive age who are married or 
in a union are using a contraceptive method. Globally, female sterilization is the most 
common method of contraception, used by 19% of women of reproductive age (15-49 
years) who are married or in a union. The IUD, used by 14% of women of reproductive 
age who are married or in a union, is the second most widely used contraceptive method in 
the world, followed by the pill used by 9% of these women. 
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However, Sub-Saharan Africa had the lowest regional contraceptive prevalence, which 
was said to stand at 31 percent. In Ghana, the 2014 Ghana Demographic and Health 
Survey showed that 27% of women of reproductive age who are married or in a union are 
using a contraceptive method (GSS) et al., 2015a). This represents a differential increase 
from the 2008 GDHS levels of 24%. Among modern methods, injectables (8%), implants 
(5%), and the pill (5%) were the most used ones by women of reproductive age who are 
married or in a union, although the traditional rhythm (3.2%) also had a higher use than 
the other surveyed modern methods, including the widely known male condom (Ghana 
Statistical Service et al., 2015a). This contraceptive usage is however low and much below 
that found in southern African countries such as South Africa, Namibia and Botswana 
with contraceptive prevalence of more than 50% (Sharan, Ahmed, May, & Soucat, 2010). 
This low contraceptive prevalence rate in Ghana can be partly attributed to discontinuity, 
which occurs among one in four contraceptive users mainly due to observed side effects 
(Ghana Statistical Service et al., 2015a). 
Forrest (2013) in her study on the epidemiology of unintended pregnancy and 
contraceptive use in the United States found that women of low socioeconomic status and 
those formerly married as well as adolescents were less likely to use contraceptives. This 
also tallies with findings in sub-Saharan Africa where women of lower education and 
socio-economic status were less likely to use and also women empowerment was 
associated with increased likelihood of contraceptive use (Asiimwe, Ndugga, & Mushomi, 
2013; DeRose & Ezeh, 2010). The use of contraception was generally more common 
among single women, the more highly educated, those with children and recent visit to the 
health facility (Palamuleni, 2013). 
 
 
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2.4 Unmet need prevalence and pattern 
Critical to an understanding of unmet need is delineating those who do have such a need 
from those who don’t. This assesses commonly used to do this is a framework designed by 
West off & Ochoa (1991) as presented in Figure 2.1 (Westoff & Ochoa, 1991). 
According to the framework, unmet need is solely calculated among women of 
reproductive age (WORA) 15-49 years, who are currently married or in a union. Within 
this population sub-group, women either use a contraceptive (for spacing or for limiting) 
or they do not use at all. Those who use obviously have their needs satisfied. Those who 
don’t use are either pregnant or amenorrheic (according to the revised definition, these are 
women whose period has not returned since last live birth in last 5 years) or not pregnant 
or amenorrheic. Among those pregnant/amenorrheic, those that are mistimed or unwanted 
have an unmet need for contraceptives as long as such is not due to method failure. Also, 
among those not pregnant/amenorrheic but are fecund, those that want no more children or 
want it later have an unmet need. Women who are not pregnant/amenorrheic but are 
infecund or have entered menopause are said not to have an unmet need. 
Figure 2.1: Based on: Westoff C.F and L. H. Ochoa (1991). Unmet Need and the Demand 
for Family Planning, DHS Comparative Studies No. 5. 
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In terms of prevalence, the latest global estimate for unmet need shows that in 2010, 
12.3% of all WORA married or in a union around the world had an unmet need (Alkema, 
Kantorova, Menozzi, & Biddlecom, 2013). In sub-Saharan Africa, this goes even higher, 
as 60% of WORA had an unmet need  for contraceptives (Darroch & Singh, 2013). In 
Ghana, 30% of currently married women have an unmet need for contraceptives, with 
17% having an unmet need for spacing and 13% having an unmet need for limiting 
(Ghana Statistical Service et al., 2015a). According to the 2014 GDHS, unmet need is 
highest among women in the rural area, young people (age 15-24 years), women of lower 
education and socio-economic status. This tallies with findings around the world shows 
that in developing countries, unmet need has similar prevalence patterns (Darroch & 
Singh, 2013). However, this relationship is complex, as seen in nations where unmet need 
is highest among women with primary education, and lower among women with either no 
education or a secondary or higher education. Also, unmet need for spacing is higher than 
unmet need for limiting in Ghana (17.4% and 12.5% respectively) and in sub-Saharan 
Africa, getting as high as 89% of those with unmet need in Chad  needed contraceptives 
for spacing (Ghana Statistical Service et al., 2015a; Singh & Darroch, 2012). 
2.5 Socio-demographic determinants of unmet need 
A study on the unmet need among young women in the developing world showed that just  
more than half (57.7%) of the total demand for contraceptives is being satisfied among 
young married women (age 15-24 years) (MacQuarrie, 2014). This is in contrast to 
findings that show that in Uganda, one-third of adolescents (15-19)—and women ages 40-
44—have an unmet need, compared to about 36 percent of women between the ages of 20 
and 39. This is somehow similar to the findings of the GDHS. However, across surveys in 
both developed and developing world, women aged 45-49 have the least demand and need 
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for unmet need (Hailemariam & Haddis, 2011). Finally, there is also a consistency in the 
pattern of unmet need observed by age, with those aged 44-49 more likely to use 
contraceptives to limit than to space, whereas those aged 24-34 years used it more for 
spacing (Alkema et al., 2013). 
Across the developing world, unmet need has been found to decrease as women’s 
education increases. However, among women who are not educated, unmet need is low 
largely because these women have a low demand for contraceptives (Bradley et al., 2012). 
However, this slightly differs from findings by Hameed et al. (2011) showing that unmet 
need was highest among the women with no formal education (Hameed, Azmat, Bilgrami, 
& Ishaqe, 2011b). However, this is not evident from the 2014 GDHS as the link between 
education and unmet need is not so direct, although highly educated women do have the 
lowest unmet need. A study by Machiyama and Cleland (2013) on unmet need in Ghana 
did show a clear gradient in the level of unmet need by education, as uneducated women 
had the highest level of unmet need (Machiyama & Cleland, 2013a). This is further 
confirmed by studies conducted in Ghana and Ethiopia by  Tawiah (1997) and 
Hailemaraiam (2013) that education affected contraceptive use as educated people have 
better access to contraceptives and thus have their needs satisfied than the uneducated 
(Hailemariam & Haddis, 2011; Tawiah, 1997). 
Women in the rural areas are less likely to have their demand for contraceptives met than 
their counterparts in the urban areas (Bradley et al., 2012). This is due to several socio-
economic disparities such as the lower availability of health providers in the rural areas, 
the lack of logistical supply of contraceptives as much as in the urban area, lesser 
education and economic empowerment among other reasons (Machiyama & Cleland, 
2014; Sedgh & Hussain, 2007; Sibley & Glazier, 2009). 
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Religion also plays a role in determining unmet need among women. Devoutly religious 
people are more likely to have unintended children, this is because some religious groups 
prohibit contraceptive use, and this means women’s demand becomes lower or their 
demand is unmet (Mekonnen & Worku, 2011). A study by Ali and Okud (2013) in Eastern 
Sudan showed that religious belief by the woman or her husband affected the likelihood of 
her family needs being met. This is corroborated by Feyisso et al. (2015) in their study 
among married women of reproductive age in South Ethiopia, where they found that about 
one in five women (20.3%) with unmet needs pointed out religion as the reason for not 
meeting their stated contraceptive need, a similar find to another study in Ethiopia 
showing that 22.2% of women with unmet need expected rejections by religious leaders 
(Feyisso, Belachew, Tesfay, & Addisu, 2015; Mekonnen & Worku, 2011). A longitudinal 
study in Nigeria among currently married women and sexually active unmarried women 
aged 15-49 found that while Catholics and non-Catholic Christians had similar unmet 
need, Muslims and Traditionalists had lower odds of having unmet need than Catholics 
(Oginni, Ahonsi, & Adebajo, 2015). This is in contrast to a study in India where Muslim 
women not only had higher unmet needs and lower likelihood of using contraceptives than 
non-Muslim women, but the Muslim women also had lower odds of using contraceptives 
in the future (Patra & Singh, 2015). This ties in with a study in Ghana showing that among 
women with unmet need for contraceptives, women who identify as being Muslim were 
less likely to use contraceptives than those who identify as being Christian (Crissman, 
Adanu, & Harlow, 2012). However, a study in Ethiopia found that religion was not a 
major determinant of contraceptive use (D, 2015). 
It has been documented that there is a significant association between parity and unmet 
need (Anthony et al., 2009). In Uganda and Kenya unmet need for family planning is 
higher among younger women, women who live in rural areas, who are of higher parity, 
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and who have no knowledge of contraceptive methods or sources of supply (Blacker, 
Opiyo, Jasseh, Sloggett, & Ssekamatte-Ssebuliba, 2005; Khan, Bradley, Fishel, & Mishra, 
2008; King et al., 2011). Unmet need was also found to be of the highest prevalence 
among women who have five or more children and those with no education compared 
with women who had some higher education (Mawadjeh, 2007; Wablembo et al ;2011).  
In Ghana, high parity is associated with increased demand for contraceptives, with much 
of that demand left unmet 
Key to unmet need is the fear of side effects such as menstrual disruption and infertility, 
which makes many women either refuse to use family planning methods even though they 
need them or discontinue them while still wanting to avoid pregnancy ( Sedgh et al., 2007; 
Sedgh & Hussain, 2014); Abeje & Ejigu, 2015) . It consistently ranks as the most 
important reason for unmet need across the world, and especially in Ghana (Govindasamy 
& Boadi, 2000; Population Reference Bureau (PRB), 2012); K Machiyama & Cleland, 
2013; Kazuyo Machiyama & Cleland, 2013) . 
2.6 Socio-economic determinants 
Central to a woman’s decision to use contraceptives is her ability to make such decisions 
freely without being coerced into it or over-ruled by another agency –spousal, familial or 
communal (Stanfors & Larsson, 2014). Due to the gendered nature of contraceptive use, a 
woman must be able to have independence of decision and action for her to space and 
limit her children as she wants (Malhotra & Schuler, 2005). Empowered women have 
better access to health facilities and information about modern contraceptive methods 
(Ayele, Tesfaye, Gebreyes, & Gebreselassie, 2013). However, the prevailing patriarchal 
values systems in Ghana forces a woman not to only conform to spousal demands but also 
limits her socio-economic prospects, disempowering her (Achana et al., 2015). This leads 
to an increase in unmet needs. Generally, women’s empowerment in sub-Saharan Africa is 
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measured by her education, income/occupation, social status, unilateral decision making 
power in the household, and non-adherence to beliefs about women’s subordinate role 
(DeRose & Ezeh, 2010). 
A study assessing women’s empowerment and choice of contraceptive Methods in sub-
Saharan Africa using the demographic and health surveys showed that there is a negative 
association between women’s unmet need for contraception and high women 
empowerment scores especially in their involvement in decision making and freedom of 
movement (Do & Kurimoto, 2012). In Egypt and Oman, a woman having freedom of 
movement, having at least some control in household matters and budget decisions, and 
being involved in family planning decision making was more likely to have met need for 
contraceptives (Al Riyami, Afifi, & Mabry, 2004; Govindasamy & Malhotra, 1996). In 
Uganda, intimate partner violence was used as a measure of women empowerment, and 
women who experience it were more likely to have an unmet need (Nalwadda, Mirembe, 
Byamugisha, & Faxelid, 2010). This tendency to seek spousal approval curtails 
contraceptive use, even when there is a stated need, as seen in a study in Rwanda where 
unmet need was higher among women whose spouse did not approve of its use 
(Ndaruhuye, Broekhuis, & Hooimeijer, 2009). In Ghana, a study by Crissman et al. (2012) 
among non-pregnant married and partnered women not desiring to conceive in the three 
months after the study showed that increasing levels of sexual empowerment are found to 
be associated with use of contraceptives, even after adjusting for demographic predictors 
of contraceptive use (Crissman et al., 2012). This association is however moderated by the 
wealth of the woman. However, this empowerment that leads to higher met need for 
contraceptives is influenced by increased age, higher literacy, a greater number of 
children, or being in a household that has superior socio-economic status (Hameed et al., 
2014). 
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A woman’s occupation and wealth/income status as well as wealth status of household she 
is in affects whether she has an unmet need or not (Beekle & McCabe, 2006). In Kenya, 
women who worked were less likely to have an unmet need for contraceptives than those 
who don’t, and much of their unmet need relates not to access or unavailability as that 
among non-working women, but to method-related reasons (Ojakaa, 2008). Women who 
worked in the home or had occupations not requiring high levels of education were found 
to have higher unmet need in a study conducted in Ethiopia (Woldemicael & Beaujot, 
2011). In Uganda, Kiisakye (2013) found that the richest women were about 42% less 
likely to have unmet need compared to the poorest women, just as women with low 
financial autonomy are more likely to have had higher unmet need for family planning 
than women with medium or high autonomy (Kisaakye, 2013b). However, a study in 
Ghana showed that unmet need did not differ significantly by household wealth 
(Machiyama & Cleland, 2013b). 
The number of children that a woman desires, the gender composition of her children and 
the experience of the loss of a child affects the likelihood of her having an unmet need for 
contraceptives (Konje & Ladipo, 1999; Mason & Smith, 2000; Sedgh & Hussain, 2007; 
Yotebieng et al., 2015).  A study in Ethiopia showed that unmet need for limiting was 
significantly lower among those who had experienced child loss, though they may still 
demand for contraceptives to space (Hailemariam & Haddis, 2011). As a woman’s desired 
family size is achieved, her demand from contraceptives changed from spacing to limiting, 
which is why unmet need for limiting is higher among older women who have achieved 
their desired family size (McCarraher et al., 2008; Wanyenze et al., 2015). Also, in 
cultures where there are sex-preferences, unmet need would be based on achieving the 
right composition of children (Sedgh & Hussain, 2007, 2014). 
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Apart from the wives’ characteristics, the spousal features such as education, income and 
religious beliefs also influence the unmet need status of a woman (Irani, Speizer, & Fotso, 
2014). A study in Ethiopia found that women who had disproportionate education with 
their husband (higher or lower) had lower unmet need than those on an equal footing 
(Tadesse, Teklie, Yazew, & Gebreselassie, 2013). Further, spouses with higher incomes 
were more likely to let a woman meet her demand for contraceptives than one with lower 
income (King et al., 2011). 
2.7 Context determinants 
A number of contextual and community factors affect unmet need for family planning. A 
study in sub-Saharan Africa showed that the level of community approval of family 
planning had a larger effect on contraceptive use than the perceived approval of the 
woman’s partner (Stephenson, Baschieri, Clements, Hennink, & Madise, 2007). Also, the 
association between contraceptive use and the levels of approval and met needs by women 
of family planning in the community may also reflect various underlying community 
processes, such as prevailing cultural norms surrounding the expected roles of women. 
Highly educated, more religiously diverse and places with higher rainfall levels have 
lower unmet need for family planning (Stephenson et al., 2007). A case-control study in 
Nkwanta district of Ghana showed that socio-cultural beliefs of the woman such as 
influenced demand and met need for contraceptives (Eliason, Awoonor-Williams, et al., 
2014). A woman who is heavily attached to family values and opinions may not use 
contraceptives even though they express a need for it (Aransiola, Akinyemi, & Fatusi, 
2014). Also, the social networks of a woman, as well as her spouse can affect her use of 
contraceptives, with those interacting with enlightened, urban and international persons 
more likely to have lower unmet needs (Avogo & Agadjanian, 2008; Lindstrom & Muñoz-
Franco, 2005). Social networks determine the contraceptive information received from 
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other women and determine the choice of methods that have lower physical and social 
risks (Hall, Stephenson, & Juvekar, 2008; Montgomery et al., 2001). 
2.8 Health provider determinants 
The influence of providers in the occurrence of unmet need for family planning cannot be 
over-emphasized, as the unavailability of desired methods, distance to source of 
contraceptives and poor management of the context of service provision can worsen unmet 
need (Sedgh & Hussain, 2007, 2014; Sulthana, Shewade, Sunderamurthy, Manoharan, & 
Subramanian, 2015). Also, the technical competence, counselling, family planning 
information, professionalism, interpersonal relations with clients and other quality of care 
services received by women from the provider can determine if she fulfils the stated 
demand for contraceptives (Heard, Larsen, & Hozumi, 2004). Further, policies about 
informing partners and medical barriers such as inappropriate contraindications, restrictive 
eligibility criteria, process or scheduling hurdles, provider bias, regulatory barriers, 
unnecessary laboratory testing and spousal notification conditions increase unmet need in 
developing nations (Konje & Ladipo, 1999). 
2.9 Conceptual Framework of the study 
Figure 1.1 illustrates the conceptual framework this study will be based on. It was 
developed by the researcher based on readings from various literatures (Ali, Rayis, 
Mamoun, & Adam, 2011; Woldemicael & Beaujot, 2011); Population Reference Bureau, 
2012; Bhattathiry & Ethirajan, 2014;) .This framework shows the role various factors play 
in determining the prevalence of unmet need, and the pathway by which these factors 
influence the unmet need for family planning. This conceptual framework was developed 
because it does not only theoretically explain the study’s objectives best, but it is also 
adaptable to the data limitations (recall and privacy challenges) that this study might 
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encounter during data collection. The study categorized variables into three categories – 
independent, intermediate and outcome. 
The independent variables are the demographic characteristics of all married women of 
reproductive age in the study area. All of the characteristic to be assessed are very 
pertinent to the understanding of the underlying factors of unmet need. A woman’s age 
have been found influential in determining if their need for contraceptives is met, as a 
study by Bhattathiry and Ethirajan (2014) conducted in India showed that unmet need was 
higher among younger women than older women (Bhattathiry & Ethirajan, 2014). This 
finding is similar to that of Woldemicael and Beaujot (2011) who also stated that younger 
women experienced more unmet need for family planning than older women. A woman’s 
religious beliefs have strong influences on her perspectives on and use of family planning 
(Barrett, DaVanzo, Ellison, & Grammich, 2014; Hailemariam & Haddis, 2011). 
Occupation and education are important factors as well. Hailemariam and Haddis (2011) 
found that among Ethiopian women, education and work status were significantly 
associated with unmet need. This is confirmed by a study in eastern Sudan where low 
education (of married women and their spouses) and the woman’s education were 
associated with total unmet need (Ali et al., 2011). 
Residing in a rural or urban area has been found to influence unmet need by different 
studies. Generally, Kamvazina and Kisaakye found that rural dwellers often have more 
unmet need than urban dwellers. (Kamvazina, 2007; Kisaakye, 2013a). 
The parity of the woman, which refers to the number of her surviving children, is an 
important determinant of whether a woman has an unmet need or not. The implication in 
this is that women who have lost children or have had their fertility desires remain 
unfulfilled due to the death of a child or more, will less likely demand and use 
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contraceptives. While these factors can directly determine unmet need, they can also work 
through context factors as well as socio-economic factors to do so. 
  
Figure 1.1: Conceptual Framework of the study 
 
It is imperative that a woman must know about the existence and use of contraceptives if 
she is to use them. Often, the education and place of residence determines the knowledge 
and availability of information about contraceptives, as increasing education increases the 
likelihood of having some knowledge of contraceptives, and being in an urban area 
increases the chances that the woman encounters and accesses needed information. The 
availability of the contraceptives themselves presents another determinant of unmet need, 
as the source of the contraceptive must be socially acceptable, and must have people who 
are professional and collaborative with the client. 
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The method of contraceptive is a key factor as the method available must be pleasing to 
women, effective, easy to use and has little side effects. The concern about side-effects is 
especially important as it is one of the most commonly cited reasons for non-use of 
contraceptives, even when a need-to-use is identified.  
These context factors all have a direct relationship to the outcome variable but they also 
constitute intermediates. For example, available information may still remain inaccessible 
if the education level is so low that comprehension is near impossible. A woman’s age 
may also affect the source of her contraceptive, as some providers may have processes that 
discriminate against younger women. Parity may also affect the type of contraceptive 
used, as those with lower parity may go for short term methods, while those with higher 
parity demand longer-lasting methods. Place of residence and education can also affect 
concern and management of side effects, as those in the rural areas will be less likely to 
have immediate access to very competent medical help in case of serious side-effects, just 
as lesser educated women are more likely to understand observed side-effects and seek for 
medical help appropriately. 
Socio-economic factors also play an important part in determining unmet need for family 
planning. A woman’s autonomy and self-efficacy would mean the woman is able to 
single-handedly take decisions on whether she wants to use family planning or not, 
without social or economic restraints or being over-ruled by others. 
This ties with the income level of the woman primarily, and the family secondarily. A 
woman who has high personal income will be more likely to have ownership over 
decisions on her childbearing, as she can afford to give birth when she wants, and also 
acquire/use contraceptives to limit or space her childbearing (Kisaakye, 2013a). 
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In addition, spousal communication and approval is a key component in meeting the 
demand for women to access family planning (Bawah, 2002). A review of some studies 
showed that women who communicate with their partners and who make joint decisions 
with them are more likely to use contraception than those who do not make such joint 
decisions (Sedgh & Hussain, 2007). 
The fertility desires of a woman and her spouse are very significant influencers of their use 
of family planning methods or not. When a woman’s desires are not met, she will not use 
contraceptives, but if they are, she will. 
The fertility desires however do not stand in isolation, as social norms, beliefs and 
practices affects it. Yet, the use of contraceptives also has social consequences as 
conservative societies may hold that married women using contraceptives is a license to 
promiscuity. 
These socio-economic factors explained above interact with socio-demographic factors in 
many ways to determine unmet need for family planning. For example, a woman’s social 
network is determined by her place of residence, her education, her occupation and even 
her age. Also, a woman’s occupation clearly determines her income and in many cases, 
her autonomy. 
All of these inter-relationships explored in the conceptual framework were measured, 
which eventually determined the unmet need for family planning of a woman. 
 
 
 
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                                            CHAPTER THREE 
METHODOLOGY 
3.1 Introduction 
This section talks about the study design, study area, target population, source of data, 
sampling technique and sample size, methods for data collection, analysis and ethical 
consideration. 
3.2 Study Design 
This study is a descriptive cross-sectional study which involved the use of quantitative 
methods in data collection. 
3.3 Study Area 
The research was conducted in Sunyani West district of Brong Ahafo region. It has a 
population of 85,272, representing 3.7% of the region’s total population (GSS, 2014). The 
male population is 42,210 (49.5%) and the female population is 43,062 (51.5%).The 
number of fecund women who are married or in a union totals 12,635 and the general 
fertility is 95.8 births per 1000 women among women aged 15-49 years (GSS, 2014). 
Sunyani West district has one district polyclinic, seven health centres and sixteen CHPS 
zones which provide health care to the people living within the district and also to those 
from neighbouring communities. The study was conducted in the Sunyani west district 
which has nineteen well distributed settlements, of which twelve are rural and seven are 
urban (GSS, 2014). 
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Figure 3.1: Map of Ghana, indicating Sunyani-West District, Brong Ahafo Region. 
 
3.4 Variables 
The outcome variable for the study was unmet need for family planning among married 
women in Sunyani west district. The main independent variables were socio-demographic 
factors (woman’s age, religion, occupation, parity, education, place of residence, age at 
first sex, marriage, pregnancy and birth) as well as the intermediate variables, presented in 
the conceptual framework. It included the contextual and socio-economic factors. 
 
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3.5 Ethical Consideration 
3.5.1 Ghana Health Service Ethical Approval 
Before data collection, ethical approval was obtained from the Ghana Health Service 
Ethical Review Committee of the Research and Development Division of the Ghana 
Health Services. 
3.5.2 Approval from study area 
Permission and approval was sought from the Sunyani West District council and health 
directorate, as well as from the traditional leaders in the specific communities where the 
study was conducted. 
3.5.3 Description of subjects involved in the study 
The study population was married women aged 15-49 years in Sunyani West district. 
3.5.4 Potential risks/benefits 
Both the target population and the society benefited from the study. The target population 
gained appreciable knowledge about family planning and how to meet their need for it. 
Also, identification of the factors that influence unmet need for family planning served as 
a platform to address the contraceptive needs of married women aged 15-49 years in 
Sunyani West district. In addition, the study results helped inform decisions about the use, 
benefits and availability of family planning in the study area. The research posed no risks 
to the target population or society. 
 
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3.5.5 Privacy/confidentiality 
All interviews were conducted in a manner that ensures the privacy of the participant. This 
included personally interviewing the participant while no other person is within earshot. 
Data was reported in a way that reduced the possibility of tracing the information gathered 
back to any of the participants. This ensured the anonymity of respondents. Finally, no 
information/response of participants was allowed to be made public, or accessed by 
anyone except the research assistant during data collection and the researcher after data 
collection. 
3.5.6 Compensation 
Respondents were given no compensation during the data collection. Their inputs were 
however recognized and appreciated verbally at the time of data collection. 
3.5.7 Data storage and usage 
Questionnaires were coded and locked in a shelf-drawer, while the key was kept by the 
researcher. For the duration of data collection, data collected daily were immediately 
coded at the end of the day, and entered within 24 hours of collection into a Microsoft 
Excel 2013 spread sheet. This was then imported into STATA version 13.0 at the 
completion of data collection. Data entered were saved under a password known only to 
the researcher. A digital copy of the dataset was stored on a secure cloud drive. All data 
collected would be kept by the researcher for 3-5 years to allow for publication of 
research, after which questionnaires were properly destroyed by incineration. 
 
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3.5.8 Voluntary consent 
Written consent was sought from all respondents before data were collected from them. 
Participation was fully voluntary. Respondents were given the opportunity to refuse 
answering any question they deem uncomfortable, end the interview any time they want, 
and adopt out of the study if they choose to. 
3.5.9 Conflict of interest 
Apart from the academic and public health importance of the study, the researcher 
declares no other personal interest in the study. 
3.5.10 Proposal and funding information 
This research was self-financed 
3.6 Study Instrument 
 The study used semi-structured questionnaire in collecting data among married women aged 
15-49 years. Respondents who could read and understand were required to complete the 
questionnaire since all instructions and explanations were done in English language. The 
questionnaire contained mostly closed- ended questions. The few open - ended questions were 
to help the respondents to provide additional information which was not included on the 
questionnaire and the closed-ended questions required the respondents to provide answers from 
the options that were provided. 
Pre-testing of at least 30 questionnaires was done in Sunyani East, a neighbouring district to 
Sunyani West district whose married women aged 15-49 years have similar socio-demographic 
characteristics as that of the study area. However, the responses from this pretesting were not 
included in the study. The pre-test was to help the researcher modify questions which did not 
contribute to achieving the research objectives, and it also allowed for a hitch-free 
administration of the questionnaire in the study area later. 
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3.7 Target population 
The population of married women in Sunyani West district is 12,635, from which a 
sample size of 300 was drawn. 
3.8 Inclusion Criteria 
Married or in-union women aged 15-49 years living in Sunyani West who freely consent 
to participate in the study. 
3.9 Exclusion Criteria 
1. Married women above the age of 49 or less than 15 years 
2. Women not married or not in a union who were in their reproductive age of 15-49 
years 
3. Married women who did not give their consent to participate in the study. 
 
3.10 Sample Size and Sampling Technique 
3.10.1 Sampling size determination 
Sample size was estimated based on an expected unmet need rate of 26.5%. This is 
assumed from the findings of the 2014 Ghana demographic health survey report which 
puts the unmet need of Brong Ahafo region at 26.5%. A confidence interval of 95% and a 
significance level of 5% were used. The Cochran’s (1977) formula below was used to 
calculate the sample size. 
 
Where n= sample size 
p= probability of the event occurring, in the Brong Ahafo region, the prevalence of 
contraceptives is 26.5% (0.2655) 
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q= 1-p= probability of the event not occurring, in this case 1-0.265= 0.735 
d=margin of error (0.05) 
Z= 1.96 normal deviate representing a 95% confidence interval 
The sample size was estimated as follows: 
 
 
 
Hence, a sample size of 300 was calculated for this study. The sample frame consisted 
married women between ages 15-49 years who lived in Sunyani West district. 
3.10.2 Sampling Technique 
Sunyani west has 19 settlements, of which 12 are rural and 7 urban. All of these 
settlements are about equally distributed in terms of population size. 
The researcher used a systematic stratified random selection method to choose five (5) 
communities. This was done by listing the communities by rural or urban classification. 
The 12 rural communities were put on a list in alphabetic order and each one was assigned 
a number from 1 to 12 in descending alphabetic order. The same was done for the urban 
communities which were assigned a number from 1 to 7 in descending alphabetic order. 
Then a random number generator was used to pick out three (2) numbers on the rural list 
and two (3) from the urban list, the urban constituted communities like Fiapre, Odumase 
and Nsoatre while the rural included Kwatire and Kobedi. 
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 A sample size of 300 was obtained for the study. Adjusting for an anticipated 10% non- 
response rate, a total of 330 participants were used. The sample frame consisted of married 
women between ages 15-49 years who lived in Sunyani-west. 
In sampling, the geographic centre of each settlement was allocated, and the bottle method 
was used to identify what direction to begin sampling. With the assistance of a health 
worker, the center of the community was identified then a bottle was spinned and where 
the direction of the mouth of the bottle points at after settling was the starting point for the 
researcher. The first 33 houses in the selected direction were identified and numbered, and 
a random number generator was used to pick any number in that range. After which every 
33rd house after the number picked was sampled. 
This sampling is based on the assumptions that a house contains at least one household. 
This household would consist of a man, his wife or wives and children and some relatives 
or non-relatives who may be living with them. It was expected that each household had at 
least one fecund woman in a marriage or union. A sampled household that does not meet 
this criterion of having a currently married fecund woman was skipped, and the immediate 
next household was sampled. Then subsequent selection of every 33rd household was 
made. 
On arrival at each household, women of reproductive age who were married and not pregnant 
were identified. Where there was no married woman in a household, a participant from the next 
household was selected and interviewed. In addition, where it was a polygamous home, only 
one of the married women that meet the inclusion criteria was interviewed (based on 
availability and readiness).  
In all, 330 questionnaire were filled, but only 300 of them were validated and used for the 
analysis. With the help of the research assistance, a 100% response rate was attained. 
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3.11 Quality control 
The researcher employed three research assistants who helped in the data collection 
process. To ensure reliability of data, the research assistants were trained for two days on 
principles, ethical considerations, procedures and meanings of the questions included in 
the questionnaire and how data should be collected. The researcher supervised the data 
collection process as the research assistants carry it out. Data were checked daily for 
completeness, accuracy and correctness by the researcher, and problems detected were 
immediately fixed. The raw data were entered into a Microsoft Excel 2013 spread sheet by 
the principal researcher, and they were validated and cleaned after entry (by matching 
each observation to the appropriate questionnaire response) to ensure accuracy and 
consistency of data. 
 
3.12 Data Handling 
Questionnaires were coded, validated, cleaned and manually entered into Microsoft Excel 
2013 spread sheet. After which they were imported into STATA version 13.0 for analyses. 
3.13 Data Analyses 
The outcome of interest, which is the outcome/dependent variable was unmet need for 
family planning among married women aged 15-49 years in Sunyani West district. This 
variable was binary in nature (family planning needs met or family planning needs unmet). 
Independent variables included; socio-demographic characteristics (age, sex, education, 
occupational status, religion), Socio-economic characteristics and contextual 
characteristics. 
Socio-demographic variables like age, sex, education, occupational status, religion and 
marital status were described using frequencies and cross tabulations. Categorical 
variables were analysed using chi square (and Fisher’s exact test where needed) to 
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measure associations with the dependent variable. Westoff (2006) model was used to 
estimate the dependent variable (unmet need). Those that attained statistical significance 
were further analysed using binary logistic regression. Crude and adjusted odd ratios 
(ORs) were calculated with a 95% confidence interval (CI 95%). All reported p-values 
were two-tailed and considered statistical significance at a level of p<0.05. A multiple 
logistic analysis was carried out to determine the total effect of selected independent 
variables on the dependent variables. A binary logistic regression was used because the 
dependent variable of the study was treated as a categorical variable with two categories 
(use or non-use of contraceptives). This procedure assumes that there is no ordering in the 
categorical dependent variable. Data were analysed using STATA version 13. 
 
3.14 Dissemination of findings 
The study targeted groups listed below for the dissemination of the study findings: 
1. School of Public Health, University of Ghana, Legon 
2. Participants involved in the survey 
3. Scientific paper will be written for publication and dissemination of conferences 
 
3.15 Source of Data 
The study employed primary, quantitative data which were collected from Sunyani West 
district. Data were obtained through the administration of a semi-structured questionnaire. 
The researcher collected data from the target population based primarily on the socio-
demographic characteristics of the respondents, as well as their need for family planning. 
 
 
 
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CHAPTER FOUR 
RESULTS  
This chapter presents information on the variables, objectives and findings of the study. It 
is organized as follows: socio-demographic characteristics of respondents, spousal 
characteristics, perception and spousal communication on family planning, socio-
demographic characteristics by contraceptive uptake, pattern of modern contraceptive use 
among respondents, the level of unmet need among married women, and socio-economic 
and context factors associated with unmet need among married women.  
 
4.1 Background characteristics of Respondents  
This section describes the socio demographic characteristics of the respondents. The 
sample size was 300 married women. Ages of respondents in this study ranged from 15 to 
49 years. Table 4.1 shows that 39.7% of the respondents were between ages 25 to 29. Age 
category 35-49 and 15-24 constituted 22.3% and 20% respectively while those that fall in 
the age category of 35 and above constituted the smallest age group with 18%. Thirty 
percent of the respondents have Senior High Level Education while 12.3% of the 
respondents have up to primary school. 
 On employment, 48.7% (n=146) of the respondents were self-employed while 10.0% 
were public workers. Majority of the respondents were Christians (84.3%), while Muslims 
represented 14.7%.  In terms of place of residence, 37.3%of respondents (n=112) were 
rural dwellers while 62.7% were urban dwellers. (See Table 4.1)  
 
 
 
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Table 4.1: Socio-Demographic Characteristics of respondents 
Variable name Frequency n=(300) Percentage (%) 
Age 
15-24 60 20.0 
25-29 119 39.7 
30-34 54 18.0 
35-49 67 22.3 
Educational status 
 No education  50 16.7 
Primary 57 12.3 
JHS/Technical* 85 28.3 
SHS* 90 30.0 
Tertiary 85 12.7 
Occupational status 
Public worker 30 10.0 
Private worker 36 12.0 
Self-employed 146 48.7 
Unemployed 88 29.3 
Religious status 
Christian 253 84.3 
Muslim 44 14.7 
Traditionalist  3 1.0 
Place of residence   
Rural 112 37.3 
Urban  188 62.7 
*JHS- Junior High School 
*SHS -Senior High School 
 
 
 
 
 
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4.2 Spousal characteristics of respondents  
Given the critical role of spouses in family planning decision-making, data were collected 
on respondents’ spouses. The data indicate that the ages of spouse lie between ages 15-49. 
The largest proportion of respondents’ spousal age falls between 35 - 49(42.3%) while 3% 
are in 15 - 24 age category. Less than half (35.7%) of the respondents’ spouses had Senior 
High school education while 6.7% of respondents’ spouses had up to primary education. 
In terms of their current working status, 36% of the spouses were self-employed and 2.3% 
were unemployed. Majority of the spouses were Christians (83.7%) while Muslims form 
14.3%.Results are shown in table 4.2 below: 
 
Table 4.2: Spousal characteristics of unmet need for family planning 
Variable name Frequency 
n=(300) 
Percentage 
(%) 
Age Group of husband                                         
15-24   9  3.0 
25-29 60 20 
30-34 104 34.7 
35-49 127 42.3 
Educational status of husband 
No education  22 7.3 
Primary 20 6.7 
JHS/Technical 85 28.3 
SHS 107 35.7 
Tertiary 66 22 
Occupational status of husband 
Public worker 63 21 
Private worker 43 14.3 
Self-employed 187 62.3 
Unemployed 7 2.3 
Religious status of husband 
Christian 251 83.7 
Muslim 43 14.3 
Traditionalist  6 2.0 
                                                                                                                             
 
 
 
 
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4.3 Perception and Spousal communication on family planning 
Table 4.3 shows that about 45% of women acknowledged discussing family planning 
issues with their spouses. In terms of frequency of discussion, 38.2% of the respondents 
discuss family planning issues once in three months with their spouses while 7.4% discuss 
weekly with their spouses. A large proportion (66.2%) of the women initiate family 
planning discussion with their spouse and nearly half (48.5%) of the respondents indicated 
that their spouses were not aware of their contraceptive use. Regarding the woman’s 
autonomy, half of the respondents (50%) made decisions on how to spend their own 
earning while (45.3%) of the respondents made decisions on their own health care. Also 
65.3% of currently married women reported that their husbands made decisions on their 
own earned money. 
Perception about contraceptives was categorised into positive and negative perceptions.  
While 79 (29.9%) of the respondents had negative perception, 185 (70.1%) had positive 
perception about family planning. A total number of 244 respondents representing (81.3%) 
had ever received family planning information from a health worker. 
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Table 4.3: Perception and Spousal communication on family planning 
Variable name Frequency 
n=(300) 
Percentag
e (%) 
Discuss FP with spouse 
Yes 
No 
Frequency of Discussion 
 
136 
164 
 
45.3 
54.7 
Weekly 10 7.4 
Once a month 25 18.4 
Once in three months 52 38.2 
Rarely, may be once a year                                                                                 49 36.0 
Initiator of Discussion   
Respondent 90 
 
66.2 
Spouse/partner 46 33.8 
Spouse aware of FP use   
Yes 63 46.3 
No   66          48.5 
Don’t know                                                                                                                                                                                     7 5.2 
Decides how to spend own earning   
Respondent 150 50.0 
Spouse/partner 78 26.0 
Respondent and spouse/partner jointly 68 22.7 
Someone else                                                                                                                 4 1.3 
Decides on own health care   
Respondent 136 45.3 
Spouse/partner 91 30.3 
Respondent and spouse/partner jointly 70 23.3 
Someone else 3 1.0 
Decide what to do with money husband earns   
Respondent 19 6.3 
Spouse/partner 196 65.3 
Respondent and spouse/partner jointly 82 27.3 
Perceptions about contraceptives 
Positive perception 
Negative perception 
 
185 
79 
 
70.1 
29.9 
Ever received FP from health worker 
Yes 
No 
 
244 
56 
 
81.3 
18.7 
 
4.4 Contraceptive use  
Table 4.2 describes the use of contraceptives among married women. Contraceptive use 
varies with age, from around 18 percent for those under thirty years (18.3 % for 15-24), -
18.5 % for 25-29), to 31.5 % among those aged 30-34 years and to 35.8 % for those in   
 
 
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35-49 years age group. Contraceptive use among those with Junior High school education 
was 28.2% whiles use among respondents with no education was 14.0%. The occupation 
of a married woman also determines their use of contraceptives. Contraceptive use was 
higher among women who were self–employed (29.2%) than unemployed (19.3%). 
Similarly, contraceptive uptake among Christians (28.1%) was higher than among 
Muslims (6.8%). Use of contraceptives varied with the number of children a woman had. 
The proportion using contraceptives was highest (39.6%) among married women who 
desire to have more than four children and lowest (27.9%) among those who want fewer 
than four children. Contraceptives use also varied by place of residence. While 28.6% of 
rural dwellers use contraceptives, the proportion of use in urban areas is 22.3%. Out of 
300 respondents 24.7 % (74) were currently on contraceptives while the rest were not. 
 
 
 
 
 
 
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Table 4.4:  Contraceptive use by Socio-Demographic characteristics of respondents  
Variable name Total, N= 300 Contraceptive Uptake (Freq.) p-value 
Age 
 
Yes (n %) No (n %) <0.05 
15-24 60 (20.0) 11(18.3) 49(81.7)  
25-29 119(39.7) 22(18.5) 97(81.7)  
30-34 54(18.0) 17(31.5) 37(68.5)  
35-49 67(22.3) 24(35.8) 43(64.18)  
Educational status 
 
 
No education  50(16.7) 7(14.0) 43(86.0) 0.329 
Primary 57(12.3) 11(29.7) 26(70.3)  
JHS/Technical 85(28.3) 24(28.2) 16(71.8)  
SHS 90(30.0) 24(26.7) 66(73.3)  
Tertiary 85(12.7) 8(21.1) 30(78.9)  
Occupational status 
 
 
Public worker 30(10.0) 8(26.7) 22(73.3) 0.2160 
Private worker 36(12.0) 6(16.7) 30(83.3)  
Self-employed 146(48.7) 43(29.5) 103(70.6)  
Unemployed 88(29.3) 17(19.3) 71(80.7)  
Religious status 
 
 
Christian 253(84.3) 71(28.1) 182(71.9) <0.05 
Muslim 44(14.7) 3(6.8) 41(93.2)  
Traditionalist  3(1.0) 0(0.0) 3(100.0)  
Place of residence 
 
  
 
Rural 112(37.3) 32(28.6) 80(71.4) 0.226 
Urban  188(62.7) 42(22.3) 146(77.7)  
Fertility Desires 
 
  
 
<4 101(46.1) 40(39.6) 61(60.4) 0.069 
≥4 108(53.9) 33(27.9) 85(72.0)  
Total 300 (100.0) 74(24.7) 226(75.3)  
 
 
 
 
         
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Figure 4.1: Pattern of modern contraceptive use among Respondents 
 
Figure 4.1 shows an overview of modern contraceptives use among the respondents. The 
respondents in this study mostly knew of the pill method of contraceptive.The pill was the 
highest currently used method by 72.3% of the respondents as compared to 
depo/injectables with usage by 27.3% of the respondents. intra-utrine device (IUD), 
female condom, male condom,rhythm method, implants and Lactational Amenorrhea 
method (LAM) were the least used though some of the respondents were aware of them. 
Female and male sterilisation were recorded no usage. 
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The proportion of women with unmet need for family planning in sunyani –west  
 
 
 
 
 
 
 
 
 
 
Figure 4.2: The level of unmet need for family planning among married women living 
in Sunyani-West District. 
 
Married woman whose pregnancies were unwanted or mistimed or who became pregnant 
unintentionally due to non-use of contraceptives has an unmet need (Yadav, 2013). 
The revised definition for unmet need for family planning includes pregnancies that were 
mistimed or unwanted as long as it is not due to method failure. (Westoff & Ochoa, 1991). 
Out of the 300 respondents, 32.3% had an unmet need for mistimed/unplanned pregnancy 
as shown in Figure 4.1 above. Overall the total unmet need rate was 32.2%. However, 
two-thirds of the respondents were without an unmet need for family planning. The 
percentage of married women who were currently not on any contraception were 24.3%. 
 
 
 
Currently married women of reproductive 
age n = (300) 
Not on any 
contraception 
n=73(24.3) 
(Unmet need) for Pregnancy 
mistimed/unwanted n=97(32.3) 
Without unmet need for FP 
n=203(67.7) 
Total unmet need for FP n=97(32.3) 
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4.5 Associations between socio-demographic characteristics and unmet need for 
family planning. 
Table 4.5 presents a chi-square analysis to determine the associations between 
respondent’s socio-demographic characteristics and unmet need for family planning 
(defined as mistimed or unwanted pregnancies). The highest level of unmet need for 
family planning was observed among age group 15-24 years (36.7%), while it begins to 
drop at age 25-29 (30.3), 30-34(31.5) and age category 35-49(32.8). Young women (15-24 
years) do have unmet need because of their early childbearing age. However the 
association between age and unmet need was not significant (p>0.05). There was a 
significant relationship between the educational status of married women and unmet need 
for family planning (p<0.05). Respondents with senior high school education had the 
highest unmet need (44.4%) while the lowest unmet need was among those with no 
education (20.0%). This suggests that women with up to senior high school education are 
more likely to report their last pregnancies as either mistimed or unwanted.  There was 
also no significant association between occupation and unmet need for family planning 
thus (p>0.05) likewise religion, there was no significant relationship between religion and 
unmet need for family planning although Christians had the highest level  of unmet need 
(33.2%) while Muslims had an unmet need of (29.6).  
In addition, there was no significant association between respondents’ place of residence 
and unmet for family planning with p> 0.05. Similarly, the study however found no 
significant association between age at first pregnancy, currently pregnant, want baby later 
or never and the desired number of children with unmet need for family planning. There 
was a significant relationship between the length period of how they could have delayed 
their pregnancies with unmet need for family planning. The shorter the delay the higher 
the level of unmet need. 
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Table 4.5: Unmet need by socio-demographic characteristics  
 N (%)  
Characteristics Without 
unmet need 
With unmet 
need Total 
X2 (df), 
p-value 
Age of women (years) 
15 – 24 
25 – 29 
30 – 34 
35 – 49 
 
38 (63.3) 
83 (69.8) 
37 (68.5) 
45 (67.2) 
 
22 (36.7) 
36 (30.3) 
17 (31.5) 
22 (32.8) 
 
60 (100.0) 
119 (100.0) 
54 (100.0) 
67 (100.0) 
0.78 (3), 
0.855 
Level of education 
No education 
Primary 
JHS/Technical 
SHS 
Tertiary 
 
40 (80.0)  
22 (59.5)  
62 (72.9)  
50 (55.6)  
29 (76.3) 
 
10 (20.0) 
15 (40.5) 
2 3(27.0)  
40 (44.4) 
9 (23.7) 
 
50 (100.0) 
37 (100.0) 
85 (100.0) 
90 (100.0) 
38 (100.0) 
13.03 (4), 
0.011 
Occupation 
Public Worker 
Private Worker 
Self-employed 
Unemployed 
 
20 (66.7) 
22 (61.1) 
100 (68.5) 
61 (69.3) 
 
10 (33.3) 
14 (38.9) 
46 (31.5) 
27 (30.7) 
 
30 (100.0) 
36 (100.0) 
146 (100.0) 
88 (100.0) 
0.88 (3), 
0.824 
Religion status 
Christian 
Muslim 
Traditionalist 
 
169 (66.8) 
31 (70.5) 
3 (100.0) 
  
84 (33.2) 
13 (29.6) 
0 (0.0) 
 
253 (100.0) 
44 (100.0) 
3 (100.0) 
1.68 (2), 
0.432 
Place of Residence 
Rural 
Urban 
 
81 (72.3) 
122 (64.9) 
 
31 (27.7) 
66 (35.1) 
 
112 (100.0) 
188 (100.0) 
1.77 (1), 
0.183 
Age at first pregnancy 
15 – 24 
25 – 29 
30 – 34 
 
80 (54.8) 
45 (60.0) 
4 (80.0) 
 
66 (45.2) 
30 (40.0) 
1 (20.0) 
 
146 (100.0) 
75 (100.0) 
5 (100.0) 
1.64 (2), 
0.439 
Currently pregnant 
Yes 
No 
 
20 (71.4) 
109 (55.05) 
 
8 (28.6) 
89 (44.9) 
 
28 (100.0) 
198 (100.0) 
2.69 (1), 
0.101 
Want baby later or never 
Later 
Never 
 
127 (57.9) 
2 (28.6) 
 
92 (42.0) 
5 (71.4) 
 
219 (100.0) 
7 (100.0) 
2.40 (1), 
0.122 
If later, period from now 
6 - 12 months 
13 - 18 months 
19 - 24 months 
25 - 36 months 
More than 36 months 
 
10 (34.5) 
33 (47.1) 
40 (66.7) 
29 (70.7) 
15 (78.9) 
 
19 (65.5) 
37 (52.9) 
20 (33.3) 
12 (29.3) 
4 (21.1) 
 
29 (100.0) 
70 (100.0) 
60 (100.0) 
41 (100.0) 
19 (100.0) 
17.97 (4), 
0.001 
No. of children desired* 
<4 
≥4 
 
62 (61.4) 
65 (55.1) 
 
39 (38.6) 
53 (44.9) 
 
101 (100.0) 
118 (100.0) 
0.89 (1), 
0.346 
Total 203 (67.7) 97 (32.3) 300 (100.0)  
*Only those who want later 
 
 
 
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4.6 Associations between household factors and unmet need for family planning 
Regarding household factors, discussing family planning issues with the spouse was found 
to be significant (p<0.05). Frequency of the discussion, initiator of the discussion, and the 
spousal awareness of family planning were all found not to be significant or associated 
with unmet need for family planning. Respondents who discuss family planning are more 
likely to have unmet need. Similarly, unmet need was also associated with the frequency 
of discussion. The level of unmet need among respondents who discussed weekly or 
monthly was 60% compared with 28.6% among those who rarely discussed as shown in 
Table 4.6. In terms of who initiates family planning discussion, there is no relationship 
between unmet need and whether it was husband or wife who initiated the discussion. 
Also 36.7% of the respondents made decisions on their own earning which was found 
significant (p<0.05). Household decisions such as healthcare, large household purchases, 
visit to relatives and the husband’s earnings were all found not significant to unmet need. 
 
 
 
 
 
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Table 4.6: Unmet need by household factors  
 N (%)  
Characteristics Without 
unmet need 
With unmet 
need Total 
X2 (df) 
p-value 
Discuss FP issues with spouse 
Yes 
      No  
 
81  (59.6) 
122(74.4) 
 
55(40.4) 
42(25.6) 
 
 136(100.0) 
 164(100.0) 
 
7.47(1), 
  0.006   
 
Frequency of discussion* 
Weekly 
Once a month 
Once in three months 
Rarely, maybe once a year 
 
4(40.0) 
10(40.0) 
32(61.5) 
35(71.4) 
6(60.0) 
15(60.0) 
20(38.5) 
14(28.6) 
10(100.0) 
25(100.0) 
52(100.0) 
49(100.0) 
8.51(3), 
0.037 
Initiator of discussion* 
Respondent 
    Spouse/partner 
 
53(58.9) 
28(60.9) 
37(41.1) 
18(39.1) 
90(100.0) 
46(100.0) 
0.05(1), 
0.824 
Decides how to spend own earnings 
Respondent 
Spouse/partner 
Respondent and spouse/partner jointly 
     Someone else 
 
95(63.3) 
49(62.8) 
55(80.9)  
4(100.0) 
55(36.7) 
29(37.2) 
13(19.1)  
0(0.0) 
150(100.0) 
78(100.0) 
68(100.0) 
 4(100.0) 
9.46(3), 
0.024 
Decides on your health care 
Respondent 
Spouse/partner 
Respondent and spouse/partner jointly 
      Someone else 
 
93(68.4) 
52(57.1) 
56(80.0) 
 2(66.7) 
 
43(31.6) 
39(42.9) 
14(20.0) 
1(33.3) 
 
136(100.0) 
91(100.0) 
70(100.0) 
3(100.0) 
9.51(3) 
 0.095 
 
Decides on large household purchases 
Respondent 
Spouse/partner 
Respondent and spouse/partner jointly 
Someone else 
 
 
 
29(70.7) 
108(64.7) 
66(73.3) 
 0(0.0) 
 
 
12(29.3) 
59(35.3) 
24(26.7) 
2(100.0) 
 
 
41(100.0) 
167(100.0) 
90(100.0) 
2(100.0) 
 6.37(3), 
  0.095 
Decides on visits to family or relatives 
Respondent 
Spouse/partner 
Respondent and spouse/partner jointly 
Someone else 
 
 
30(68.18) 
82(64.1) 
90(71.4) 
1(50.0) 
 
14(31.82) 
46(35.9) 
36(28.6) 
1(50.0) 
 
44(100.0) 
128(100.0) 
126(100.0) 
2(100.0) 
1.87(3), 
0.601 
Decides what to do with money husband 
earns 
Respondent 
Spouse/partner 
Respondent and spouse/partner jointly 
Someone else 
 
 
 
11(57.9) 
131(66.8) 
59(71.9)  
2(66.7) 
 
 
8(42.1) 
65(33.2) 
23(28.1) 
1(33.3) 
 
 
19(100.0) 
196(100.0) 
82(100.0) 
3(100.0) 
1.58(3) 
0.664 
Total     203 (67.7)       97 (32.3)  300(100.0)  
*Only 136 respondents who discussed FP issues with spouse 
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4.7 Perception about family planning and unmet need for family planning 
As shown in Table 4.7, ever heard of a method was not associated with unmet need. 
Similarly respondents’ perception about family planning as well as whether they had ever 
received family planning information from a health worker were not statistically 
associated with unmet need.  
 
Table 4.7: Unmet need by context factors  
 
 N (%)   
 
Characteristics 
Without 
unmet need  
With 
unmet need  
Total X2 (df) 
p-value 
Ever heard of any method used to delay or 
avoid getting pregnant 
Yes 
      No 
 
176(66.7) 
27(75.0) 
 
88(33.3) 
9(25.0) 
 
264(100.0) 
36(100.0) 
1.00(1) 
0.316 
Intend to use a method to prevent, delay 
or avoid pregnancy the next 12 months 
Yes 
      No 
 
 
65(58.6) 
 138(73.0)  
 
 
46(41.4) 
51(26.9) 
 
 
111(100.0) 
189(100.0) 
 
     6.68(1), 
0.010 
Perception about Contraceptives 
Positive Perception 
Negative Perception 
 
129(69.7) 
47(59.5) 
 
56(30.27) 
32(40.2) 
 
185(100.0) 
79(100.0) 
2.61(1) 
0.106 
Ever received family planning information 
from a health worker 
  Yes 
        No 
 
 
167(68.4) 
36(64.3) 
 
 
77(31.6) 
20(35.7) 
 
 
244(100.0) 
56(100.0) 
 
0.36(1) 
0.549 
Total                                                                     203 (67.7)          97 (32.3)          300(100.0) 
 
 
4.8 Results of Logistic Regression 
Table 4.8 shows the results of both simple and multiple logistic regression which were 
conducted to determine the relationship between unmet need for family planning against 
some factors that showed significant association from the Chi-square tests. From Table 
4.8, participants who had SHS education have higher odds of having unmet need 
compared to those without education, this relationship was also significant when 
unadjusted (OR= 3.20, 95% CI=1.42, 7.18; p<0.05). Similarly those with primary 
education are nearly three times likely to have unmet need compared to those with no 
education (AOR= 2.74, 95% CI= 0.85, 8.78; P>0.05). 
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Table 4.8 further indicates the preferred period participants would want to delay 
pregnancy. Participants who would want to delay pregnancy between 19 to 24 months 
were less likely to have unmet need for family planning compared with those who wanted 
delay of pregnancy between 6 to 12 months (OR= 0.26, 95% 0.10, 0.67; P<0.05).Even 
when other factors were adjusted for, the relationship still remained statistically significant 
(AOR= 0.26, 95% CI= 0.09, 0.69; P<0.05).  
Furthermore, participants were also asked if they discuss family planning issues with their 
partners. Participants who do not discuss family planning issues with their spouse were 
49% times less likely to have unmet need for family planning compared to their 
counterparts who discussed family planning issues with their spouses; This relationship 
was significant (OR= 0.51, 95% CI= 0.31, 0.83; P<0.05) but when other variables were 
adjusted for, the relationship was no longer significant (OR= 0.87, 95% CI= 0.46, 1.66; 
P>0.05). 
Deciding of how to spend own earnings was yet another predictor of unmet need. Partners 
who made decisions on how to spend their earnings together had a lower odds of  unmet 
need for family planning compared to respondents who take their own decisions on how to 
spend their earnings (OR= 0.41, 95% CI= 0.20, 0.81; P<0.05).  
 
 
 
 
 
 
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Table 4.8: Unmet need and significant factors 
 Unadjusted  Adjusted 
Characteristic OR (95% CI) p-value  OR (95% CI) p-value 
Level of education 
No education 
Primary 
JHS/Technical 
SHS 
Tertiary 
 
Ref 
2.73 (1.05, 7.08) 
1.48 (0.64, 3.44) 
3.20 (1.42, 7.18) 
1.24 (0.45, 3.44) 
0.011 
  
Ref 
2.74(0.85,8.78) 
1.06(0.38,2.93) 
2.73(0.99,7.56) 
1.26(0.35,4.51) 
0.053 
Preferred pregnancy delay 
6 - 12 months 
13 - 18 months 
19 - 24 months 
25 - 36 months 
More than 36 months 
 
Ref 
0.59(0.24,1.45) 
0.26(0.10,0.67) 
0.22(0.79,0.60) 
0.14(0.04,0.54) 
0.001 
  
Ref 
0.63(0.24,1.65) 
0.26(0.09,0.69) 
0.21(0.73,0.63) 
0.14(0.04,0.59) 
 
0.003 
Discuss FP issues with 
spouse 
Yes 
      No 
 
 
Ref 
0.51(0.31,0.83) 
0.006 
  
 
Ref 
0.87(0.46,1.66) 
0.671 
Decider of how to spend 
own earnings 
Respondent 
Spouse or partner 
Both spouse and partner 
 
 
Ref 
1.02(0.58,1.80) 
0.41(0.20,0.81) 
0.018 
  
 
Ref 
0.73(0.34,1.54) 
0.44(0.19,1.02) 
0.160 
Intend to prevent, delay or 
avoid pregnancy the next 12 
months 
Yes 
No 
 
 
 
Ref 
0.52(0.32,0.86) 
0.010 
  
 
 
Ref 
0.79(0.41,1.52) 
0.482 
 
 
 
 
 
 
 
 
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CHAPTER FIVE 
DISCUSSION 
5.1 Introduction  
In this chapter, the results of the study are discussed. Comparisons are made between 
previous related studies and the findings of this study. 
The purpose of this study was to explore the nature of unmet need and to identify the key 
factors that explain unmet need among married women in Sunyani West district. Unmet 
need in this study was restricted to unmet need arising from mistimed or unwanted 
pregnancy. The study comprised 300 married women in their reproductive age. In terms of 
age, the largest proportion were in the 25 to 29 years (39.7%). while those that fall in the 
age category 35 and above constituted the smallest group with 18%. Age had no 
relationship with a woman’s unmet need in this study, Nyauchi, and collagues (2015) 
stated age as a predictor of  unmet need. The association between unmet need and 
women’s level of education as established by this study, conforms with previous studies 
by (Hameed, Azmat, Bilgrami, & Ishaqe, 2011a). Other findings however stated the 
contrary (Laryea, Amoako, Spangenberg, Frimpong, & Kyei-Ansong, 2014).  
In Africa and other developing countries, about 25% of pregnancies are either unwanted or 
mistimed which sometimes leads to unsafe abortions or lack of knowledge about 
contraceptives. The  latest global estimate for unmet need shows that in 2010, 12.3% of all 
WORA married or in a union around the world had an unmet need (Alkema et al., 2013) - 
a figure far lower than the findings of this study. This can be associated with the fact that 
family planning is not yet a widely accepted practice among married women and even 
other religions and cultures in the world still frown on its practice. Pregnant women are 
considered to have an unmet need for spacing or limiting if their pregnancy was mistimed 
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or unwanted. Similarly, amenorrhoeic women are categorised as having an unmet need if 
their last birth was mistimed or unwanted. Compared to this study, current national 
surveys have reported a lower figure of 30% of married women in Ghana with unmet need 
for family planning while 27% of married women are currently using a contraceptive 
method. Therefore, less than six in ten currently married women (57 %) have a demand for 
family planning.(Ghana Statistical Service (GSS) et al., 2015a). These differences are 
possible, considering that the previous survey covered a wider proportion of women and 
the high demand for family planning can also be resulting from limited spousal support 
and education on the benefits of family planning in Ghana. 
Though the concept seems straightforward, the calculation is complex and has changed 
over time. Definition of unmet need for contraception has become increasingly refined. 
The standard method of calculating unmet need usually involves women who are fecund 
and are sexually active but do not want any more children (limiters) or wanting to delay 
(spacers) for at least the next two years. According to the revised definition, pregnancies 
that are mistimed or unwanted have an unmet need for contraceptives as long as it is not 
due to method failure.) (Westoff & Ochoa, 1991). 
However this study calculated the unmet need for family planning based on pregnancy 
mistimed or unwanted among married women who were not on contraception. It was 
observed that 32.3% of currently married women in the Sunyani West District have unmet 
need for family planning (pregnancy mistimed or unwanted). This is similar to a study 
conducted in Ethiopia where it was found that 29% of women in their reproductive age 15-
49 feel that their pregnancies were mistimed or unwanted (Ayele et al., 2013) Other 
studies in Ghana further reported even lower figure of 27.8% (Laryea et al., 2014) – a 
trend that can be observed in most African countries. Though efforts have been made, it 
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will not be wrong to conclude that strict policy implementation and education on family 
planning are still key components to the success of family planning in Ghana. 
A woman’s age has been found influential in determining if their need for contraceptives 
is met. A study by Bhattathiry and Ethirajan (2014) conducted in India showed that unmet 
need was higher among younger women than older women (Bhattathiry & Ethirajan, 
2014). Similar to this study, while not statistically significant, unmet need was generally 
higher among younger respondents; 36.7% among age category 15-24 whiles decreasing 
to 32.8% among age 35-49. While this study may want to assume that most women at 
older ages of 35 – 49 may have reached their desired number of children, accounting for 
the decrease in unmet need, previous studies have stated side effects of contraceptive as 
the main reason for lower rates among the older age group (Ferdousi et al., 2010) Across 
the developing world, unmet need has been found to decrease as women’s education 
increases. However, among women who are not educated, unmet need is low, largely 
because these women have a low demand for contraceptives (Bradley et al., 2012). This is 
generally true in this study.  Respondents with no education had an unmet need of 
(20.0%), (40.5%) by primary school, (27.0%) by JHS/Technical, (44.4%) by SHS and 
(23.7%) by Tertiary. This indicates that women with higher level of education are less 
likely to have unmet need for family planning compared to women with lower educational 
background, apart from those with no or primary education. According to the (GSS et al 
2015), the link between education and unmet need is not so direct, although highly 
educated women do have the lowest unmet need. There was a higher level of significance 
between education and unmet need for family planning. 
Religion also determines unmet need for family planning among married women. A 
longitudinal study in Nigeria among currently married women and sexually active 
unmarried women aged 15-49 years found that while Catholics and non-Catholic 
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Christians had similar unmet need, Muslims and Traditionalists had lower odds of having 
unmet need than Catholics (Oginni et al., 2015). A similar pattern was observed in this 
study, Christian (33.2%) were with the highest unmet need for family planning while 
Muslims (29.6%) and Traditionalists (0.0%) had lower odds of having unmet need for 
family planning, although the relationship was not significant . 
Literature also reveals that rural areas are less likely to have their demand for 
contraceptives met than their counterparts in the urban areas (Bradley et al., 2012). A 
similar trend in this study indicates that unmet need among the rural married women was 
27.7% while their counterparts in the urban were 35.1%. Both this and the previous study 
indicate that unmet need is more a challenge to urban women than it is to rural dwellers, 
considering that both studies concluded there was less demand among rural women. 
Regarding age at first pregnancy of married women, total unmet need for family planning 
was 45.2% but on age differentials, was observed to be  high among age 15-24 but low at 
age 35-49. With regards to fertility desire, variations were observed among married 
women who intended to have four or more children (44.4%) and those who desired to 
have four or less children (38.6%). Similarly, previous studies done in DR. Congo also 
indicate variations in fertility desire and variations in number of children a woman 
intended to have (Yotebieng et al., 2015). These variations can be associated with the fact 
that an intention to have fewer or more children leads to less or more maternal fertility 
desire. The low fertility desire recorded in both studies may also have implications on 
mother-to-child transmission programmes in Africa – considering mothers now desire to 
have fewer children. 
Spousal characteristics such as education, religion and occupation could influence the 
unmet need status of a woman. In Ethiopia, it was indicated that women who had 
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disproportionate education with their husband (higher or lower) had lower unmet need 
than those on an equal footing (Tadesse et al., 2013). This is supported in this study. 
Education was associated with unmet need. Unmet need is highest among those with SHS 
education but lower among women with no education and those with tertiary education. 
Contrary, Letamo & Navaneetham, (2015) found unmet need to be highest among married 
women with no education, and lowest among those with secondary education. Aside 
differences in health system strength in the two study areas, one can conclude that 
educated women may have greater awareness on the range of contraception methods 
available and may also have greater autonomy in decision-making than uneducated 
women. Exposure to electronic media is an important source of information about the 
range of contraceptive methods, which is also a factor in favour of educated women. It 
goes further to imply that girl child education has a long term benefit on contraceptive use 
and unmet need in later reproductive life of every woman.  
Spousal communication plays a major role in the level of unmet need for family planning 
among married women which includes partner’s opposition to contraceptives, partner’s 
discussion of family planning issues and the frequency of discussion. Inversely, other 
studies have indicated that among other factors, spousal communication was not a 
determinant of a woman’s level of unmet need and had no influence on her family 
planning practice (Letamo & Navaneetham, 2015). These variables show the level of the 
relationship that exists between the married couples especially in terms of decision 
making. Partners who oppose or disapprove of the use of contraceptive and do not discuss 
family planning issues are likely to have high unmet needs than those who approve and 
discuss.  
Other studies in Rwanda have supported the findings by Letamo and colleagues,  revealing 
that contraceptive use relies on spousal approval and unmet need becomes high among 
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women whose spouse did not approve of contraceptives (Ndaruhuye et al., 2009). 
Literature supporting spousal communication widely indicates the subject (spousal 
communication) as an important predictor of unmet need among married women. This 
further supports the finding of this study - discussion of family planning among couples, 
as a significant factor of unmet need.  Showing that only 25.6% of respondents with an 
unmet need do not discuss FP with their spouses. 
Key to a woman’s autonomy or self- efficacy is the issue of unmet need. Married women 
who have a say on issues or have control over family affairs, are able to avoid unintended 
or unwanted pregnancies. Hence, they are empowered to overcome family pressure on 
contraceptive use, demand on when to limit or how to space their births and how to spend 
their own earning. Such married women are less likely to have an unmet need for family 
planning. Though these associations were not significant in this study, about 36.7% of 
respondents decide how to spend their own earning while 37.2% of spouse decides for 
their partners. This low figure is an indication that more married women may still lack the 
autonomy to decide on family planning and contraceptive use, leading to higher unmet 
need. Other national surveys in Ghana have supported the same assertion that 
contraceptive use increases with women empowerment (GSS et all, 2015), showing a 
positive link between women autonomy and their unmet need. 
 A recurrent trend in a study by Kisaakye & Wado (2013) found that women who had 
considerably low autonomy in their family had higher unmet need compared to their 
counterparts with moderate and high autonomy in the family. Wado and colleagues further 
explains that the autonomy of women is an important influence on the behaviour of their 
reproductive health services. 
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Woman’s fertility desires varied among respondents in this study; 38.6% of women 
wanted a maximum of four children while 44.9% of married women would want more 
than four children. Therefore those who want three or just four intend to limit while those 
who want to exceed four would prefer to space. Though respondents had the intention to 
limit or space child birth, about 26.9% of them indicated they do not intend to use any 
method of contraception to avoid or delay pregnancy within the next 12 months. This 
figure is higher as compared to the findings of other studies, where both unmet need for 
spacing and limited was found to be only 8% (Bhattacharya et al., 2006) 
The importance of context factors in determining an unmet need for family planning 
among married women, looks at the knowledge and available information on 
contraceptives, the kind of information received and the source. Women’s source of 
information about contraceptives was mainly from health workers, friends was the next 
most popular contraceptive information source. It is informative that  about one third (31.6 
%)  of respondents got their information from health workers  while previous finding 
indicated a lower figure of 23% (Hameed et al., 2011a). The study also found  that 12.0% 
of married women have never heard of a method used to delay or avoid pregnancy, a 
finding that agrees with that of Bhattacharya et al. (2006). Based on perception of 
contraceptives, a large proportion of the respondents (40.2%) had a negative perception 
and knowledge about contraceptives. A study conducted in sub-Saharan Africa showed 
that the level of community approval of family planning had a larger effect on 
contraceptive use than the perceived approval of the woman’s partner (Stephenson et al., 
2007). 
 A study by Ayele et al. (2013) showed that women who discussed family planning with a 
fieldworker were significantly less likely to have an unmet need especially for limiting, 
compared to women who visited a health facility and who discussed family planning with 
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a health worker at that facility were less likely to have an unmet need. Reasons accounting 
for this are that unwanted pregnancies are considered unmet need for limiting and most 
women with unwanted pregnancies restrict themselves from visiting health facilities for 
fear of public criticism and stigma. Such women are more likely to encounter a fieldwork 
on home visiting than a health worker at a health facility. Considering that women with 
unmet need for spacing do not harbour the fear of stigma, they are likely to visit a health 
facility in need of health service and engages discussions with a health worker on family 
planning, leading to less unmet need for spacing.    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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5.2 Limitations of the study 
Firstly, because of the cross sectional nature of the study, different results may be gotten 
using a different time frame. It is difficult to make causal inferences with a cross sectional 
study. 
Considering that a quantitative method was employed in this study, the research was 
limited on the type of data that could be collected, limiting the collection of in-depth 
information and experiences of respondents.  
In studies like this, recall bias is considered one major limitation. Considering the fact that 
respondents had already gone through the experience and may not be able to remember the 
exact experiences that were required. Aside this, the study was only limited to Sunyani 
West and only married women. This study place is only but a small portion of a large 
region containing only limited number of married women as compared to the regional 
population. This therefore makes it inappropriate to generalize the findings of this study as 
a regional coverage. 
Lastly, issues relating to sex are usually considered sensitive and most people find it 
difficult to share such information, it was possible that respondents answered questions 
with limitations to information demanded by the researcher.   
 
 
 
 
 
 
 
 
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CHAPTER SIX 
CONCLUSIONS AND RECOMMENDATIONS 
6.1 Conclusions 
The study was conducted to explore the nature of unmet need and to identify the key 
factors that explain unmet need among married women in their reproductive age in 
Sunyani-west district. The objectives of the study were to estimate the level of unmet need 
for pregnancy mistimed or unwanted, to find out the demographic characteristics of 
married women with unmet need and to determine the socio-economic and context factors 
associated with unmet need for family planning. 
Globally about 12.3% of married women in their reproductive age have an unmet need for 
family planning. In Sub-Saharan Africa, unmet need for contraception is 60% higher 
among married women of reproductive age. This study revealed that 32.3% of currently 
married women in Sunyani west had unmet need for pregnancy mistimed or unwanted. 
Thus policy-makers and programme managers need to carefully consider the unmet need 
for family planning when making decisions about service integration especially in the 
Sunyani-west district. 
Respondent’s level of education, spousal communication and their level of autonomy were 
significant predictors for the study while age, occupation, religion, place of residents, 
spousal characteristics, as well as information about family planning though were 
influential determinants, did not show significant relationship in the study. 
The level of education among married women in this study was an important predictor of 
unmet need for family planning. Respondents who completed Senior high school were 
more likely to have high (44.4%) unmet need than no education (20.0%). Married women 
who discuss family planning issues with their husbands were less likely to have unmet 
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need for family planning than those who do not discuss. In addition, Spouses who make 
decision about their wife’s earnings were (37.2%) likely to have unmet need than 
respondents and their husbands (19.1%) who jointly decide on the wife’s earnings. 
Women’s source of information about contraceptives was mainly from health workers, 
friends was the next most popular contraceptive information source. It is informative that 
about one third (31.6 %) of respondents got their information from health workers while 
12.0% of married women have never heard of a method used to delay or avoid pregnancy. 
 
6.2 Recommendations 
 Recommendations for policy makers 
1. Findings of this study suggest higher unmet needs prevalence among women who 
completed senior high school. It is highly recommended that family planning 
education begins at an early age and should specifically target young people in 
second cycle schools, from early teenage years. This needs to be made a sustained 
and continuous process as new cohorts of teenage groups sprout up every year. 
This can be done through the existing School Health Education Program and can 
be expanded in collaboration with Ministry of Health and Ghana Education 
Service.  
2. The Municipal Health Directorate of Sunyani should consider collecting data on 
unintended pregnancies from all its facilities. This will facilitate budget and 
logistic adjustments to meet the contraceptive needs of women in all coverage 
areas at every point in time, preventing unwanted pregnancies as a result of unmet 
needs. 
3.  There is also the need for continuous in-service training for health professionals 
especially field staff to enable them improve on contraceptive counselling, 
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education and the provision  informed choices to women of reproductive age. This 
helps women make right reproductive health choices and are motivated towards 
family planning and contraceptive uptake.  
4. Considering that spousal discussion and approval of earnings influenced 
contraceptives uptake, continuous education and development of policies and 
programs that enhance women empowerment and inclusion in decision making 
with husbands should be considered a necessary component of contraceptives 
campaigns. 
5.  As a form of expanding policy and programme implementation and further 
widening the coverage for family planning services, health authorities should 
consider including religious and cultural leaders as health and development 
partners into the main stream of family planning programme implementation. This 
will encourage and promote family panning discussions in their various 
communities to help shape reproductive preferences among married women, 
particularly in the Sunyani-West district. 
Recommendations for Research 
6.  Considering that this study was done in only one district of the region, experiences 
and prevalence of unmet need in other parts of the region are likely to be different. 
The researcher recommends that a wider survey should be done to ensure a 
universal representation of women’s views before major decisions and 
programmes can be implemented in the region. 
7.  It will also be paramount to consider including other sections of the women 
population, including unmarried women and young teenagers of reproductive age 
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into further studies. This will presents a clearer picture on the unmet needs 
situation in the region, leading to better policy formulation and decision making.  
8.  Other researchers can also consider using a qualitative or mixed method for future 
studies, considering that this study was limited to quantitative methods and as a 
result did not collect much in-depth information.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDICES 
APPENDIX 1 
Informed Consent Form 
University of Ghana, School of Public Health 
Department of Population, Family and Reproductive Health 
CONSENT FORM 
Title: Unmet need for family planning among married women in their reproductive age in 
the sunyani- west district of Brong Ahafo region. 
Consent to participate in study: 
Hello. My name is ……………………………………….. I am doing a research on unmet 
needs among married women in the Sunyani West district 
Dear Respondent, 
You are invited to participate in a research title stated above. You are entreated to read the 
information below very careful before you agree to take part. 
General Information about Research 
The purpose of the study is to explore the nature of unmet need and to identify the key 
factors that explain unmet need among married women in the Sunyani-west district of 
Brong Ahafo region. 
The study will address the three objectives to: 
1. To estimate the level of unmet need among women in the Sunyani West district 
2. To find out the demography characteristics of women with unmet compared to 
women without unmet need in the Sunyani-West District 
3. To determine the socio-economic and context factors associated with unmet need 
in the Sunyani -West district. 
You will be required to answer interview questions which will take you 45 to 60 minutes 
to go through the interview at a convent place of your choice. The findings will be 
discussed by comparing it to other related researches and conclusion drawn. 
 
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Possible Risks and Discomforts 
You will not be exposed to any risk during the research. 
Possible Benefits 
You will not receive any direct benefit for participating but the findings of the study will 
be used for advocacy to get support for the district and also inform health providers 
especially on designing effective interventions to help address issues of unmet need 
among married women in the district. 
Confidentiality 
All the information you will provide will be known exclusively to the researcher and her 
supervisors. Your name will not be included in any of the information you give me. The 
interview will be done at a place where nobody will be able to identify you. The 
information you provide will be kept under lock for five years and if the need to use it 
again arise permission will be sought from you. 
Compensation 
You will be given refreshments after the interview. 
Voluntary Participation and Right to Leave the Research 
Please be assured that your participation in this study is solely voluntary. You have the 
right to participate or refuse to participate and this will not result in any penalty in the 
service you are entitled to. You have the right to drop out of the research at any time you 
desire. 
Contacts for Additional Information 
If you ever have any questions concerning this study you should contact the principal 
investigator Pearl Aovare, from University of Ghana, School of Public Health. Mobile 
phone number; 0245239510 or Professor Augustine Ankomah on 0261524407 who is the 
supervisor of this study. If you ever need more clarifications, you have every right to also 
contact Hannah Frimpong from the Ghana Ethical Review Committee on 0507041223                                                          
 
 
 
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Participant Agreement 
The above document describing the benefits, risks and procedures for the research titled 
“unmet need for family planning: a case study of the Sunyani-West district of Brong 
Ahafo region” has been read and explained to me. I have been given an opportunity to 
have any questions about the research answered to my satisfaction. 
By ticking this box,       I voluntarily agree to participate in the research. 
_____________                                ______________________________ 
Date                                             Signature or thumbprint of participant 
If volunteers cannot read the form themselves, a witness must sign here: 
I was present while the benefits, risks and procedures were read to the volunteer. All 
questions were answered and the volunteer has agreed to take part in the research. 
_____________                                ______________________________ 
Date                                                    Signature or thumbprint of witness 
 
I certify that the nature and purpose, the potential benefits, and possible risks associated 
with participating in this research have been explained to the above individual 
 
_______________________   _____________________________________ 
Date     Name & Signature of Person Who Obtained Consent 
 
 
 
 
 
 
 
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APPENDIX 2: Questionnaire 
QUESTIONNAIRE FOR RESEARCH TO EXPLORE THE NATURE OF UNMET 
NEED AND TO IDENTIFY THE KEY FACTORS THAT EXPLAIN UNMET 
NEED AMONG MARRIED WOMEN IN THEIR REPRODUCTIVE AGE IN THE 
SUNYANI WEST DISTRICT OF BRONG-AHAFO REGION. 
Dear participant, 
Introduction 
My name is Pearl Aovare, I am a Masters in Public Health student from the School of 
Public Health, University of Ghana, Legon. I am interviewing people here in Sunyani 
West district in order to identify the extent of unmet need for planning among women in 
Sunyani West district 
Confidentiality and consent:  
I am going to ask you questions some of which may be very personal.  Your answers are 
completely confidential.  Your name will not be written on this form, and will never be 
used in connection with any of the information you tell me. You may need to know that 
this interview will help me complete my dissertation for the award of my Masters’ degree.  
Your honest answers to these questions will help us better understand how common unmet 
need for family planning is among married women of reproductive age.  The information 
collected from you and people like you will help the government to find solution to poor 
uptake of family planning in this district. I would greatly appreciate your help in 
responding to this questionnaire.  
I would therefore like to take a little of your time for you to answer the following 
questions. 
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_____________________________________________________ 
(Signature of interviewer certifying that informed consent has been given by respondent). 
Result codes: 1…Completed; 2…Respondent not available; 3…Refused; 4…Partially 
completed; 5… Others (Specify). 
Date of interview: ______________ 
Questionnaire code____________ 
Location: _______________ Interviewer name: 
_____________________________________ 
Instruction for interviewer: Except otherwise indicated in the instruction column beside each 
question, only one option is to be ticked 
 
SECTION A: SOCIODEMOGRAPHIC CHARACTERISTICS 
I. Respondent characteristics 
S/N Question Response Code 
1. Age at last birthday  
________________ 
 
 
2.  Level of education No education  
Primary                  
JHS/Technical       
SHS                         
Tertiary                   
1 
2 
3 
4 
5 
 
3.  Occupation Public Worker       
Private Worker     
Self-employed      
Unemployed         
1 
2 
3 
4 
4.  Religion Christian                
Muslim                   
Traditionalist         
1 
2 
3 
 
 
 
ii. Spousal characteristics 
S/N Question Response Code 
1. Age at last birthday  
________________ 
 
 
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2.  Level of education No education         
Primary                  
JHS/Technical        
SHS                          
Tertiary                    
1 
2 
3 
4 
5 
3.  Occupation Public Worker       
Private Worker      
Self-employed       
Unemployed          
1 
2 
3 
4 
4.  Religion Christian                
Muslim                  
Traditionalist        
1 
2 
3 
    
 
SECTION B: KNOWLEDGE AND PERCEPTIONS ABOUT CONTRACEPTIVES 
S/N Question Response Code 
1.  Have you ever heard of any method used 
to delay or avoid getting pregnant? 
NB: If response is NO, Skip to Section 
C. 
Yes        No    1 
2 
2.  Which of the methods listed next have you 
heard of? 
NB: More than one option can be ticked 
Male Sterilisation                     
Female Sterilisation                 
Pills                                             
Intrauterine Device (IUD)       
Injectables/Depo                     
Implants                                    
Male condoms                         
Female condoms                     
Rhythm Method                      
Withdrawal Method               
Lactational Amennorhea 
Method (LAM)                         
Other ___________(Specify) 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
3.  What is your major source of information 
about these methods 
NB: More than one option can be ticked. 
Parents                                      
Sibling                                        
Friend                                         
Government Health facility    
Community Health Worker    
Pharmacy or Chemical Drug 
Seller                                          
TV or Radio                               
Community or religious group                                        
Other _____________Specify) 
1 
2 
3 
4 
5 
6 
7 
8 
9 
 
4.  Have you ever used any method to to delay 
or avoid getting pregnant? 
NB: If response is NO, Skip to Question 
B5 
Yes           No    1 
2     
5. Which of the following methods have you 
ever used? 
Male Sterilisation                  
Female Sterilisation              
1 
2 
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NB: More than one option can be ticked Pills                                           
Intrauterine Device (IUD)     
Injectables/Depo                  
Implants                                  
Male condoms                      
Female condoms                   
Rhythm Method                    
Withdrawal Method            
Lactational Amennorhea 
Method (LAM)                       
Other __________(Specify) 
3 
4 
5 
6 
7 
8 
9 
10 
11 
 
12 
6. If No, for B3, Why have you not used a 
method to prevent pregnancy? 
NB: More than one option can be ticked 
Want more Children             
Infrequent sex                        
Can’t get pregnant/infertility                
Partner opposed                      
Religious prohibition               
Fear of side effects                  
Not bothered/up to God        
Cost                                            
No access to preferred method                                     
Other____________(specify) 
1 
2 
3
4 
5 
6 
7 
8 
9
10 
 
 
7.  Are you currently using any method to 
delay or avoid getting pregnant? 
NB: If No, Skip to B8 
Yes             No    
 
1 
2 
8.  Which of the following methods are you 
currently using? 
NB: Skip to B9 after answering this 
question. 
 
Also, More than one option can be 
ticked. 
 
 
 
 
 
 
 
 
  
Male Sterilisation                   
Female Sterilisation               
Pills                                           
Intrauterine Device (IUD)     
Injectables/Depo                   
Implants                                  
Male condoms                      
Female condoms                   
Rhythm Method                   
Withdrawal Method             
Lactational Amennorhea 
Method (LAM)                        
Other _____________(Specify) 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
 
12 
 
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9.  If No to B6, Why did you stop using? 
NB: More than one option can be ticked. 
 
Has side effects                      
Partner opposes use             
Cost                                          
Preferred method unavailability                            
Not having sex                          
Not bothered though sexually 
active / up to God                   
Has side effects                       
Religious prohibition             
Breastfeeding                          
Menopause                              
Amenorrhoea since last birth                                        
Other___________(specify) 
 
1 
2 
3 
 
4 
5 
 
6 
7 
8 
9
10 
 
 
 
10. Contraceptives are for only adult married 
persons? 
True       False       1 
2 
11. Contraceptive use leads to infertility True        False     1 
2 
12. Contraceptive use promotes promiscuity 
among women 
True       False    1 
2 
13. Breast-feeding is totally effective in 
preventing pregnancy 
True           False   1 
2 
14. Most methods of contraception do protect 
you from sexually transmitted infections 
True            False    1 
2 
15. You can’t get pregnant if the woman 
doesn’t have an orgasm 
True            False   1 
2 
16. Use of injectables after sex can prevent 
pregnancy 
True            False  1 
2 
17. Having sex standing up will not prevent 
pregnancy 
True             False   1 
2 
18. A single condom can be used many times 
to prevent pregnancy 
True              False   1 
2 
19. There is no pregnancy risk if your partner 
isn’t wearing a condom but pulls out 
before he ejaculates? 
True              False   1 
2 
20. Female sterilization is a permanent method 
of contraception 
True              False   1 
2 
21. Withdrawal is one of the newly introduced 
method of contraception 
True               False   1 
2 
 
SECTION C: REPRODUCTIVE CHARACTERISTICS OF RESPONDENT 
S/N Question Response Code 
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1.  When was the last time you had sexual 
intercourse? 
Days ago (less than 1 month)                              
 
Weeks ago (More than 1 month 
ago)                       
 
Months ago (More than two 
months ago)                       
 
More than 1Year ago        
 
1
 
2 
 
 
3 
 
 
4 
2. Have you ever gotten pregnant? 
N/B: If No, Skip to C6 
Yes               No     1 
2 
3. How old were you when you got 
pregnant for the very first time? 
_________________ years 
Don’t know    
1 
2 
4. Are you currently pregnant? Yes            No     1 
2 
5. When you last got pregnant, did you 
want to get pregnant at that time? 
 
Yes            No     1 
2 
6. Did/do you want to have a baby later on 
or did/do you not want any (more)? 
N/B: If No, Skip to C8 
Yes, Later       No, No more     1 
2 
7. If later, how long from then/now? 6-12 months                     
13-18 months                  
19-24 months                  
25- 36 months                 
More than 36 months    
1 
2 
3 
4 
5 
8. How many children would you want to 
have? 
N/B: For those who answered No to 
C2, Skip to C11 after answering this 
questions 
 
____________________ 
 
 
9. Were you using any form of 
contraception (child spacing and family 
planning method) at the time of your last 
pregnancy (at the time you got 
pregnant)? 
Yes               No     1 
2 
10. Did you experience any unplanned 
pregnancy with your spouse in the last 1 
year? 
Yes               No     1 
2 
11. When did you have your last menstrual 
period? 
 
Days ago                                
Weeks ago                             
Months ago                           
In menopause/ has had 
hysterectomy                        
Before last birth                    
Never menstruated              
1 
2 
3 
 
4 
5 
6 
12. Do you intend to use a method to 
prevent, delay or avoid pregnancy the 
next 12 months? 
N/B: If No, Skip to C13 
Yes               No     1 
2 
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13. What is the main reason why you do not 
intend to use a method to delay or avoid 
pregnancy in the next 12 months? 
N/B: More than one option can be 
ticked 
Wants more/as many children 
as possible                                  
Know no method                       
It causes infertility/abortion     
Fear of other side effects         
Cost too much                            
It is religiously prohibited        
No access to family planning 
products                                      
Partner opposed to family 
planning                                     
1 
 
2 
3 
4 
5 
6 
7 
 
8 
 
 
SECTION D: SERVICE PROVIDER FACTORS 
S/N Question Response Code 
1. Have you ever received family 
planning information from a health 
worker? 
N/B: If No, skip to D5 
Yes                                                         
 No                                                 
Can’t remember                          
 
1 
2 
3 
2. If yes, from what health worker? Community Health Worker    
Public Hospital worker            
Private Hospital/Clinic worker                                      
Chemical Drug Store/ Pharmacy                                
Other (specify) _____________ 
1 
 
2
3 
 
4 
 
5 
3. What family planning information did 
you receive from the health worker?     
 
Types of modern family planning methods                                        
Sources of   family planning methods                                        
Side effects and its management                                 
Legible users for each method   
Benefits of family planning         
Other (specify)____________ 
1
2
3 
4 
5 
6 
 
4. Were you satisfied with the care or 
information you received? 
Yes                 No     1 
2 
5. If you have ever used contraceptives, 
what was your source of 
contraceptives? 
N/B: If not ever used contraceptives, 
Skip to Section E. 
 
More than one option can be ticked. 
Friend                                           
Community Health Worker      
Mobile Health unit       
Private health facility                
Public health facility                   
NGO outreach/unit  
Pharmacy/Chemical Drug seller                                             
Other (Specify)______________ 
1 
2 
3 
4 
5 
6 
7
8 
6. If you are currently using 
contraceptives, are you still using the 
same source of contraceptives? 
Yes                No     1 
2 
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7. If No, what is your current source of 
contraceptives? 
N/B: More than one option can be 
ticked. 
Friend                                           
Community Health Worker      
Mobile Health unit                     
Private health facility                 
Public health facility                   
NGO outreach/unit                     
Pharmacy/Chemical Drug seller                                    
Other (Specify)___________ 
1 
2 
3 
4 
5 
6 
7
8 
8. Why did you change your source of 
contraceptives 
N/B: more than one option can be 
ticked. 
Cost                                                 
Lack of preferred method          
Location                                          
Unprofessional attitude of provider                                         
Spousal disapproval                      
Inconvenient provider process   
Other (specify)______________ 
1 
2 
3 
4
5 
6 
7 
9. Are you satisfied with the method you 
use? 
Yes                 No     1 
2 
10.  Do you experience method shortages 
at your service provider? 
Yes                  No     1 
2 
11.  Does the provider describe possible 
side effects and kind of problems you 
can experience when using a specific 
method? 
Yes                  No     1 
2 
12. Does the provider explain what you 
should do if you have side effects from 
a modern family planning method? 
Yes                  No     1 
2 
13. Are you required to provide any of the 
following before given contraceptive? 
N/B: More than one option can be 
ticked 
Proof of Age                        
Spousal Permission              
Laboratory testing                
1 
 
2 
 
3 
14. The process of acquiring 
contraceptives is often embarrassing 
Yes                 No     1 
2 
15. What other service related challenges 
that impede service provision? 
N/B: More than one option can be 
ticked. 
Unprofessional provider attitude                                            
Busy schedule of  service provider                                           
Poor skill of service provider        
Long distance from service provider                                          
Cost of contraceptives                  
Lack of IEC & guideline materials at service 
provider.  
Inadequate number of staff at service 
provider                             
1
2
3 
4
5 
 
6 
7 
 
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Section E: RELATIONSHIP FACTORS 
S/N Question Response Code 
1. Do you discuss family planning issues 
with your spouse? 
N/B: If No, Skip to E4 
Yes                 No     
 
1 
2 
2. How often do you discuss it? 
 
Weekly                                     
Once a month                      
Once in three months         
Rarely, maybe once a year   
Never                                       
1 
2 
3 
4 
5 
3. Who initiates the discussion Respondent                        
Spouse/partner               
1 
 
2 
4. If you currently use contraceptives, is your 
spouse aware of your use 
N/B: If not current contraceptive user, 
skip to E5 
Yes                                        
No                                         
I don’t know                        
 
1 
2 
3 
5. Who decides how you spend most/all of 
your own earnings? 
Respondent                      
Spouse/partner                
Respondent and spouse/partner jointly    
Someone else                    
1 
 
2 
 
3 
 
4 
6. Who usually decides on your health care Respondent                        
Spouse/partner                
Respondent and spouse/partner jointly     
Someone else                     
1 
 
2 
 
3 
 
4 
7. Who usually decides on large household 
purchases? 
Respondent                        
Spouse/partner                 
Respondent and spouse/partner jointly     
Someone else                     
1 
 
2 
 
3 
 
4 
8. Who usually decides on visits to family or 
relatives? 
Respondent                       
Spouse/partner                 
Respondent and spouse/partner jointly    
Someone else                    
1 
 
2 
 
 
 
3 
9. Who usually decides what to do with 
money husband earns? 
Respondent                       
Spouse/partner                
Respondent and spouse/partner jointly   
Someone else                   
1 
 
2 
 
3 
 
4 
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