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

Abstract

Objective: To understand the barriers and facilitators of hormonal contraceptive use among Ghanaian women, in order to help improve contraceptive counseling and reduce the high rates of unintended pregnancy. Study design: We conducted a nationally representative community-based survey of 4143 women aged 15-49 in 2018, and used descriptive statistics and logistic regression to examine correlates of current hormonal method use, preferred method attributes and their association with method choice, and the role of side effects in hormonal method discontinuation. Results: Hormonal method use (vs. contraceptive non-use) was associated with younger age, higher parity and education, but not with union status, wealth or residence. Preferences for key method attributes were associated with choosing particular methods. Most valued attributes were effectiveness at preventing pregnancy, and low risks of harming health and future fertility. These last 2 concerns are echoed in the second most common reason for discontinuation (health concerns). While menstrual changes were a common concern, leading some respondents to discontinue hormonal contraceptives, many were willing to endure these effects. In contrast, having experienced long-term health issues as a perceived result of hormonal method use more than halved the odds of current use. Contraceptive counseling on menstrual changes, other side effects, and impacts on future fertility had not been universally provided. Conclusions: Ghanaian women value hormonal methods for their effectiveness against pregnancy. However, concerns about side effects (particularly bleeding changes), future fertility impairment, and longterm health issues led some women to discontinue hormonal methods. Counseling on these issues was reportedly inadequate. Implications: Identifying barriers to, and facilitators of, hormonal contraceptive use, as well as method attributes important to Ghanaian women, can help to better tailor contraceptive counseling to individual needs, in order to ensure that all women can access the method that suits them best, and decide whether and how to manage side effects, switch methods or discontinue.

Use of Fertility Awareness-Based Methods for Pregnancy Prevention Among Ghanaian Women: A Nationally Representative Cross-Sectional Survey

“…Prior analyses of these data showed that among all respondents aged 15-49 years in our sample who had ever had sex (n=4,139), 33.7% currently reported using any contraceptive method. 44…”

Factors That Influence Contraceptive Use Among Women Aged 35 - 49 Years and Their Male Partners in Gomoa West District, Ghana: A Qualitative Study

“…A major concern of using MCMs is side effects as has been established by several studies conducted in LMICs and sub-Saharan Africa [12,14,28].The experience of side effects resulted in discontinuation of MCMs, switching between MCMs or shifting to TCMs. Moreover, the fear of side effects as a result of the experiences of friends or close relatives was the reason for the nonuse of MCMs, as reported by studies in Ghana [29,30,31,32,10]. The reported side effects were headaches; dizziness; heart palpitations; and irregular, ceased or excessive menstruation.…”

Contraceptive and abortion practices of young Ghanaian women aged 15–24: evidence from a nationally representative survey

“…Young people’s preference for condoms and withdrawal over hormonal methods appears somewhat discrepant with their ranking effectiveness as their most valued method attribute. One explanation is inaccurate perceptions around the relative effectiveness of various contraceptive methods [ 37 ]. Alternatively, their method choices may be explained by other top attributes: no risk of harming health or future fertility.…”

“…Data for this analysis come from a 2018 nationally representative household-based survey of Ghanaian women aged 15–49. Information on the study design and sampling plan are described in depth elsewhere [ 37 ]. Trained interviewers administered a structured questionnaire face-to-face in a private area using password-protected Android tablets enabled with Open Data Kit.…”