Standard approaches underestimate fertility awareness-based method (FABM) use; we posit that at least 18% of contracepting Ghanaian women likely use an FABM.n Economically and educationally advantaged women had higher odds of current FABM use (versus intrauterine device/hormonal method), which may suggest deliberateness of method selection (as opposed to limited access to alternatives).n Most (92%) rhythm users wish to improve the effectiveness of their method, and many are willing to track additional biomarkers, but only 17% ever discussed their method with a health professional.