Using a pragmatic philosophical underpinning, this article analyses how land use planning actions and inactions contribute to flood risk creation in Sekondi-Takoradi, Ghana. In recent times, the planning system in Ghana has come under intense public criticism for failure to effectively control physical development in the major cities. The recurring flooding in the cities of Accra, Kumasi, Tamale and Sekondi-Takoradi seems to testify to this failure. Many lives and property have been lost through these flooding events in the country. This article argues from a disaster risk reduction point of view that the ineffectiveness in elementary processes of land use planning, such as delays in permit approval, inadequate monitoring and inspections, and lax enforcement of regulations, potentially creates flood risk. The rational of this study is therefore to bring to light the land use planning actions and inactions that create flood risk in Sekondi-Takoradi exposing urban dwellers to flooding. Because of the article’s pragmatic underpinning, a mixed-methods case study approach was adopted for this investigation. Both survey and interview data were collected from homeowners and planning institutions in Sekondi-Takoradi to ascertain how land use control practices seem to be contributing to flood risk in the municipality. The analyses comprised simple statistical analysis of the survey data in Statistical Package for the Social Sciences (SPSS) and thematic analyses of the interview data. The findings reveal that institutional incapacities have resulted in delays in permit approvals, non-compliance with permit regulations, uncontrolled conversion of vegetated land, lax monitoring and inspections of physical developments and poor enforcement. These institutional challenges have emboldened prospective land developers and homeowners to flout building and land use regulations. This has led to the building of residential properties in swamps, waterways and other flood-prone locations, creating flood risk.