Many women report that they will not use modern contraceptives despite the availability of contraceptive methods and the unmet family planning needs in Ghana. This study examined the use of modern family planning methods in rural Ghana and looked at the impact of side effects on women's decision to continue or stop using them.
Methods
The exploratory mixed-methods survey included 281 questionnaires and 33 in-depth interviews with women aged 18 to 49 in the Amansie West District in Ghana, between May 2018 and July 2018. The survey evaluated contraceptive use as well as predictors. In-depth interviews examined the context surrounding contraceptive use and its continuation, particularly concerning the impact of side effects experienced and perceived.
Results
The percentage of women with a sexually active partner who wants to avoid pregnancy was 68.9%. There were no significant differences in the proportions of those with a met or unmet need for modern family planning. Qualitative interviews raised concerns about side effects based on past experiences with family planning and rumors about the perceived long-term and short-term consequences. Some side effects are menstrual changes, such as heavier bleeding, amenorrhea and oligomenorrhea, infertility, and complications during childbirth.
Conclusion
While programs have made it easier for women to access modern family planning, addressing patient-level barriers, including misconceptions and side effects, is important. Comprehensive counseling on contraceptive options, including information about side effects and contraceptive technology development that meets women's needs in low-income countries, can reduce unintended pregnancies.
Background
Modern family planning is a cost-effective way to reduce high-risk pregnancies and decrease unsafe abortions. It also allows for birth spacing and limits . In 2017, 214 million women still needed modern family planning, despite advances in contraceptive technology.
It is crucial to understand what factors and characteristics influence a woman's decision about modern family planning to provide the best family planning services. Family planning can be influenced by demographic factors such as age, family size, and distance from a healthcare facility. Women's perceptions and norms also influence family planning. There may be cultural or religious pressures on women to avoid family planning. These are often rooted in the belief that family planning is unfaithful or impairs procreation goals.
Modern family planning methods can have side effects that are either anticipated or experienced. This is why many women choose to discontinue or not start contraceptives. Side effects include changes in menstrual patterns (heavier bleeding or oligomenorrhea), weight changes, dizziness, nausea, and cardiovascular issues. Women may also be concerned about the long-term effects of contraceptive use on their fertility and childbirth. A systematic review in 2014 found that many women attribute their unmet family planning needs to fear of side effects. This was 28% in Africa, 23% in Asia, 35% in Latin America, and 35% in the Caribbean . Fear of side effects can occur when a woman, or someone she knows, has had side effects from a method or when rumors, overestimations, or rare complications are accepted as fact
Despite a strong family planning program, Ghana's unmet family planning needs have been high in Africa for decades. Ghana's unmet family planning need for married women is 32.9, while many other countries, such as Nigeria (26.2), Senegal (23.7), or Cote d'Ivoire (30.9), have lower rates. There are many contraceptive options available in both public and private healthcare facilities. These include injectables and hormonal birth control pills. There are 22 public health facilities in the Amansie West region. These include 6 health centers, 16 Community-based Health Planning and Services compounds, 5 private facilities, and 1 hospital. These health facilities offer modern family planning options (pills and intrauterine devices (IUDs) and implants), which can be administered by qualified medical doctors, midwives, and community health officers. Nurses in health facilities can administer condoms and pills. Condoms, pills, and injectables can be purchased at drug shops and pharmacies outside hospitals.
Although contraceptives are now easily accessible, around one-third of married women still have an unmet family planning need . One in four contraceptive users stopped using modern family planning methods within the first year, despite a 5 to 22% rise in their use between 1988 and 2014. Side effects and other health concerns were the main reasons people quit injectables or implants. This trend has continued
The study aimed to understand modern family planning in rural Ghana. We first sought to determine the extent of family planning usage in modern Ghana and the unmet family planning needs. We also identified factors contributing to unmet family planning needs at the individual, household, and healthcare levels. We also sought to qualitatively analyze and understand women's experiences and choices regarding family planning, focusing on side effects. These data will help to inform the delivery and use of modern contraceptives for women who want to limit or delay their pregnancies.
Methods
Setting
The exploratory mixed-methods study occurred in the Ashanti Region's Amansie West District. The area's population is almost entirely rural (95.6%), and there has been an annual growth rate of 2.7% in the population
Sampling
This study comprised 281 household surveys and 33 in-depth interviews with women aged 18 to 49 from six sub districts within the Amansie West District. The data were collected from May 2018 to July 2018 as part of a larger study examining community health workers' role in family planning. Sixteen of seven districts within the Amansie West District have been selected for their accessibility and penetration to the national CHW program. Six sub-districts were broken down into 11 geographic zones that contained at least 100 women between 18 and 49 years of age whose households were registered by a CHW. In each zone, 30 women were recruited on average. This was to ensure that we had geographic representation. The final sample size was determined by the resources in the study. A subset of household survey respondents was selected for an in-depth interview. Participants in the in-depth interview were chosen based on their current, past, or lack thereof, use of modern methods.
Procedures
Six female research assistants were trained in research ethics and procedures to collect survey data. They were bilingual in English as well as Twi. They approached women at their homes to inform them of the study and invited them to participate. The interview was conducted using an electronic tablet and took about 45 minutes. Participants were asked at the end of the interview if they would be interested in participating in an in-depth interview. If yes, their contact information was taken to schedule the interview.
Three bilingual nurses from the area were trained in qualitative and research ethics to conduct in-depth interviews. Participants were scheduled for IDIs at their homes conveniently and with maximum privacy. Participants received a separate written consent, which included consent to an audio recording. The IDIs were conducted using Twi and took an average of 30 minutes. After each interview, field notes were taken and later shared with the entire research team.
Instruments
Structured survey
The structured survey was developed based on an analysis of the literature and consultations with local public health professionals. To verify the accuracy, the survey was translated into Twi by locals and then reviewed by multiple people. The survey was tested in a rural community before data collection. This resulted in minor modifications.
The survey covered the following constructs: demographics, pregnancy history, knowledge and perceptions of contraceptives; use and intention to use contraceptives (a= 0.81); depression PHQ-9(a= 0.74); autonomy; partner communication (a= 0.74); freedom of coercion (a= 0.80); and support for partners
Interviews in depth
Interviews were conducted using a semistructured guide. It included open-ended questions that probed community and individual views on family planning. Local public health professionals reviewed and tested the interview guide for this study. Research assistants translated the guide into Twi during interviews to adapt the phrasing to a casual, natural conversation.