Table 1 presents socio-demographic characteristics of respondents. In all the three surveys, a higher proportion of males were aged 25-39 years. The mean age participants between 2003 and 2014 did not change: 35±11.1 in 2003 and 35±11.6 in 2014. There was decline in the proportion of men who had never been to school - from 17.6% in 2003 to 10.8% in 2014. Corresponding increases in the proportion of men who had secondary and tertiary education occurred over the same period. The proportion of rural dwellers dipped from 54.0% to 52.8% to 46.9%, characterizing growing urbanisation. Across the entire period, less than 10% were unemployed, and among the employed, majority were engaged in Agriculture (44.3%-32.2%) and manual jobs (23.6%-32.5%). The proportion of men living below the middle class (poorest and poorer quintiles) decreased from 34.0% in 2003 to 32.2% in 2014. Less than 10% of respondents were separated or co-habiting.
Table 2 presents demographic and sexual and reproductive health characteristics of participants. The proportion of married men reduced by approximately 8 percentage points, while the proportion of men who had never married or been in a recognised union increased by about 7 percentage points. Over half remained in monogamous relationships (55.4% – 52.9%) as polygynous relationships decreased (7.0% – 4.3%). Between 32.4% and 34.8% had no living children whilst, 21.9% to 23.1% reported five (5) or more surviving children. Men’s knowledge of any contraceptive method appeared almost universal over the period (99.6% - 99.7%) although a small proportion (4.4% – 5.6%) reported uneasy access to contraceptives like condoms.
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Trends in contraceptive use among men: 2003 – 2014
A downward trend in contraceptive use among sexually active Ghanaian men was noted from analysis. Contraceptive use declined from 44.3% in 2003 to 35.6% in 2014, suggesting a nearly 1 percentage point decline per annum over the ten-year interval. Realistically, an acute decline occurred in 2008, followed by a marginal drop of about 0.08% between 2008 and 2014 (Figure 1). Conversely, there was an increasing trend in sexual activity among Ghanaian males over the same period of time from 77% to 81.3%, widening the gap between sexual activity and contraceptive use (Figure1).
Changes observed in male contraceptive use were significant overall (z=6.84, p<0.001) between 2003 and 2014. However, between successive surveys, the difference was only significant between 2003 and 2008 (z=6.75, p<0.001) but not 2008 and 2014 (z=0.16, p=0.873) as shown in Table 3.
Pattern of men’s contraceptive method preference at last sex among users: 2003 – 2014.
The analysis revealed that among the proportion of male contraceptive users, there was a drop from 2003(44.5%) to 2014(41.5%) in male condom use across the period of the study. Modern female methods increased by more than 10 percentage points (28.8% – 39.4%), with male sterilization being the least preferred method (0.1%). The 2008 survey which serves as the mid-period in this analysis recorded hikes in male condom (49.8%) and sterilization (1.7%) uptakes but a dip (26.4%) in modern female methods (the pill, IUD, injectable, implant, female condom, female sterilization)). However, a continuous decline occurred from 2003(26.6%) to 2014(19.0%), in Traditional and Folk methods (Figure 2).
Trends in male contraceptive use by selected socio-demographics (2003 – 2014).
Among MC users, majority (81.6% in 2003 to 83.0% in 2014) of adolescents used modern male methods. However, adult male contraceptive users age 40 years or more were increasingly shifting reliance onto modern female methods from 2003 (45.1%) to 2014 (62.3%). These differences were statistically significant across all surveys (p<0.001). An increasing proportion of MC users from 2003 (34.3%) to 2014 (63.6%) who relied on modern female methods had no formal education. Among educated males, 30% to 68% depended on modern male methods across the study, a difference which was only significant for 2003 and 2008 (p<0.001).
Difference in inter-regional method preference by users was significant for each survey (p<0.001). By religion, among Catholic MC users, modern methods use increased for both male (43.6% - 52.5%) and female methods (23.3% -29.5%), with a 13.2 percentage point drop in traditional and folk method use (31.2% - 18.0%) between 2003 and 2014. Similarly, Traditional and other faith groups recorded an increased modern female method use in 2014(54.4%) than in 2003(28.8%), and a drastic decline in traditional and folk method use (26.6% - 4.7%) between the same period. The religious differences in contraceptive preference were significant for 2003 (p<0.001) and 2014(p<0.01) as shown in Table 4.
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The results (Table 5) shows that over a third of male adolescents (35.3%-34.5%) [2003 – 2008] had never used any contraception, and over the same period, an increasing proportion (23.1%-30.6%) reported inconsistent contraceptive use. Again, a decreasing proportion (41.6% in 2003 to 34.9% in 2008) of adolescents reported consistent contraceptive use. Conversely, majority of men aged 40 years and above were inconsistent contraceptive users in 2003(35.4%) and 2008(44.6%). This difference in contraceptive use consistency between age groups was statistically significant (p<0.001) in the two surveys.
Between 2003 and 2008, over a third of rural dwelling men had never used contraceptives (33.9%-33.7%), whilst consistent rural male contraceptive users decreased from 36.4% to 28.4%. For uneducated men, majority had never used contraceptives (58.0%-61.5%) compared to their counterparts with tertiary education (8.6% - 8.8%). Over half the men in the Savanna-North geographical region had never used contraceptives over the period (50.8%-51.1%), compared to only a fifth of their counterparts in the Coastal region (19.1% -19.3%). Place of residence, Educational attainment, occupation, region of residence and religious affiliation were all statistically significant with men’s contraceptive use consistency in the two surveys (p<0.001).
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