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 of participants between 2003 and 2014 did not change: 35±11.1 in 2003 and 35±11.6 in 2014. There was a decline in the proportion of men who had never been to school - from 17.6% in 2003 to 10.8% in 2014 The proportion of rural dwellers dipped from 54.0% to 52.8% to 46.9%, characterizing growing urbanisation. The proportion of men living below the middle class (poorest and poorer quintiles) decreased from 34.0% in 2003 to 32.2% in 2014.
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. 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 one (1) percentage point decline per annum over the ten-year interval. 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, the inter-survey difference was only significant between 2003 and 2008 (z=6.75, p<0.001) as shown in Table 3.
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Pattern of men’s contraceptive method preference at last sex among users: 2003 – 2014.
The analysis revealed that among the proportion of men who reported contraceptive use at last sexual intercourse, 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 (the pill, IUD, injectable, implant, female condom, female sterilization) increased by more than 10 percentage points (28.8% – 39.4%), with male sterilization being the least preferred method (0.1%). However, a continuous decline occurred from 2003(26.6%) to 2014(19.0%), in Traditional/other methods such as withdrawal, rhythm. (See Figure 2).
Trends in male contraceptive use by selected socio-demographics (2003 – 2014).
Among men who reported contraceptive use at last sexual intercourse, the majority (81.6% in 2003 to 83.0% in 2014) of adolescents used modern male methods, namely male condom and vasectomy/male sterilization. However, an increasing shift in contraceptive method from male condom to modern female methods was observed among men aged 40 years and above from 2003 (45.1%) to 2014 (62.3%). These differences were statistically significant across all surveys (p<0.001). An increasing proportion of contraceptive users from 2003 (34.3%) to 2014 (63.6%) who relied on modern female methods had no formal education.
Difference in inter-regional method preference by users was significant for each survey (p<0.001). By religion, modern methods use increased for both male (43.6% - 52.5%) and female methods (23.3% -29.5%) among catholic men, with a 13.2 percentage point drop in traditional/other method use (31.2% - 18.0%) between 2003 and 2014. This difference in religious distribution of contraceptive use was 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. 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%. The majority of men with no formal education had never used contraceptives (58.0%-61.5%) compared to their counterparts with tertiary education (8.6% - 8.8%).. 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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