This study examined the prevalence and determinants of the current use of any contraceptive method in the rural Eastern region of Ghana. The study is relevant as it highlights the prevalence and determinants of the current use of any contraceptive method in the rural Eastern region of Ghana. Previous studies on contraceptives have focused on modern contraceptives in urban and the entire country with few studies in rural areas [27–28]. However, few studies in rural areas do not incorporate contraceptives for any method. Therefore, it is very important we understand the use of contraceptives for any method in the rural Eastern region of Ghana to help inform policymakers on the need to improve contraceptive interventions.
The overall prevalence of contraceptive use was 27.8%, which is very low despite the government of Ghana’s intervention and strategies to increase the use of family planning in Ghana. Though the prevalence rate is low, it is close to the national prevalence rate (25%) reported by the Ghana Maternal and Health Survey in 2017 [7]. This difference could be attributed to an increase in access to information about family planning and contraception use. Also, the prevalence rate in this study is higher than what has been recorded in other studies. Achana et al., [32] reported 13% contraceptive prevalence rate in the Upper East rural areas in Ghana, 16.8% was reported in rural Osun State in Nigeria [33], 13.7% in rural Zambia [34] and 20% in rural Ethiopia [35]. On the other hand, a contraceptive prevalence rate (43%) higher than what was reported in this study was recorded in Zambia [36]. The low prevalence of contraceptive use in this study compared with other studies could be a result of the timing and settings of the study. Though in this study, about 7 out of 10 women had formal education, factors such as fear of side effects of modern contraceptives, myths surrounding contraceptive use, partner opposition, the dominance of men in reproductive decision-making due to the patriarchal system and limited access to family planning products/services could hinder the use of contraceptives [8, 27, 37]. Also, most of the communities in this study were remote areas hence there were few healthcare facilities to provide family services to clients.
We found that age was significantly associated with the current use of contraceptives. The results show that women who were 18–35 and 36–40 were more likely to currently use contraceptives than those who were 41 − 39 years. This implies that adolescents and youth were more likely to use contraceptives to prevent pregnancy than adults. The findings of the study corroborate other studies that reported that age is very significant in the use of contraceptives [35, 38–39]. In rural areas, majority of the adolescent and youth (18–30 years) are sexually active and may understand the consequences of engaging in unprotected sex. Hence, they will use contraceptives to protect themselves from unwanted pregnancies or spacing births [39]. In addition, the few women who may be single may not want to give birth out of wedlock, hence, may be serious about family planning to regulate their sexual activities. In this study, the odds of contraceptive decreases with an increase in age. Though sexual activity for women in their thirties tends to be high, most of them are concerned about giving birth and may reduce contraceptive use. Therefore, they will engage in unprotected sex to enable them to conceive and give birth. However, in the later age groups, there is a decrease in sexual activity as age increases [38]. This, therefore, reduces contraceptives use.
Migration status was found to be significantly associated with contraceptive use in the rural areas in Eastern Ghana. The findings show that migrants are less likely to use contraceptives than non-migrants. This study, however, contradicts findings from a similar study [40] which found that women who migrate, whether from rural to urban areas, rural to rural areas or between urban centers, are more likely to use contraceptives than non-migrant rural women. The. In this study, the probable reason could be the women migrated alone due to economic reasons and may not have their partners around. This could reduce their sexual activity or make them sexually inactive hence not using any contraceptive to prevent pregnancy. However, there may also be a qualitative study to provide in-depth knowledge as to why migrants in rural areas are less likely to use contraceptives.
Our findings point to the influence of the head of household having a significant effect on current contraceptive usage. A household where the head is a partner/husband were more likely to currently use contraceptive than households headed by females. The finding of this study is similar to other studies that have reported that partners/husbands help in female contraceptive usage [8]. Evidence shows that there is no sexual activity in most female-headed households than in male-headed households. In that, a female-headed household may not be single either through divorce, separation or loss of a partner and may not be married at all [41]. Compared to the male-headed household, the partner (female) may be there and may be engaged in sexual activities, which could influence the use of contraceptives among male-headed households than female-headed households.
Limitation Of Study
This study has a number of limitations. First, use of contraception was dichotomous, so we were unable to determine the depth or accuracy of the use of specific contraceptive method women reported they use. Additionally, numerical problems with the data prohibited us from including all contraceptive methods in the analysis. Second, the analysis would be strengthened by the inclusion of more measures at the couple’s level beyond demographics, knowledge of and attitudes towards contraception. Finally, there are limitations due to the study design. Because of the cross-sectional nature of this study, the results should be interpreted with caution as causality assumptions cannot be made. Despite these limitations, these data provide a sample of rural women to inform the literature on factors influencing contraceptive use. Moreover, the limitations of the small sample size and lack of qualitative part are recommended for further studies.