"When you use tramadol, the sperms will not come out. . .": Unconventional strategies for avoiding unintended pregnancy among adolescents in Ghana.

Background: In spite of adolescents' high knowledge about modern contraceptives, usage is low especially in sub-Saharan Africa. Little is known about what adolescents use in place of modern contraceptive methods. Objective: This paper discusses lay strategies that adolescents use in their quest to prevent unintended pregnancy. Methods: A qualitative approach was used in the study reported in this paper. The paper draws on focus group data from a larger study looking at adolescent contraceptive needs in Ghana. A purposive sampling technique was used to select 79 adolescents who participated in a focus group discussion. Eight focus group discussions were held with both male and female adolescents aged 15-19. The data were analysed using the inductive thematic analysis method after transcribing the data. Results: We found that after having sex without using condom, adolescent girls ejected sperms by using water, salt solution or ice cubes, while others engaged in pushing with pelvic floor muscles. In their bid to prevent pregnancy, for boys, engaging in masturbation and the intake of Tramadol before sex was observed. When these lay strategies fail, adolescents resorted to unsafe and illegal abortion. Conclusions: Though adolescents girls engaged in unprotected sex, they still tried to avoid pregnancy, and consequently adopted lay strategies of pregnancy prevention that do not expose them to stigma. It is therefore recommended that the Ministry of Health through the Ghana Health Service consider establishing more adolescent-friendly health centres and expanding existing ones where adolescents could easily visit to have their sexual and reproductive health needs addressed in a very confidential and non-judgemental manner.

Consistent condom use among sexually active young adults in Ghana: an analysis of prevalence and associated factors.

Consistent and proper condom use offers a safer, economically cheap and practically effective means of preventing HIV infection. Using the 2014 Ghana Demographic and Health Survey with a sample of 2779 sexually active youth (males = 682 and females = 2,097) in the age range 15-24, this study explored the prevalence of, and factors associated with consistent condom use among sexually active young adults in Ghana. Multivariate logistic regression was used to analyse the data. Our results showed that approximately 11% of the respondents reported consistent condom use in their previous sexual activity. Females were more likely than males to have used a condom consistently. The logistic regression results showed that females who had tested for HIV were less likely to use a condom consistently. However, those who have obtained family planning information from print media and those from the northern part of Ghana were more likely to practise consistent condom use. Furthermore, males who professed the Traditional African religion were less likely to use a condom consistently. In contrast, males in the rich wealth category were more likely to use a condom consistently. These findings underscore the need for behavioural change campaigns targeting young adults, particularly those who are sexually active, to encourage consistent condom use. These interventions should target young adults with less family planning knowledge, those who know their HIV status and those who profess the Traditional African religion.

Intimate Partner Violence and Health Outcomes Among Women Living With HIV/AIDS in Ghana: A Cross-Sectional Study.

Intimate partner violence (IPV) is known to have negative health consequences for victims. For women living with HIV/AIDS, whose health may be compromised, exposure to IPV can be devastating. Yet few (if any) studies have explored the health implications of exposure to IPV among HIV-positive women. We begin to fill this gap by examining the effects of various dimensions of IPV (physical, sexual, psychological/emotional, and economic) on the cardiovascular, psychosocial, and sexual reproductive health outcomes of HIV-positive women in Ghana. Data were collected from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern Region. We used logit models to explore relationships between IPV and health. The findings indicate high prevalence of IPV in our sample: physical violence (61%), sexual violence (50.9%), emotional/psychological violence (79.6%), and economic violence (66.8%). Generally, participants with experiences of IPV reported cardiovascular health problems, unwanted pregnancies and pregnancy loss, and poor psychosocial health. Our findings suggest the importance of screening for IPV as part of HIV care in Ghana.

Exploring Adolescents' (Non-)Use of Modern Contraceptives in Ghana Through the Lens of the Theory of Gender and Power.

Despite the benefits of modern contraceptives, its usage is low among adolescents in sub-Saharan Africa. Based on the theory of gender and power, this study explored adolescents' (non-)use of contraceptives in the context of their sexual and reproductive health. Data were collected from adolescents (15-19 years) through focus group discussions as well as through interviews with five key informants. The collected data were investigated through thematic analysis. The study revealed that gender and power influenced adolescents sexual behavior. Both young men and young women engaged in risky sexual behavior, which exposed them to unintended pregnancy. Whereas some young women engaged in risky sexual behaviors due to financial reasons, young men engaged in such behaviors for pleasure. Lack of knowledge about the correct use of modern contraceptives, type of sexual relationship, and cultural norms of adolescent girls' appropriate sexual behavior influenced the use of contraceptives by adolescent girls. Avoiding pregnancy could be easier for adolescent girls if only they could have easy access to more long-term and reliable contraceptive methods. Education on the need to use condoms during sexual intercourse should be intensified to create awareness about using condoms to avoid sexually transmitted infections in addition to unwanted pregnancy.

Exploring the Causes of Change in Adolescent Girls' Sexual Behaviour in Begoro, Ghana.

There is a changing trend in adolescent girls' sexual and reproductive behaviour in Ghana. However, contemporary perspectives on adolescent girls' sexual behaviours are largely missing hence this study. Thematic analysis of data collected through in-depth interviews with adolescent girls and community members as well as focus group discussions with adolescent boys identified several factors accounting for the changes in adolescent girls' sexual and reproductive behaviour. These factors include changes in girls' attitudes to traditional practices, diversity in the agents of socialization as well as the age at menarche. This has resulted in a clash of value system between girls' sexual behaviours and that of the elderly. Thus, the social context in which girls are experiencing sexual and reproductive life in Ghana is changing and this must be taken into consideration when designing any intervention to help adolescent girls become resilient in their sexual and reproductive lives.

SOCIAL CAPITAL AND ADOLESCENT GIRLS' RESILIENCE TO TEENAGE PREGNANCY IN BEGORO, GHANA.

This study focuses on how older adolescent girls access and utilize social capital to develop resilience against teenage pregnancy in Begoro, Ghana. A survey of 419 non-pregnant girls aged 15-19 years, selected using a multi-stage cluster sampling technique, was conducted in 2012. Qualitative data were gathered through in-depth interviews with ten girls purposively selected from the survey respondents. Parents, relatives, teachers and religious groups were found to be important sources of social capital for the non-pregnant girls in developing resilience against teenage pregnancy. In addition, resilient girls tended to rely on multiple sources of social capital. It is recommended that stakeholders and policymakers in Ghana ensure that these significant sources of social capital in adolescent girls' sexual experience are equipped with the right information to help girls decrease the risk of teenage pregnancy.

Exploratory Study of the Current Status of the Rights and Welfare of Ghanaian Women: Taking Stock and Mapping Gaps for New Actions.

This paper assesses the progress Ghanaian women have made in terms of rights and welfare in the last three decades or more when democratic politics was introduced in the country. It examines the legislative and policy environment that exist to combat all forms of discrimination against women and assesses women?s rights and welfare on a number of indicators: women?s rights to life, marriage, participation and representation in politics, access to justice, right to education, reproductive health, and sustainable development. The study revealed that there is a robust legislative and policy environment for pursuing women?s issue in Ghana. There are constitutional and legal provisions and state institutions as well as a number of NGOs acting as duty bearers to combat all forms of discrimination against women. However, the evidence from these indicators, suggests that there is a gap between the legal and policy environment on the one hand and the rights and welfare of women on the other hand. Women in Ghana are still threatened by early and forced marriages, deficit in political participation, limited access to health services, and harmful traditional norms and cultural practices. We conclude that duty bearers such as the policymakers and other stakeholders need to scale-up their activities and programmes that advance the rights and social well-being of Ghanaian women.