Reproductive experiences and factors influencing contraceptive use among female head-porters in Ghana: A cross-sectional study.

Background and Aims: Female head-porters are a cohort of women who have migrated from their rural communities into commercial cities in search of better economic opportunities. These young women are vulnerable to untoward reproductive experiences. The study assesses the reproductive experiences of women and the factors influencing contraceptive use among them. Methods: A cross-sectional study was conducted from January to May 2021 in the Kumasi Metropolis (n = 280). The study included 280 female head-porters within the reproductive age of 15-49 years. Convenience sampling and consecutive recruitment were used to obtain the needed sample size. All statistical significance was declared at a p-value of <0.05. Results: Forty-two percent of respondents had a history of contraceptive use (all modern or artificial contraception). The study found gravidity (p < 0.0001), parity (p < 0.0001), number of sexual partners post-migration (p = 0.008), and age of first sex (p = 0.033) to be associated with contraceptive use among female head-porters. Conclusion: Fourteen percent had experienced sexual exploitation post-migration, the first sexual encounter of one-third of participants were nonconsensual, 19% had sex at or before 16 years, and 72% were aware of contraception. Reproductive experiences such as gravidity and sexual debut (age at first sex) have a significant influence on the use of contraception.

Give women what they want: contraceptive discontinuation and method preference in urban Ghana.

BACKGROUND: Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. METHODS: Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. RESULTS: Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). CONCLUSIONS: To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.

Sexual and reproductive rights violations at sexual debut of male and female adolescents in Ghana.

OBJECTIVE: To examine the social and ethical challenges in enforcing sexual and reproductive rights of male and female adolescents abused at sexual debut in Ghana. METHODOLOGY: This was a secondary analysis of cross-sectional survey data on 278 sexually experienced male and female teenagers from 12 communities selected by cluster random sampling in the Ejisu-Juben district. We extracted relevant data from a 2009 academic thesis project involving 481 respondents. We assessed differences between sexual debut experiences of males and females using Pearson's chi-square and ANOVA tests. P-values ≤0.05 were considered significant. RESULTS: Mean ages at sexual debut for males and females were 16.05 ± 1.8 and 15.98 ± 1.47 years respectively (P=0.719). Adolescents of both sexes experienced defilement and forced sexual debut; similar proportions had early sexual debut. Females who had early sexual debut were more likely than their older counterparts to have low educational attainment and induced abortion. CONCLUSIONS: Many male and female adolescents experience sexual and reproductive rights breaches at sexual debut. Prevailing circumstances hinder optimization of sexual and reproductive rights of juveniles in Ghana. We recommend making clear provisions for young persons in the law on sexual offences in the criminal code to facilitate development of interventions to improve access to justice for offenders and victims.

Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana.

BACKGROUND: Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension. METHODS: An analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant. RESULTS: A total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or "self-referred" from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01-1.87), preterm delivery at <34 weeks' gestation (adjusted RR, 2.74; 95% CI, 1.40-5.36) and preterm delivery at <37 weeks' gestation (adjusted RR, 1.89; 95% CI, 1.25-2.85), compared to women with chronic/gestational hypertension. CONCLUSION: Women with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.

Postpartum contraceptive choices among women attending a well-baby clinic in Ghana.

OBJECTIVE: To assess postpartum contraceptive choices among women attending a well-baby clinic in Ghana. METHODS: From April 1 to May 31, 2011, a descriptive cross-sectional survey was conducted among women who attended the well-baby clinic of Komfo Anokye Teaching Hospital, Kumasi, at 6-24 months after delivery. Participants were consecutively recruited and interviewed using semi-structured questionnaires. Data were collected on demographics, exposure to family planning counseling, message content, and postpartum contraceptive choices. Differences between the profiles of women who did or did not take up postpartum family planning were assessed. RESULTS: Of the 200 women enrolled, 44 (22.0%) wanted no more children and the last pregnancy was unintended among 88 (44.0%). In all, 110 (55.0%) women took up postpartum contraception, with the calendar method (n=57; 51.8%) and injectable contraceptives (n=22; 20.0%) cited as popular choices. Family planning counseling was received at the prenatal clinic by 47 (23.5%) women, with 12 (6.0%) given written referrals on the postnatal ward. More previous contraceptive users than previous non-users chose long-acting or permanent postpartum methods (P<0.001). CONCLUSION: Inadequate postpartum family planning counseling and referrals during maternity care were recorded, suggesting that a comprehensive educational intervention is required to improve uptake.

Health information-seeking behaviours among pregnant teenagers in Ejisu-Juaben Municipality, Ghana.

OBJECTIVE: to examine health information-seeking behaviours among pregnant teenagers. DESIGN: qualitative design using semi-structured interviews and focus groups. The study followed the Consolidated Criteria for Reporting Qualitative Studies (COREQ). SETTINGS/PARTICIPANTS: antenatal clinic at Ejisu Government hospital, Ghana. Twenty eight pregnant teenagers aged 15-19 and one midwife participated in the study. METHOD: the participants were interviewed in person at the antenatal clinic. The individual interviews and focus groups were digitally recorded, transcribed, and then analysed using thematic framework analysis. FINDINGS: three themes emerged from the analysis of the transcripts: information needs, sources of information and barriers to information seeking. Findings indicate unmet information needs among pregnant teenagers including proper understanding of pregnancy stages, infant feeding practices, nutrition, labour and birth and postnatal care. Pregnant teenagers largely relied on traditional sources for information on pregnancy as compared to official sources such as midwives, nurses or doctors. CONCLUSION/IMPLICATIONS FOR PRACTICE: given that traditional sources, such as family and neighbours were the predominant sources of information, to effectively and comprehensively address the information needs of pregnant teenagers, interventions should target both the expecting teenagers and the family and/or the community at large. The findings further point to a need for a shift in maternal health care policy through the establishment of adolescent only antenatal care day to effectively meet the heath information needs of pregnant teenagers.

Characteristics and contributory factors for injectable contraceptive usage among women in Kumasi, Ghana.

BACKGROUND: Preferred methods of contraception vary from country to country. Family Planning services have been available on a large scale in Ghana since the 1980's and their use has contributed to gradual decline in the total fertility rate from 6.4 in 1988 to 4.2 in 2014. Since their introduction in Ghana in the early 1990's, Injectable contraceptives have seen increasing patronage and are currently the most preferred method of contraception. We set out to identify possible factors contributing to the preference for injectable contraceptives among women in Ghana. METHODS: We conducted a descriptive cross-sectional survey of women accessing contraceptive services at the Family Planning Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Women who reported for the second dose of their injections were eligible to be selected for participation in the study. Informed consent was obtained from eligible participants. Data was collected using a structured questionnaire in January and February 2011. Data captured included age, marital status, highest level of education completed, religion, ethnicity and employment status, previous contraceptive use, sources of contraceptive information and reasons for choosing injectable contraceptives. Quantitative data was entered into a Microsoft Access Database and analysed using Epi Info Version 7.1.4. Qualitative data was analysed thematically. RESULTS: A total of 247 respondents participated in the study. One hundred and seventy three (70.0 %) were using Depot Medroxyprogesterone Acetate and 74 (30.0 %) were using NorethisteroneEnanthate/Estradiol Valerate. The mean age for women on Depot Medroxyprogesterone Acetate was higher than those on NorethisteroneEnanthate/Estradiol Valerate (p < 0.001). The effectiveness of method, recommendation from other users, low incidence of forgetfulness and the relatively longer intervals for administration were the commonest reasons for the use of injectables among respondents. The majority of users, 225 (91.1 %), were satisfied with the method and will recommend it to other potential users. Only 10.8 % of the 68 respondents reporting undesirable effects of the injectables intend to change the method. CONCLUSION: A high level of satisfaction exists among current users of injectables in Ghana and is influenced by a variety of factors. Strategies to increase the uptake of injectables can go a long way to increase the contraceptive prevalence rate and reduce the unmet need for Family Planning in Ghana.

Post-abortion contraception choices of women in Ghana: a one-year review.

Low rates of contraception in much of sub-Saharan Africa result in unplanned pregnancies, which in young, unmarried women often result in unsafe abortion. Increasing the use of highly effective forms of contraception has the potential to reduce the abortion-related mortality and morbidity. In this cross-sectional study, information collected by the post-abortion family planning counsellor was analysed. De-identified data from one year (June 2012-May 2013) were extracted from the logbook. Multivariate linear and logistic regression was performed. A total of 612 women received care for post-abortion complications from June 2012 to May 2013. Young, unmarried women, and those who were being treated for complications arising from an induced versus spontaneous abortion were more likely to report they would use 'abstinence' as their method of contraception following their treatment. This vulnerable group could benefit from an increased uptake of long-acting reversible contraceptive methods to avoid repeated unplanned pregnancies and the potential of future unsafe abortions.

Maternity care provider knowledge, attitudes, and practices regarding provision of postpartum intrauterine contraceptive devices at a tertiary center in Ghana.

OBJECTIVE: To assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. METHODS: A descriptive, cross-sectional study was conducted between June 28 and July 15, 2011. Specialists, residents, house officers, and nurse midwives who had been working in the Department of Obstetrics and Gynecology for at least 3months were included. Self-administered questionnaires assessed formal training, current proficiency in IUD insertion, and attitudes toward postpartum IUD provision. RESULTS: Of 91 providers surveyed, 70 (77%) reported previous training in contraceptive counseling. Fewer than one in three respondents had ever inserted an IUD: 17 (44%) of 39 physicians and 9 (17%) of 52 midwives reported ever having inserted an IUD. A total of 33 (36%) respondents reported that they would recommend an IUD in the immediate postpartum period. CONCLUSION: Although most maternity care providers at KATH had received training in contraceptive counseling, few felt confident in their ability to insert an IUD. Further training in postpartum contraceptive management is needed.

Severe morbidities associated with induced abortions among misoprostol users and non-users in a tertiary public hospital in Ghana.

BACKGROUND: Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana. METHODS: This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher's exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. RESULTS: Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks' gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06). CONCLUSION: Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

Reproductive experiences of teenagers in the Ejisu-Juabeng district of Ghana.

OBJECTIVE: To determine the proportions of male and female teenagers aged 15-19 years who have ever been involved in pregnancy, and to examine factors associated with involvement in teenage pregnancy in the Ejisu-Juabeng district of Ghana. METHODS: In a household-based cross-sectional survey, 481 randomly selected male and female teenagers were enrolled between August 3 and September 17, 2009. Study variables included demographics; sexual exposure; contraceptive use; and involvement in pregnancy, childbirth, and induced abortion. Multivariable multinomial logistic regression analyses were used to examine the association between involvement in pregnancy, and the background and reproductive profiles of the respondents via SPSS version 16.0. RESULTS: Both the mean and median ages of the respondents were 17.2 years. One-third of respondents lived with both parents, and one-third lived with single mothers. The median age of sexual debut was 16.0 years. Approximately 58% of sexually experienced females had been pregnant, and 37% had had an induced abortion. Age at sexual debut, gender, and being out of school were significantly associated with involvement in teenage pregnancy, whereas residential status, relationship with first partner, and contraceptive use were not. CONCLUSION: Keeping adolescents enrolled in school might reduce their risk of involvement in pregnancy in the Ejisu-Juabeng district of Ghana.

Attitude of women with abortion-related complications toward provision of safe abortion services in Ghana.

OBJECTIVES: To determine the attitude and perception of women with abortion-related complications toward the provision of safe abortion services, their sociodemographic characteristics, and their awareness of the law permitting abortion under certain circumstances in Ghana. METHODS: A cross-sectional study using a standardized questionnaire was conducted over a 2-month period among patients admitted with abortion-related complications at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. RESULTS: Abortion-related complications accounted for 42.7% of admissions to the gynecological ward. The median age of the women was 26 years. Of the 296 patients interviewed, 28% reported induced abortion in the index pregnancy, 29% were not married, 30% had no formal education, and 92% were not aware of the current legal status of abortion in Ghana. They thought there was the need to provide safe abortion services in the country, and almost all of them were willing to patronize such services. CONCLUSIONS: Awareness of the current legal status of abortion was lacking among women with abortion-related complications attending a tertiary center in Kumasi. However, the provision of safe abortion services was much needed in this population.