Misperception and Myths About Contraceptive Use in Ghana
Misperception and Myths About Contraceptive Use in Ghana
We found fear of side effects to be a leading reason for non-use of contraception. Menstrual irregularities due to hormonal methods, and concerns that contraception can lead to infertility, particularly among young women, emerged as key themes. Hearsay about side effects and misinformation were common reasons for non-use. Women believed that blood tests are required for clinicians to recommend the best method for an individual woman.
Despite the consistency in themes that emerged, there are some limitations to our study. Our sample was limited to women who were attending clinics in a local hospital in the capital city who are likely to be different from women not seeking health care for themselves or their children and women in rural areas. We did not interview providers or male partners, who are a likely influence in the decision to use contraception. Despite these limitations, we were able to get a wide cross-section of women and find common themes.
Some of the key findings match some of what has been found in other settings. Women in our sample relied on hearsay about contraception, as found in Kenya. Concerns regarding menstrual irregularities and concerns that hormonal methods cause infertility, particularly for younger women, have been documented elsewhere. We found that few women had a clear knowledge of how methods are used or how they worked. Nationally representative data from DHS reports on knowledge of methods based on the combination of unprompted and prompted awareness of each method. This measure of awareness rather than knowledge may lead to the false sense that efforts to educate the population on methods are not needed. In addition, providers in Ghana and elsewhere in Africa may perpetuate some of the misinformation that women reported.
The belief that blood tests are necessary to determine the appropriate contraceptive method has not been documented elsewhere. In part, this finding may be due to the sample being hospital-based. The perceived need for blood tests may be inhibiting uptake of methods readily available at pharmacies (condoms, oral contraceptives and emergency contraception). Further work is needed to see if this belief is more widespread, particularly in rural areas where women may have poor access to health facilities.
Targeted efforts are needed to address real and perceived side effects, as well as provider-level training, particularly at hospitals and clinics, to ensure that women know what to expect when using modern contraceptive methods. While we did not document potential supply-side issues such as the unavailability of methods or poor method mix, it is essential that facilities have adequate stocks and offer a variety of methods for new users and users who want to switch methods. In addition, basic information about reproductive biology is needed. This could be accomplished with mass media, school-based curricula and provider training. Educational videos in waiting areas in antenatal, postnatal, child welfare and other wards, where women often spend many hours, could provide this information.
This study highlights some of the important barriers that need to be surmounted to create a greater demand for family planning in Ghana. Women need reliable sources of information and better access to trained providers who can address their concerns. Retraining providers is both time and resource intensive. An additional approach could be to reinvigorate the mass media campaigns of the late 1980s and 1990s. While mass media campaigns are often difficult to evaluate properly, they have been shown to be effective in increasing contraceptive use. By taking a multi-faceted approach, the myths and misperceptions that Ghanaian women report regarding contraception could be overcome.
Conclusions
We found fear of side effects to be a leading reason for non-use of contraception. Menstrual irregularities due to hormonal methods, and concerns that contraception can lead to infertility, particularly among young women, emerged as key themes. Hearsay about side effects and misinformation were common reasons for non-use. Women believed that blood tests are required for clinicians to recommend the best method for an individual woman.
Despite the consistency in themes that emerged, there are some limitations to our study. Our sample was limited to women who were attending clinics in a local hospital in the capital city who are likely to be different from women not seeking health care for themselves or their children and women in rural areas. We did not interview providers or male partners, who are a likely influence in the decision to use contraception. Despite these limitations, we were able to get a wide cross-section of women and find common themes.
Some of the key findings match some of what has been found in other settings. Women in our sample relied on hearsay about contraception, as found in Kenya. Concerns regarding menstrual irregularities and concerns that hormonal methods cause infertility, particularly for younger women, have been documented elsewhere. We found that few women had a clear knowledge of how methods are used or how they worked. Nationally representative data from DHS reports on knowledge of methods based on the combination of unprompted and prompted awareness of each method. This measure of awareness rather than knowledge may lead to the false sense that efforts to educate the population on methods are not needed. In addition, providers in Ghana and elsewhere in Africa may perpetuate some of the misinformation that women reported.
The belief that blood tests are necessary to determine the appropriate contraceptive method has not been documented elsewhere. In part, this finding may be due to the sample being hospital-based. The perceived need for blood tests may be inhibiting uptake of methods readily available at pharmacies (condoms, oral contraceptives and emergency contraception). Further work is needed to see if this belief is more widespread, particularly in rural areas where women may have poor access to health facilities.
Targeted efforts are needed to address real and perceived side effects, as well as provider-level training, particularly at hospitals and clinics, to ensure that women know what to expect when using modern contraceptive methods. While we did not document potential supply-side issues such as the unavailability of methods or poor method mix, it is essential that facilities have adequate stocks and offer a variety of methods for new users and users who want to switch methods. In addition, basic information about reproductive biology is needed. This could be accomplished with mass media, school-based curricula and provider training. Educational videos in waiting areas in antenatal, postnatal, child welfare and other wards, where women often spend many hours, could provide this information.
This study highlights some of the important barriers that need to be surmounted to create a greater demand for family planning in Ghana. Women need reliable sources of information and better access to trained providers who can address their concerns. Retraining providers is both time and resource intensive. An additional approach could be to reinvigorate the mass media campaigns of the late 1980s and 1990s. While mass media campaigns are often difficult to evaluate properly, they have been shown to be effective in increasing contraceptive use. By taking a multi-faceted approach, the myths and misperceptions that Ghanaian women report regarding contraception could be overcome.