Academic journal article Journal of Health Population and Nutrition

Discontinuation of Contraceptive Use in Ghana

Academic journal article Journal of Health Population and Nutrition

Discontinuation of Contraceptive Use in Ghana

Article excerpt

INTRODUCTION

The Ghana Demographic and Health Survey (GDHS) 1998 recorded a total fertility rate (TFR) of 4.6 births per woman, comfortably the lowest national level of fertility in West Africa (1). Fertility has fallen markedly in Ghana since the mid-1980s (1-4). Ghana's entry into fertility decline occurred somewhat later than those observed for black South Africans, in Botswana, Zimbabwe, and Kenya (5-8). More recently, significant reductions in fertility have been observed in many other sub-Saharan African countries, including other West African states, such as Cameroon, Senegal, and Togo (9-11).

Extended periods of breast-feeding and postpartum sexual abstinence have traditionally been of major importance in shaping fertility patterns in Ghana (12). The principal aims of the use of these practices have been to promote child survival and birth-spacing, opposed to limiting the ultimate size of the family (13). Women whose children are too closely spaced may be subject to ridicule and name calling (14-15). In this cultural context when contraception is used, it is often with the aim of ensuring the achievement of culturally-acceptable periods of birth-spacing (16).

Although most women aged 15-49 years, surveyed by the GDHS 1998, had heard of a contraceptive method and nearly half (45%) had used at least one, the prevalence of contraceptive use still remains moderate, with only 18% of women reporting that they were currently using a method of contraception. A significant increase in contraceptive prevalence was observed between 1988 and 1993, but there was a slight decline between 1993 and 1998. While the percentages of women who have never used contraception have declined over time, there have been significant increases in the proportions of women who have used contraception in the past but were not doing so at the time of the survey (henceforth termed 'former users') (1-3).

This paper examined the discontinuation of contraceptive use in Ghana, using data from the GDHS 1998. While discontinuation of contraception has been extensively studied in other parts of the less-developed world, West Africa, with its distinctive patterns of family formation, has received little attention (17). The first section of the analysis describes the background characteristics of former and current users of contraception. The duration of use, the reasons for which former users are not currently using contraception, and the intention to use contraception in the future are then examined. Finally, the wider implications of these patterns for the future course of the fertility transition and for the design of family-planning policies in Ghana are discussed.

MATERIALS AND METHODS

Using a nationally-representative, stratified, two-stage cluster sample, the GDHS 1998 interviewed 4,483 women aged 15-49 years. The response rate for eligible women was 97%. Data on fertility, use and knowledge of family planning, child health, nutrition and mortality, breast-feeding and maternity care, and awareness of AIDS and sexually transmitted diseases (STDs) were collected. The interviews were conducted in local languages between November 1998 and February 1999 (1).

Former users of contraception were asked about the last method they used, the length of time it was used continuously, the main reason for which they were not currently using contraception, and their future intentions about contraceptive use. The GDHS did not collect data on duration of contraceptive use prior to the last method, or the reasons for discontinuation. Current users of contraception were asked which method they were using and the length of time they had been using that method. The use of combinations of methods, for example, combining the use of condoms, withdrawal, and periodic abstinence or double protection from the use of both condom and pill, was not identifiable from the data.

Life tables were generated to describe the duration of use of the last method of contraception by type of method and by background characteristics. …

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