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. 2023 Jun 8;18(6):e0286585. doi: 10.1371/journal.pone.0286585

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana

Ebenezer Jones Amoah 1,*, Thomas Hinneh 2,*, Rita Aklie 3
Editor: Akaninyene Eseme Bernard Ubom4
PMCID: PMC10249812  PMID: 37289674

Abstract

Introduction

Contraceptive use among sexually active women in Ghana remains low despite the efforts by the Ghana Health Service. This development has negative consequences on reproductive health care, particularly among adolescents. This study assessed the prevalence and factors influencing contraceptive use among sexually active young women in the Berekum Municipality, Ghana.

Method

A community-based cross-sectional analytical study was carried out in Berekum East Municipality among young women between the ages of 15 to 24 years. Using a probabilistic sampling technique, we recruited 277 young women from the four selected communities in the Berekum Municipality based on data available from the Municipal Health Administration. We applied a univariate and multivariate logistic regression analysis to test the associations between the dependent and independent variables at a 95% Confidence interval (CI) and 5% significance (p value = 0.005).

Results

The modern contraceptive prevalence rate among the study participants was 211 (76%). Contraceptives ever used were emergency contraceptive pills 88 (41.7%) condoms 84 (39.8%), injectables 80 (37.9%) and the rest used the Calendar method 16 (7.58%), withdrawal 15 (7.11%), and implants 11 (5.21%). In the adjusted multivariate logistic regression, Age (AOR = 2.93; 95% CI; 1.29–7.50) p = 0.023, marital status (AOR = 0.08; 95%CI; 0.01–0.91) p = 0.041 and religion (AOR = 0.17; 95% CI; 0.05–0.64) p = 0.009 were significantly associated with contraceptive use. Other determinants such as hearing about contraceptives (AOR = 9.44; 95%CI; 1.95–45.77) p = 0.005, partner opposition (AOR = 33.61; 95%CI; 1.15–985.39) p = 0.041, side effects (AOR = 4.86; 95%CI; 1.83–12.91) p = 0.001, lack of knowledge (AOR = 5.41; 95%CI; 1.15–25.42) p = 0.032, and respondents receiving counselling on family planning were significantly associated with contraceptive use (AOR = 4.02; 95% CI;1.29–12.42), p = 0.016.

Conclusion

Contraceptive use among sexually active women in the Berekum Municipality is higher than the national conceptive prevalence rate. However, factors such as knowledge about the side effects of contraceptive influences contraceptive use among women. Healthcare providers must explore avenues to enhance partner involvement, intensify health education and detailed counselling about contraceptive use to address misconceptions and myths surrounding the side effects of contraceptives.

Introduction

Unplanned teenage pregnancy is an issue of public health concern since both unintended pregnancy and pregnancy at a young age are linked with negative health consequences for the mother and the infant [1]. About 218 million unwanted pregnancies, fifty-five (55) million unintended births, 138 million abortions and 118 million maternal deaths were averted in developing countries owing to the subscription to family planning methods [2]. Global performance towards achieving the SDG target on family planning and conception stands at 75.7%, with middle and western Africa doing less than 50% [3]. Despite these substantial gains, about 222 women in developing countries still have unmet family planning and contraception needs [4]. Only 21% of women of reproductive age who are married or in cohabitation utilize some type of contraception in Sub-Saharan Africa [5].

In Ghana, unsafe abortion is the second leading cause of pregnancy-related deaths accounting for 20.7% of all-cause put together [6]. Younger women are at a higher risk of dying from abortion-related complications in Ghana [7]. Given that most adolescents indulge in sexual activities even before age 17 years, there is a need to improve adolescent reproductive family planning services to meet the needs of this population [8]. Moreover, younger women have reported more unwanted births than older women in Ghana [9]. The Ghana Statistical Service suggests that about 30% of pregnancies and births occur among young adolescent women in Ghana [10, 11]. Given the increased teenage sexual activity and decreased age of first sex in low-income countries, the use of contraception will be essential in preventing unintended pregnancy and unsafe abortion [12].

The use of contraception in Ghana appears to be low, leading to high rates of unwanted pregnancies, unintended births, unsafe abortions, and maternal mortality [13]. In the past years, Ghana has made strides in eliminating barriers to access to family services through the Costed implementation plan (CIP) initiative [10]. Besides the gains made through the CIP, limited access to family planning services, compounded by limited human resources across health facilities continue to undermine contraceptive utilization in Ghana [10]. Currently, modern contraceptive rates stand at 22.2% among all women in Ghana [14]. Despite the benefit of family planning and contraceptive, uptake of contraceptives among adolescents is affected by numerous socio-cultural and demographic factors [15, 16] which includes cultural beliefs, peer influence, religion, and fear of side effects [17, 18] father’s educational background and prior discussion of contraceptive use with a partner [19, 20] age of adolescent, education, work status, knowledge of ovulatory cycle, visit of health facility, non-youth-friendly health services and marital status [21, 22] spouses or partners made the decision for them to utilize contraception [23]. Other health-related factors reported includes counselling on contraceptive and health provider attitudes [24, 25].

The Berekum East Municipality, between 2018–2019, recorded pregnancy rates of 26.5% and 32% among young people aged 10–24 years [26]. Although studies have reported poor uptake of contraceptives across the various communities in Ghana and mostly these respondents are adolescents, data on family planning utilization among the female youth is limited in the Berekum municipality [11, 27]. As a result, the purpose of this study is to ascertain the prevalence and factors determining contraceptive usage among female youth in Berekum Municipality.

Materials and methods

Study design

This cross-sectional analytical study was conducted between June and July 2020 in the Berekum East Municipality.

Study setting

The Municipality covers a total land area of about 863.3 sq. km. It is bordered to the northeast and North-west by Tain District and Jaman South Districts respectively, South-west by Dormaa East District and Sunyani West District to the southeast. The municipality has the following: two hospitals, a health centre, seven rural clinics, four maternity homes, two private clinics and ten Community Health Planning Services (CHPS) serving a total population of 106,741 people. The Total Fertility Rate for the municipality is 2.8. One facility within the municipality does not provide family planning services. Four sub-municipalities (Berekum central, Zongo, Kato and Mpatasie) and a community within each selected Municipality were chosen for the study.

Study population

The study population included all female youth aged 15 to 24 years in Berekum Municipality who are sexually active.

Females who lived in the study area for at least six months and consented to the study were included. This enabled us to sample participants who have adequate contextual and cultural understanding of contraceptive use in the locality.

Sampling techniques

The probability sampling technique was employed. simple random was used to select four sub-municipals out of five sub municipals. the sample size was allocated to each selected sub municipal proportionally based on their expected number of women in reproductive age in each sub municipal. A community was selected randomly from the four sub municipals. The study participant was selected by systematic random sampling method for the households every 8th household. A central reference point, such as a borehole, church, or mosque, was identified in each community. If the chosen household did not have an eligible youth, the next household in the same direction was chosen until the appropriate sample size for the community was reached. In the household, the study was explained to the household members, and approval was sought from the head. Residents between the ages of 15 and 24 were invited individually to a secluded place by the research assistant to inquire about sexual activity, and those who fulfilled the criteria were asked to participate. After explaining the study’s objectives, informed consent was sought, and a questionnaire was administered in English or a local language understandable by both the research assistant and the participant. In the instance of teenagers under the age of 18, consent was sought from a parent/guardian, with assent from the adolescent.

Data collection techniques

Four research assistants were trained for the data collection from each community. The research assistant visited the chosen communities to select households and recruit participants. A structured questionnaire was used to collect data. The first section of the questionnaire collected information of participants’ socio-demographic characteristics including age, marital status, educational level, religion, ethnicity, place of residence, and person living with. The second section of the questionnaire focused on sexual behaviors and knowledge of modern contraceptives. The third section elicited information about potential barriers and facilitators of modern contraceptive use. Modern contraceptive methods include contraceptive pills, implants, injectables, intrauterine devices (IDU), female and male condoms, female and male sterilization, vaginal barrier methods (including the diaphragm, cervical cap, and spermicidal agents), lactational amenorrhea method (LAM), emergency contraception pills. Knowledge was measured as ever heard (Yes/No), use of modern contraceptives (Yes/ No) and mention of at least one of the modern contraceptive methods.

Sample size calculation

The study population included all youth aged 15 to 24 years in Berekum Municipality. The sample size was calculated in Epi Info, version 7.1.1.14 (Centers for Disease Control and Prevention, Atlanta, GA, USA). To achieve 80% power, we allowed 95% confidence intervals (CIs) and a 5% margin of error and accounted for 10% contingency. We calculated that a sample size of 277 would have adequate power (80%) to detect factors with use of Epi info StatCalc.

Statistical analysis

Descriptive statistics were adopted to describe the factors associated with contraceptive use using the statistical software STATA version 15. A Chi-square test was used to measure the association or relationship between the outcome variable (contraceptive use) and the explanatory variables. Regression analysis (logistic regression) was employed to assess the odds ratio (ORs) of the factors associated with contraceptive use at a 95% Confidence interval (CI) and 5% significance (p value = 0.005).

Ethical consideration

Ethical approval for the study was obtained from the Committee on Human Research, Publications and Ethics (CHRPE) of KNUST with reference number CHRPE/AP/306/20. Written consent was sought from the study participants after an informed consent form was read and explained to them. While those below 18 years, consent from parents/guardian was sorted before obtaining assent from each respondent. We assured privacy and confidentially of information collected during the process.

Results

Socio-demographic characteristics of the respondents

A total of 277 females were approached to participate in the current study. The mean age of the respondents was (mean SD) 19 ± 2.6 years. More than half,148 (53.4%) of the respondents were between the ages of 15–19 years. Almost half of the respondents 114 (41.2%) and 107 (38.6%) have had Primary/JHS and Secondary education respectively. The majority 170 (61.4%) of the study population were students and a vast majority 202 (73%) were from the Akan tribe. About 223 (81%) and 234 (84.48%) of the respondents were single and were Christians respectively. Most respondents 169 (61.0%) reside in rural areas and 125 (45.1%) live with both parents (Table 1).

Table 1. Socio-demographic characteristics of participants.

Variables Freq. Percent
Mean Age (SD) 19 (2.6)
Age group
15–19 148 53.43
20–24 129 46.57
Education level of Respondent
No formal Education 30 10.83
Primary / JHS 114 41.16
Secondary 107 38.63
Tertiary 26 9.39
Occupation of Respondent
Apprentice 55 19.86
Employed 20 7.22
Students 170 61.37
Unemployed 32 11.55
Ethnicity
Akan 202 72.92
Northern ethnics 75 27.08
Marital status
Married/ co-habiting 54 19.49
Single 223 80.51
Religion
Christianity 234 84.48
Islamic 43 15.52
Residence status
Both Parent 125 45.13
Guardian 27 9.75
Live alone 25 9.03
Partner 21 7.58
Single Parent 79 28.52
Place of Residence
Rural 169 61.01
urban 108 38.99
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Knowledge of contraceptive uses

Almost all 253 (91%) of the respondents ever heard of contraceptives or family planning. Respondents indicated multiple reasons for contraceptive use which include delaying pregnancy 219 (88%), preventing STIs and HIV/AIDS 51 (20%), spacing up birth 58 (23%) and 41 (16%) stated that contraceptives are used to prevent pregnancy (Table 2).

Table 2. Knowledge of respondent on contraceptive.

Variables Freq. Percent
Ever heard about FP
    No 24 8.66
    Yes 253 91.34
Uses of FP methods  *
    To prevent pregnancy 41 16.47
    To delay pregnancy 219 87.95
    To space up birth 58 23.29
    To prevent STI/HIV 51 20.48
FP methods heard about *
    Male condom 131 51.98
    Female condom 33 13.1
    Injectables 129 51.19
    Implants 32 12.7
    Sterilization 8 3.17
    Emergency Contraceptive Pill 82 32.54
    IUD 10 3.97
    COC and POP pills 66 26.19
    Calendar Method 28 11.11
    Lactational Amenorrhea Method 1 0.4
Source Information *
    Radio/Television 86 34.13
    Teacher 44 17.46
    Friend 117 46.43
    Health worker 144 57.14
    Partner 37 14.68
    Parent 11 4.37
    Other relatives 7 2.78
Who is eligible to use FP
Adult only 43 15.52
All sexually active person 206 74.37
Married couples 28 10.11
Women who use FP are promiscuous
Don’t know 79 28.52
No 165 59.57
Yes 33 11.91
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* Multiple responses

Among the respondents the most known contraceptives were male condom 131(52%), Injectables129 (51.2%), Emergency contraceptive Pill (ECP) 82 (32.5%), Pills (Microgynon and Microlut) 66 (26.2%) and Implants 32 (12.7%). Other known family planning methods includes Natural/ calendar method, IUD, Male sterilization, and LAM. A vast majority 206 (74%) of the respondent indicated that all sexually active persons should use contraceptives. About 60% (165) of the respondent believe women who use contraceptives are not promiscuous. Among all respondents, majority received source information from a health worker 144 (57.14%), friends 117 (46.43%) and Radio/Television 86 (34.13%) (Table 2).

Contraceptive utilization among sexually active female youth

Prevalence of contraceptive use among the study participants was significantly high as a little over 76% (211) of the respondents reported ever using any modern contraceptive. However, a little over 63% (132) used contraceptive methods in their first sexual encounter (Table 3). The common methods of contraceptives used before were emergency pills 88 (41.2%), condoms 84 (39.8%) injectables 80 (37.9%) implants 11 (5.21%) and IUDs 1 (0.47%), also traditional methods such as calendar 16 (7.6%) and withdrawal methods 15 (7.1%) used before (Fig 1). At the time of the study, about 151 (72%) of the respondents were currently using some form of modern contraceptives which were Injecta ble 56 (37.1%), ECP 47 (31.13%) and Male Condoms 9 (19.2%). However, only 10 (6.6%) are LARC (Implants) users. Half 75 (50%) of the respondents get their source of contraceptives from a Health Facility, whiles 48 (32%) get theirs from a Drug store/pharmacy shop. Most 89 (42%) of the respondents have been using contraceptives for about 1–11 months and 95 (45%) used these contraceptives occasionally during sexual intercourse. About 33% (90) of the respondents had ever been pregnant and more than half 56% (50) of those pregnancies resulted in livebirth whiles 29 (32%) resulted in induced abortion. More than half 48 (53%) of the respondents had their first pregnancy between the ages of 11 and 18 years. The number of sexual partners ever had included 1 (47.6%), 2 (25.6%), 3 (18.4%) and 23 (8.3%) ever had four sex partners. It was evident that majority of respondents had their first sex between the ages of 10–16 years (Table 3).

Table 3. Contraceptive utilization among respondents.

Variables Freq. Percent
Ever use FP before
No 66 23.83
Yes 211 76.17
Currently using FP methods?
No 60 28.44
Yes 151 71.56
Which method currently using
Emergency Contraceptive Pills 47 31.13
Implants 10 6.62
Injectables 56 37.09
Male Condom 29 19.21
Withdrawal 9 5.96
Source of FP
Drug store/ Pharmacy shop 48 32.21
Friend 3 2.01
Health facility 75 50.34
Not Applicable 8 5.37
Partner 15 10.07
How often do you use FP
Every time 81 38.39
Just once 35 16.59
once a while 95 45.02
How long have you use FP
1 to 11 months 89 42.18
1 to 2 years 69 32.70
3 years above 20 9.48
Less than 1 month 33 15.64
FP method used during first sex
No 79 37.44
Yes 132 62.56
Age at first sex
10–16 151 54.51
17–23 126 45.49
Number of sex partners
1 132 47.65
2 71 25.63
3 51 18.41
4 23 8.30
Ever been pregnant before
No 187 67.51
Yes 90 32.49
Pregnant for how many times
1 67 74.44
2 18 20.00
3 5 5.56
Age at first pregnancy
11–18 48 53.33
19–24 42 46.67
First pregnant outcome
Currently pregnant 3 3.33
Induced abortion 29 32.22
Miscarriage 8 8.89
Resulted in livebirth 50 55.56
Feel pressure to have sex
No 207 74.73
Yes 70 25.27
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Fig 1. FP method ever used before.

Fig 1

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Socio-cultural and health-related factors influencing contraceptive use among sexually active

The study identified several socio-cultural and health-related factors that are associated with contraceptive use. Among these factors, the most significant predictors were minimal side effects (54.18%), receipt of counselling on contraceptives (42.55%), partner support (36.73%), religious beliefs (36.36%), lack of knowledge (21.45%), attitude of service providers (26.18%), and parental support (11.64%) etc. (Fig 2).

Fig 2. Socio-cultural and health-related factors influencing contraceptive use.

Fig 2

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Determinants of modern contraceptive use among sexually active young women

As presented in Table 4, In a univariate analysis, the following independent variables were significantly associated; Age group (p<0.001), marital status (p = 0.002), religion (p = 0.027), age at first sex(p = 0.001), number of sex partners(p = 0.003), feeling pressure to have sex(p = 0.033), ever heard about FP(p<0.001), partners opposition (p = 0.039), side effect (p = 0.029), lack of knowledge (p = 0.038), partners support (p = 0.036), parental support(p = 0.007), counselling received on contraceptive (p = 0.045) were all significantly associated with contraceptive use.

Table 4. Univariate and multivariate regression model on determinants of modern contraceptive use among sexually active female youth.

Crude Odds Ratio Adjusted Odds Ratio
Variables COR (95% CI) p-value AOR (95% CI) p-value
Age group
15–19 1 1
20–24 2.96 (1.62–5.42) <0.001 2.93 (1.20–7.50) 0.023
Marital status
Married/ cohabiting 1 1
Single 0.15 (0.05–0.50) 0.002 0.08(0.01–0.91) 0.041
Religion
Christianity 1
Islamic 0.46 (0.23–0.917) 0.027 0.17 (0.05–0.64) 0.009
Age at first sex
10–16 1 1
17–23 2.80 (1.53–5.12) 0.001 1.35 (0.40–4.55) 0.627
Number of sex partners
1 1 1
2 3.33 (1.51–7.32) 0.003 1.17 (0.33–4.13) 0.808
3 1.76 (0.82–3.76) 0.146 0.23 (0.05–1.01) 0.052
4 3.22 (0.91–11.43) 0.07 0.74 (0.07–7.39) 0.798
Feel pressure to have Sex
No 1 1
Yes 2.23 (1.10–4.65) 0.033 3.19(0.96–10.62) 0.058
Ever heard about FP
No 1 1
Yes 22.50 (7.34–68.96) <0.001 9.44 (1.95–45.77) 0.005
Who is eligible to use FP
Adult only 1 1
All sexually active person 2.90 (1.45–5.81) 0.003 0.91(0.25–3.25) 0.884
Married couples 2.16 (.76–6.16) 0.15 1.31(0.26–6.61) 0.744
Partner opposition
No 1 1
Yes 8.43 (1.12–63.58) 0.039 33.61(1.15–985.39) 0.041
Side effects
No 1 1
Yes 1.87 (1.07–3.27) 0.029 4.86(1.83–12.91) 0.001
Lack knowledge
No 1 1
Yes 2.34 (1.05–5.23) 0.038 5.41(1.15–25.42) 0.032
Attitude of Health Provider
No 1 1
Yes 3.81 (1.65–8.78) 0.002 2.15(0.56–8.27) 0.264
Partner support
No 1 1
Yes 1.94 (1.05–3.59) 0.036 1.06(0.37–3.01) 0.909
Parental support
No 1 1
Yes 0.35(0.16–0.75) 0.007 0.31(0.07–1.42) 0.132
Counselling received
No 1 1
Yes 1.82 (1.01–3.27) 0.045 4.02(1.29–12.42) 0.016
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Adjusting for the confounders of the variables on the dependent variable in the model, the multivariate logistic regression revealed a statistically significant association between age group, marital status, religious affiliation, heard about contraceptives, partner opposition, side effect, lack of knowledge and counselling received. It was evident that Age was a factor in contraceptive use. older youth (20–24) were 2.93 times more likely to use contraceptives than those at the adolescent stage (15–19) (AOR = 2.93; 95% CI; 1.29–7.50), p = 0.023. Marital status was significantly associated with contraceptive use. Respondents who were single were less likely to use contraceptives as compared to those who were married (AOR = 0.08; 95%CI; 0.01–0.91), p = 0.041 (Table 4).

Respondents affiliated with the Islamic religion were less likely to use contraceptives as compared to those affiliated with Christianity (AOR = 0.17; 95%CI; 0.05–0.64), p = 0.009. Respondents who have heard about contraceptives before were 9.44 more likely to use contraceptives as compared to respondents who have never heard about contraceptives (AOR = 9.44; 95%CI; 1.95–45.77), p = 0.005. Partner opposition as a factor was 33.61 more likely to influence contraceptives as compared to those who did not (AOR = 33.61; 95%CI; 1.15–985.39), p = 0.041. Respondents reporting side effects were significantly associated with 4.86 times likely to use contraceptives (AOR = 4.86; 95%CI; 1.83–12.91), p = 0.001. Respondents with a lack of knowledge of contraceptives were 5.41 times more likely to use contraceptives compared to those respondents with knowledge of contraceptives (AOR = 5.41; 95%CI; 1.15–25.42), p = 0.032. Respondents receiving counselling on family planning were 4.02 more likely to use contraceptives compared to those who do not receive counselling on family planning (AOR = 4.02; 95% CI;1.29–12.42), p = 0.016 (Table 4).

Discussion

The benefit of contraceptive use is critical to safe adolescent and sexual reproductive health. Credible information and unlimited access to quality and culturally appropriate adolescent services influence the uptake of modern contraceptives. The study revealed that most of the participants reported using modern contraceptive methods, and this prevalence was higher than that reported in previous studies of sexually active young women in Ghana [11, 28]. However, a similar study reported low contraceptive use among sexually active unmarried adolescent girls (10–19 years; 35.6%) and young women (15–24 years; 49.0%) [29]. The widespread availability and affordability of certain modern contraceptive methods, such as ECPs and condoms sold in various locations like chemical seller’s shops, restaurants, and supermarkets, have contributed to the high prevalence of modern contraceptive use among female youth. These results imply a positive trend in the use of contraception among young women in Ghana.

The emergency contraceptive pill, condoms, and injectables were identified as the most commonly preferred modern contraceptive methods among the participants, which is consistent with previous research highlighting these options as popular choices among unmarried adolescents and young women [25, 29, 30]. The widespread use of these methods may be due to their greater accessibility, availability, perceived efficacy, and convenience of use, which come with fewer side effects than injectables and implants.

Several studies have observed comparable patterns in Ghanaian individuals’ understanding and awareness of modern contraceptive methods [23, 31–33]. In the current study, evidence suggests that there is a positive correlation between individuals’ awareness and knowledge of modern contraceptive methods and their adoption of these methods. This is supported by a study conducted among female undergraduates in Tanzania, which found that participants displayed a high level of awareness and knowledge regarding modern contraceptive methods [34]. Improved access to information on reproductive health, as well as the use of behavior change communication and social marketing techniques, may have contributed to the observed developments. These factors have helped to increase awareness and knowledge of modern contraceptive methods, leading to a greater uptake of these methods among individuals [35, 36].

The study found that respondents reported using modern contraceptives for various reasons, including delaying pregnancy, spacing out births, preventing sexually transmitted infections (STIs) and HIV/AIDS, and preventing unintended pregnancy. This finding is consistent with previous research, such as the Katama and Hibstu study (2016) in South Ethiopia, where many participants reported using modern contraceptives to avoid unintended pregnancy, space out or limit conception, and prevent STIs and HIV/AIDS [37, 38]. This suggests that these reasons for modern contraceptive use are prevalent across different geographic locations and populations, underscoring the universal importance of accessible and comprehensive reproductive health services.

One possible reason for the high percentage of delaying pregnancy is that individuals may want to establish their careers, achieve financial stability, or complete their education before starting a family. Furthermore, many individuals may want to ensure that they are emotionally and mentally ready for parenthood before deciding to conceive.

Our study found a statistically significant association between age group and modern contraceptive use. Older youth were more likely to use modern contraceptives compared to those in the adolescent stage. This finding is consistent with a similar study, which found that girls aged 15–19 were more likely to practice contraception compared to those aged 10–14 [39]. Other studies from different parts of Africa also confirm this finding [40, 41]. The higher likelihood of contraceptive use among older youth in Africa may be attributed to differences in social norms around sexual behavior and contraceptive use, as well as greater access to reproductive health services compared to younger adolescents. Older youth may have more autonomy and agency in making decisions about their reproductive health and have greater opportunities to obtain modern contraceptives.

Single women in our study were much less likely to use contraceptives compared to those who were married or cohabiting. This finding is consistent with previous research, which has shown that marital status is a significant factor in contraceptive use among women, especially teenagers [21, 39, 42]. Married women may have a greater desire to control their fertility and plan their family size due to various reasons such as financial stability, career aspirations, and a desire to provide the best possible care for their children. They may also have access to reproductive health services, including information and counselling on contraceptive methods, and may have more social support for contraceptive use from their partners and families. Our study found a significant difference in contraceptive use between respondents affiliated with the Islamic religion and Christianity. Islamic respondents reported lower use of contraceptives compared to their Christian counterparts, which is consistent with previous studies conducted in Ghana [17, 43]. Kumbeni et al. (2019) presented a divergent perspective on the topic of contraceptive use by revealing significant variations in usage rates between Muslims and Christians. Specifically, their study found that Muslims reported greater rates of contraceptive use than Christians, contrasting with prior research [39]. Religious groups that provide sex education on modern contraceptives tend to have higher contraceptive use than those that do not [44]. Also, the differences could be religious interpretations and beliefs regarding family planning and contraception. Some Christians may view contraception as a means of responsible parenthood, while others may believe that it goes against God’s plan for procreation.

The reported side effects of contraceptives have been identified as a common obstacle to contraceptive use, as supported by various studies. Concerns about potential side effects can have a notable influence on an individual’s choice to utilize contraceptives [17, 22, 25, 39]. These findings underscored the importance of good education and counselling in reducing lack of contraceptive desire among sexually active young women. Recognizing and understanding these challenges is critical for developing effective solutions to address the poor contraceptive usage among youth in our societies and around the country.

In the study, partners who opposed contraceptive use were found to have a significant influence on whether or not the respondent used contraceptives, which is consistent with previous studies [39, 45]. On the contrary, a study conducted by Asiedu et al. (2020) [23], indicated that husbands or partners agreeing on the use of modern contraceptives influenced the usage of modern contraceptives among women. This was the case in another study conducted in Ghana where contraceptive use was higher among women if their spouses or partners support it [46].

This development may trace its roots to typical African societal norms, where a man is the head of the home and decides all matters, including their spouses’ reproductive health issues [47]. In some cultures, having many children is a sign of wealth and prosperity and contraceptive use is against religious or moral principles.

In line with previous research, our study has demonstrated that a lack of knowledge and counseling regarding contraceptives, as well as a lack of credible and unbiased sources of information, can significantly hinder their utilization. The evidence highlights the importance of comprehensive and impartial contraceptive education and counseling to increase the likelihood of contraceptive use [48–50]. Additionally, a study conducted in the US found that women who got contraceptive counselling were nearly seven times more likely to use highly effective contraception than women who did not [51]. A lack of knowledge, counselling, and access to credible sources of information on contraception can negatively impact contraceptive use. Individuals may not fully understand the benefits and potential risks associated with different methods of contraception, may not receive guidance from healthcare providers, and may rely on unreliable sources of information. Ultimately, this can increase the risk of unintended pregnancy or sexually transmitted infections.

Inadequate knowledge of contraceptives is linked to wrong beliefs about the risk and negative effects of using them, improper or irregular usage, as well as method discontinuation [52]. This implies that healthcare providers must give evidence-based information on contraception methods while also listening to women’s views and thoughts so that they may make well-informed choices regarding the most appropriate contraceptive methods for them. Furthermore, the fact that worries about side effects are becoming widespread shows that contraceptive products are becoming more widely available and that counselling about contraceptive alternatives is an important component of good service delivery.

Strengths and limitations of the study

In Ghana, most women prefer to conserve privacy with the use of contraceptives. Also, the estimation of contraceptive use was based on participants self -reports. These factors could potentially cause social desirability biases and affect the actual prevalence of contraceptive use in Berekum Municipality. Despite these limitations, this study provides insights on contraceptives in the Berekum municipality which may be useful in improving reproductive health among young women in Ghana.

Conclusion

The contraceptive prevalence rate among sexually active youth in Berekum municipality was high

Emergency contraceptives, condoms and injectables were the most preferred option compared to other methods. The study also highlighted potential determinants of contraceptives among the female youth in the Berekum Municipality.

There is need for stakeholders, and healthcare providers to focus on addressing factors influences contraceptive use among sexually active women. The Ghana Health Service must initiate measures to fully rectify adolescent health as part of the mainstream school health activities in Senior high Schools in Ghana as a strategy to improving sexual health education Ghana.

Supporting information

S1 Dataset

(XLSX)

Click here for additional data file. (99.5KB, xlsx)

Acknowledgments

The authors are grateful to the Bono Regional Health Directorate for granting us permission to conduct the study. We are also thankful for the Berekum municipal health directorate, especially the staff who were recruited as research assistants for their cooperation and support.

Abbreviations

AIDS

Acquire Immune Deficiency Syndrome

AOR

Adjusted Odds Ratio

BMHD

Berekum Municipal Health Directorate

CDC

Center for Disease Control

CHPS

Community–Based Health Planning Services

CHRPE

Committee on Human Research Public and Ethics

CIP

Costed Implementation Plan

CI

Confidence Interval

CPR

Contraceptive Prevalence Rate

ECP

Emergency Contraceptive Pill

GSS

Ghana Statistical Services

HIV

Human Immune Deficiency Virus

KNUST

Kwame Nkrumah University of Science and Technology

IUD

Intrauterine Device

LAM

Lactation Amenorrhea Method

OR

odds ratio

SDGs

Sustainable Development Goals

STI

Sexual Transmitted Infection

UNFPA

United Nations Population Funds

USA

United State of America

WHO

World Health Organization

Data Availability

All relevant data are within the paper and its Supporting Information files

Funding Statement

The author(s) received no specific funding for this work.

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Decision Letter 0

Akaninyene Eseme Bernard Ubom

10 Apr 2023

PONE-D-23-04760Determinants and prevalence of modern contraceptive use among sexually active women in the Berekum East Municipality, Ghana.PLOS ONE

Dear Dr. Amoah,

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Additional Editor Comments:

Abstract

Results:

-Absolute numbers should be reported in addition to percentages.

-Where significant association is reported, p values should be quoted.

Manuscript Text:

Materials and Methods (sampling techniques): Page 6, line 125: "The probability sampling technique was employed" Multistage sampling is mentioned in the Abstract. Please clarify/reconcile.

Results

-Where percentages are reported, absolute numbers should also be reported.

-Page 11, Lines 210-211: "The common methods of contraceptives.....,also traditional methods such as calendar and withdrawal methods used before." What were the absolute numbers and percentages of respondents that used these traditional methods?

-Page 12, Lines 221-222: "Shockley majority of respondents had their first sex between the ages of 10-16 years (Table 3)." Please replace "shockingly", this is academic writing. Indicate the absolute number and percentage of women

-Table 2: What is the difference between "to prevent pregnancy", "to delay pregnancy" and "to space birth"? What do you mean by "multiple response"? indicate as a footnote under the table.

-Table 3: Correct "Your source FP supply" to "Source of FP" What does "Not applicable" mean? "Just once" response under "how often do you use FP" does it mean the respondents have used FP only once in their lifetime? Please clarify

-Pages 13-14, lines 231-234: "Socio-cultural and health-related predictors of contraceptive use were minimal side effects (54.18%), counselling received on contraceptives (42.55%), partners support (36.73%), religious belief (36.36%), lack of knowledge (21.45%), the attitude of a service provider (26.18%), parental support (11.64%) etc (Fig 2)." This is not clear, please recast. What exactly is figure 2 about, please explain.

-Page 14, lines 239-247: "As presented in Table 4, In a univariate analysis, the following independent variables were significantly associated;......lack of knowledge and counselling received." Please quote p values for every variable reported as significantly associated with contraceptive use.

-Page 14, lines 247-248: "It was evident that Age was a factor in contraceptive use. older youth were 2.93 times more likely to use contraceptives than those at the adolescent stage." Please clarify which age groups were classified as "older youth" and "adolescent"

-Page 14, lines 250-253: "Respondents who were single were 92 times less likely to use contraceptives as compared to those who were married (AOR=0.08; 95%CI; 0.01-0.91), p=0.041 (Table 4). Respondents affiliated with the Islamic religion were 83 times less likely to use contraceptives as compared to those affiliated with Christianity (AOR=0.17; 95%CI; 0.05-0.64), p=0.003" Please reconcile the figures 92 and 83 quoted with the AOR.

-Table 4: How was "pressure to have sex" assessed?

Discussion:

-Page 16, lines 272-274: "However, similar studies reported low contraceptive use among sexually active unmarried adolescent girls (15–19 years; 35.6%) and young women (20–24 years; 49.0%) [29]" Similar studies is mentioned by only one is cited/referenced. The adolescent age group is 10-19 and youth "15-24"; please reconcile with 15-19 and 20-24 years quoted here.'

-The Discussion should be rewritten. Results should not be re-reported verbatim in the Discussion but discussed. Beyond simply comparing the results of this study with those of other studies, authors should explain possible reasons for their findings with relevant literature references. Results not initially reported in the results section should not be introduced for the first time in the Discussion

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

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Reviewer #1: Partly

**********

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Reviewer #1: Yes

**********

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Reviewer #1: Yes

**********

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5. Review Comments to the Author

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Reviewer #1: 1. The title of the study needs to be modified to reflect the actual study population. The study was titled ‘Determinants and prevalence of modern contraceptive use among sexually active women’. This gives an impression that all sexually active women in reproductive age group should be part of the study. However, the Methodology and study in itself was limited to youths (people aged 15-24 years by United Nation’s definition).

2. How does the findings from this study speak to a GLOBAL AUDIENCE with respect to contraceptive prevalence among young people?

3. The verbal interpretation of the odds ratio for Married respondents and Islamic faithfuls does not align with the data on the regression table. It was reported that Married youths and Islamic faithfuls were 92 and 83 times less likely to use contraceptives (respectively). This statement can’t be deduced from the table. Kindly reconcile

4. The discussion was quite lacking in intellectual content. It appeared to be more of a repetition of the results. I will be good to revisit the discussion

5. The references were not properly written. They should be rewritten according to Vancouver guidelines.

**********

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Reviewer #1: No

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PLoS One. 2023 Jun 8;18(6):e0286585. doi: 10.1371/journal.pone.0286585.r002

Author response to Decision Letter 0

3 May 2023

Journal Submissions Rebuttal Letter

Akaninyene Eseme Bernard Ubom, MBBS, MWACS, OMI Fellow

Academic Editor

PLOS ONE

4th May 2023.

Dear Dr Akaninyene,

Re: Resubmission of a manuscript (PONE-D-23-04760)

Thank you for inviting us to submit a revised draft of our manuscript entitled, "Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana” to PLOS ONE for publication. We also appreciate the time and effort you and other reviewers have dedicated to providing insightful feedback on ways to strengthen our paper. Thus, it is with great pleasure that we resubmit our manuscript for further consideration. We have incorporated changes that reflect the detailed suggestions you have graciously provided. We also hope that our edits and responses below satisfactorily address all the issues and concerns you have noted.

Below we provide the point-by-point responses. All modifications in the manuscript have been highlighted in red and are in track changes.

Yours Sincerely,

Ebenezer Jones Amoah (corresponding author)

ejamoah25@gmail.com

Journal Requirements

Comment: In the ethics statement in the Methods, you specified that verbal consent was obtained. Please provide additional details regarding how this consent was documented and witnessed, and state whether this was approved by the IRB

Response: Thank you for the observation, we initially explained the intent and procedures of data collection of the research to the participant verbally. Upon agreement to part-take, we administered the consent form. Given the fact that some of the participants could not read and write, they were asked to thumbprint. The consent form was sent in addition to the proposal and approval was given by the Kwame Nkrumah University of Science and Technology IRB to start data collection. Sorry for the omission.

Additional Editor Comments:

Abstract

Results:

Comment: Absolute numbers should be reported in addition to percentages.

Response: Thank you for these observations. We have added the absolute numbers in addition to the percentages in the abstract in lines 47 – 57.

Comment: Where significant association is reported, p values should be quoted.

Response: Thank you once again for these observations. p-values have been quoted to show how significantly variables are associated in the abstract in lines 51 - 57

Manuscript Text:

Comment: Manuscript Text: Materials and Methods (sampling techniques): Page 6, line 125: "The probability sampling technique was employed" Multistage sampling is mentioned in the Abstract. Please clarify/reconcile

Response: Thank you for the observation, Page 2, line 39 has been reconciled from multistage to probabilistic to align with page 6, line 127.

Results

Comment:

Where percentages are reported; absolute numbers should also be reported.

Response: Thank you for the observation. Where percentages were reported in the result session, absolute numbers have also been reported.

Comment: Page 11, Lines 210-211: "The common methods of contraceptives.....,also traditional methods such as calendar and withdrawal methods used before." What were the absolute numbers and percentages of respondents that used these traditional methods?

Response: Thank you for the observation. On page 11, line 214 The percentages and absolute numbers of calendar-16 (7.6%), and withdrawal-15 (7.1%) have been reported. Thank you for the observation.

Comment: Page 12, Lines 221-222: "Shockley majority of respondents had their first sex between the ages of 10-16 years (Table 3)." Please replace "shockingly", this is academic writing. Indicate the absolute number and percentage of women.

Response: Thank you very much for alerting us. Sorry for using such a word as “shockingly” in line 225. “shockingly” has been replaced with “It was evident that the.” Also, the absolute number and percentage have been indicated.

Comment: Table 2: What is the difference between "to prevent pregnancy", "to delay pregnancy" and "to space birth"?

Response: Thank you for the enquiry. Please, while all three phrases relate to family planning, they have different meanings and objectives. "To prevent pregnancy" is about avoiding pregnancy altogether, "to delay pregnancy" is about postponing pregnancy until a later time, and "to space birth" is about waiting for a certain period of time between pregnancies. The objective is to seek the understanding from respondent’s perspective on why the use of contraceptives

Comment: What do you mean by "multiple responses"? indicate as a footnote under the table.

Response: Thank you for the enquiry. Multiple responses in the data collection refer to the situation where respondents are allowed to choose more than one answer or option for a particular question or item in a research questionnaire since multiple responses will better answer such questions. However, we have indicated it as a footnote under the table.

Comment: Table 3: Correct "Your source FP supply" to "Source of FP" What does "Not applicable" mean? "Just once" response under "how often do you use FP" does it mean the respondents have used FP only once in their lifetime? Please clarify.

Response: Thank you for providing these insights, the comment “Your source of FP supply” in Table 3 has been corrected as you proposed. Also, “not applicable” refers to those participants who said that the FP methods ever used are calendar and Withdrawal methods. Since these methods are not sold in drug stores but rather based on personal decisions, the source of supply does not apply. Also, the response under "How often do you use FP" means the respondent has used FP only once at the time the data was collected.

Comment: Pages 13-14, lines 231-234: "Socio-cultural and health-related predictors of contraceptive use were minimal side effects (54.18%), counselling received on contraceptives (42.55%), partners support (36.73%), religious belief (36.36%), lack of knowledge (21.45%), the attitude of a service provider (26.18%), parental support (11.64%) etc (Fig 2)." This is not clear, please recast. What exactly is Figure 2 about, please explain.

Response: Thank you for asking. On pages 13-14, lines 231-234, These are the socio-cultural and health-related factors that influence contraceptive use that was mentioned by the respondents apart from the demographic factors. These were multiple response types of data where respondents were asked to choose the various socio-cultural and health-related factors that can influence their contraceptive use. The statement has been recast as you proposed. Very grateful.

Comment: Page 14, lines 239-247: "As presented in Table 4, In a univariate analysis, the following independent variables were significantly associated;......lack of knowledge and counselling received." Please quote p values for every variable reported as significantly associated with contraceptive use.

Response: Thank you for the observation. On page 14, lines 249-253. The corresponding p-values have been reported.

Comment: Page 14, lines 247-248: "It was evident that Age was a factor in contraceptive use. older youth were 2.93 times more likely to use contraceptives than those at the adolescent stage." Please clarify which age groups were classified as "older youth" and "adolescent"

Response: Thank you for notifying us, please "older youth" and "adolescent" is explained as “Older youth” (20-24) and "adolescent” (10-19) on page 14, lines 259 and 260.

Comment: Page 14, lines 250-253: "Respondents who were single were 92 times less likely to use contraceptives as compared to those who were married (AOR=0.08; 95%CI; 0.01-0.91), p=0.041 (Table 4). Respondents affiliated with the Islamic religion were 83 times less likely to use contraceptives as compared to those affiliated with Christianity (AOR=0.17; 95%CI; 0.05-0.64), p=0.003" Please reconcile the figures 92 and 83 quoted with the AOR.

Response: Thank you for providing these insights and we would like to appreciate you for an in-depth examination of our manuscript. We have rectified the comments on lines 257 and 260.

Comment: Table 4: How was "pressure to have sex" assessed?

Response: Thank you for the inquiry, Participants were asked about their encounters with situations where they felt compelled to participate in sexual activities, either by their romantic partner, acquaintances, or even family members, to satisfy certain desires or receive material benefits. So, the question was put “Do you feel pressured to have sexual intercourse”?

Discussion:

comment: Page 16, lines 272-274: "However, similar studies reported low contraceptive use among sexually active unmarried adolescent girls (15–19 years; 35.6%) and young women (20–24 years; 49.0%) [29]" Similar studies is mentioned by only one is cited/referenced. The adolescent age group is 10-19 and the youth "15-24"; please reconcile with 15-19 and 20-24 years quoted here.

Response: We are grateful for the observation. The statement “similar studies” have been rectified to “similar study” on line 289 and the age group has been reconciled to 15-19 and 20-24 on line 260, page 17.

Comment: The Discussion should be rewritten. Results should not be re-reported verbatim in the Discussion but discussed. Beyond simply comparing the results of this study with those of other studies, authors should explain possible reasons for their findings with relevant literature references. Results not initially reported in the results section should not be introduced for the first time in the Discussion

Response: Thank you for the comments on the discussion part of our manuscript. We are pleased to inform you that almost the entire discussion session has been rewritten.

Review Comments to the Author

Reviewer #1: 1. The title of the study needs to be modified to reflect the actual study population. The study was titled ‘Determinants and prevalence of modern contraceptive use among sexually active women’. This gives an impression that all sexually active women in reproductive age group should be part of the study. However, the Methodology and study in itself was limited to youths (people aged 15-24 years by United Nation’s definition).

Response: Thank you very much for your meticulous observation of our work, the title has been revised to “Determinants and prevalence of modern contraceptive use among sexually active youth in the Berekum East Municipality, Ghana”.

2. How does the findings from this study speak to a GLOBAL AUDIENCE with respect to contraceptive prevalence among young people?

Response: Thank you for the enquiry. The findings of this study on contraceptive prevalence among young people are of great significance to a global audience. With over 1.2 billion adolescents worldwide, the importance of effective contraceptive use cannot be overemphasized. The study reveals that there is a low uptake of modern contraceptive methods among young people, which puts them at risk of unintended pregnancies and unsafe abortions.

This issue is not confined to a specific region or country; it affects young people across the globe. By highlighting this problem, the study provides a global call to action for policymakers, healthcare providers, and educators to prioritize comprehensive sex education and access to modern contraceptive methods for young people.

The implications of this study go beyond just preventing unintended pregnancies. It speaks to the fundamental right of young people to make informed decisions about their sexual and reproductive health, and the need for them to have access to quality healthcare services that cater to their specific needs.

Therefore, the findings of this study should serve as a wake-up call to all stakeholders, regardless of geographic location, to prioritize and invest in programs and policies that promote the use of modern contraceptives among young people. Doing so will help to reduce the global burden of unintended pregnancies, unsafe abortions, and maternal mortality, and improve the overall health and well-being of young people.

3. The verbal interpretation of the odds ratio for Married respondents and Islamic faithful does not align with the data on the regression table. It was reported that Married youths and Islamic faithful were 92 and 83 times less likely to use contraceptives (respectively). This statement can’t be deduced from the table. Kindly reconcile

Response: We would like to appreciate you for an in-depth examination of our manuscript. We have rectified the comments on lines 261 and 264. Also, on page 16, line 277. The Table 3 heading has been edited as “Table 4: Univariate and multivariate regression model on determinants of modern contraceptive use among sexually active female youth”

4. The discussion was quite lacking in intellectual content. It appeared to be more of a repetition of the results. It will be good to revisit the discussion.

Response: Thank you for the comments on the discussion part of our manuscript. We are pleased to inform you that almost the entire discussion session has been rewritten.

5. The references were not properly written. They should be rewritten according to Vancouver guidelines.

Response: Thank you once again for your time invested in our manuscript. The references have now been properly written in the Vancouver style.

CONCLUDING REMARKS: Again, thank you for allowing us to strengthen our manuscript with your valuable comments and queries. We have worked hard to incorporate your feedback and hope that these revisions persuade you to accept our submission.

Attachment

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Decision Letter 1

Akaninyene Eseme Bernard Ubom

19 May 2023

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana

PONE-D-23-04760R1

Dear Dr. Amoah,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Akaninyene Eseme Bernard Ubom, MBBS, MWACS, OMI Fellow

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Acceptance letter

Akaninyene Eseme Bernard Ubom

25 May 2023

PONE-D-23-04760R1

Determinants and prevalence of modern contraceptive use among sexually active female youth in the Berekum East Municipality, Ghana

Dear Dr. Amoah:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Akaninyene Eseme Bernard Ubom

Academic Editor

PLOS ONE

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