Abstract
Background
Modern contraceptives have proven to be more scientifically effective at preventing unwanted pregnancies than the traditional methods. However, there is dearth of evidence on teenage girls’ contraceptive use and associated factors in Ghana.
Objective
This study sought to examine teenage girls (15–19 years) contraceptive use and associated factors using a nationally representative data from the Ghana Living Standards Survey 7 (GLSS7).
Methods
The study analyzed data from GLSS7, involving 3233 15–19 year-old teenagers. Using a cross-sectional design, descriptive statistics, chi-square tests, and multiple regression were performed to analyze factors influencing contraceptive use. Stata software version 16 was used, with statistical significance set at p ≤ 0.001.
Results
Out of a total of 3,233 teenage girls aged 15-19years, the majority were in the primary level of education (71.59%). Furthermore, more than two-thirds of the participants were Christians (75.83%). The results showed that only 12.87% of teenage girls reported current contraceptive use. Religion, type of residence, region, wealth index and marital status was found to have a relationship with modern contraceptive use. Also, majority of the respondents preferred modern contraceptive methods (85.60%) as compared to traditional methods (14.40%). The region was significantly associated with preferences for modern contraceptive use. Teenage girls in the Central and Volta regions had 88% and 89% lower odds of preferring modern contraceptive use, respectively as compared with those in the western region. Moreover, marital status was found to have a significant association with barriers to contraceptive use. Teenage girls that were not married had 88% lower odds of having barriers to contraceptive use as compared to those that were married.
Conclusion
The study suggests that the government through the Ministry of Health (MOH) should establish targeted community-based awareness campaigns and enhance access to adolescent-friendly family planning services to increase contraceptive uptake.
Keywords: Ghana living standard survey 7, Teenage girls, Modern contraceptive, Ghana
Introduction
Over the years, contraceptive use has surged globally, particularly among Women of Reproductive Age (15–44 years), including adolescent girls. Currently, out of the estimated 1.9 billion women in this age group, approximately 874 million use modern family planning methods (MFPM), while 92 million rely on traditional methods—up from a total of 467 million users of both methods in 1990 [1]. This growth is not confined to developed countries; in fact, sub-Saharan Africa (SSA) is experiencing the fastest increase in contraceptive use globally. According to United Nations statistics, contraceptive use among women of reproductive age rose from 700 million in 1990 to 1.1 billion in 2021. Of the ten countries with the highest rate of increase, eight are in SSA; however, Ghana is not among them [1, 2]. At the same time, the proportion of women whose need for modern contraceptives is met—a key indicator for Sustainable Development Goal (SDG) target 3.7.1—has also increased. The United Nations Department of Economic and Social Affairs, Population Division (UNDESA-PD), reports that globally, the met need for family planning stands at 77%, up from 67% in 1990 [1]. Despite this improvement, a substantial unmet need remains, particularly among adolescent girls [3, 4]. Globally, 164 million women wish to delay or avoid pregnancy but are not using any form of contraception. In SSA, including Ghana, the met need remains among the lowest worldwide—only 56%, compared to the global average of 77% [1].
Contraceptive use tends to be higher among women aged 25–44 and lowest among adolescents [1, 5]. Adolescence (10–19 years) is marked by increased curiosity and vulnerability to risky behaviors, including unprotected sexual activity. Evidence shows that over 20 million sexually active adolescents who need modern contraception are not using any method [6], resulting in unintended pregnancies and unsafe abortions, recognized as both public health and social issues. This highlights the urgent need for targeted interventions to promote safe reproductive health practices among teenage girls.
Among the range of modern contraceptive methods, including injectables, implants, sterilization, pills, and intrauterine devices (IUDs), condoms are the most effective for reducing the risk of sexually transmitted infections (STIs), including HIV. Other methods primarily prevent pregnancy but do not offer protection against infections. However, effective use of these methods is often hindered by a range of personal and socio-demographic factors, such as household wealth, place of residence, educational attainment, and marital status [7, 8]. Addressing these barriers is essential for improving adolescent access to MFPM and advancing progress toward universal access to family planning under SDG target 3.7; ensuring that no one is left behind.
While modern contraceptive use among adolescent girls aged 15–19 has been studied, many investigations have relied on localized or non-representative data, limiting the generalizability of findings [9]. Despite growing advocacy and interventions aimed at improving adolescent reproductive health, contraceptive prevalence among teenagers remains low, underscoring the need to explore both barriers and facilitators in greater depth [10]. This study seeks to assess the prevalence of contraceptive use and examine the socio-demographic determinants, preferences, and barriers to uptake among teenage girls aged 15–19 years. Access to family planning among adolescents is critical for regulating fertility and achieving future aspirations, which are often disrupted by unintended pregnancies. Enhancing MFPM utilization in this population is crucial not only for preventing early pregnancies but also for supporting continued education and broader participation in socio-economic development. Findings from this study will contribute to policy development and help bridge existing knowledge gaps in adolescent reproductive health.
Methods
Study design
The Ghana Living Survey Round Seven (GLSS7) adopted a cross-sectional design relying on a two-stage cluster sampling methodology to recruit the respondent. Studies of such nature offer practical and cost-effective means of gathering data. The detailed design and sampling methodology can be accessed in a previously published report [11].
Settings
The study was conducted in Ghana, a country in West Africa that spans along the Gulf of Guinea and the Atlantic Ocean, sharing a border with the Ivory Coast in the west, Burkina Faso in the north, Togo in the east, the Gulf of Guinea and the Atlantic Ocean in the south. Ghana covers an area of 238,535 km2. It is the second-most populous country in West Africa, after Nigeria; Accra is its capital and largest city [11]. The country lies between latitudes 4° and 12°N and longitudes 4°W and 2°E, and the Greenwich Meridian line passes through the sea point of Tema about 24 km to Accra. Ghana’s estimated population, per the 2021 Population and Housing Census, is 30.8 million, with females representing 50.7% and an average household size of 3.6 [12]. The Ghana Health Service (GHS) has improved access to reproductive health services by implementing a number of family planning (FP) utilization strategies in response to the expanding population and the need for reproductive health services. One important part of this is the Community-based Health Planning and Services (CHPS) initiative [13, 14], which aims to provide family planning and other health services closer to communities, particularly in underserved and rural areas [14]. Community health officers use CHPS compounds to make family planning education, contraception delivery, and counselling more widely available to the public. In order to support the larger objectives of lowering maternal mortality and enhancing child health outcomes in Ghana, the GHS has concentrated on expanding FP accessibility so that women and couples can make knowledgeable decisions on their reproductive health.
Participants
In this study, adolescents aged 15–19 were extracted F for the study. Specifically, only those who provided definitive responses to the contraceptive use questions were included in the analysis.
Study variables
The variables were extracted from the GLSS 7 structured questionnaires. The dependent variable was modern contraceptive use among teenage girls 15–19 years. From the GLSS 7, the information on contraceptive use was collected from participants’ verbal responses to these questions: use of method to prevent or delay pregnancy, main method or name or your partner using?”. Modern methods included sterilization, IUDs, implants, injectables, male/female condoms, and pills. Responses were binary. “Yes” or “No,” and were coded as 1 and 0, respectively. Only teenage girls who provided clear responses (Yes or No) were included in the final analysis.
The independent variables included in the study were the age of the teenager, level of education, religion, type of residence, region, wealth index, marital status, and occupation. The wealth index was constructed using Principal Component Analysis (PCA). The variables included in the PCA were ownership of durable assets (e.g., television, refrigerator, mobile phone, bicycle, car), housing characteristics (e.g., type of flooring, roofing material, access to electricity), and access to basic services (e.g., source of drinking water, type of toilet facility).
Each household was assigned a wealth score based on the first principal component, which captures the maximum variance among the included indicators. The wealth scores were then divided into quintiles, ranging from the poorest (lowest 20%) to the richest (highest 20%).
These variables were available in the GLSS7 dataset. The choice of these variables was informed by a comprehensive review of existing literature on the subject and a thorough examination of the survey questions.
Data source
The secondary data was obtained from the Ghana Living Standards Survey Round Seven (GLSS7), which provides a wealth of information for understanding living conditions and monitoring the welfare system in Ghana. The GLSS7 is a nationally representative household survey that offers accurate, disaggregated and globally comparable information on Ghana’s welfare and living circumstances. It is an essential instrument in the welfare monitoring system, and along with other surveys like the Core Welfare Indicators Questionnaire (CWIQ) and the Ghana Demographic and Health Survey (GDHS), it has given a lot of information for understanding Ghana’s living circumstances [11]. This is the seventh round of a nationwide household survey. The data collection was over a period of 12 months (22nd October 2016 to 17th October 2017). For this study, contraceptive information was extracted from the dataset of women aged 15–19 years living in the selected households (N = 3,233) [11].
Study size
The analytical sample consisted of 3,233 teenage girls aged 15–19 years [11] were extracted for the study.
Data analysis
Data were analyzed using STATA version 16.0. Frequencies and percentages were used to present contraceptive preferences and barriers among adolescent. Pearson chi-square test was used to assess association between explanatory variables and outcomes. Significant variables were included in a multiple logistics regression model to assess the strength of association between predictors and both contraceptive use and barriers to use. Results were presented using crude odd ratios (COR) and adjusted odds ratios (OAR) with statistical significance set at p ≤ 0.001.
Regression assumptions (e.g., linearity in the logit, absence of multicollinearity, and goodness-of-fit) were tested. Missing or incomplete cases were excluded from final models. The study used the GLSS7’s two-stage sampling strategy and included sensitivity analyses to assess the impact of missing data on outcomes.
Findings
Socio-demographic characteristics of teenage girls
Table 1 presents the results of the sociodemographic characteristics of the teenagers (N = 3,233). The majority of participants were in primary (71.6%), with 27.3% having some level of secondary education. Furthermore, more than two-thirds of the teenagers were Christians (75.8%) and 21.4% were Islamic. Only a few teenage girls were traditionalists (2.8%). Also, most of the teenage girls were in the rural region (61.7%) of Ghana and about a quarter of them were from the urban region (38.3%). Also, the majority of the teenage girls were from the Upper East region of Ghana (13.6%). A greater proportion of teenagers belonged to the poorer wealth quintile (79.7%). Almost all the teenage girls were involved in non-professional occupations (98.0%) and about a few of them had professional occupations (2.0%). The majority of the teenagers (96.2%) were not married.
Table 1.
Socio-demographic characteristics of teenage girls (15–19 years) in Ghana
| Variables | Frequency (N) | Percentages (%) |
|---|---|---|
| Education | ||
| No education | 3 | 0.1 |
| Primary | 2,149 | 71.6 |
| Secondary | 819 | 27.3 |
| Tertiary | 31 | 1.0 |
| Religion | ||
| Christianity | 2,407 | 75.8 |
| Islam | 679 | 21.4 |
| Traditionalist | 88 | 2.8 |
| Type of residence | ||
| Urban | 1,237 | 38.3 |
| Rural | 1,996 | 61.7 |
| Region | ||
| Western | 309 | 9.6 |
| Central | 309 | 9.6 |
| Greater Accra | 249 | 7.7 |
| Volta | 304 | 9.4 |
| Eastern | 262 | 8.1 |
| Ashanti | 278 | 8.6 |
| Brong Ahafo | 308 | 9.5 |
| Northern | 400 | 12.4 |
| Upper East | 441 | 13.6 |
| Upper West | 373 | 11.5 |
| Wealth index | ||
| Quintile 1 (Poorest) | 167 | 5.2 |
| Quintile 2 (Poorer) | 2,577 | 79.7 |
| Quintile 3 (Middle) | 140 | 4.3 |
| Quintile 4 (Richer) | 161 | 5.0 |
| Quintile 5 (Richest) | 188 | 5.8 |
| Occupation | ||
| Professional | 26 | 2.0 |
| Non-professional | 1,248 | 98.0 |
| Marital status | ||
| Married | 123 | 3.8 |
| Not Married | 3,110 | 96.2 |
Relationship between socio-demographic variables and contraceptive use
Table 2 shows the relationship between socio-demographic variables and contraceptive use. The religion of respondents was statistically significantly related to contraceptive use (p = < 0.001). Thus, 15.75% of Christian teenage girls aged 15–19 years used contraceptives compared to 4.57% and 0.00% of contraceptive use among teenage girls who were Islamic and Traditionalist, respectively. Also, the type of residence of the participants was statistically significantly related to contraceptive use (p = < 0.001). Whereas 18.92% of teenage girls aged 15–19 years who used contraceptives were in the urban region, only 9.12% of the teenage girls who used contraceptives were from the rural region of Ghana. The region of the participants was statistically significantly related to contraceptive use (p = 0.001). For instance, 100% of teenage girls who were found to be living in the Western region used contraceptives compared with 34.63% and 0.00% of contraceptive use among teenage girls who were found to be living in the Central region and all the remaining regions, respectively. The wealth index of teenage girls aged 15–19 years was statistically significantly related to contraceptive use (p = 0.001). For instance, 68.62% of teenage girls who were richer (quintile 5) used contraceptives compared with 26.35% of the teenage girls who were poorer (quintile 1). The marital status of participants was statistically significantly related to contraceptive use (p = 0.007). For instance, 13.18% of teenage girls who were not married used contraceptives compared with 4.88% of teenage girls who were married. However, socio-demographic variables such as education and occupation had no significant association with contraceptive use.
Table 2.
Relationship between socio-demographic variables and contraceptive use
| Variables | Modern contraceptive use | p-value | ||||
|---|---|---|---|---|---|---|
| Not Use | Use | |||||
| N | % | N | % | |||
| Education | ||||||
| No Education | 3 | 100 | 0 | 0.0 | 0.388 | |
| Primary | 1,864 | 86.7 | 285 | 13.3 | ||
| Secondary | 715 | 87.3 | 104 | 12.7 | ||
| Tertiary | 24 | 77.4 | 7 | 22.6 | ||
| Religion | ||||||
| Christianity | 2,028 | 84.3 | 379 | 15.8 | 0.000 | |
| Islam | 648 | 95.4 | 31 | 4.6 | ||
| Traditionalist | 88 | 100.0 | 0 | 0.0 | ||
| Type of Residence | ||||||
| Urban | 1,003 | 81.1 | 234 | 18.9 | 0.000 | |
| Rural | 1,814 | 90.9 | 182 | 9.1 | ||
| Region | ||||||
| Western | 0 | 0.0 | 309 | 100.0 | 0.000 | |
| Central | 202 | 65.4 | 107 | 34.6 | ||
| Greater Accra | 249 | 100.0 | 0 | 0.0 | ||
| Volta | 304 | 100.0 | 0 | 0.0 | ||
| Eastern | 262 | 100.0 | 0 | 0.0 | ||
| Ashanti | 278 | 100.0 | 0 | 0.0 | ||
| Brong Ahafo | 308 | 100.0 | 0 | 0.0 | ||
| Northern | 400 | 100.0 | 0 | 0.0 | ||
| Upper East | 441 | 100.0 | 0 | 0.0 | ||
| Upper West | 373 | 100.0 | 0 | 0.0 | ||
| Wealth Index | ||||||
| Quintile 1 | 123 | 73.7 | 44 | 26.4 | 0.000 | |
| Quintile 2 | 2,501 | 97.1 | 76 | 3.0 | ||
| Quintile 3 | 63 | 45.0 | 77 | 55.0 | ||
| Quintile 4 | 71 | 44.1 | 90 | 55.9 | ||
| Quintile 5 | 59 | 31.4 | 129 | 68.6 | ||
| Marital Status | ||||||
| Married | 117 | 95.1 | 6 | 4.9 | 0.007 | |
| Not Married | 2,700 | 86.8 | 410 | 13.2 | ||
| Occupation | ||||||
| Professional | 23 | 88.5 | 3 | 11.5 | 0.652 | |
| Non-professional | 1,136 | 91.0 | 112 | 9.0 | ||
Statistically Significant (p ≤ 0.001)
Preferences of contraceptive use among teenage girls
Table 3 reveals the preferences of contraceptive use among female teenagers aged 15–19 years. A total of 416 (85.60%) teenagers were found to prefer modern methods of contraceptives, while a few opted for traditional methods 70 (14.40%). The table indicates that there is a higher preference for modern contraceptive methods among teenage girls aged 15–19 years in Ghana than the traditional method.
Table 3.
Preferences of contraceptive use among teenage girls (15–19 years) in Ghana
| Preferences of Contraceptive Use | Frequency (N) | Percentage (%) |
|---|---|---|
| Modern methods | 416 | 85.60 |
| Traditional methods | 70 | 14.40 |
| Total | 486 | 100.00 |
Relationship between socio-demographic variables and preferences of contraceptive use
The results in Table 4 show that there was a statistically significant relationship between region and preferences of modern contraceptive use (p = 0.001). Thus, 96.30% of teenage girls aged 15–19 years in the upper west region preferred modern contraceptives as compared to 66.67% of modern contraceptive use among female adolescents aged 15–17 years in the central region of Ghana.
Table 4.
Relationship between socio-demographic variables and preferences of contraceptive use
| Variables | Preferences of contraceptive use | P-value | |||
|---|---|---|---|---|---|
| Modern | Traditional | ||||
| Freq (N) |
Percent (%) |
Freq (N) |
Percent (%) |
||
| Education | |||||
| Primary | 297 | 85.84 | 49 | 14.16 | 0.782 |
| Secondary | 103 | 83.74 | 20 | 16.26 | |
| Tertiary | 1 | 100.00 | 0 | 0.00 | |
| Religion | |||||
| Christianity | 324 | 84.38 | 60 | 15.63 | 0.233 |
| Islam | 74 | 91.36 | 7 | 8.64 | |
| Traditionalist | 10 | 90.91 | 1 | 9.09 | |
| Type of Residence | |||||
| Urban | 142 | 85.54 | 24 | 14.46 | 0.980 |
| Rural | 274 | 85.63 | 46 | 14.37 | |
| Region | |||||
| Western | 45 | 93.75 | 3 | 6.25 | 0.000 |
| Central | 22 | 66.67 | 11 | 33.33 | |
| Greater Accra | 26 | 86.67 | 4 | 13.33 | |
| Volta | 48 | 70.59 | 20 | 29.41 | |
| Eastern | 28 | 80.00 | 7 | 20.00 | |
| Ashanti | 27 | 79.41 | 7 | 20.59 | |
| Brong Ahafo | 32 | 84.21 | 6 | 15.79 | |
| Northern | 56 | 94.92 | 3 | 5.08 | |
| Upper East | 106 | 92.98 | 8 | 7.02 | |
| Upper West | 26 | 96.30 | 1 | 3.70 | |
| Wealth Index | |||||
| Quintile 1 | 6 | 75.00 | 2 | 25.00 | 0.756 |
| Quintile 2 | 353 | 86.31 | 56 | 13.69 | |
| Quintile 3 | 14 | 77.78 | 4 | 22.22 | |
| Quintile 4 | 20 | 83.33 | 4 | 16.67 | |
| Quintile 5 | 23 | 85.19 | 4 | 14.81 | |
| Marital Status | |||||
| Married | 19 | 76.00 | 6 | 24.00 | 0.161 |
| Not Married | 397 | 86.12 | 64 | 13.88 | |
| Occupation | |||||
| Professional | 4 | 66.67 | 2 | 33.33 | 0.161 |
| Non-professional | 214 | 86.64 | 33 | 13.36 | |
Statistically Significant (p ≤ 0.001)
However, socio-demographic factors such as education (p = 0.782), religion (p = 0.233), type of residence (p = 0.980), wealth index (= 0.756), marital status (p = 0.161) and occupation (p = 0.161) had no significant relationship with preferences of contraceptive use.
Multivariate analysis of socio-demographic variables and preferences of modern contraceptive use
Table 5 presents the results of the factors associated with the preference of contraceptive use among teenagers. Teenagers in the Central region had 88% lower odds of preferring modern contraceptive use compared to those in the Western region [AOR = 0.12; (95% CI: 0.03, 0.50), p = 0.004]. Also, teenagers in the Volta region had 89% lower odds of preferring modern contraceptive use relative to those in the western region [AOR = 0.11 (95% CI: 0.02, 0.67), p = 0.017].
Table 5.
Logistic regression analysis of socio-demographic variables and preferences of modern contraceptive use
| Variables | Preferences of contraceptive use | COR [95% CI] p-value | AOR [95% CI] p-value | overall p-value | |||
|---|---|---|---|---|---|---|---|
| Modern | Traditional | ||||||
| Freq (N) |
Percent (%) |
Freq (N) |
Percent (%) |
||||
| Religion | |||||||
| Christianity | 60 | 15.63 | 324 | 84.38 | Ref | Ref | |
| Islam | 7 | 8.64 | 74 | 91.36 | 1.96(0.86, 4.46), 0.109 | 1.04(0.41, 2.62), 0.933 | 0.142 |
| Traditionalist | 1 | 9.09 | 10 | 90.91 | 1.85(0.23, 14.73), 0.560 | 0.93(0.10, 8.30), 946 | |
| Type of Residence | |||||||
| Urban | 24 | 14.46 | 142 | 85.54 | Ref | Ref | |
| Rural | 46 | 14.37 | 274 | 85.63 | 1.01(0.59, 1.72), 0.980 | 0.82(0.45, 1.49), 0.514 | 0.401 |
| Region | |||||||
| Western | 3 | 6.25 | 45 | 93.75 | Ref | Ref | |
| Central | 11 | 33.33 | 22 | 66.67 | 0.13(0.03, 0.53), 0.004 | 0.12(0.03, 0.50), 0.004 | |
| Greater Accra | 4 | 13.33 | 26 | 86.67 | 0.43(00.09, 2.09), 0.297 | 0.33(0.05, 2.05), 0.233 | |
| Volta | 20 | 29.41 | 48 | 70.59 | 0.16(0.44, 0.58), 0.005 | 0.11(0.02, 0.67), 0.017 | 0.000 |
| Eastern | 7 | 20.00 | 28 | 80.00 | 0.27(0.06, 1.12), 0.071 | 0.17(0.03, 1.17), 0.072 | |
| Ashanti | 7 | 20.59 | 27 | 79.41 | 0.23(0.06, 1.08), 0.063 | 0.19(0.03, 1.29), 0.088 | |
| Brong Ahafo | 6 | 15.79 | 32 | 84.21 | 0.36(0.08, 1.53), 0.165 | 0.24(0.03, 1.63), 0.143 | |
| Northern | 3 | 5.08 | 56 | 94.92 | 1.24(0.24, 6.46), 0.795 | 0.98(0.11, 8.30), 0.988 | |
| Upper East | 8 | 7.02 | 106 | 92.98 | 0.88(0.22, 3.48), 0.859 | 0.60(0.09, 3.97), 0.595 | |
| Upper West | 1 | 3.70 | 26 | 96.30 | 1.73(0.17, 17.53), 0.641 | 1.29(0.09, 19.17), 0.855 | |
| Wealth Index | |||||||
| Quintile 1 | 2 | 25.00 | 6 | 75.00 | Ref | Ref | |
| Quintile 2 | 56 | 13.69 | 353 | 86.31 | 2.10(0.41,10.67), 0.370 | 2.97(0.40, 22.01), 0.286 | |
| Quintile 3 | 4 | 22.22 | 14 | 77.78 | 1.17(0.17, 8.19), 0.877 | 1.38(0.15, 12.92), 0.776 | |
| Quintile 4 | 4 | 16.67 | 20 | 83.33 | 1.67(0.24, 11.45), 0.603 | 2.15(0.24, 19.07), 0.493 | 0.702 |
| Quintile 5 | 4 | 14.81 | 23 | 85.19 | 1.92(0.28, 13.08), 0.507 | 2.20(0.23, 20.95), 0.491 | |
| Marital Status | |||||||
| Married | 6 | 24.00 | 19 | 76.00 | Ref | Ref | |
| Not Married | 64 | 13.88 | 397 | 86.12 | 1.96(0.75, 5.09), 0.168 | 2.93(0.99, 8.72), 0.053 | 0.000 |
| Occupation | |||||||
| Professional | 2 | 33.33 | 4 | 66.67 | Ref | ||
| Non-professional | 33 | 13.36 | 214 | 86.64 | 3.24(0.57, 18.41), 0.184 | 0.048 | |
Statistically Significant (p ≤ 0.001)
Barriers to contraceptive use among the teenagers’ girls
Table 6 indicates that the majority of the teenage girls (69.14%) did not use contraceptives because they were not married. Also, the table shows that just a few (0.03%) did not use contraceptives because of the lack of access, menopausal/ hysterectomy, and not being available.
Table 6.
Barriers to contraceptive use among teenage girls (15–19 years) in Ghana
| Barriers of Contraceptive Use | Frequency (N) | Percentage (%) |
|---|---|---|
| Not married | 1,981 | 69.14 |
| Pregnant/ Partner pregnant | 27 | 0.94 |
| Infrequent sex | 34 | 1.19 |
| No sex | 570 | 19.90 |
| Menopausal/ hysterectomy | 1 | 0.03 |
| Fear of side effect | 38 | 1.33 |
| Religious prohibition | 18 | 0.63 |
| Wants as many children as possible | 71 | 2.48 |
| Spouse/ partner opposed | 7 | 0.24 |
| Respondent opposed | 15 | 0.52 |
| Lack of knowledge (knows no method) | 15 | 0.52 |
|
Lack of knowledge (Knows no source) |
6 | 0.21 |
| Health concerns | 9 | 0.31 |
| Lack of access/ too far | 1 | 0.03 |
| Inconvenient to use | 11 | 0.38 |
| Interferes with body’s normal processes | 2 | 0.07 |
| Not available | 1 | 0.03 |
| Don’t know | 49 | 1.71 |
| Other | 9 | 0.31 |
| Barriers to contraceptives | ||
| Yes | 107 | 3.3 |
| No | 3126 | 96.7 |
Relationship between socio-demographic variables and barriers to contraceptive use
Table 7 shows the relationship between socio-demographic variables and barriers to contraceptive use. The type of residence of participants was statistically significantly related to barriers to contraceptive use (p = 0.044). Thus, 3.81% of teenage girls aged 15–19 years in the rural region had barriers to contraceptive use as compared to 2.51% of teenage girls aged 15–19 years in the urban region of Ghana.
Table 7.
Relationship between Socio-Demographic variables and barriers to contraceptive use
| Variables | Barrier to Contraceptive Use | P-value | ||||
|---|---|---|---|---|---|---|
| Disagree | Agree | |||||
| Freq (N) |
Percent (%) |
Freq (N) |
Percent (%) |
|||
| Education | ||||||
| No Education | 3 | 100.00 | 0 | 0.00 | 0.386 | |
| Primary | 2,078 | 96.70 | 71 | 3.30 | ||
| Secondary | 800 | 97.68 | 19 | 2.32 | ||
| Tertiary | 31 | 100.00 | 0 | 0.00 | ||
| Religion | ||||||
| Christianity | 2,330 | 96.80 | 77 | 3.20 | 0.883 | |
| Islam | 658 | 96.91 | 21 | 3.09 | ||
| Traditionalist | 86 | 97.73 | 2 | 2.27 | ||
| Type of Residence | ||||||
| Urban | 1,206 | 97.49 | 31 | 2.51 | 0.044 | |
| Rural | 1,920 | 96.19 | 76 | 3.81 | ||
| Region | ||||||
| Western | 302 | 97.73 | 7 | 2.27 | 0.007 | |
| Central | 293 | 94.82 | 16 | 5.18 | ||
| Greater Accra | 246 | 98.80 | 3 | 1.20 | ||
| Volta | 297 | 97.70 | 7 | 2.30 | ||
| Eastern | 251 | 95.80 | 11 | 4.20 | ||
| Ashanti | 266 | 95.68 | 12 | 4.32 | ||
| Brong-Ahafo | 299 | 97.08 | 9 | 2.92 | ||
| Northern | 376 | 94.00 | 24 | 6.00 | ||
| Upper East | 430 | 97.51 | 11 | 2.49 | ||
| Upper West | 366 | 98.12 | 7 | 1.88 | ||
| Wealth Index | ||||||
| Quintile 1 | 159 | 95.21 | 8 | 4.79 | 0.702 | |
| Quintile 2 | 2,492 | 96.70 | 85 | 3.30 | ||
| Quintile 3 | 137 | 97.86 | 3 | 2.14 | ||
| Quintile 4 | 157 | 97.52 | 4 | 2.48 | ||
| Quintile 5 | 181 | 96.28 | 7 | 3.72 | ||
| Marital Status | ||||||
| Married | 100 | 81.30 | 23 | 18.70 | 0.000 | |
| Not Married | 3,026 | 97.30 | 84 | 2.70 | ||
| Occupation | ||||||
| Professional | 25 | 96.15 | 1 | 3.85 | 0.687 | |
| Non-professional | 1,177 | 94.31 | 71 | 5.69 | ||
Statistically Significant (p ≤ 0.001)
Also, the region of the participants was statistically significantly related to modern contraceptive use (p = 0.007). Whereas 6.00% of teenage girls aged 15–19 years in the Northern region had barriers to contraceptive use, only 1.20% of the teenage girls aged 15–19 years in the Greater Accra region had barriers to contraceptive use.
The marital status of the participants was statistically significantly related to modern contraceptive use (p = 0.001). For instance, 18.70% of teenage girls who were married had barriers to contraceptive use as compared with 2.70% of teenage girls who were not married.
Factors associated with barriers to contraceptive use
Results of the logistic regression analysis of factors associated with barriers to contraceptive use are presented in Table 8. The results showed that unmarried teenagers had 88% lower odds of having barriers to contraceptives use compared to those that were [AOR = 0.12 (95% CI: 0.07, 0.20), p = < 0.001].
Table 8.
Logistic regression analysis of socio-demographic variables and barriers to contraceptive use
| Variables | Barrier to Contraceptive Use | COR [95% CI] p-value | AOR [95% CI] p-value | Overall p-value | |||
|---|---|---|---|---|---|---|---|
| Disagree | Agree | ||||||
| N | % | N | % | ||||
| Religion | |||||||
| Christianity | 2,330 | 96.80 | 77 | 3.20 | |||
| Islam | 658 | 96.91 | 21 | 3.09 | |||
| Traditionalist | 86 | 97.73 | 2 | 2.27 | 0.254 | ||
| Type of Residence | |||||||
| Urban | 1,206 | 97.49 | 31 | 2.51 | Ref | Ref | |
| Rural | 1,920 | 96.19 | 76 | 3.81 | 1.54(1.01, 2.35), 0.046 | 1.43(0.90, 2.27), 0.133 | 0.847 |
| Region | |||||||
| Western | 302 | 97.73 | 7 | 2.27 | Ref | Ref | |
| Central | 293 | 94.82 | 16 | 5.18 | 2.36(0.96, 5.81), 0.063 | 2.45(0.99, 6.09), 0.053 | |
| Greater Accra | 246 | 98.80 | 3 | 1.20 | 0.53(0.13, 2.06), 0.356 | 0.64(0.16, 2.58), 0.534 | |
| Volta | 297 | 97.70 | 7 | 2.30 | 1.02(0.35, 2.93), 0.975 | 0.86(0.30, 2.52), 0.786 | |
| Eastern | 251 | 95.80 | 11 | 4.20 | 1.89(0.72, 4.95), 0.195 | 1.93(0.73, 5.08), 0.185 | 0.000 |
| Ashanti | 266 | 95.68 | 12 | 4.32 | 1.95(0.76, 5.02), 0.168 | 2.15(0.83, 5.61), 0.117 | |
| Brong Ahafo | 299 | 97.08 | 9 | 2.92 | 1.30(0.48, 3.53), 0.609 | 1.25(0.46, 3.44), 0.660 | |
| Northern | 376 | 94.00 | 24 | 6.00 | 2.75(1.17, 6.48), 0.020 | 1.70(0.70, 4.14), 0.239 | |
| Upper East | 430 | 97.51 | 11 | 2.49 | 1.10(0.42, 2.88), 0.840 | 0.81(0.30, 2.15), 0.671 | |
| Upper West | 366 | 98.12 | 7 | 1.88 | 0.83(0.29, 2.38), 0.722 | 0.57(0.19, 1.69), 0.314 | |
| Wealth Index | |||||||
| Quintile 1 | 159 | 95.21 | 8 | 4.79 | |||
| Quintile 2 | 2,492 | 96.70 | 85 | 3.30 | |||
| Quintile 3 | 137 | 97.86 | 3 | 2.14 | 0.039 | ||
| Quintile 4 | 157 | 97.52 | 4 | 2.48 | |||
| Quintile 5 | 181 | 96.28 | 7 | 3.72 | |||
| Marital Status | |||||||
| Married | 100 | 81.30 | 23 | 18.70 | Ref | Ref | |
| Not Married | 3,026 | 97.30 | 84 | 2.70 | 0.12(0.07, 0.20) < 0.001 | 0.12(0.07, 0.20) < 0.001 | 0.000 |
| Occupation | |||||||
| Professional | 25 | 96.15 | 1 | 3.85 | |||
| Non-professional | 1,177 | 94.31 | 71 | 5.69 | 0.537 | ||
Statistically Significant (p ≤ 0.001)
Discussion
Our study examined teenage girls (15–19 years) contraceptive use and associated factors using nationally representative data from the Ghana Living Standards Survey 7 (GLSS7). The results showed that only a few (12.87%) teenage girls reported current contraceptive use, indicating low utilization despite their sexual activity. This finding aligns with existing literature on the unmet need for modern contraceptives among adolescents, which contributes to high rates of teenage pregnancies and unsafe abortions [15–18]. Although contraceptive services are among the most widely available family planning services [19], uptake remains low, underscoring the need to understand the barriers to effective use. The study found a significant association between religion and modern contraceptive use. Christianity had a higher usage rate compared to Islam, while Traditionalists reported no use of modern methods. Religious doctrines and cultural beliefs may shape attitudes toward contraception, with Christian communities generally more accepting compared to Islamic or Traditionalist groups [20, 21]. Urban residents had greater access to health services and education, resulting in higher contraceptive use compared to rural residents, who faced barriers such as limited access, lower education levels, and strong traditional norms [22, 23]. There was also significant regional variation in contraceptive use. Regions such as the Western Region had higher usage rates, while others like Greater Accra and Volta reported none. These differences likely reflect variations in healthcare infrastructure, education, and family planning outreach programs [24, 25]. The wealth index was significantly associated with contraceptive use, with higher usage among individuals in the upper quintiles; for example, quintile 5 had a 68.6% usage rate, indicating better access among wealthier adolescents [26]. Marital status was another key factor. Married teenage girls may face societal or familial expectations to have children or may not perceive the need for contraception. In contrast, unmarried girls might be more motivated to prevent unintended pregnancies [27]. These findings highlight the need for targeted reproductive health interventions, such as school-based education and culturally sensitive campaigns, to improve access and reduce disparities. Preferences for modern versus traditional contraceptives also varied by region, though other factors like education, religion, wealth, and occupation did not show significant associations. Regions such as Upper West and Northern showed greater preference for modern methods, possibly due to stronger healthcare systems or effective family planning initiatives. In contrast, Central and Volta regions showed higher preference for traditional methods, potentially due to cultural norms or limited access to modern options [28, 29]. These regional differences may also be influenced by the availability of services and localized health education campaigns [30]. After adjusting for other variables, region, marital status, and occupation remained significantly associated with preferences for modern contraceptive use. This is consistent with findings from Tsegaw et al. (2022), which reported that employment status, number of children, education level, and wealth influenced contraceptive use among women in Liberia [30, 31]. The lower odds of modern contraceptive use in regions like Central and Volta may reflect deep-rooted traditional beliefs and limited access [32, 33], while higher usage in regions like Western may be linked to better healthcare systems and public health campaigns [34]. The marginal influence of marital status suggests differing contraceptive needs and access between married and unmarried adolescents. These findings have important implications for resource allocation and the design of inclusive family planning programs.
Types of residence, region, and marital status also showed significant relationships with barriers to contraceptive use, with marital status being particularly influential. This is supported by Ochako et al. [35], who found that region, marital status, religion, wealth, and media exposure affect contraceptive use [34]. Urban areas generally offer better access to healthcare, reducing barriers, while rural areas often face challenges like distance, lack of privacy, and cultural resistance. Regions such as Northern and Central reported higher barriers, while Greater Accra reported fewer. Married girls were more likely to report barriers, possibly due to limited autonomy and societal expectations, while unmarried girls faced fewer restrictions.
Logistic regression analysis further showed that rural residence initially appeared to be associated with more barriers, but this was not significant after adjustment. Similarly, the Northern region showed a crude association, but this diminished in the adjusted model. However, the Central region remained borderline significant. Marital status continued to be a strong predictor, with unmarried adolescents less likely to perceive barriers. These patterns reflect the influence of healthcare access, cultural norms, and gender expectations on contraceptive use. [36]. These disparities in access and barriers have major implications for public health. They may lead to lower contraceptive uptake, higher rates of unintended pregnancies, and increased strain on healthcare systems, especially in rural and underserved regions. To address these challenges, public health strategies should focus on improving healthcare access through mobile clinics and community outreach, strengthening school-based reproductive health education, and promoting couple-based counseling. Community health workers should play a central role in educating adolescents and distributing contraceptives in remote areas. Culturally tailored policies are essential to ensure equitable access to family planning services and reduce regional and socio-demographic disparities in contraceptive.
Limitations
The source of the data was solely dependent on teenage girls between the ages of 15 and 19 years in Ghana. As such, the findings cannot be transferable since the study is not representative of the entire teenage population, but it may be generalized to make inferences. As a cross-sectional study, causality cannot be established. Additionally, self-reported data may introduce social desirability bias, potentially overestimating contraceptive prevalence. Future research directions, such as longitudinal studies should be done to track contraceptive use trends among adolescents.
This study identified potential biases in using secondary data for cross-sectional analysis, including selection bias, recall bias, misclassification bias, temporal bias, and data quality issues. Selection bias may have occurred due to the sampled population not aligning with the target population, recall bias could have been due to inaccurate self-reported information, and misclassification bias could have affected the analysis. The study mitigated potential biases by aligning objectives with available data, minimizing selection, recall, and misclassification biases, considering temporal bias, and handling data quality issues by excluding missing or incomplete cases and performing sensitivity analyses.
Conclusion
This study sought to assess the modern contraceptive use among teenage girls aged 15–19 years in Ghana. To achieve this objective, data from the Ghana Living Standard Survey round 7 was retrieved and analyzed using Stata 16. This study found that contraceptive use remains suboptimal among teenage girls (87.13%), with a few of them (12.87%) using it. The majority of them preferred modern contraceptive methods (85.60%) as compared to the traditional methods (14.40%). Major factors identified to have a relationship with modern contraceptive use were marital status, region, religion, wealth index and type of residence. Moreover, there was an association between region and preferences of modern contraceptive use. Marital status was also found to have an association with barriers to contraceptive use.
Expanding youth-centered family planning initiatives and addressing sociocultural barriers may enhance contraceptive uptake among teenage girls. Further studies should explore the impact of peer-led interventions on contraceptive awareness and uptake among adolescents.
Also, a field that employs a multidisciplinary approach to reach the adolescents, such as health, education sector, community, religion, and peers can be looked at.
Acknowledgements
The authors are grateful to all stakeholders who participated in the study.
Abbreviations
- AOR
Adjusted odds ratio
- COC
Combined oral contraceptive
- COR
Crude odds ratio
- ECP
Emergency contraceptive pills
- FDA
Food and drugs authority
- GDHS
Ghana demographic and health survey
- GHS
Ghana health service
- GLSS7
Ghana living standard survey
- GSS
Ghana statistical service
- HIV
Human immunodeficiency virus
- IUCD
Intrauterine contraceptive device
- LAM
Lactational amenorrhoea method
- POP
Progestin only pills
- PPAG
Planned parenthood association of Ghana
- STI
Sexually transmitted infection
- UN
United nations
- WHO
World health organisation
Author contributions
AOR: Adjusted Odds Ratio, COC: Combined Oral Contraceptive, COR: Crude Odds Ratio, ECP: Emergency Contraceptive Pills, FDA: Food and Drugs Authority, GDHS: Ghana Demographic and Health Survey, GHS: Ghana Health Service, GLSS7: Ghana Living Standard Survey, GSS: Ghana Statistical Service, HIV: Human Immunodeficiency Virus, IUCD: Intrauterine Contraceptive Device, LAM: Lactational Amenorrhoea Method, POP: Progestin Only Pills, PPAG: Planned Parenthood Association of Ghana, STI: Sexually Transmitted infection, UN: United Nations, WHO: World Health Organisation.
Funding
The present study did not receive any financial support.
Data availability
Data is available upon reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval was given by the University of Health and Allied Sciences Ethical Review Committee (UHAS-REC A.1 [27] 21–22).
Consent for publication
Our manuscript does not contain any individual person’s data.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data is available upon reasonable request.