Access to this full-text is provided by Springer Nature.
Content available from BMC Public Health
This content is subject to copyright. Terms and conditions apply.
RESEARCH Open Access
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you
give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modied the
licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the
material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or
exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit h t t p : / / c r e a t i
v e c o m m o n s . o r g / l i c e n s e s / b y - n c - n d / 4 . 0 /.
Sulemana et al. BMC Public Health (2025) 25:462
https://doi.org/10.1186/s12889-024-21122-3 BMC Public Health
*Correspondence:
Gifty Apiung Aninanya
gapiung@gmail.com
1Department of Social and Behavioural Change, University for
Development Studies, Tamale, Ghana
2Drylands Research Institute, University for Development Studies, Tamale,
Ghana
3Institute of Health Research, University of Health and Allied Sciences,
PMB 31, Ho, Volta Region, Ghana
4Department of Health Services Policy Planning Management and
Economics, University for Development Studies, Tamale, Ghana
5School of Public Health, University for Development Studies, Tamale,
Ghana
Abstract
The study investigated the prevalence and determinants of family planning services uptake among women of
reproductive age (15 to 49 years) in the Yendi municipality in the northern region of Ghana. A health facility-based
cross-sectional study was conducted among 396 reproductive-aged women, sampled from 6 randomly selected
health facilities in the Yendi municipality. The child welfare clinic (CWC) served as the point for the sampling of
study respondents. Data was collected with questionnaires adapted from previously validated tools. Data was
analysed using SPSS v27 in descriptive and inferential statistics. More than half of the respondents (54.3%) said
they had ever used a family planning method and almost half of them said they were still using a family planning
method. The desire to control pregnancy was a key factor for wanting family planning (79.3%). Most respondents
(80.6%) had high knowledge of family planning services and injectables (37.1%) and condoms (24.7%) were the
preferred family planning methods. The signicant sociodemographic determinants of family planning uptake were
religion (Christians (aOR: 7.51; 95%CI: 1.48–38.00:; p = 0.015), traditionalist (aOR: 12.1; 95%CI: 1.90–78.36; p = 0.009)),
education (secondary education (aOR: 84.99; 95%CI: 20.02–360.84:; p = 0.000), tertiary education (aOR: 158.74; 95%CI:
33.71–747.52; p = 0.000), no formal education (aOR: 11.83; 95%CI: 2.10–46.76:; p = 0.000)), occupation (farmers (aOR:
12.30; 95%CI: 3.21–47.03; p = 0.000)), and marital status (married (aOR: 0.13; 95%CI: 0.03–0.57; p = 0.007)). Factors
that made women less likely to use family planning were unfriendly service providers (aOR: 2.33; 95%CI: 1.28–4.21;
p = 0.005), fear of side eects (aOR: 2.19; 95%CI: 1.19–4.05; p = 0.012), and lack of knowledge about available FP
services (aOR: 0.45; 95%CI: 0.26–0.77; p = 0.004). Though the knowledge of family planning was high, current uptake
of family planning services was modest and there are still sociodemographic and health-related barriers to family
planning utilization. Highlighting the need for training programs and policy interventions to improve uptake,
reduce nancial barriers, and foster a supportive environment.
Keywords Family planning, Contraceptives, Uptake, Determinants, Reproductive health
Determinants of family planning services
uptake among women within the
reproductive age in the Yendi municipality
in Northern Ghana
IddrisuSulemana1, CollinsGbeti2, MaxwellDalaba3, AdadowYidana1 and Gifty ApiungAninanya1,4,5*
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 12
Sulemana et al. BMC Public Health (2025) 25:462
Introduction
Unintended pregnancy remains a major public health
concern around the world, with a recent global estimate
indicating that 44% of all pregnancies were unplanned
between 2010 and 2014 [1]. Notably, the prevalence of
unintended pregnancy varies by country and even within
countries [2]. Unintended pregnancy is more common
among unmarried women, adolescent girls, and women
over 40 years old than among married women and those
aged 20–39 years old [2].
Modern contraception continues to be an eective
method of preventing unintended pregnancies [3, 4].
Despite the wide range of eective modern contraceptive
options available to women, global statistics show low
usage with rising unintended pregnancies in both devel-
oped and developing countries [5].
Globally, family planning services are an essential com-
ponent of reproductive health care, and they make a sig-
nicant contribution to lowering the global burden of
maternal and child morbidity and mortality [6, 7]. Family
planning services primarily enable couples and individu-
als to freely and responsibly decide the number and spac-
ing of their children, as well as to have the information
and means to do so, as well as to ensure informed choices
and provide a full range of safe and eective meth-
ods. Contraception is used by the majority of women in
the reproductive age range (15–49 years) in almost all
regions of the world, and its goals are commonly dened
using the concepts of unmet needs [8–10].
Unsafe abortion is a common result of poor family
planning and a major cause of maternal death. Complica-
tions from unsafe abortions are a massive contributor to
maternal mortality and morbidity in Ghana [11, 12]. e
Ghana Medical Association (GMA) stated that abortions
are the principal cause of maternal mortality in Ghana
and account for about 15–30% of maternal deaths [13,
14]. A national survey found that 15% of all women in
the reproductive age group (15–49 years) sought unsafe
abortions [15].
Meeting women’s needs for modern family planning
services is estimated to prevent one-quarter to one-third
of all maternal deaths worldwide each year. Modern con-
traceptive uptake has been reported to be generally low
in Middle and Western Africa, with values as low as 25%
compared to Europe, Latin America, and the Caribbean,
where uptake can reach up to 70% [8].
According to research conducted in Accra, Ghana, the
overall prevalence of contraceptive use of 21%, similar
to the 22% reported by the Ghana Demographics and
Health Survey [16], but this was lower than the Ghana
Health Service’s national family planning target rate of
23.3% [4].
According to the 2017 Ghana Maternal Health Survey
(GMHS), knowledge of contraceptive methods is nearly
universal in Ghana; 99% of women aged 15–49 have
heard of contraceptive methods, with the male condom
being the most common modern method (98% of women
aged 15–49 years). Despite this knowledge, the contra-
ceptive prevalence rate (CPR) among women in fertile
age (WIFA) is only 25%, with a modern CPR (mCPR) rate
of 20%. In addition to these staggering national m/CPR
statistics, there is some disparity between northern and
southern Ghanaian regions. e southern parts of the
country appear to report a higher prevalence of contra-
ceptive use compared to the northern part [17].
Weak government programs, poor access of clients
to providers, clients’ wealth quintile, educational sta-
tus, rural/urban inuence, and marital status all have an
impact on contraceptive uptake [18, 19]. As a fast-grow-
ing Municipality in the Northern region, with potential
economic prospects, a healthy reproductive age popula-
tion is essential to meeting competing economic desires,
and this includes choice and use of suitable contracep-
tives in the Yendi municipality.
e 2014 GDHS report shows a national average con-
traceptive prevalence rate of 35.7%, with Yendi munici-
pality in the Northern Region having a lower rate of
23.1%. To date, studies to unearth this problem for the
necessary interventions appears limited in the Yendi
Municipality [40]. Although there are studies on family
planning uptake in Ghana, more research that focuses
on Yendi municipality in particular is necessary to com-
prehend the local environment and factors that inuence
family planning uptake. Eorts by Abdul-Manan et al.
(2023) in the Yendi municipality of Ghana only focused
on emergency contraceptive use among high school stu-
dents [20]. It is therefore vital to study the prevalence and
determinate of family planning services uptake among
reproductive-age women (15–49 years) in the Yendi
municipality.
Materials and methods
Study design and setting
is study adopted a health facility-based cross-sectional
survey involving a quantitative approach and was car-
ried out in November 2020. e Yendi Municipality
of the Northern region of Ghana was the study setting.
According to the 2020 Population and Housing Census,
Yendi Municipality has a total population of 154,421, out
of which 76,142 are males and 78,279 are females. e
Municipality has four health centres, two clinics, four
Community-based Health and Planning Services (CHPS)
compounds, and a Municipal Hospital. e Municipal
Hospital serves as a referral centre for the whole munici-
pality. ese facilities provide family planning services
to the entire population. e municipality has about 20
major communities. is study was carried out in 6 of
these communities among females of reproductive age
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 12
Sulemana et al. BMC Public Health (2025) 25:462
(15 to 49 years) recruited from health facilities. e study
was conducted in the municipality to ll the research gap
that exists on family planning uptake.
Sample size determination
e study adopted the Yamane’s formula to determine
the sample size for this study
n=
N
1+N(e)
2
Where, n: sample size, N: estimated study population,
and e: margin of error. e Yendi municipality has an
estimated reproductive women population age (15 to
49 years) of 35,676. At a condence level of 95% error
margin of 5%, the sample size was estimated to be 396
respondents.
Inclusion and exclusion criteria
e inclusion criteria for this study considered women of
reproductive age (15 to 49 years), who were permanently
residing in the Yendi municipality for at least six months.
However, all females below or above this age bracket
were excluded from the study.
Sampling procedure
A multistage stratied sampling technique was employed
in the selection of respondents. First, the study commu-
nities were stratied into urban and rural communities.
ree health facilities were randomly sampled within
each community. To avoid all forms of sampling or selec-
tion biases, the estimated study sample was proportion-
ally distributed for all six facilities. e sample for each
facility was determined based on the average daily atten-
dance to the child welfare clinic (CWC). e details of
the sampling strategy, including the probability propor-
tional to the strata size approach that we applied, have
been presented in Table1.
Data collection
e tool used for data collection was a pretested struc-
tured close-ended questionnaire (paper-based ques-
tionnaire), adapted from studies that were published
previously [21] and revised to meet the objective of the
study. After obtaining verbal and written informed con-
sent, hard copies of the questionnaire were given to ve
trained research assistants to assist respondents in com-
pleting the questionnaires. at is, the data collection
process adopted the research assistant or interviewer-
assisted approach in the data collection process. is
eorts to a large extent prevented response biases, as
respondents were made to clearly understand a question
and subsequently provided a suitable answer as per their
understanding. Completed questionnaires were reexam-
ined by the research assistants together with the respon-
dents to ensure the validity and accuracy of responses.
Data analysis
e study’s data was sorted, coded, and entered into SPSS
version 27 for analysis. Frequencies and percentages were
used to summarize data on the socio-demographic char-
acteristics, knowledge, use, and factors inuencing the
use of family planning services. Composite scores for
knowledge of family planning services were computed by
scoring the responses of the respondents by summation.
Correctly answered questions were each awarded 1 point
while wrong answers attracted no point. e minimum
score for each knowledge was 0 while the maximum
composite knowledge score obtainable by a respondent
was 12. Summary statistics of mean (and standard devia-
tion), minimum, and a maximum of the composite scores
on knowledge of family planning services were then com-
puted. e data for the composite scores on knowledge of
family planning services was normally distributed. ere-
fore mean (and standard deviation) was reported as the
measure of central tendency for each of the knowledge
indicators. e overall knowledge of the respondents was
then categorized based on composite scores. Using the
50% midpoint of the obtainable composite scores, overall
knowledge was categorized into low knowledge of fam-
ily planning services (composite scores of ≤ 6) and high
knowledge (composite scores > 6).
Logistic regression models were used to analyze the
association between the independent variables (sociode-
mographic information, service-related factors, and
knowledge of family planning services) and the depen-
dent variable (currently using any family planning
method). Bivariate analysis was performed to identify the
Table 1 Sample of health facilities and respondents
Type of Community Facility Average daily CWC attendance Percentage Proportional sample size (Respondents)
Urban Yendi municipal hospital 169 41.02 164
Urban Bunbonayili health center 64 15.53 61
Urban Eastern coridor hospital 40 9.71 39
Rural Ngani health center 41 9.95 43
Rural Sunsong CHPS 43 10.44 40
Rural Adibo health center 55 13.35 49
Total 412 100 396
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 12
Sulemana et al. BMC Public Health (2025) 25:462
independent predictors of utilization at a 5% signicance
level (p < 0.05). Variables found to be statistically sig-
nicantly associated with the utilization of family plan-
ning services were then included in a multivariate binary
logistic regression model to eliminate spurious predictors
at a 5% signicance level, with adjusted odds ratios (aOR)
reported at 95% condence intervals (CI).
Validity and reliability
After an extensive review of literature, the data collection
tool was adapted from published works [17, 21]. Face and
content validity of the tool was done and unclear state-
ments were rephrased, after pretesting. Using Cronbach’s
alpha test for internal consistency reliability, the scales of
knowledge on family planning, usage, and factors inu-
encing utilization were tested for internal consistency
reliability. e alpha coecients for knowledge on fam-
ily planning, usage, and factors inuencing utilization
were αk = 0.691 and αc = 0.783 respectively, with an over-
all alpha coecient of αo = 0.761. ese were considered
acceptable alpha coecients [22, 23].
Ethical consideration
is study obtained approval from the Kwame Nkrumah
University of Science and Technology’s (KNUST) Com-
mittee on Human Research Publications and Ethics
(CHRPE/AP/277/21). e Northern Regional Health
directorate and the head of the facilities used for the
study granted institutional access. Respondents’ con-
sent was also obtained before participating in the study.
Assent (from parents) was obtained from respondents
less than 18 years. e study respondents were assured
of utmost condentiality regarding the use and storage of
the data collected.
Results
Sociodemographic characteristics of respondents
As shown in Table 2, a total of 396 respondents were
involved in the study with a 100% response rate. Little
over half (56.8%) were between the ages of 20 to 29 years.
Secondary education was the level most (33.3%) respon-
dents had attained. e majority (59.6%) were married
and 80.1% belonged to the Islamic faith. e unem-
ployed/housewives were more (40.4%), and 11% were
teachers. Little below 50% (44.4%) of the study respon-
dents had had 1 or 2 children and a minimal birth inter-
val of 2 years respectively.
Knowledge of respondents on family planning methods
Table3 indicates the knowledge level of respondents on
family planning. e majority (91.9%) conrmed they
had ever heard of family planning with 37.1% and 24.7%
indicating injectables and condoms as the common
methods they have heard of respectively. Friends and
Table 2 Sociodemographic characteristics of respondents
Variables Frequency Percent
Age of respondent
15–19 55 13.9
20–29 225 56.8
30–39 82 20.7
40–49 34 8.6
Total 396 100.0
Level of Education
Primary 58 14.6
Secondary 132 33.3
Tertiary 117 29.5
No education
Total
89
396
22.5
100
Marital status
Single 113 28.5
Married 236 59.6
Divorced/Widowed 47 11.9
Total 396 100
Religion of Respondent
Islam 317 80.1
Christianity 59 14.9
Traditionalist
Total
20
396
5.1
100.1
Occupation of respondent
Housewife 160 40.4
Teacher 44 11.1
Farmer 37 9.3
Student 93 23.5
Others
Total
62
396
15.7
100.0
Number of children
0 75 18.9
1–2 176 44.4
3–4 121 30.6
5-above
Total
24
396
6.1
100.0
Minimal interval between birth
1 year 46 11.6
2 years 176 44.4
3 years 90 22.7
4 years 18 4.5
5 or more years
Total
66
396
16.7
100.0
Ethnicity
Dagomba 308 77.8
Konkonba 6 1.5
Gonja 8 2.0
Akan 25 6.3
Ewe 14 3.5
Others 35 8.8
Total 396 100.0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 12
Sulemana et al. BMC Public Health (2025) 25:462
Variable and category Frequency Percent
Have you heard of family planning methods?
No 32 8.1
Yes
Total
364
396
91.9
100.0
If yes, which type of family planning method do you know?
Injectables 147 37.1
Intrauterine device 2 0.5
Natural family planning methods 43 10.9
Implants 37 9.3
Emergency contraception 5 1.3
Condoms 98 24.7
Oral contraceptive pill 6 1.5
Others specify
Total
26
364
6.6
100.0
Where did you rst learn about family planning methods?
Hospital/ health facilities 144 36.4
Mass media 18 4.5
Friends and family 206 52.0
Literature 4 1.0
Don’t know/Not aware
Total
24
396
6.1
100.0
Women can have an operation to avoid having any more children
No 85 21.5
Yes 257 64.9
Don’t know
Total
54
396
13.6
100.0
Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy
No 70 17.7
Yes 313 79.0
Don’t know
Total
13
396
3.3
100.0
Women can have an injection by a health provider that stops them from becoming pregnant for one or more
months
No 52 13.1
Yes 332 83.8
Don’t know
Total
12
396
3.0
99.9
Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnan-
cy for one or more years
No 71 17.9
Yes 306 77.3
Don’t know
Total
19
396
4.8
100.0
Women can take a pill every day to avoid becoming pregnant
No 75 18.9
Yes 312 78.8
Don’t know 9 2.3
Total 396 100.0
Women can place a sheath in the vagina before sexual intercourse
No 93 23.5
Yes 287 72.5
Don’t know
Total
16
396
4.0
100.0
Lactational amenorrhea is a type of family planning method
No 92 23.2
Table 3 Knowledge of family planning methods
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 12
Sulemana et al. BMC Public Health (2025) 25:462
family (52.0%) constituted the main source of informa-
tion on family planning followed by hospitals or health
facilities (36.4%).
e majority (64.9%) conrmed that women could have
an operation to avoid having more children. Similarly,
79.0% agreed that a loop or coil could be placed inside a
woman by a physician to avoid pregnancy. Again, 83.8%
conrmed injection as a means of stopping pregnancy.
e use of pills was conrmed by 72.5% of the respon-
dents as a family planning method. Most (69.4%) dis-
agreed with the assertion that family planning decreased
sexual urge while 71.2% agreed some of the methods pre-
vented sexually transmitted diseases. In an overall sense,
the majority of the respondents (80.6%) expressed high
knowledge of family planning services or commodities.
Uptake of family planning services
From Table4, little above 50% of the respondents (54.3%)
said they had ever used a family planning method. At the
time of data collection for this study, almost half (49.5%)
said they were still using a family planning method. For
those who said they were not using any family planning
method, fear of side eects was the major reason given by
46.5% of respondents. On the contrary, 45.4% said birth
spacing was a major reason for using a family planning
method. e most common method used by the majority
(64.8%) was condoms followed by injectable use by 23.5%
of respondents. e study further revealed that family
planning was occasionally used among most (82.1%) of
respondents. Respondents (45.9%) mentioned that they
had been using family planning for the past 1 to 2 years.
e main source of family planning services as indicated
by the majority (68.9%) of respondents was the chemical
shops and pharmacies. e main promoter factor for the
use of family planning among respondents was conve-
nience (35.7%) and aordability as said by 24.5% of the
study respondents.
Perceived service-related factors inuencing family
planning utilization
e factors that inuence the use of family planning ser-
vices is presented in Table5. A total of 29.3% said the
bad attitude of health workers/unfriendly health sta
prevented them from using family planning services,
(48.7%) identied disapproval by their partners or spouse
as a barrier to FP use, and 56.3% said stigma was a bar-
rier to the use of family planning services. e majority
(63.9%) said they were afraid of the side eects of family
Variable and category Frequency Percent
Yes 295 74.5
Don’t know
Total
9
396
2.3
100.0
To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get
pregnant
No 57 14.4
Yes 336 84.8
Don’t know
Total
3
396
0.8
100.0
As an emergency measure, within three days after they have unprotected sexual intercourse, women can take
special pills to prevent pregnancy
No 62 15.6
Yes 331 83.6
Don’t know
Total
3
396
0.8
100.0
Does family planning decrease the sexual urge?
No 275 69.4
Yes 69 17.4
Don’t know
Total
52
396
13.1
100.0
Do some of the methods prevent sexually transmitted diseases (STIs)?
No 76 19.2
Yes 282 71.2
Don’t know
Total
38
396
9.6
100.0
Overall Knowledge
Low Knowledge 77 19.4
High knowledge 319 80.6
Total 396 100.0
Table 3 (continued)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 12
Sulemana et al. BMC Public Health (2025) 25:462
Table 4 Uptake of family planning services
Variables/Categories Frequency Percentage
Have you ever used any family planning methods before?
No 181 45.7
Yes
Total
215
396
54.3
100.0
Are you currently doing something or using any method to delay or avoid getting pregnant?
Yes 196 49.5
No
Total
200
396
50.5
100.0
If no, why are you not using any method?
Desired for more children 47 23.5
Fear of side eects 99 49.5
Non-aordability 14 7.0
Lack of information 30 15.0
Lack of spousal consent 10 5.0
Total 200 100.0
If yes, why are/were you practicing family planning?
Limit family size 38 19.4
Space birth 89 45.4
Both 64 32.6
Other
Total
5
196
2.6
100.0
Which of the methods are you using?
Injections 46 23.5
Pills 6 3.1
Implants 15 7.6
Condoms 127 64.8
Emergency contraception
Total
2
196
1.0
100.0
How often do you use family planning contraceptives?
Most often 18 9.2
Occasionally 161 82.1
When an encounter an emergency 5 2.6
Not often
Total
12
196
6.1
100.0
For how long have you been using this method?
Less than one year 66 33.7
1–2 years 90 45.9
3-5years
Total
40
196
20.4
100.0
Will you advise a friend or relative to practice family planning?
Yes 108 55.1
No
Total
88
196
44.9
100.0
If yes why and if no why
Fear of side eects 92 46.9
Non-aordability 11 5.6
Space birth 56 28.6
Limit family size 17 8.7
Not to give birth before married
Total
20
196
10.2
100.0
Where do you often get your family planning contraceptives when you need them?
Hospitals 46 23.5
Health centers or clinics 15 7.6
Chemical shops or pharmacies
Total
135
196
68.9
100.0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 12
Sulemana et al. BMC Public Health (2025) 25:462
planning, 51.8% noted religious convictions as a barrier
to family planning use, and 79.1% mentioned diculty
in getting pregnant as a major reason for the non-use of
family planning services.
Sociodemographic determinants of FP use
e binary logistic regression analyses for FP utilization
among respondents are shown in Table6. For religion,
Christians (aOR: 7.51; 95%CI: 1.48–38.00; p = 0.015) and
traditionalists (aOR: 12.1; 95%CI: 1.90–78.36; p = 0.009)
were statistically signicantly more likely to use FP
method compared to respondents who belonged to the
Islamic faith. e Akan (aOR: 0.08; 95%CI: 0.01–0.55;
p = 0.011) were signicantly less likely to use FP meth-
ods while other (minority Northern tribes) (aOR: 27.13;
95%CI: 6.04–121.92; p = 0.000) were signicantly more
likely to use FP services compared to respondents
belonging to the Dagomba tribe. Respondents with sec-
ondary education (aOR: 84.99; 95%CI: 20.02–360.84;
p = 0.000), tertiary education (aOR: 158.74; 95%CI: 33.71
747.52; p = 0.000), and respondents with no formal edu-
cation (aOR: 11.83; 95%CI: 2.10–46.76; p = 0.000) were
signicantly at higher odds of using FP services com-
pared to basic (primary/JHS) leavers.
e study again revealed that farmers (aOR: 12.30;
95%CI: 3.21–47.03; p = 0.000) were signicantly associ-
ated with higher odds of using a FP method compared to
the unemployed/housewives. Married respondents (aOR:
0.13; 95% CI: 0.03–0.57; p = 0.007) were signicantly less
likely to use an FP compared with single respondents.
Similarly, respondents with 3 to 4 children (aOR: 0.23;
95%CI: 0.06–0.94; p = 0.041) and 5 or more children
(aOR: 0.15; 95% CI: 0.02–0.092; p = 0.040) were signi-
cantly less associated with the use of FP methods com-
pared with those without children.
Service-related determinants of family planning Use
As shown in Table 7, respondents who disagreed with
unfriendly service providers (aOR: 2.33; 95% CI: 1.28–
4.21; p = 0.005) were statistically signicantly associ-
ated with higher odds (2.33 times) of using FP services.
Respondents who reported no fear of side eects were
more likely to use FP than those who did (aOR: 2.19; 95%
CI: 1.19–4.05; p = 0.012). Conversely, respondents with
inadequate knowledge about FP’s eectiveness were less
likely to use FP methods (aOR: 0.45; 95% CI: 0.26–0.77;
p = 0.004). In general, respondents with good or adequate
knowledge were signicantly more likely to use FP, with
odds 52.73 times higher compared to those with poor
knowledge.
Discussion
is study assessed the prevalence and determinants of
family planning services uptake among women within
the reproductive age (15–49) years in the Yendi munici-
pality. e study revealed that the majority (91.9%) of the
women were aware of family planning methods. Among
those who were aware of the various family planning
methods, the majority of the women indicated that they
rst learned of the various family planning from their
friends/family (53.0%) followed by the education received
from the hospital and health centers 36.4%.
e high level of awareness aligns with global trends
where family planning education is increasingly inte-
grated into public health eorts. According to the World
Health Organization [37], awareness of family planning
methods is generally high in many regions, but actual
knowledge and understanding of dierent methods vary
widely. e current study’s ndings again corroborate
that of Apang and Adam (2015) in Ghana’s Talensi dis-
trict, were 89% of the study’s respondents were found to
be aware of family planning services [4].
Again, the role of social networks in disseminating
information could account for friends and family being
the most common sources of information on family plan-
ning methods is could be benecial or detrimental
depending on the accuracy of the information shared.
Peer inuence has been shown to signicantly aect con-
traceptive use and choice, particularly among young peo-
ple [38]. It was however expected that; hospitals or health
care facilities were the second leading point of aware-
ness of family planning methods. Particularly giving the
immense role health facilities play in educating and advo-
cating for family planning adoption in Ghana.
e methods of family planning commonly known
in this study were injectables (37.1%), male condoms
(24.7%), and natural family planning methods (10.9%).
Additionally, research conducted in Uyo revealed that
condoms, pills, and injectables were the most commonly
recognized contraceptive methods [26]. Another study
Table 5 Perceived service-related factors inuencing family
planning uptake
Variables Yes
N(%)
No
N(%)
Bad attitude of health workers 116(29.3) 280(70.7)
Unfriendly health sta 116(29.3) 280(70.7)
Non-availability of FP services 246(62.1) 150(37.9)
Stigmatization against FP users 223(56.3) 173(43.7)
Partner disapproval/opposition 193(48.7) 203(51.3)
Pressure from mother-in-law 234(59.1) 162(40.9)
Fear of FP side eects 249(62.9) 147(37.1)
Conict with religious conviction 205(51.8) 191(48.2)
Inadequate knowledge on the eectiveness
of FP methods
282(71.2) 114(28.8)
High cost of family planning services 54(13.6) 342(86.4)
Diculty to get pregnant 314(79.3) 82(20.7)
Lack of access/FP facilities too far 190(48.0) 206(52.0)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 12
Sulemana et al. BMC Public Health (2025) 25:462
Table 6 Sociodemographic determinants of family planning uptake
Variables No
(N= )
Yes
(N= )
cOR (95%CI) aOR (95%CI) P-Value
n (%) n (%)
Age
15–19 (Ref) 26(47.3) 29(52.7) 1
25–29 125(55.6) 100(44.4) 0.72 (0.40–1.30)
35–39 38(46.3) 44(53.7) 1.04 (0.52–2.06)
45–49 11(32.4) 23(67.6) 1.88 (0.77–4.58)
Religion
Islam 186(58.7) 131(41.3) 1
Christianity 10(16.9) 49(83.1) 6.96 (3.40-14.24) 7.51 (1.48-38.00) 0.015
Traditionalist 4(20.0) 16(80.0) 5.68 (1.86–17.38) 12.1 (1.90-78.36) 0.009
Ethnicity
Dagomba 172(55.8) 136(44.2) 1
Konkonba 4(66.7) 2(33.3) 0.64 (0.114-3.50) 0.09 (0.00-111.83) 0.512
Gonja 0(0.0) 8(100.0)
Akan 11(44.0) 14(56.0) 1.61 (0.71–3.66) 0.08 (0.01-0 0.55) 0.011
Ewe 2(14.3) 12(85.7) 7.59 1.67–34.48) 2.20 (0.22–21.91) 0.503
Others 11(31.4) 24(68.6) 2.76 (1.31–5.83) 27.13 (6.04-121.92) 0.000
Level of education
Basic 48(82.8) 10(17.2) 1
Secondary 47(35.6) 85(64.4) 8.68 (4.02–18.73) 84.99 (20.02-360.84) 0.000
Tertiary 43(36.8) 74(63.2) 8.26 (3.79–17.99) 158.74 (33.71-747.52) 0.000
No education 62(69.7) 27(30.3) 2.09 (0.92–4.74) 11.83 (2.10-46.76) 0.000
Occupation
Housewife/unemployed 101(63.1) 59(36.9) 1
Teacher 12(27.3) 32(72.7) 4.57 (2.18–9.54) 1.84 (0.64–5.32) 0.261
Farmer 12(32.4) 25(67.6) 3.57 (1.67–7.62) 12.30 (3.21–47.03) 0.000
Student 40(43.0) 53(57.0) 2.27 (1.35–3.82) 0.47 (0.17–1.30) 0.147
Others 35(56.5) 27(43.5) 1.32 (0.73–2.40) 0.80 (0.29–2.24) 0.675
Marital status
Single 41(36.3) 72(63.7) 1
Married 139(58.9) 97(41.1) 0.40(0.25–0.63) 0.13(0.03–0.57) 0.007
Divorced/ Widow 20(42.6) 27(57.4) 0.77(0.38–1.54) 1.30(0.23–7.38) 0.771
Years of marriage
1–5 110(65.9) 57(34.1) 1
6–10 13(28.9) 32(71.1) 4.75 (2.31–9.76)
11–15 10(83.3) 2(16.7) 0.39 (0.08–1.82)
16–20 6(60.0) 4(40.0) 1.29 (0.35–4.74)
Don’t know 0(0.0) 2(100.0)
Number of children
0 27(36.0) 48(64.0) 1
1–2 77(43.8) 99(56.2) 0.72 (0.41–1.26) 1.78 (0.45–7.08) 0.411
3–4 80(66.1) 41(33.9) 0.29 (0.16–0.54) 0.23 (0.06–0.94) 0.041
5 and above 16(66.7) 8(33.3) 0.28 (0.11–0.74) 0.15 (0.02–0.92) 0.040
Minimal interval between birth
0 19(36.5) 33(63.5) 1
1 17(37.0) 29(63.0) 0.98 (0.43–2.24) 1.08 (0.17–7.01) 0.934
2 66(53.2) 58(46.8) 0.51 (0.26-0.98) 2.68 (0.47–15.26) 0.266
3 55(61.1) 35(38.9) 0.36 (0.18–0.74) 1.23 (0.21–7.33) 0.823
4 13(72.2) 5(27.8) 0.22 (0.07–0.72) 0.1 (0.01–1.48) 0.094
Others 30(45.5) 36(54.5) 0.69 (0.33–1.45) 0.92 (0.27–3.14) 0.897
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 12
Sulemana et al. BMC Public Health (2025) 25:462
found that injectables, pills, and implants were the most
well-known contraceptive methods, whereas diaphragm/
foam/jelly, male and female sterilization, and emergency
contraceptives were the least known [27]. Numerous
studies have documented that injectable contraceptives
and pills are the most widely used contraceptive meth-
ods [27–29], it was therefore not surprising majority of
the respondents in this study were aware of injectables.
ese fewer familiar methods may be as a result of fre-
quent discussed during health education sessions with
healthcare providers or probably due to high preference,
and fewer side eects for these contraceptive methods.
Literature suggests that in many low- and middle-
income countries (LMICs), injectables are often pre-
ferred due to their ease of use and long-term protection
[39]. Condoms are also widely known and used due to
their dual role in preventing pregnancy and sexually
transmitted infections (STIs).
Overall, 80.6% of the respondents were found to have high
or good knowledge of family planning services. In Southeast
Nigeria, there was a study conducted and it was found that
Table 7 Service-related determinants of family planning uptake
Variables No
(N= )
Yes
(N= )
cOR (95%CI) aOR (95%CI) P-value
n (%) n (%)
Bad attitude of health workers
Agree 67(57.8) 49(42.2) 1
Disagree 133(47.4) 147(52.5) 1.51 (0.98–2.34)
Unfriendly health sta
Agree 76(65.5) 40(34.5) 1
Disagree 124(44.3) 156(55.7) 2.39 (1.53–3.75) 2.33 (1.28–4.21) 0.005
Stigmatization against FP users
Agree 101(45.3) 122(54.7) 1
Disagree 99(57.2) 74(42.8) 0.62 (0.42–0.92) 1.73 (0.92–3.23) 0.087
Partner disapproval/opposition
Agree 105(54.4) 88(45.6) 1
Disagree 95(46.8) 108(53.2) 1.36 (0.91–2.01)
Pressure from mother-in-law
Agree 147(62.8) 87(37.2) 1
Disagree 53(32.7) 109(67.3) 3.48 (2.28–5.30)
Fear of side eects
Agree 117(47.0) 132(53.0) 1
Disagree 83(56.5) 64(43.5) 0.68 (0.45–1.03) 2.19 (1.19–4.05) 0.012
Conict with religious conviction
Agree 75(36.6) 130(63.4) 1
Disagree 125(65.4) 66(34.6) 0.31 (0.20–0.46)
Inadequate knowledge on the eectiveness of FP
Agree 130(46.1) 152(53.9) 1
Disagree 70(61.4) 44(38.6) 0.54 (0.35–0.84) 0.34 (0.18–0.62) 0.000
High cost of FP services
Agree 28(51.9) 26(48.1) 1
Disagree 172(50.3) 170(49.7) 1.06 (0.60–1.89) 0.45 (0.26–0.77) 0.004
Non availability of FP services
Agree 132(53.7) 114(46.3) 1
Disagree 68(45.3) 82(54.7) 1.40 (0.93–2.10)
Diculty to get pregnant
Agree 152(48.4) 162(51.6) 1
Disagree 48(58.5) 34(41.5) 67 (0.41–1.09)
Lack of access/FP facilities too far
Agree 67(35.3) 123(64.7) 1
Disagree 133(64.6) 73(35.4) 0.30 (0.20–0.45) 1.06 (0.57–1.97) 0.851
Overall Knowledge of family planning methods
Poor knowledge 74(96.1) 3(3.9) 1
Good Knowledge 126(39.5) 193(60.5) 37.78 (11.66-122.46) 52.73 (15.24 -182.49) 0.000
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 11 of 12
Sulemana et al. BMC Public Health (2025) 25:462
80% of the respondents knew about family planning, which
is comparable to the current situation [24, 25].
e ndings underscore the need for targeted educational
interventions to improve knowledge of less known methods
like IUDs and emergency contraception. Healthcare facili-
ties should be supported to provide comprehensive family
planning counseling, and public health campaigns should be
designed to leverage both mass media and community net-
works eectively.
In this study, more than half (54.3%) of the women sur-
veyed reported using family planning at some point in their
lives. A comparable study conducted among rural women
in Bauchi State, Nigeria found that 42% of respondents had
ever used any of the family planning methods [28]. Despite
the high level of family planning knowledge observed in this
study, it did not lead to high levels of contraceptive usage,
which is a trend that has been observed in other stud-
ies conducted throughout Nigeria [30]. e ease of use of
condoms, in contrast to implants and intrauterine devices,
could account for their high usage in this study. Further-
more, the frequent use of the injectables in this study may
be attributed to the easy accessibility from pharmacies, for
convenience’s sake, fewer side eects and the fact that their
usage does not require intervention from healthcare provid-
ers. us, programs designed to increase family planning
adoption should not only focus on raising awareness but
also on addressing barriers and beliefs that may discourage
individuals from using family planning methods.
Factors that deter individuals from using family planning
include a desire to get pregnant, lack of spousal support for
family planning, and fear of experiencing intolerable side
eects. A comparable study conducted in Ethiopia found
that a desire for more children was a prevalent reason for
not using family planning [31]. Moreover, a study conducted
among Igbo women in Southeast Nigeria identied spousal
rejection of family planning as the most common reason for
nonuse [32]. Additionally, previous research has revealed
that there is a resistance to family planning in Ghana that is
rooted in attitudes, as well as a growing tendency to be wary
of potential side eects [33, 34]. Similar studies in Nigeria
have reported fear of side eects as a deterrent to using fam-
ily planning [27, 30].
Ghana exhibits religious diversity, and the impact of
religion on women’s utilization of family planning has
been both benecial and detrimental. Some family plan-
ning users have attributed their decision to religious
educational outreach, while others have disregarded reli-
gious teachings that did not align with their situation or
aspirations. Conversely, 51% of non-users of family plan-
ning acknowledged the signicant role of religion in their
choice to abstain from utilizing it.
e study found that religion, ethnicity, marital sta-
tus, level of education, occupation, and number of chil-
dren were all found to be signicant predictors of family
planning usage when controlled for other variables. e
results of the logistic regression indicated that farmers
had signicantly higher odds of having ever used fam-
ily planning than housewives. However, this was in con-
trast to a study carried out in Nigeria [35]. is could
potentially be attributed to the cultural practice among
farmers, where they prefer having more children who
can assist with farm work. It is widely recognized in tra-
ditional peasant agriculture, particularly in Nigeria, that
children are the main source of family labor [35, 36].
Study strengths and limitations
e study has lled the research gap of family plan-
ning utilization in the reproductive-age population in
the Yendi Municipality. e study, however, was unable
to draw samples from all the health facilities within the
municipality due to resource constraints. Again, the
study failed to dive deep into the sociocultural factors
that are likely to inuence family planning utilization.
Conclusions
While most women of reproductive age women in the
Yendi municipality had a good understanding of family
planning, fewer than half were currently using FP services.
Sociodemographic characteristics such as religion, edu-
cational level, occupation, and marital status and health-
related factors such as unfriendly service providers, side
eects, and knowledge of family planning services were
all found to be signicant determinants of family planning
utilization. ese ndings highlight the need for targeted
educational campaigns to address these barriers.
Acknowledgements
We will like to extend our appreciation to the sta and management of
various hospitals we sampled our participants. Again, the women who
accepted to participate in the research and for providing us the necessary
information are well appreciated.
Author contributions
1. I.S. conceived the idea, did literature review, eld data collection and
started the original draft of the manuscript. 2. C.G. undertook literature
review, assisted with eld data collection, data cleaning, formal analyses of
data, drafting the original manuscript and editing. 3. M.D. assisted with data
cleaning and supported in drafting the original manuscript. 4. A.Y. contributed
in reviewing and editing the manuscript. 6. G.A.A. supervised the production
of the manuscript from the idea conception stage, through literature review,
eld work, data analysis, draft of the original manuscript and review and
editing.
Funding
No funding was obtained for this study.
Data availability
Data in Excel or SPSS format will be made available on request. Request can
be made to Gifty Apiung Aninanaya, the corresponding author for this paper.
Declarations
Ethics approval and consent to participate
The consent of health facility authorities, and participating women in selected
health facilities was obtained. In the case of respondents less than 18 years
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 12 of 12
Sulemana et al. BMC Public Health (2025) 25:462
of age, their husbands or parents were contacted for consent. The consent of
respondents was obtained after the purpose of the study was well explained
to the best of their understanding. Methods adopted for the conduct of this
study were all in accordance with established standards for research outlined
by the Committee of Human Research and Publications Ethics of the Kwame
Nkrumah University of Science and Technology, Kumasi, Ghana. This same
institution granted the ethical approval for the conduct of this study. The
choice of the institution for ethical clearance was due to its readily availability
and timeliness in giving feedback at the time of the conduct of this study.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Received: 21 May 2024 / Accepted: 17 December 2024
References
1. Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subre-
gional trends in unintended pregnancy and its outcomes from 1990 to
2014: estimates from a bayesian hierarchical model. Lancet Global Health.
2018;6(4):e380–9.
2. Ameyaw EK, Budu E, Sambah F, Baatiema L, Appiah F, Seidu AA, Ahinkorah
BO. Prevalence and determinants of unintended pregnancy in sub-saharan
Africa: a multi-country analysis of demographic and health surveys. PLoS
ONE. 2019;14(8):e0220970.
3. Antarini R, Contraception. Overview. In StatPearls StatPearls Publishing 2021.
h t t p s : / / w w w . n c b i . n l m . n i h . g o v / b o o k s / N B K 4 7 0 5 5 6 /
4. Apanga PA, Adam MA. Factors inuencing the uptake of family planning
services in the Talensi District, Ghana. Pan Afr Med J. 2015;20(1).
5. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies world-
wide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301–14.
6. Beson P, Appiah R, Adomah-Afari A. Modern contraceptive use among
reproductive-aged women in Ghana: prevalence, predictors, and policy
implications. BMC Womens Health. 2018;18:1–8.
7. Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs
to improve quality of care for maternal and newborn health: interventions
and ndings. Reproductive Health. 2014;11:1–9.
8. United Nations. World Contraceptive Use. United Nations. Population Divi-
sion, Department of Economic and Social Aairs; 2022.
9. Singh S, Darroch J, Ashford LS. 2014. Adding it up: the costs and benets of
investing in sexual and reproductive health 2014.
10. Kabir R, Uddin J, Hossain MZ. Socioeconomic and demographic determinants
of contraceptive use among currently married women in Bangladesh. Sex
Reproductive Healthc. 2017;11:58–64.
11. Dickson KS, Adde KS, Amu H. Prevalence and determinants of unintended
pregnancy among women in rural Ghana. BMC Pregnancy Childbirth, 18(1)
2018.
12. Nyarko SH. Unintended pregnancy among pregnant women in Ghana:
prevalence and predictors. Journal of pregnancy. 2019;2019.
13. Boah M, Bordotsiah S, Kuurdong S. Predictors of unsafe induced abortion
among women in Ghana. Journal of pregnancy. 2019;2019.
14. Rominski SD, Lori JR. Abortion care in Ghana: a critical review of the literature.
Afr J Reprod Health. 2014;18(3):17–35.
15. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. 2017.
Ghana Malaria Indicator Survey 2016. Accra, Ghana, and Rockville, Maryland,
USA: GSS, GHS, and ICF.
16. Ghana. Statistical Service. 2010 Population & Housing Census Report: Atwima
Kwanwoma District. Ghana Statistical Service; 2014.
17. Oppong RA, Kugbey N, Nyarko SH, Badu E. Contraceptive use and family
planning services utilization among women of reproductive age in the 2014
demographic and health survey in Ghana. Heliyon, 2021, 7(4), e06871.
18. Makumbi FE, Nabukeera S, Tumwesigye NM, Namanda C, Atuyambe L,
Mukose A, Ssali S, Ssenyonga R, Tweheyo R, Gidudu A, Sekimpi C. Socio-
economic and education related inequities in use of modern contraceptive
in seven sub-regions in Uganda. BMC Health Serv Res. 2023;23(1):201.
19. Dery LG. Ghana’s Health Policy: Human Resources and Health Outcomes
Inequality in Northern and Southern Ghana (Doctoral dissertation).
20. Abdul-Manan S, Abukari A, Nukpezah RN, Adadow Y, Owusu-Marfo J. Preva-
lence of emergency contraceptive use and associated determinants among
senior high students in Yendi Municipal of Northern Ghana. 2023.
21. Okunlola DA. Women’s and male partners’ socio-demographic and economic
characteristics associated with contraceptive decision making in Nigeria.
BMC Womens Health. 2022;22(1):450.
22. Cronbach LJ. Coecient alpha and the internal structure of tests. Psy-
chometrika. 1951;16(3):297–334.
23. Daud IF, Hisham N, Fauzi A. Reliability and validity: Criterion versus predictive
validity. J Eng Sci Technol. 2018;13(7):2038–46.
24. Barrow A. A survey on prevalence and knowledge of family planning among
women of childbearing age in the provincial settings of the Gambia: a
descriptive cross-sectional study. Adv Prev Med. 2020;2020:1–2.
25. Oluwasanu MM, John-Akinola YO, Desmennu AT, Oladunni O, Adebowale AS.
Access to information on family planning and use of modern contraceptives
among married Igbo women in Southeast, Nigeria. Int Q Community Health
Educ. 2019;39(4):233–43.
26. Osinowo K, Sambo-Donga F, Ojomo O, Ibitoye SE, Oluwayemi P, Okunfulure
M, Ladipo OA, Ekholuenetale M. Resilient and accelerated scale-up of sub-
cutaneously administered depot–medroxyprogesterone acetate in Nigeria
(RASuDiN): a mid-line study in COVID-19 era. Open Access J Contracept 2021
Dec 2:187–99.
27. Tilahun T, Coene G, Luchters S, Kassahun W, Leye E, Temmerman M,
Degomme O. Family planning knowledge, attitude and practice among mar-
ried couples in Jimma Zone, Ethiopia. PLoS ONE. 2013;8(4):e61335.
28. Kana MA, Tagurum YO, Hassan ZI, Afolanranmi TO, Ogbeyi GO, Difa JA, et al.
2016. Prevalence and determinants of contraceptive use in rural Northeast-
ern Nigeria: results of a mixed qualitative and quantitative assessment.
29. Johnson AK, Fletcher FE, Ott E, Wishart M, Friedman EE, Terlikowski J, Haider S.
Awareness and intent to use pre-exposure prophylaxis (PrEP) among African
American women in a family planning clinic. J Racial Ethnic Health Dispari-
ties. 2020;7:550–4.
30. Johnson D, Ugaz J. Determinants of quality of family planning counseling
among private health facilities in Lagos. Stud Fam Plann. 2016;47(3):239–51.
31. Duressa LT, Getahun A, Regassa T, Babure ZK, Bidu KT. Unmet need for family
planning and related factors among currently married women in Sibu Sire
district, 2016. J Women’s Health Care. 2018;7(446):2167–0420.
32. Ogidi CI, Okere AU, Ogbuabor SE, Nwadike AN, Usen SA, Onumonu AJ, Ozo-
emena LC, Edeh NC, Egwim CE. Knowledge and use of Birth Control methods
for Family Planning by Married people in Nsukka Education Zone of Enugu
State. Global J Health Sci. 2019;11(8):96.
33. Machiyama K, Cleland J. Unmet need for family planning in Ghana: the shift-
ing contributions of lack of access and attitudinal resistance. Stud Fam Plann.
2014;45(2):203–26.
34. Hindin MJ, McGough LJ, Adanu RM. Misperceptions, misinformation and
myths about modern contraceptive use in Ghana. J Family Plann Reproduc-
tive Health Care. 2014;40(1):30–5.
35. Ofuoku AU, Idoge DE, Ovwigho BO. Child labor in agricultural production
and socioeconomic variables among arable farming households in Nigeria. J
Rural Social Sci. 2014;29(2):4.
36. Owolabi JO, Abubakar BZ, Amodu MY. Assessment of farmers
(women)’access to agricultural extension, inputs and credit facility in Sabon-
Gari Local Government Area of Kaduna State. Nigerian J Basic Appl Sci.
2011;19(1).
37. World Health Organization. Family planning/Contraception [Internet]. 2023
[cited 2024 Sep 20]. h t t p s : / / w w w . w h o . i n t / n e w s - r o o m / f a c t - s h e e t s / d e t a i l / f a m i
l y - p l a n n i n g - c o n t r a c e p t i o n
38. Calhoun LM, Mirzoyants A, Thuku S, Benova L, Delvaux T, van den Akker T,
McGuire C, Onyango B, Speizer IS. Perceptions of peer contraceptive use and
its inuence on contraceptive method use and choice among young women
and men in Kenya: a quantitative cross-sectional study. Reproductive Health.
2022;19(1):16.
39. Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing
countries. examining women’s reasons for not using a method; 2016.
40. Marcolino MS, Oliveira JA, D’Agostino M, Ribeiro AL, Alkmim MB, Novillo-Ortiz
D. The impact of mHealth interventions: systematic review of systematic
reviews. JMIR mHealth uHealth. 2018;6(1):e8873.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional aliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
