Targeting women at risk of unintended pregnancy in Ghana: Should geography matter?

University of Southampton, Highfield, United Kingdom.
Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives (Impact Factor: 1.25). 01/2011; 2(1):29-35. DOI: 10.1016/j.srhc.2010.10.003
Source: PubMed


Unintended childbearing in Ghana is estimated to be about 0.7 births per woman, thus contributing to the high total fertility rate of more than 4 births. About one-third of women of reproductive age have an unmet need for family planning and there are strong geographic differences between and within ecological zones. Spatial analysis of risk of unintended pregnancies planning can reveal differences in the provision and usage of contraceptive commodities, thereby providing information of areas where programmes should be strengthened. This study uses data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine geographical variation in the risk of unintended pregnancies among women in the three ecological zones of Ghana (Savannah, Forest, and Coastal). The data was analysed using multilevel logistic regression. Approximately 55% of Ghanaian women (married or in union) are at risk of unintended pregnancies and there are differences between urban and rural women, with rural women more likely to have their demand for contraception unmet. After adjusting for the socio-economic and demographic factors, the results show little differences between ecological zones in the levels of women exposed to the risk of unintended pregnancy, but they demonstrate significant within community effects, which influence the risk of unintended pregnancies for women within the community. Communities, therefore, can be used as units for targeting services aimed at increasing coverage of contraceptive commodities.

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    • "Ghana initiated the policy of controlling the population back in 1969 (Johnson & Madise, 2011; Stanback & Twum- Baah, 2001) through family planning. The initial response was sluggish, but by 1988 the acceptance rate had been 5% and 13% by 1998 (Stanback & Twum-Baah, 2001) and increased slowly to 25% by 2003 (Johnson & Madise, 2011). This was in recognition of the fact that fertility, mortality, and migration are the main demographic variables that interact to increase population (Asante-Sarpong, 2007). "
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    ABSTRACT: Ghana, a lower-middle income country that is still grappling with fertility and birth rates, initiated family planning for the youth decades ago. This mainly targeted deprived communities, and the Muslim youth were also exposed to contraception. However, contraception awareness among the Muslim youth has had difficulties and repercussions. Against the social and economic challenges facing the Ghanaian Muslim youth, this article evaluates their awareness about contraception focusing on the issues and their ramification with the aim of identifying prospects for development. The findings reveal that awareness is high but not in a positive sense as the general patronage among couples is low, while among the unmarried, the awareness has negatively affected their morality. Among the issues, there is a disconnection between service providers and the community while some Muslims think that contraception can reduce the Muslim population and is un-Islamic. It was argued that contraception is permitted for Muslims provided there is ethical justification and that in view of the social and economic challenges, including school dropouts and Muslim child migration due to the poverty of parents, the Muslim youth must plan their childbirth. Hence, it was recommended that government must tackle the problem of education in Muslim communities. The Ulama should also dialogue with the service providers to create trust between the health providers and the Muslims.
    Full-text · Article · Jul 2014 · SAGE Open
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    • "Safe birth control can be difficult to access or may be avoided by the women for a variety of reasons [56,57]. Unintended pregnancies may put strain on maternal role assumption and mother-infant relationships [58,59]. Other causes for high PS may include poverty [60], exhaustion following childbirth due to iron deficiency anemia [61,62], pregnancy and childbirth not providing relief from daily duties, and the continued maternal responsibility for family income in addition to early childcare, that is imposed mainly on the mothers [63]. "
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    ABSTRACT: Background There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS. Methods A longitudinal birth cohort of 577 women from Ghana and Côte d’Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women’s depression/anxiety and PS adjusting for age, child sex, women’s anemia, education, occupation, spouse’s education, and number of sick child visits. Results A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d’Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables. Conclusions Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.
    Full-text · Article · May 2014 · BMC Psychiatry
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    • "Thus, researchers must take into account the contextual factors – such as access to contraceptive services and the gender power structures in society – that shape women’s ability to exercise their reproductive rights [10,22]. Although quantitative studies have assessed the relationship between IPV and unintended pregnancies [4,18-21], few have attempted to include in their analysis the measurement of contextual factors that influence women’s fertility [23-25] and even fewer have included community-level measures of VAW [22]. In a pioneering population-based study assessing the relationship between community-level measures of IPV and unintended pregnancies among Colombian women, Pallito and O’Campo found that the odds of having an unintended pregnancy were higher in settings with high levels of patriarchal control and high rates of IPV [22]. "
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    ABSTRACT: Despite an increased use of contraceptive methods by women, unintended pregnancies represent one of the most evident violations of women's sexual and reproductive rights around the world. This study aims to measure the association between individual and community exposure to different forms of violence against women (physical/sexual violence by the partner, sexual abuse by any person, or controlling behavior by the partner) and unintended pregnancies. Data from the 2006/2007 Nicaraguan Demographic and Health Survey were used. For the current study, 5347 women who reported a live birth in the five years prior to the survey and who were married or cohabitating at the time of the data collection were selected. Women's exposure to controlling behaviors by their partners was measured using six questions from the WHO Multi-Country Study on Women's Health and Domestic Violence against Women.Area-level variables were constructed by aggregating the individual level exposures to violence into an exposure measurement of the municipality as a whole (n = 142); which is the basic political division in Nicaragua. Multilevel logistic regression was used to analyze the data. In total, 37.1% of the pregnancies were reported as unintended. After adjusting for all variables included in the model, individual exposure to controlling behavior by a partner (AOR = 1.28, 95% CrI = 1.13-1.44), ever exposure to sexual abuse (AOR = 1.31, 95% CrI = 1.03-1.62), and ever exposure to physical/sexual intimate partner violence (AOR = 1.44, 95% CrI = 1.24-1.66) were significantly associated with unintended pregnancies. Women who lived in municipalities in the highest tertile of controlling behavior by a partner had 1.25 times higher odds of reporting an unintended pregnancy than women living in municipalities in the lowest tertile (AOR = 1.25, 95% CrI = 1.03-1.48). Nicaraguan women often experience unintended pregnancies, and the occurrence of unintended pregnancies is significantly associated with exposure to different forms of violence against women at both the individual and the municipality level. National policies aiming to facilitate women's ability to exercise their reproductive rights must include actions aimed at reducing women's exposures to violence against women.
    Full-text · Article · Feb 2014 · BMC Women's Health
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