Meeting women’s demand for contraceptives in Ghana: Does autonomy matter?

ABSTRACT

This study addressed a basic conceptual gap in research on the relationship between women’s autonomy and contraceptive behavior and included intention to use while measuring the unmet demand for family planning. The study used data from the 2014 Ghana Demographic and Health Survey. The weighted sample included 2,017 sexually active, non-pregnant, fecund women in unions, aged 15–49 years, who wanted to delay conception for at least 2 years. The relation of household decision-making autonomy to current contraceptive use and intention was assessed, adjusting for women’s socio-demographic, partner, and couple characteristics. About half of the women studied had a met demand for contraception, and over a third had no intention to use a contraceptive method in the future. In adjusted multinomial logistic regression models, household decision-making autonomy was not significantly associated with met contraceptive demand for contraceptives, but was associated with their intentions to use contraception (p = .05). Formal education, age, wealth, and region of residence were significantly associated with having a met demand. In Ghana, women’s household decision-making autonomy appears to have modest relation to contraceptive uptake. Programs to improve meeting contraceptive demand should consider contextual factors and place differences in contraceptive uptake.

KEYWORDS:

• Contraceptives
• Ghana
• pregnancy intentions
• unmet demand
• women’s autonomy

Acknowledgments

The authors acknowledge Dr. Adriana A. E. Biney of the Regional Institute for Population Studies, University of Ghana, Legon, for proofreading the first draft of this document.

Competing interests

The authors declare that they have no competing interests.

Notes

¹ These women tend to be included in unmet need measures based on their responses to questions about desire for their current pregnancies. However, retrospective recall of such behavioral responses may be unreliable. In addition, women’s autonomy at conception was not measured by the survey. Thus, the effect of their autonomy on their recalled met or unmet demand could not be ascertained.

² Women who do not have any earnings are included among those not involved in decisions on how women’s earnings should be spent. Among those who actually earn income (n = 1345), only 6 percent are not involved in decisions regarding how their income is spent.