Determinants of unintended pregnancies in rural Ghana.

BACKGROUND: Unintended pregnancies may carry serious consequences for women and their families, including the possibility of unsafe abortion, delayed prenatal care, poor maternal mental health and poor child health outcomes. Although between 1993 and 2008, unintended births decreased from 42% to 37% in Ghana, the rate of decline is low, whilst levels are still very high. This raises the need to understand factors associated with unintended pregnancies, especially among women in rural settings where the rates and risks are highest to help improve maternal health. METHOD: We collected data from 1,914 pregnant women attending antenatal clinic between January 2012 and April 2012 in four health facilities in the Mfantseman Municipal of the Central Region of Ghana. We used bivariate and multivariate logistic regression analyses to explore how socio-demographic characteristics, past reproductive health experiences, partner characteristics and relations, awareness and past experience with contraceptives, influenced the status of women's current pregnancy (whether intended or unintended). RESULTS: The mean age of the 1,914 respondents in this study was 25.6 ± 6.5 years. Seventy percent (70%) said the pregnancies they were carrying were unintended. The odds of carrying unintended pregnancy among women with five or more children were higher than those with one to two children [AOR 6.06, 95% CI (3.24-11.38) versus AOR 1.48, 95% CI (1.14-1.93)]. Women with other marital arrangements showed significantly higher odds of carrying unintended pregnancy compared to those married by ordinance (Muslim or Christian wedding). Women not living with their partners exhibited increased odds of having unintended pregnancies compared to women who lived with their partners (AOR 1.72, 95% CI: 1.28 - 2.30). Awareness of traditional methods of family planning (withdrawal and rhythm) was associated with lower odds of having unintended pregnancy compared to non-awareness (AOR 0.66, 95% CI (0.49-0.89). CONCLUSIONS: In this study, important risk factors associated with unintended pregnancies were: parity, living arrangements with partner, marriage by ordinance and awareness of traditional, non-pharmacological contraceptive methods. Family planning interventions targeting different groups of women, especially during the postpartum period, would be essential to reduce rates of unintended pregnancies and promote positive health outcomes

Sex composition of living children in a matrilineal inheritance system and its association with pregnancy intendedness and postpartum family planning intentions in rural Ghana.

BACKGROUND: Sex composition of living children within the context of "sex preference" and its association with various reproductive health outcomes has been extensively studied in South and South East Asia. Although sex preference has been observed in sub-Saharan Africa, there is paucity of research on sex composition of living children and its association with reproductive health behaviours and outcomes, particularly in a matrilineal inheritance system. The purpose of the study was to explore the existence of sex preference in a matrilineal inheritance system. Specifically, the study sought to better understand the issues by examining the sex composition of living children and how it is associated with reproductive outcomes such as pregnancy intendedness and intention to use postpartum family planning among women in a matrilineal area of Ghana. METHODS: This was a cross sectional study conducted at four selected health facilities in the Mfantseman municipality of the Central Region of Ghana. Out of the 1914 pregnant women attending antenatal clinic selected using total enumeration, from 2nd January to 30th April 2012, 1091 with living children and complete socio-demographic data were recruited for this study. Descriptive, chi square and multivariate logistic regression analyses were conducted. RESULTS: The mean age of the 1091 respondents in this study was 28.2 ± 6.0 years with mean gestational age of 26.7 ± 6.6 weeks. Whilst 78% of the women had at least a son, 71% had at least a daughter, with those having only sons exceeding those with only daughters by 6.3%. Also, majority of the women with more sons than daughters did not intend their current pregnancies. These observations, coupled with a sex ratio of 109 males to 100 females, inferred the existence of son preference. The levels of unintended pregnancy and intention to use postpartum family planning were high (70% and 78% respectively). There was an association between sex composition of living children and unintended pregnancy but no association between sex composition of living children and intention to use postpartum family planning. Women with only sons were 50% less likely to have unintended pregnancies compared to those with equal number of sons and daughters [AOR 0.5, 95% CI (0.3-0.8)]. Similarly, women over 30 years were 80% less likely to have unintended pregnancies compared to those 15-19 years [AOR 0.2, 95% CI (0.1-0.6)]. The women with parity of 5 or more and resident in Anomabo were more likely to have unintended pregnancy compared to those with parity of up to two [AOR 3.8, 95% CI (1.7-8.59)] and those resident in Saltpond [AOR 1.8, 95%CI (1.1-2.8), respectively. In addition, the women resident in Anomabo were more likely to have intention to use postpartum family planning compared to those in Saltpond [AOR 1.8, 95% CI (1.0-3.3)]. CONCLUSION: There was persistence of more sons than daughters born in a predominantly matrilineal inheritance system and sex composition of living children had significant association with pregnancy intendedness but not with intention to use postpartum family planning

Factors influencing the intention of women in rural Ghana to adopt postpartum family planning.

BACKGROUND: Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa and very little is known about how pregnant women arrive at their decisions to adopt PPFP. This information is needed to guide the development of interventions to promote PPFP. METHODS: We conducted a survey among pregnant women attending antenatal clinics in a rural district in Ghana. We used univariate and multivariate logistic regression analysis to explore how knowledge of various family planning (FP) methods, past experience with their use and the acceptability of PPFP to male partners and close relations influenced the intention of pregnant women to adopt PPFP. RESULTS: We interviewed 1914 pregnant women in four health facilities. About 84% considered PPFP acceptable, and 70% intended to adopt a method. The most preferred methods were injectables (31.5%), exclusive breastfeeding (16.7%), and oral contraceptive pills (14.8%). Women whose first choice of PPFP method were injectables were more likely to be women who had had past experience with its use (O.R = 2.07, 95% C.I. 1.50-2.87). Acceptability of PPFP by the pregnant woman (O.R. = 3.21, 1.64-6.26), perception of partner acceptability (O.R. = 3.20, 1.94-5.48), having had prior experience with the use of injectables (O.R. = 3.72, 2.61-5.30) were the strongest predictors of the intention to adopt PPFP. Conversely women who knew about the diaphragm (O.R. = 0.59, 0.38-0.93) and those who had past experience with IUD use (O.R. = 0.13, 0.05-0.38) were less likely to want to adopt PPFP. CONCLUSIONS: Acceptability of PPFP to the pregnant woman, male partner approval, and past experience with the use of injectables are important factors in the PPFP decisions of women in this population. Antenatal and early postnatal care need to be adapted to take these factors into consideration

Postpartum fertility behaviours and contraceptive use among women in rural Ghana

Abstract Background Although most women would want to wait for more than two years before having another baby, their fertility behaviours during the first year following birth may decrease or increase the length of the birth interval. The objectives of this study were to: assess how protected postpartum women in the Mfantseman municipal were against pregnancy, based on their patterns of amenorrhoea and sexual abstinence; determine the timing of postpartum contraception in relation to amenorrhoea and sexual abstinence; and determine the predictors of postpartum contraceptive use. Methods This was a prospective study carried out in the Mfantseman Municipality of the Central region of Ghana. Out of 1914 women attending antenatal clinic in the municipal within the study period, 1350 agreed to be part of the study to ascertain their postpartum fertility and contraceptive behaviours a year following delivery. These women were traced to their communities using telephone and house numbers provided and only 1003 of the women were finally traced and interviewed. The women were asked about their breastfeeding behaviour, postpartum sexual abstinence, duration of amenorrhoea and postpartum contraceptive use. Results The mean age of the respondents was 29.9 ± 6.5 years; adolescents constituted the least proportion (3.3%) of the women. More than half (54.1%) of the women had Middle, Junior secondary school or Junior high school education. Most (43.3%) of the women were married by means of traditional rites and more than half (51.4%) of them were petty traders. The mean durations of breastfeeding, amenorrhoea and sexual abstinence were 6.6 ± 2.8 months, 7.8 ± 3.8 months and 4.4 ± 3.1 months respectively, whilst mean time of first contraceptive uptake was 3.5 ± 2.7 months postpartum. The time to first use of modern contraceptive method during the postpartum period indicates that about 50% of the women had started use of modern contraceptive methods by 2.7 months postpartum, and occured 0.6 and 3.6 months before sexual relations and resumption of menses respectively. Occupation (likelihood ratio p = 0.013), area of residence (likelihood ratio p = 0.004), mode of delivery (likelihood ratio p < 0.001), breastfeeding (p = 0.024), period since delivery (p < 0.001), preferred number of children (p < 0.001) and parity (p < 0.001) were found to be predictors of postpartum contraceptive use. Conclusion Postpartum women in the Mfantseman municipal who did not use contraceptives or delayed in the use of contraceptives after birth were least likely to be protected against pregnancy in the post partum period, whilst those who adopted postpartum family planning were likely to be better protected because they were likely to adopt it within the first three months after birth and before the onset of sexual relations and first menses. The predictors of postpartum contraceptive use were breastfeeding pattern, occupation, parity, preferred number of children, period since delivery, place of residence and mode of delivery