Spatial distribution and factors associated with unmet need for contraception among women in Ghana.

Abstract

Background: Unmet need for contraception is a significant public health concern in sub-Saharan Africa, affecting over 20% of women. We assessed the spatial distribution and factors associated with unmet need for contraception among women in Ghana.

Methods: The study was conducted in Ghana, and data was extracted from the 2022 Demographic and Health Survey. A weighted sample of 7762 women who were either married or cohabiting and aged 16-49 years was included in the study. Multilevel regression analysis was performed to identify the factors associated with unmet need for contraception. The results were presented using adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Spatial analysis using GetisOrd G hotspot and cluster and outlier analyses were employed to examine the patterns of unmet need for contraception at the district level.

Results: The proportion of unmet need for contraception among the women was 26.7% [25.3-28.2]. The hotspot districts for a high unmet need for contraception in Ghana were West Mamprusi Municipal, Mamprugu Moagduri, East Mamprusi Municipal, Yunyoo-Nasuan, and East Gonja Municipal. Women's age was associated with a lower likelihood of unmet need for contraception with the lowest odds among those aged 35-39 years [AOR = 0.31, 95%CI = 0.18, 0.53] compared with those aged 16-19. Working women [AOR = 0.74, 95%CI = 0.60, 0.91] and those who heard family planning messages at community meetings [AOR = 0.84, 95%CI = 0.70, 0.99] had lower odds of unmet need for contraception compared to those who were not working and those who did not hear family planning messages at community meetings.  Cohabiting women [AOR = 1.25, 95%CI = 1.01, 1.53] and those from female-headed households [AOR = 1.36, 95%CI = 1.13, 1.63] were more likely to have unmet need for contraception relative to their married counterparts and those from male-headed households, respectively. Parity was associated with unmet need for contraception, with the highest likelihood reported among women with four or more births [AOR = 6.47, 95%CI = 3.99, 10.48] compared to nulliparous women. Women residing in Greater Accra, Volta, Eastern and Bono East regions had higher odds of unmet need for contraception than those in the Western region, with the highest odds among those in Greater Accra [AOR = 2.38, 95%CI = 1.52, 3.72].

Conclusion: Our study has shown that there are regional and district variations in the unmet need for contraception among women in Ghana. Improving access to and availability of contraceptive methods, particularly in hotspot districts in the northern parts of Ghana, is crucial. Targeted interventions for specific age groups, empowerment of women through employment, and the promotion of shared decision-making are recommended strategies to reduce the unmet need for contraception and enhance reproductive health outcomes.