title: Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance.
abstract: In Ghana, despite a 38 percent decline in the total fertility rate from 1988 to 2008, unmet need for family planning among married women exposed to pregnancy risk declined only modestly in this period: from 50 percent to 42 percent. Examining data from the five DHS surveys conducted in Ghana during these years, we find that the relative contribution to unmet need of lack of access to contraceptive methods has diminished, whereas attitudinal resistance has grown. In 2008, 45 percent of women with unmet need experienced no apparent obstacles associated with access or attitude, 32 percent had access but an unfavorable attitude, and 23 percent had no access. Concerns regarding health as a reason for nonuse have been reported in greater numbers over these years and are now the dominant reason, followed by infrequent sex. An enduring resistance to hormonal methods, much of it based on prior experience of side effects, may lead many Ghanaian women, particularly the educated in urban areas, to use periodic abstinence or reduced coital frequency as an alternative to modern contraception.
authors.affiliation: Research Fellow, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. kazuyo.machiyama@lshtm.ac.uk.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Machiyama
authors.forename: John
authors.initials: J
authors.lastname: Cleland
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000523:psychology* / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult