Misperception and Myths About Contraceptive Use in Ghana
Misperception and Myths About Contraceptive Use in Ghana
Table 1 summarises the characteristics of the women who participated in the focus groups.
A number of key themes emerged from the focus group transcripts. One of the most common themes was fear of changes in menstrual patterns related to hormonal contraception. "You see fibroid is caused by blood clot and when you use some of them [hormonal methods] it causes your menses to stop. So the blood remains there and it clots leading to fibroid." [Woman aged 21–35 years, single, student clinic] "I have never experienced it [contraception] before but a sister [friend] has. When she did it [used hormonal contraception] she was not having her menses but whenever it was time for her menses she had severe menstrual pains and we had to bring her to the hospital for medication before it stops." Interviewer: "Which one was she using?" "The injectable. So we told her to stop but she also says if she stops what will she do? Another one also when she took the injection, something like a lump came into her abdomen and it was really aching and so she had to go to the hospital." [Woman aged 26–30 years, in union, antenatal clinic] "There was a sister who also took the injection and her breast became big and hard. It was the blood, which was not flowing which clotted in her breast. So she went to the hospital several times before she was cured." [Woman aged 26–30 years, in union, antenatal clinic]
In general, women who had never used contraception were fearful of methods based on hearsay or sometimes first-hand accounts of friends, relatives or acquaintances: Interviewer: "So why don't women use contraceptives?" Respondent: " It is because of what they have heard others say." [Woman aged 26–30 years, in union, antenatal clinic] "I want to do it [contraception] but because of what people say about it, that it can make you sick, I am afraid… They say that, for instance the 5 years [implant] they will insert something like needle into the arm and you will not feel normal again." [Woman aged 26–30 years, in union, antenatal clinic] "I had a friend who used the 5 years [implant]. She continued to bleed until she stopped. And while she was using it, she became very fat and so when she stopped, she became very slim like a pen." [Woman aged 26–30 years, in union, child welfare clinic]
Some women who had used contraception in the past confirmed these fears, noting that hormonal methods "made them fat" and changed their menstrual patterns. Some ever users did offer positive experiences, but these were not common.
Most women believed that the best place to get contraception was the hospital and women needed to be sure someone "tested their blood" to be sure they had the right method. "My problem is that they should check our blood before giving it [contraception] to us. But now it is as if we just decide what we want. And if something is good then do it for a fee. But now they give it [contraception] to us free without testing us and it is causing a lot of problems. So they are helping us and hurting us at the same time." [Woman aged 26–30 years, in union, child welfare clinic]
Abena Many women expressed concern that Abena was "too young" to be sexually active. Some suggested that were she to use contraception, she should use a "natural" method such as counting days, as modern contraception could lead to infertility or a delay in getting pregnant. As has been found in Ghana and other settings, perceived or diagnosed infertility is a significant concern. In our sample, some women believed that contraceptive use at too young an age could result in delayed childbearing or in infertility. "You see, if you are a girl who has never given birth and you are taking those tablets, it can delay you in giving birth when you get married." [Woman aged 26–30 years, in union, antenatal clinic] Interviewer: "Do you think she will encounter any problems when she gets family planning or contraceptives?" Respondent: "Barrenness." [Woman aged 21–25 years, not in union, student clinic]
Some women did not consider condoms a method of contraception or "family planning". "She should just go get a condom and use because it is not compulsory that you use family planning but condoms are always available to help you prevent pregnancy." [Woman aged 26–30 years, in union, antenatal clinic] "Abstinence is the best. But if they can't abstain, then they can use condoms. But family planning is too early." [Woman aged 26–30 years, in union, child welfare]
Georgina Women felt in the case of Georgina, that if her husband opposed her using contraception, covert use was Georgina's right. "These days if you follow a man, it is you the woman who will suffer, he will get up and leave for work and the children will be surrounding you. If you die he will go marry another woman. So as for me I think she should just forget about the husband and think about her own well-being." [Woman aged 26–30 years, in union, antenatal clinic] "I think they have been married for some time now so she knows the kind of man he is. She should discuss with him and see if he agrees. But if it were me and he doesn't agree, I will ask the doctors to tie my womb after I deliver the last child." [Woman aged 21–25 years, not in union, student clinic]
Others believed Georgina could just convince her husband. "At the beginning, he might object but if you the woman take your time to pamper him as time goes on, he will give in." [Woman aged 26–30 years, in union, antenatal clinic]
Hanna For Hanna, focus group respondents were divided between three possibilities: some respondents believed she should go back and use Depo-Provera® despite irregular menses; others felt she should consider a longer-term method such as the implant or intrauterine device, and just get it removed in 2 years; whereas a final group of respondents were concerned about her menstrual irregularities and she should just "count days" to determine when she can and cannot have sex. In discussing Hanna's situation, and in the open-ended questions on awareness of different modern methods of contraception, many women lacked specific knowledge about how methods work or how they are supposed to be used. "I learned the pills, Secure [combined oral contraceptive], for instance are taken 30 minutes before the act so that it will reduce the potency of the sperms." [Woman aged 26–30 years, in union, antenatal clinic]
Women also lacked knowledge about basic reproductive biology. "I have also heard that after the act you can get up and push the sperms out like you are pushing out a baby. I know how to push it out so I have been with my husband for about 6 years without using a condom and never became pregnant." [Woman aged 26–30 years, in union, antenatal clinic] "I also know that there are men who if they sleep with you, you can only be pregnant when he sleeps with you the next 3 days [in a row]. So you can calculate and if sleeps with you today, you can do it without a condom and then the next day, you use a condom." [Woman aged 26–30 years, in union, antenatal clinic]
Few women raised vasectomy spontaneously as a method of contraception despite efforts to increase vasectomy prevalence in Ghana through provider training. Like in other settings, women had misinformation about this method. "It [vasectomy] will have a psychological effect on the man and he will think he is no more a man." [Woman aged 21–25 years, not in union, student clinic]
Results
Socio-demographics
Table 1 summarises the characteristics of the women who participated in the focus groups.
Overall Themes
A number of key themes emerged from the focus group transcripts. One of the most common themes was fear of changes in menstrual patterns related to hormonal contraception. "You see fibroid is caused by blood clot and when you use some of them [hormonal methods] it causes your menses to stop. So the blood remains there and it clots leading to fibroid." [Woman aged 21–35 years, single, student clinic] "I have never experienced it [contraception] before but a sister [friend] has. When she did it [used hormonal contraception] she was not having her menses but whenever it was time for her menses she had severe menstrual pains and we had to bring her to the hospital for medication before it stops." Interviewer: "Which one was she using?" "The injectable. So we told her to stop but she also says if she stops what will she do? Another one also when she took the injection, something like a lump came into her abdomen and it was really aching and so she had to go to the hospital." [Woman aged 26–30 years, in union, antenatal clinic] "There was a sister who also took the injection and her breast became big and hard. It was the blood, which was not flowing which clotted in her breast. So she went to the hospital several times before she was cured." [Woman aged 26–30 years, in union, antenatal clinic]
In general, women who had never used contraception were fearful of methods based on hearsay or sometimes first-hand accounts of friends, relatives or acquaintances: Interviewer: "So why don't women use contraceptives?" Respondent: " It is because of what they have heard others say." [Woman aged 26–30 years, in union, antenatal clinic] "I want to do it [contraception] but because of what people say about it, that it can make you sick, I am afraid… They say that, for instance the 5 years [implant] they will insert something like needle into the arm and you will not feel normal again." [Woman aged 26–30 years, in union, antenatal clinic] "I had a friend who used the 5 years [implant]. She continued to bleed until she stopped. And while she was using it, she became very fat and so when she stopped, she became very slim like a pen." [Woman aged 26–30 years, in union, child welfare clinic]
Some women who had used contraception in the past confirmed these fears, noting that hormonal methods "made them fat" and changed their menstrual patterns. Some ever users did offer positive experiences, but these were not common.
Most women believed that the best place to get contraception was the hospital and women needed to be sure someone "tested their blood" to be sure they had the right method. "My problem is that they should check our blood before giving it [contraception] to us. But now it is as if we just decide what we want. And if something is good then do it for a fee. But now they give it [contraception] to us free without testing us and it is causing a lot of problems. So they are helping us and hurting us at the same time." [Woman aged 26–30 years, in union, child welfare clinic]
Vignette-specific Themes
Abena Many women expressed concern that Abena was "too young" to be sexually active. Some suggested that were she to use contraception, she should use a "natural" method such as counting days, as modern contraception could lead to infertility or a delay in getting pregnant. As has been found in Ghana and other settings, perceived or diagnosed infertility is a significant concern. In our sample, some women believed that contraceptive use at too young an age could result in delayed childbearing or in infertility. "You see, if you are a girl who has never given birth and you are taking those tablets, it can delay you in giving birth when you get married." [Woman aged 26–30 years, in union, antenatal clinic] Interviewer: "Do you think she will encounter any problems when she gets family planning or contraceptives?" Respondent: "Barrenness." [Woman aged 21–25 years, not in union, student clinic]
Some women did not consider condoms a method of contraception or "family planning". "She should just go get a condom and use because it is not compulsory that you use family planning but condoms are always available to help you prevent pregnancy." [Woman aged 26–30 years, in union, antenatal clinic] "Abstinence is the best. But if they can't abstain, then they can use condoms. But family planning is too early." [Woman aged 26–30 years, in union, child welfare]
Georgina Women felt in the case of Georgina, that if her husband opposed her using contraception, covert use was Georgina's right. "These days if you follow a man, it is you the woman who will suffer, he will get up and leave for work and the children will be surrounding you. If you die he will go marry another woman. So as for me I think she should just forget about the husband and think about her own well-being." [Woman aged 26–30 years, in union, antenatal clinic] "I think they have been married for some time now so she knows the kind of man he is. She should discuss with him and see if he agrees. But if it were me and he doesn't agree, I will ask the doctors to tie my womb after I deliver the last child." [Woman aged 21–25 years, not in union, student clinic]
Others believed Georgina could just convince her husband. "At the beginning, he might object but if you the woman take your time to pamper him as time goes on, he will give in." [Woman aged 26–30 years, in union, antenatal clinic]
Hanna For Hanna, focus group respondents were divided between three possibilities: some respondents believed she should go back and use Depo-Provera® despite irregular menses; others felt she should consider a longer-term method such as the implant or intrauterine device, and just get it removed in 2 years; whereas a final group of respondents were concerned about her menstrual irregularities and she should just "count days" to determine when she can and cannot have sex. In discussing Hanna's situation, and in the open-ended questions on awareness of different modern methods of contraception, many women lacked specific knowledge about how methods work or how they are supposed to be used. "I learned the pills, Secure [combined oral contraceptive], for instance are taken 30 minutes before the act so that it will reduce the potency of the sperms." [Woman aged 26–30 years, in union, antenatal clinic]
Women also lacked knowledge about basic reproductive biology. "I have also heard that after the act you can get up and push the sperms out like you are pushing out a baby. I know how to push it out so I have been with my husband for about 6 years without using a condom and never became pregnant." [Woman aged 26–30 years, in union, antenatal clinic] "I also know that there are men who if they sleep with you, you can only be pregnant when he sleeps with you the next 3 days [in a row]. So you can calculate and if sleeps with you today, you can do it without a condom and then the next day, you use a condom." [Woman aged 26–30 years, in union, antenatal clinic]
Few women raised vasectomy spontaneously as a method of contraception despite efforts to increase vasectomy prevalence in Ghana through provider training. Like in other settings, women had misinformation about this method. "It [vasectomy] will have a psychological effect on the man and he will think he is no more a man." [Woman aged 21–25 years, not in union, student clinic]
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