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Journal of Sociology & Social Welfare • September, 2023 • Volume L • Number 3
54
When Contraception Means
No Pregnancy: Narrative Account
of Contraception Use among
Reproductive-aged Women at the
Tamale Teaching Hospital, Ghana
Akosua Bonsu Karikari
University for Development Studies
Nana Aa Karikari
University of Energy and Natural Resources
Akua Afriyie Karikari
University of Cape Coast
Amos Apraku
University of Energy and Natural Resources
Contraception is a major intervention in improving maternal health. There
are about 214 million women of reproductive age in developing countries
who are not using modern contraception to prevent pregnancy. For proper
locale-specicanalysisoffemalereproductivehealthissuesinGhana,itis
vital to explore the knowledge base and hindrances to contraception use
in local communities. We used a phenomenological design to study repro-
ductive-aged women in the Tamale Metropolis of the Northern Region of
Ghana in order to comprehend the life world of study participants. This re-
search demonstrates that the majority of the women in the study area have
some form of knowledge about contraception, with mass media being their
main source of information. The contraception methods known and cited
by participants included birth control pills, condoms, injectable methods,
and IUDs, with the prevention of unwanted pregnancies as the main rea-
sonforusingcontraceptives.Formostoftheparticipants,sideeectsand
55
When Contraception Means No Pregnancy
spiritual beliefs are the major hindrances to the use of contraception. We
recommend that information on reproductive health in the Tamale Metrop-
olis should not be limited to health facilities but should include the use of
media outlets and social media platforms. Finally, clinicians should active-
ly educate religious leaders in the metropolis to demystify the numerous
superstitious beliefs associated with the use of contraception in the area.
Keywords: Contraception, reproductive age, knowledge, unwanted preg-
nancy, Tamale, Ghana.
Contraception simply denotes methods or techniques utilized
to avoid unwanted pregnancy as a consequence of sexual interac-
tion (Hubacher & Trussell, 2015). Some common modern contra-
ceptives are hormonal methods, emergency contraceptives, barrier
methods, and sterilization (Afriyie & Tarkang, 2019). The appro-
priateness of a method depends on an individual’s age, overall
well-being, number of sexual partners, frequency of sexual activity,
the desire to have children, and family history of certain diseas-
es. The practice of contraception which includes planning, spac-
ing, and delaying pregnancies is associated with improved health
of mothers and birth outcomes of babies (Colqui & Martin, 2017).
The benets of contraception outstrip the primary purpose of preg-
nancy prevention and may decrease pregnancy-related illness and
mortality, reduce the chances of developing reproductive cancers,
and can be used to treat some menstrual disorders (Kavanaugh &
Anderson, 2013). Alano & Hanson (2018) argue that contraception is
an empowering tool that not only liberates women from pregnancy
traps or reproductive engagement, but it also aords them the op-
portunity to concentrate on other aspects of their lives, like careers
and businesses which leads to sustainable development. The 2017
World Health Organization (WHO) report arms that patronage
and access to contraception are paramount in securing the welfare
and autonomy of women, which propels the development of com-
munities and nations as a whole.
Stephenson et al. (2007) report that geographical location, cul-
tural and religious opposition, limited access to contraception, and
aordability of modern contraception inuence the knowledge
and choices of women on modern contraception use. Augmenting
56 Journal of Sociology & Social Welfare
Stephenson et al.’s research, the 2017 WHO report on contraception
echoed that in developing countries, there are about 214 million
women of reproductive age who have the desire to escape unwant-
ed pregnancy; unfortunately, they do not use modern contracep-
tion because of limited access (particularly among young women),
the experience of side eects, and religious or cultural hindrances.
In the context of Ghana, Hindin et al. (2014) found that the major-
ity of the women do not understand how contraception works in
their bodies because of poor knowledge about the usage of modern
methods along with misinformation and myths about contracep-
tion. Beson et al. (2018) studied modern contraception use among
reproductive-aged women in the Ledzokuku Krowor Municipality,
a heavily populated residential area of the Greater Accra Region,
and found that 21% of 217 women sampled used modern contracep-
tion. Bawah et al. (2019) researched reproductive-aged women in
the Upper East Region and found that the practice of contraception
was as low as 13% out of a total of 5,511 women participants.
Good reproductive health depends largely on how informed
people are on contraception issues and usage (Chandra-Mouli et al.,
2014). Given the preceding data on contraception knowledge and
usage from Greater Accra and Upper East regions respectively, it
was necessary to explore further other communities’ contraception
use and the contextual peculiarities on the subject maer. Tama-
le Teaching Hospital, which is located in the Tamale Metropolis of
the Northern Region, was the focus of this study. The 2017 annual
Metropolis Narrative Report showed that the metropolis recorded
an increase in the number of teenage pregnancies, which was large-
ly aributed to the lack of knowledge on the use of contraception
and poverty levels in most parts of the metropolis. Exploring the
knowledge levels of women on contraception and comprehending
the various elements that promote or inhibit the use of contracep-
tion were the goals of this study. We aimed to provide valuable data
for the Tamale Health Management Team and other stakeholders
in the planning and implementation of policies on reproductive
health and population, as well as to contribute to scholarship on
education and promotion of contraception use.
57
When Contraception Means No Pregnancy
Theoretical Background
This study was informed by social constructionism and uses
and gratication theories. These two complementary theories are
relevant to this paper due to their practicality to the subject maer.
The fundamental explanation of social constructionism posits that
reality is a dynamic process that is socially shaped and generally
accepted (Berger & Luckman, 1967). The peculiarity of social set-
tings inuences an individual’s unique perceptions of reality; thus
knowledge, meanings, aributions, beliefs, and ideologies are com-
munally invented and experienced by members of a social milieu
(Pierce et al., 2014). This theory is useful to this study because it
gives the opportunity to acknowledge the numerous ascriptions/
perceptions women have about contraception and its usage. Given
this theory, we can assume that to some extent their constructs on
contraception and its usage are socially motivated. These interpre-
tations are not only intrinsically determined, but they are reective
of the opinions and understandings of others in their community.
Thus, their community’s understanding of contraception inuences
the usage or lack of usage of contraception.
The uses and gratication theory postulates that individuals
constantly seek out innovations to gratify their wide variety of
needs (Mondi et al., 2008). Although the theory is embedded in com-
munication and media studies, it has been adopted and reformulat-
ed in other discourses to explain a user’s acceptance and continued
use of a medium. The theory basically examines the gratication
sought from a medium and the actual gratication obtained. The
theory suggests that there are expectations in selecting a particular
option over others. A user’s preference/choice depends on wheth-
er or not the medium is able to satisfy the desired expectations
(Dunne et al., 2010; Florenthal, 2015; Weaver et al., 2011). This theory
implies that women of reproductive age make motivated choices on
contraception use, and these choices and intentions for subsequent
use are often dependent on the expected gratication oered by
contraception. The rationale for choosing a particular option may
be driven by the content, or type, of the contraception, how their
bodies responded to the contraception, availability of that contra-
ception, and aordability among other concerns.
58 Journal of Sociology & Social Welfare
Methods
We specically used a phenomenological approach to provide
participants with the avenue to express in detail their views, per-
ceptions, meanings, and aributions with regard to contraception
use. Phenomenological design is rooted in the deep understanding
of a phenomenon and its aim is to describe and interpret issues
from the lenses of those being studied (Corbin & Strauss, 2008; Ger-
ring, 2017).
StudySeing
The study seing was Tamale Teaching Hospital (TTH), which
is located in the Tamale Metropolis. This is a tertiary hospital and
is the main referral hospital that provides health care to the peo-
ple in the northern part of Ghana. It was established in 1974 and is
the third-largest hospital in Ghana. The hospital was upgraded to a
teaching hospital in 2005 to provide advance medical services, com-
plement the training of health professionals from the University for
Development Studies, and undertake health-related research. The
hospital provides specialist services such as obstetrics and gynae-
cology, surgery, orthopaedics, reproductive health, and endoscopy
among others.
Health facilities play a pivotal role in the administration, prop-
agation, and commercialization of contraception. Tamale Teaching
Hospital thus served as a logical place to recruit potential study
participants. Additionally, discussions about sexual issues in many
communities in Ghana are often regarded as sensitive and are not
overtly discussed. The socio-cultural milieu of the study area is pre-
dominantly Muslim, and these religious persons are known to be rel-
atively secretive about their reproductive lives. Given these concerns,
we considered it appropriate to use the hospital as the rst point of
contact so that we could reach out to women who visit the Family
Planning Unit as well as those seeking general health care.
The ethical board of the Tamale Teaching Hospital granted
permission for the study before data collection began. Participants
were informed about the study and its objectives and advised that
their participation was fully voluntary. Participants gave verbal
consent, and condentiality was strictly observed. Their real names
59
When Contraception Means No Pregnancy
and any other identiable aributes were delinked from the data,
and they were encouraged to use pennames to protect their iden-
tities. In addition, they were informed that they could withdraw
their participation from the study at any time.
Sample and Recruitment
The targeted population was all females within the reproduc-
tive age bracket of 15 to 49 years who, at the time of the study, vis-
ited the hospital either for medical treatment or for reproductive
purposes. The criterion for participation was women who were
currently using modern contraception or had used it in the past.
We recruited research participants using a blend of non-probabil-
ity sampling procedures—namely convenience, purposive, and re-
ferral or snowball sampling techniques. Lopez & Whitehead (2013)
dened these techniques as channels of selecting individuals of in-
terest when the exact total population is not known or unavailable.
Forty-ve participants were engaged in this study. Of this number,
15 women were selected purposely from the FPU, 12 were women
seeking general medical aention, and 18 were referred friends and
family members.
Data Collection
A semi-structured interview guide was used as the data collec-
tion tool. To Bryman (2016), although questions are systematical-
ly wrien, it still gives researchers the opportunity to expand the
scope of questioning especially when participants make striking as-
sertions. This leads to enriched dense data. Prior to the commence-
ment of the actual data collection, the semi-structured interview
guide developed was pretested in Bilpiela Health Center located in
Tamale, to eliminate ambiguity and ne-tune the questions to ad-
dress the research objectives.
Participants had the option to choose between focus group dis-
cussions (FGDs) and one-on-one interviews. Phone numbers and
residential locations were collected to draw an interviewing sched-
ule, especially for the FGDs, and this schedule was communicated
to the women mostly via phone calls. Their suggestions were incor-
porated into the schedule until a general consensus was achieved.
60 Journal of Sociology & Social Welfare
Cluster groupings were created based on respondents’ places of
residence. For example, those who reside in Dungu vicinity had the
University for Development Studies as their meeting venue. Each
participant in one-on-one interviews determined the location and
timing of the interviews. FGDs averaged 80 minutes, and one-on-
one interviews averaged 45 minutes.
Three focus group discussion sessions were conducted, with
each having a total of 12 participants. Nine women participated
in one-on-one interviews. Although the primary aim of the FGDs
was to elicit narratives from participants, it also served to highlight
group dynamics regarding how ideologies are shared, assimilated,
and refuted via interactions. The entire data collection took a peri-
od of 8 weeks from June to July 2021.
The FGDs and interviews were audio recorded and transcribed.
To address the trustworthiness of the data collected (Creswell &
Poth, 2016), we used member validation and triangulation. To ob-
tain member validation, the lead author scheduled appointments
with the participants to discuss the data. The participants had to
verify if they recognized the results as authentic and that they re-
ected accurately their thoughts or otherwise. Participant valida-
tion controls the precision of the data because it tests if the thoughts
and ideas of the participants have been captured accurately, which
invariably gives credence to a study (Babbie & Mouton, 2001). Tri-
angulation is the use of multiple methods, sources, and techniques
to increase the objectivity of a study (Bryman, 2016). To accomplish
this, we used the focus group discussions and one-on-one inter-
views to gather multiple perspectives from participants.
The three authors categorized the transcriptions thematically,
guided by the research objectives. They used the thematic analysis
approach (Braun & Clarke, 2006) to translate raw data into ndings
which informed the analytical procedures of the study. As such,
the authors became acquainted with the data, created initial codes,
identied themes, reviewed the identied themes, described and
named themes, and generated the write-up from the data set.
61
When Contraception Means No Pregnancy
Results
Socio-Demographic Data
Out of the 45 women who participated in the study, the majority
(25) were within the age bracket of 19 and 29 years. The next popu-
lous age bracket was 30 and 39 years with a total of 16 participants.
The next set, 4 participants, were within the 40 and 49 cohort. The
majority of the participants (20) were in a relationship, 17 were sin-
gle, 6 were married and 2 were divorced. Seven participants were
senior high school graduates, 2 had completed tertiary schooling,
9 had no formal education, 12 had Junior High School Certicates,
and 15 had completed primary education. Most of the participants
(34) were Muslims, with 11 being Christians.
Knowledge on Contraception
This study sought to investigate the knowledge level of the
women on the topic of contraception. It was evident from the data
set that the participants had some knowledge about contraception,
and they often referred to contraception as family planning. To the
majority of the participants, contraception basically means avoiding
unwanted pregnancy. A few mentioned that some methods could
protect them against sexually transmied diseases. Most of them
were unaware that in addition to the above-mentioned purposes,
contraception could be used to space birth and control family size.
Three dierent women aged between 20 and 25 years indicated the
following:
“Oh, to me family planning is using things to avoid pregnancy” (Ay, 25
years old, one-on-one interview)
“The purpose of contraception is to prevent unwanted pregnancy. If you
are not married and you get pregnant it becomes a shame to you and your
family. That is why I use contraception.” (Wumi, 21 years old, FGD)
“Yes I know contraception like the pill, condom…Ihave forgoen the
rest, but I know that it is used by women to avoid pregnancy and maybe
ST Ds.” (Yara, 20 years old, one-on-one interview)
62 Journal of Sociology & Social Welfare
Sources of Information about Contraception
For the sources of information about contraception, two sub-
themes emerged: the rst was that health facilities were the least
preferred source of information, and peer tutelage was perceived
as more useful.
Health Facility: The Least Preferred Source of Information
The majority (38 out of 45) of the participants mentioned the me-
dia (e.g., TV, radio, internet, and social media) as their main source
of information about contraception, followed by peer education. In-
terestingly, the hospital was the least favorite avenue for seeking in-
formation. The media is perceived by participants as an open space
where information is sourced without one’s anonymity being com-
promised. This was succinctly expressed by 19-year-old Rakiyia:
“Nowyoucanndalotofinformationinthemedia.Anythingyouwant
you will get it. You can get information and people will not know who
you are and your location. To me the media is a free medium and I will
always stick to the media to get information not only on contraception
but on anything I want.” (Rakiyia, 19 years old, FGD)
The concern of labeling and stigmatization made the media and
peer education the preferred avenues for seeking information about
contraception, according to the participants. Some participants ar-
gued that visits to the hospital or reproductive health unit to solic-
it information project on them the image of “bad girls,” and as a
result, they prefer to get information elsewhere. A journey to the
health facility is only necessary when a type of contraception needs
the ing of a clinician as in the case of injectable methods and in-
trauterine devices (IUDs). This was strongly articulated by Lamin,
who indicated:
“Personally, I feel uncomfortable visiting the health center to ask about
contraception. Sometimes when the nurses realize you are not married
they look at you with a suspicious eye, which suggests you are promis-
cuous—thatiswhyyouareaskingaboutdierentmethodsofpreventing
pregnancy?Thereisnoprivacyandcondentiality,soitisbeertoget
information from people you know and trust, so that you are not judged.
63
When Contraception Means No Pregnancy
Ithinkwhenonegetstheneededinformationandselesonapreferred
contraception,theycan thendecidetogotothehospitaltogetitxed.
At this point, there would not be much questions and answers. Madam
(referring to the interviewer), do you know why many girls don’t use
contraceptionandthoseofuswhousepreferpillsandotherstus?It’s
because we don’t want to be seen and judged.” [sic] (Lamin, 19 years
old, FGD)
Peer Tutelage: The Perceived Haven
Peer tutelage was the next most common channel of eliciting
information about contraception. Talking to friends and female
family members about their reproductive needs, according to par-
ticipants, is benecial. They are able to share ideas on the types of
contraception, how to use them, the anticipated side eects, and
suggest remedies to mitigate the expected eects. The voices of
Iyara and Ajara below demonstrate the inuence of peer interac-
tions in contraception use.
“Yes I am on family planning. My friend told me about the type that I am
using. So I sell smock, and two years ago, I was pregnant, and that was
my fourth pregnancy. I have this woman who buys in bulk from my shop.
We have traded close to 5 years so I can say we are like friends. When
she saw me pregnant she jokingly said ‘aii you want to form a football
team.’ I wasn’t pleased with her statement so I responded, what do you
want me to do? She told me to get family planning and said as for her she
isoninjectableandshethinksitisbeerformarriedwomen.Shesaidas
mothers we are under pressure and we do a lot of things so we can forget
our pills but for the injectable, you do it like every 2 or 3 months. I did
it and I think it is good.” (Iyara, 32 years old, one-on-one interview)
“Iuse postinor2 becausemy friend said it is veryeectiveto prevent
pregnancy. When I had my boyfriend I told my very close friend about
it. She told me that I should always use postinor 2. She mentioned that
if I don’t use it and I get pregnant the guy may deny and I would be in
serious trouble.” (Ajara, 19 years old, one-on-one interview)
When asked about the risk in consulting nonprofessionals
for reproductive guidance, some of the participants shared that
they interact with those who have used one or more methods of
64 Journal of Sociology & Social Welfare
contraception, hence they are in a beer position (by way of expe-
rience) to give knowledge on the types and uses of contraception.
Iyara’s (32 years old, individual interview) response illustrates the
usefulness of consulting with nonprofessionals for reproductive
guidance, stating that, “experience is the best teacher, in my case this
woman is using the injectable and it is helping her. So me I did not doubt
or think negative when she told me about it.”
Types and Usage
Commonly mentioned forms of contraception were the barri-
er method (male condoms), the oral contraceptive pill, the inject-
able, and the intrauterine contraceptive device (IUD). Most of the
participants in our study preferred oral contraception to the other
methods of contraception. Oral contraception was the most pre-
ferred because it is easily accessible, and they believed it does not
interact with other methods to cause any harm. The barrier meth-
od/condom, according to participants, was used at the initiative of
their partners. To them, it is awkward to hand in a condom to their
partners for sexual engagement. It would suggest to their partners
that they are promiscuous and this, in their sociocultural context,
would not auger well for those women. For example, Nasara and
Precious stated as follows:
“Aaah madam!!! (exclaimed and laughed loudly) how can you give baba
Seidu (a pseudonym for the husband) a condom and ask him to use it. For
me I cannot do it. He will ask questions and even get angry. A woman
does not call for sex, your duty is to be available for the……. Ahaa” (she
threw her hand in the air to describe the sex act). (She laughed excit-
edly as she presumed the interviewer and the group members
understood her suggestive gesture). (Nasara, 42 years old , FGD)
“Condom buying is the duty of the man. Oooh. Personally, I think it is
the man’s job to buy the condom. They are made for men so what is your
business going to buy a condom as a woman. It is like a man buying
pills from the pharmacy shop--the scenario would be so funny (giggles
briey).Ifawomandoesnotwanttogetpregnantthensheshouldknow
how to protect herself even when the partner does not use condom. They
should know their cycle, safe period and all that.” (Precious, 32 years
old, one-on-one interview)
65
When Contraception Means No Pregnancy
Categories of Women and Contraception Use
Almost universally, unmarried women in this study were more
likely to use contraception than married women. The whole discus-
sion centered on the avoidance of unwanted pregnancy. It was clear
from participants’ narratives that having babies within wedlock is
the expected “social fabric” in which to be clad. Being pregnant
outside the walls of marriage is not welcomed news, and it casts a
slur on the reputation of the individual and that of the family. The
reverse is the case for the married women. Having children in a
marital milieu is considered a blessing. There is, however, a twist to
just having children. For the Muslim women, a premium is placed
on the number of children (mostly male children) a woman has.
Childbearing is a disguised competition among the married wom-
en. Their marital seing is polygamous in nature (as embedded in
Islam) and they opined that bearing more children is a testament
to fertility; hence, there is a kind of reluctance to using contracep-
tion. Below are some narratives from the participants to buress
this point:
“Although contraception is for every woman, I think that girls who are
not married use it more because they do not want to get pregnant.”
(Mandy, 40 years old, FGD)
“Mmm, as a married woman you are expected to give birth, so contra-
ception is not something that comes to mind easily. What do you have
to show for as a married woman? Your children of course.” (Rush, 38
years old, FGD)
“As a Muslim, children are very important to us. In my home, for ex-
ample, I have 4 boys and 2 girls and I am happy because my boys would
takeoverfromtheirdadwhenheisnomore.Havingvechildrenshows
that Muyila is very capable of producing children anytime.” (Muyila, 35
years old, one-on-one interview)
“When I was single I used the monthly pill, but I don’t use it now be-
cause I am married. In our community, having kids, especially a male
child, is important. It shows the whole world, including your rival, that
you are a woman who can give birth. I need to produce children for my
husband. I have been married for four years and I have a boy. I want to
give birth to maybe 4, then I can think of going back to the pills. Having
66 Journal of Sociology & Social Welfare
a child is not safe. What if something happens to him and he is no more?
So I need to give birth--that is why I don’t use contraceptive for now.”
(Felicia, 28 years old, FGD)
Duality of Contraception
(Modern Contraception vis-à-vis Traditional Contraception)
As participants gave their experiential accounts on types and
preferred methods, an interesting revelation came up. The authors
assumed that most participants were into the practice of using mod-
ern and traditional contraception. Just over half of the total sample
(i.e., 35 out of 45) shared that, although they use modern contracep-
tion like birth control pills and injectables, they also used traditional
contraception. Traditional contraception is used as a complementary
option/contingency measure for a total avoidance of pregnancy. They
named herbs, spices, and other concoctions as natural means of pre-
venting unwanted pregnancy. Some of the natural remedies as listed
by participants were cloves, negro pepper, goron tula, tree barks, and
pawpaw puree mixed with local spices, among others. These were
either taken orally or used in douches. The participants indicated
that their choices were premised on the seeming side eects of arti-
cial contraception and the professed promises/assurances of natural
remedies in preventing pregnancy without any immediate or future
complications. Unmarried women were routinely combining arti-
cial and natural contraception to be completely safe from pregnancy.
They chose “absolute caution,” whereas the married women were
comfortable with one method because they were not aggressively
seeking to avoid unwanted pregnancy.
A 23-year-old participant, Ruth shared why she uses natural
and articial contraception:
“If you want to avoid pregnancy it is always best to be double sure. You
havetouseboththearticialandnaturalcontraception.Youknowsome-
timesthearticialcontraception,especiallythepill,canfailifyoumissa
day or two, so when you take a blend of glove, negro pepper and pawpaw
puree you are free…(laughsbriey).” (Ruth, 23 years old, one-on-one
interview)
When asked about the consequential risk of combining arti-
cial and natural contraception, 19-year-old Kawra stated:
67
When Contraception Means No Pregnancy
“There is no risk in combining the two. I don’t think natural things have
any negative impact on my body. It is 100% safe”. (Kawra, 19 years
old, one-on-one interview)
The Future of Contraception:
Elements Liable for Discontinuation of Contraception
Perceived Risk
Perceived risk was the main hindrance to contraception usage.
All participants alluded to the side eects of contraception as rea-
sons for either discontinuing or blending with other alternatives.
Participants’ knowledge of the risks came from interactions with
peers and family members, as well as their personal experiences.
The shared beliefs as expressed by their acquaintances on dangers
of using contraception were barrenness, obesity, and bloated stom-
ach, among others. Some of the women asserted that they had to
stop using contraception at one point in time due to the following:
irregular and sometimes temporary absence of menstrual ow;
inecacy of some methods causing unexpected pregnancy; ex-
pulsion of the IUD; and pain and bleeding. For instance, Baraka,
Soyoyo, and Sandra articulated their views as follows:
“Initially I was using IUD and I had a terrible experience with it. I was
inpainwhenitwasbeingxedbytheclinician.Aweekafter,thepain
became unbearable and I bled in addition. I reported back to the hospital
and I got it removed. It was an uncomfortable one. I lost the desire to try
on other methods. I even heard that the oral pills cause obesity so for me
Idon’tusethearticialmethodagain”. (Baraka, 27 years old, FGD)
“I was on the oral contraception and I got pregnant. I was very surprised
anddisappointedbecauseIwasnotreadyforit.Geingpregnantgave
methe impression that theoral contraception isnot eective.When I
talked to a friend about it she told me it can happen, as it is not 100%
guaranteed” [sic]. (Soyoyo, 29 years old, FGD)
“Yes, I haveusedcontraception.Istopped because itwas aectingmy
hormones.Icouldn’treallytrackmymonthlyow.Ifeltitwasdanger-
ous” [sic]. (Sandra, 35 years old, one-on-one interview)
68 Journal of Sociology & Social Welfare
Conservatism as Against Reproductive Enlightenment:
The Role of Religion and Culture
The second rationale for discontinuing contraception use was
religious and cultural backgrounds and perspectives. This created
an intense debate among participants, especially in the focus group
discussions; at this point, the cultural and religious ideological
standpoints of participants came to the fore. Expressions of partici-
pants were reected in two diverging pathways—the conservatives
and the realists.
The conservatives were the category of women who had used
contraceptives and were no longer using them, whereas the realists
were those who have used and are still using contraceptives. The
conservatives, who were in the majority (i.e., 24 out of 45—this g-
ure is an aggregate of participants from the 3 sets of FGDs), posited
that although they have used contraception before, they are of the
view that it is dangerous and not benecial to women. They argued
that using methods to avoid pregnancy is not the best choice both
culturally and religiously, because by using contraception one is
resisting the natural balance of life. They added that this could have
spiritual implications for them and their descendants. Some inti-
mated that contraception is a disguised abortion; hence, if a woman
is not ready for pregnancy, then they do not have to engage in sexu-
al acts. They added that contraception can reduce the total number
of children a woman can bear.
At this point the realists (in the minority, that is, 12 participants
from the 3 sets of FGD) interjected and branded the conservatives
as “hypocrites.” To the realists, women in the study community
normally do not have the autonomy to determine sexual engage-
ment. According to them, the fact that women do not call for sex
is all the more reason why they must protect themselves from un-
wanted pregnancy. They opined that it is beer to use contracep-
tion to avoid unwanted pregnancy than for the inevitable to hap-
pen, and one would have to either abort or care for a child she had
not planned for. Below are some of the discussions that ensued be-
tween the conservatives and the realists:
“IhavebeenreectingoncontraceptionandIhavecometotheconclusion
that it is not a good thing. You see Allah created us and his will for us is to
69
When Contraception Means No Pregnancy
multiply, so that we will have people continuing our lineage when we die.
Now, if we prevent pregnancy, who will continue our lineage for us? When
ithappenslikethat,Allahwillnotbehappyandwemaysuerwhenwe
die” (sighs deeply). (Sukoo, 30 years old, FGD—Conservative)
“I have two girls. Sometimes I think that the pills that I was taking
beforeImarriedhaveaectedme.Whoknows?Icouldhavegivenbirth
to more than two. Me, I would advise my young sisters, especially the
unmarriedones,toabstainfromsexsothatitdoesnotaecttheminthe
future.” ( Kina, 35 years old, FGD—Conservative)
“Ooh!! I don’t see anything wrong with contraception. I think it helps a
woman to plan when she is ready to bear fruit. My sisters here are just
being superstitious. There are sins which people commit that are more
dangerous than contraception. Please, they should not judge women who
use contraception as evil.” (Samankona, 26 years old, FGD—Realist)
“Ah ah!!, You people used it and now you are discouraging us from mak-
ing use of it? Well, allow us to use and we would tell our own story.”
(Adwoa, 32 years, FGD—Realist)
It is worth noting that the conservatives throughout the discus-
sion were assertive, and they intensely tried to convince the realists
to understand and appreciate their stand. The conservatives en-
treated the realists to rethink the use of contraception to avoid any
spiritual consequence they may endure either now or in the near
future. The spiritual aributions/connotations advocated by the
conservatives appealed to the supernatural sensations and emo-
tions of the realists.
Sources of Contraception
With the exception of injectable and intrauterine devices, which
are administered in a health facility, the other methods—that is
both indigenous and modern contraception—were sourced from
pharmacy shops, local markets, friends, and sexual enhancing re-
tail outlets (online and in the local markets).
“I buy my pills from pharmacy shop.” (Danaa, 30 years old, one-on-
one interview)
70 Journal of Sociology & Social Welfare
“I buy from the market. I use herbs. I have a woman who sells to me. I
patronizehermixturebecauseIfeelitiseective.Iwenttothemarket
one day and as I was buying my things, she called out to me to buy her
palm oil. I told her I am not interested. As she approached me, she told
me in the ears that she has spice and herbs that I can use to protect myself
from pregnancy since I am a young girl. She told me that I can’t use if I
am pregnant because it will cause abortion. I was interested, so I followed
her to her container and from that day I have been buying from her.”
(Moon, 22 years old, one-on-one interview)
“Depending on what I want to use, I can buy from the pharmacy shop,
local market or even online.” (Constance, 25 years old, FGD)
Discussion
This study showed that most of the women participants were
not conversant with the complete functions of contraception. To
them, contraception is synonymous with avoidance of pregnancy.
Social interaction and demographic characteristics of participants
most likely explain this nding.
It is important to acknowledge that an individual’s knowledge
of a phenomenon depends largely on the sort of information avail-
able to him/her. It can be inferred that women indicating prevention
of pregnancy as the main function of contraception, suggests that
“contraception as a barrier to pregnancy” is the information that is
often propagated in their social sphere. As such, the other functions
are relegated to the background. This reects social constructionism,
which infers that individuals are in constant interaction with one an-
other and that one’s constructs are not only intrinsically determined
but are socially molded. Therefore, participants’ constructions of
contraception and its uses are communally motivated.
The demographic distribution of the study showed that young
and unmarried women made up the bulk of participants, and they
were seeking to prevent unwanted pregnancy. Therefore, their in-
terpretation of contraception skewed toward being a medium of
avoiding unwanted pregnancy. This result is similar to a study car-
ried out in northwest Nigeria by Adefalu et al. (2018), which illus-
trated that avoidance of unwanted pregnancy was the most popular
function of contraception named by 500 reproductive-aged women.
71
When Contraception Means No Pregnancy
Discussions of reproduction are often considered sensitive;
hence people are mindful of the content and context of the discus-
sion. Individuals are often discreet and circumspect on reproduc-
tive health issues and usually have conversations with people they
are comfortable around, whom they nd trustworthy and endowed
with the requisite experience. The data showed that information
on contraception was inuenced by stigmatization and relational
condence.
The women participants, especially the young and unmarried,
found the media was a safe haven for seeking information on con-
traception because the element of stigmatization was absent, unlike
in the health centers. The seeming judgmental outlook of clinicians
toward clients made reproductive health centers unfavorable spac-
es for making inquiries. Oppong et al. (2021) also reported that the
stigma associated with contraception use among adolescents and
young women deters them from accessing contraception from re-
productive clinics. The implication of this result is that as women
seek information outside the ideal quarters, there is a chance for
these women to be misinformed.
Persons within specic locales are most likely to share homoge-
neous inuencing factors and characteristics, which result in having
relational condence in one’s peers. Therefore, the ow of informa-
tion some of the women had with their friends is not surprising. They
classied the friends as experienced and adhered to their recommen-
dations. These friends invariably had assumed the role of local in-
uencers or peer educators who informed the women on the types
of contraception and their uses. This nding resonates with Khan &
Jarifa’s (2014) study in Bangladesh, where women in their reproduc-
tive age group had relatives and trusted neighbors as informers.
Commonly mentioned and used forms of contraception were
male condoms and oral contraceptive pills. The preference for con-
traceptive pills was premised on accessibility, whereas male con-
dom use took the frame of gendered sexual engagements. That is,
the use of condoms is initiated by their male partners. Also, the
patronage of contraception was low among Muslim women. They
placed a premium on the number of children a woman has. This
is similar to Aviisah et al.’s (2018) study where they reported that
modern contraceptive use is higher among Christians than Mus-
lims in Ghana.
72 Journal of Sociology & Social Welfare
Using more than one contraception by the women is not an un-
usual act. According to Twumasi (2005) and Karikari & Boateng
(2019), in Ghana, indigenous practices are enmeshed into the health
system. As such, the health-seeking behavior of individuals is not
limited to modern medicine, and alternative treatments are sought.
Traditional beliefs and practices inltrate the patronage of modern
medicine; thus, it is dicult to decouple traditional beliefs and prac-
tices from modern medicine. There is the need, therefore, to acknowl-
edge indigenous practices and possibly streamline such practices.
As uses and gratication theory posits, individuals compare the
expected satisfaction from a medium and the actual gratication ob-
tained. When the expected results are not realized, continuing use of
that medium becomes unlikely. From the data, it is clear that women
in this study made motivated choices about contraception and chose
methods to satisfy their needs. Their beliefs, expectations, and eval-
uations of a particular form of contraception inuenced their inten-
tions for subsequent use. Selection of a particular option was driven
by the type of contraception and how their bodies reacted to it. The
decision to discontinue the use of a medium arose out of the fact the
actual satisfaction could not measure up to the expected gratica-
tion. This is in line with Barden-O’Fallon et al.’s (2018) study where
they found that women often discontinued a method to utilize an-
other when the former was deemed ineective.
In the African context, and more especially in Ghana, spiritu-
ality and the fear of the unknown permeates many facets of an in-
dividual’s social being (Karikari & Boateng, 2018). It is not surpris-
ing that the opinions stated by the conservatives were persuasive
enough to convince the realists. Again, as social constructionism
theory espouses, an individual’s reality is usually not xed or in-
herent but is impacted by the expressions of others in a social con-
text. The ability of the conservatives to inuence the realists to end
the use of contraception projects the power of social interaction as a
force in modifying an individual’s choices and perceptions.
Our ndings show that the commercialization of contraception
has become pervasive. Young women feel much more relaxed ex-
ploring other outlets for contraception because there is almost no
stigmatization from the retailers. This nding is similar to a study
73
When Contraception Means No Pregnancy
in Nigeria where very few people (1 percent) out of the 244 peo-
ple using contraception got their contraceptives from hospitals or
clinics (Oye-Adeniran et al., 2005).
Conclusion and Recommendations
To conclude, it was evident that the majority of reproduc-
tive-aged women in Tamale Metropolis equated contraception to
preventing pregnancy. Further, almost all the participants were
ignorant of the other uses of contraception. Labeling, stigmatiza-
tion, and the fear of being judged as promiscuous in health facilities
made media platforms and peer education the preferred sources of
knowledge on contraception. Ultimately, single women were more
likely to use contraception than their married counterparts. The
continued use of contraception was dependent on the gratication
gained (in terms of how ecacious the product was in preventing
pregnancy), side eects experienced, and superstitious views.
Recommendations
It was evident from the ndings that participants outsourced
information mainly from media, like television and radio, among
others. We, therefore, recommend that reproductive health infor-
mation, such as the types of contraception available to women, in-
formation on which women qualify to use contraception, and how
their bodies would respond to contraception should not be limited
to the connes of health facilities. Instead, reproductive workers
should use media outlets and social media platforms to extensively
educate the community members.
It was clear from the study that there was some kind of apathy
among the women about using the reproductive centers. We sug-
gest that reproductive workers should identify local women who
use contraception and train them to be peer advocates. We antici-
pate this approach has the propensity to reach out to more women
because they would view the peer advocates as similar to them-
selves and thus feel more comfortable discussing contraception.
Education has the propensity to change the entrenched position
of an individual. Thus, in addition to the rst recommendation, we
74 Journal of Sociology & Social Welfare
suggest that clinicians should actively educate religious leaders by
spelling out the benets of using contraception and demystifying
the various forms of superstitious beliefs associated with it. As the
religious leaders become receptive and informed on contraception,
there would be a higher chance of these leaders enlightening mem-
bers on contraception.
We found that, with the exception of injectable and intrauterine
devices (which are only available in health facilities), other methods
of contraception were not sourced only from pharmacy shops or lo-
cal chemist shops, but also from sexual enhancing retail outlets (on-
line and in the local markets). We therefore propose that the Food
and Drugs Authority and other regulatory bodies should regulate
and standardize the sale of contraception outside the approved
points of dispensary like reproductive health centers and certied
pharmacy shops. This may help to avoid the occurrences of wom-
en sourcing and consuming unwholesome contraceptive products
from unauthorized sales outlets.
As espoused by some participants, especially the young and un-
married, there is an aura of stigmatization associated with accessing
contraception at reproductive centers. We suggest that reproductive
health trainers/advocates should intensely sensitize trainees on the
importance of ensuring condentiality and avoid displaying be-
haviors that clients may interpret as judgmental. If clients perceive
reproductive centers as trusted, relaxed and non-judgmental spac-
es, we believe young and unmarried women would feel much more
comfortable seeking contraception methods from licensed health
centers instead of other unlicensed sources.
75
When Contraception Means No Pregnancy
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