Background
The purpose of this study is to explore the possible social and cultural factors contributing to the unmet
need for family planning in the Dangme West District.
Specifically, the study sought to assess the level of knowledge about Family Planning, describe Fertility
Preferences, determine the level of unmet need for Family Planning, evaluate access to family planning
services, identify cultural factors that may influence family planning use, identify the communication
environment within sexual relationship with regard to Family Planning, i.e. open communication,
need for secrecy, perceived infidelity and determine level of decision-making autonomy and financial
autonomy in relationships to evaluate how a woman’s autonomy may influence family planning use.
Study Methods
This study was a small-scale comparative and descriptive study. The social and cultural variables were
assessed through four focus groups and household surveys administered in Dodowa and Great Ningo.
Two focus groups, one for men and one for women, were conducted in each of the two sub-districts.
These were used to help refine the questionnaires as well as obtain information that respondents might
not be apt to reveal through a household survey. The focus group discussions (FGDs), were conducted
before the questionnaires were administered so that the responses could be used to confirm or adapt the
pertinence of the questions being asked in the survey.
Results and Discussion
One of the most significant conclusions from this study was that the definition of the unmet need for
family planning needs to be refined. In this study alone there were conflicting numbers that suggest that
the level of unmet need for family planning may be higher or lower than previous estimates suggest.
This is due in part to the fact that family planning is measured by contrasting the percent of women
who are currently using family planning with those who say that they wish to space and plan their
pregnancies. However, when asking women and married men simply if they, or their wives, would
like to do family planning if they are not already, the unmet need has a different value. This difference
might point out an area of need for improving family planning programs.
Knowledge of family planning was found to be significantly related to past use of family planning for
both males and females. This association could be expected with the assumption that those who have
either used family planning in the past or had a spouse who used family planning in the past would
know which types and what they can be used for based on their experience and exposure to family
planning services. Knowledge however was not significantly associated with present use of family
planning.
Physical or financial access to family planning services was not shown to be significantly associated
with family planning use. The responses indicated that access is not a barrier to use. This supports the
purpose of this study, which is to discover the social and cultural barriers to family planning use that
are contributing the high level of unmet need in Ghana. The data from these two communities supports
the notion that a series of gender differences and cultural attitudes are contributing to the discrepancies
in family planning use.
Cultural attitudes were not found to be as significantly associated with family planning use. Although
women perceived a higher level of disapproval from their families, communities, and husbands, only
the perception of the husbands was found to be associated with family planning use. Male approval
or disapproval of family planning was significantly associated with unmet need for family planning,
and it was highly associated with male concerns that family planning use will lead to infidelity. This
data suggests that one of the reasons that men would disapprove of family planning use is that they are
concerned that it would either allow or encourage their spouses to be unfaithful. Although it was not
found to be significantly associated with family planning use, concerns that family planning use would
lead to infidelity were expressed by many of the respondents in the focus groups discussions. This may
indicate that this is a more elusive issue when discussed along with family planning.
Women were more concerned about the side effects of family planning then men were. Although the
side effects were not found to be significantly associated with family planning use or unmet need, those
concerns were voiced significantly in the focus group discussions. The significance of these complaints
might be something that future family planning programs may choose to address. Religious teachings
against family planning use were found to be significantly associated with past use of family planning
in females but not males. This is also a connection that would need to be explored before a causal link
could be established.
The responses to secret family planning use had significant results. The positive responses were
significantly associated with unmet need for both males and females. These results suggest that the
anticipated response to clandestine family planning use effects a woman’s decision about whether or
not to use family planning. The approval or disapproval on the part of the male could encourage or
dissuade a woman from utilizing family planning services when she wants to space or plan the births
of her children.
Although it was unclear prior to the study whether or not autonomy would also be a concern in the
southern region of Ghana, female autonomy was found to be significantly associated with present
family planning use. The clear discrepancy between the way in which men viewed female autonomy
and the way in which women viewed their own autonomy suggests an imbalance in sexual relationship
that may need to be addressed when addressing family planning needs.
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