Factors affecting first-time expectant mothers' communication about contraception and contraceptive use with their sexual partners: a qualitative study in urban Accra, Ghana.

Abstract

To explore the factors that affect communication about contraception and modern contraceptive use among first-time expectant mothers attending antenatal clinics in urban Accra, Ghana. A phenomenological qualitative study was conducted. In-depth interviews were conducted using a semistructured guide until data saturation was achieved. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was performed, with data presented as narratives supported by quotes. The study was conducted at one polyclinic in the city of Accra, Ghana. Participants were 25 first-time expectant mothers who were attending antenatal care clinics. These were purposively sampled. The main outcome of interest was understanding the factors that affect first-time expectant mothers' communication about contraception and contraceptive use with their sexual partners. Secondary outcome was awareness/understanding about contraception and modern contraceptive methods. First-time expectant mothers reported varying levels of understanding about contraception and modern contraceptive methods. While majority reported hearing about contraception and modern contraceptives, only a few knew specific modern contraceptive methods. Information about modern contraceptives came from friends, media and midwives/nurses. As regards communication with their sexual partners about modern contraceptives, majority reported not being able to initiate any conversations. A few however reported open discussions. Key barriers to communication included women's inability to initiate discussions on contraceptive use due to traditional gender role expectations, fear of stigmatisation and religious objections. This study has highlighted that communication about contraception and modern contraceptive use among first-time expectant mothers is hindered by a complex interplay of barriers-gender role expectations, stigma and religious beliefs. These barriers hamper open discussions and informed decision-making about modern contraceptive use. To address these barriers, we call for targeted interventions to improve awareness and knowledge about contraception and modern contraceptive methods, engage both men and women in family planning education and programming, empower women to address gender inequalities and promote open dialogue and mutual decision-making among couples.