What has reproductive health decision-making capacity got to do with unintended pregnancy? Evidence from the 2014 Ghana Demographic and Health Survey

Autoři: Bright Opoku Ahinkorah aff001;  Abdul-Aziz Seidu aff002;  Francis Appiah aff002;  Linus Baatiema aff002;  Francis Sambah aff003;  Eugene Budu aff002;  Edward Kwabena Ameyaw aff001
Působiště autorů: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, NSW, Sydney, Australia aff001;  Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana aff002;  Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223389



Women’s reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana.

Materials and methods

We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively.


We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51–0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25–29 years [AOR = 0.29; CI = 0.13–0.63], 30–34 years [AOR = 0.18; CI = 0.08–0.45], and 35–39 years [AOR = 0.26; CI = 0.10–0.68] being less likely to experience unintended pregnancy compared to those aged 15–19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12–3.84].


This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15–19 years, those with primary education, Traditionalists and unmarried women.

Klíčová slova:

Copulation – Decision making – Educational attainment – Female contraception – Ghana – Health surveys – Pregnancy – Religion


1. Centers for Disease Control. Unintended Pregnancy Prevention: Home. 2015. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/.

2. Eliason S, Baiden F, Yankey BA, Awusabo–Asare K. Determinants of unintended pregnancies in rural Ghana. BMC pregnancy and childbirth. 2014;14(1):261.

3. Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health. 2018;6(4):e380–9. doi: 10.1016/S2214-109X(18)30029-9 29519649

4. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF International. Ghana demographic and health survey 2014. Rockville, Maryland: GSS, GHS, and ICF International 2015.

5. Messer LC, Dole N, Kaufman JS, Savitz DA. Pregnancy intendedness, maternal psychosocial factors and preterm birth. Maternal and child health journal. 2005 1;9(4):403–12. doi: 10.1007/s10995-005-0021-7 16249944

6. Moreland S, Talbird S. Achieving the Millennium Development Goals: the contribution of fulfilling the unmet need for family planning.2006

7. Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Studies in family planning. 2010;41(4):241–50. 21465725

8. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International 2017 Ghana Maternal Health Survey 2017.

9. Dixit P, Ram F, Dwivedi LK. Determinants of unwanted pregnancies in India using matched case-control designs. BMC pregnancy and childbirth. 2012;12(1):84.

10. UNFPA. ICPD 1994: Summary of the programme of action. Advance Physiology Education.1994

11. Nations United. Report of fourth conference on women Beijing, 4–15 September 1995. New York: United Nations.1995

12. Reinicke WH, Deng F, Witte JM, Benner T, Whitaker B. Critical choices: The United Nations, networks, and the future of global governance. IDRC, Ottawa, ON, CA; 2000.

13. Darteh EK, Doku DT, Esia-Donkoh K. Reproductive health decision making among Ghanaian women. Reproductive health. 2014;11(1):23.

14. Darteh EK, Dickson KS, Doku DT. Women’s reproductive health decision-making: A multi-country analysis of demographic and health surveys in sub-Saharan Africa. PloS one. 2019;14(1):e0209985. doi: 10.1371/journal.pone.0209985 30625212

15. Davis KC, Norris J, Hessler DM, Zawacki T, Morrison DM, George WH. College women's sexual decision making: Cognitive mediation of alcohol expectancy effects. Journal of American College Health. 2010; 58(5):481–489.

16. Prata N, Tavrow P, Upadhyay U. Women’s empowerment related to pregnancy and childbirth: introduction to special issue. BMC pregnancy and childbirth. 2017; 17(2): 352.

17. McReynolds-Pérez J. Abortion as empowerment: reproductive rights activism in a legally restricted context. BMC pregnancy and childbirth. 2017;17(2): 350.

18. Rehnström Loi U, Lindgren M, Faxelid E, Oguttu M, Klingberg-Allvin M. Decision-making preceding induced abortion: a qualitative study of women’s experiences in Kisumu, Kenya. Reproductive Health. 2018;15:166. doi: 10.1186/s12978-018-0612-6 30285768

19. Seidu AA, Ahinkorah BO, Agbemavi W, Amu H, Bonsu F. Reproductive health decision-making capacity and pregnancy termination among Ghanaian women: Analysis of the 2014 Ghana demographic and health survey. Journal of Public Health. 2019; 1–10. doi: 10.1093/pubmed/fdz027

20. Uberoi D, De Bruyn M. Human rights versus legal control over women’s reproductive self-determination. Health and human rights. 2013;15(1), 1–12.

21. Grover A. Right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Geneva: United Nations Office of the High Commissioner. 2011.

22. Oronje RN, Crichton J, Theobald S, Lithur NO, Ibisomi L. Operationalising sexual and reproductive health and rights in sub-Saharan Africa: constraints, dilemmas and strategies. BMC international health and human rights. 2011;11(3):S8.

23. Tuloro T, Deressa W, Ali A, Davey G. The role of men in contraceptive use and fertility preference in Hossana Town, southern Ethiopia. Ethiopian Journal of Health Development. 2006;20(3).

24. Adongo PB, Tapsoba P, Phillips JF, Tabong PT, Stone A, Kuffour E, Esantsi SF, Akweongo P. The role of community-based health planning and services strategy in involving males in the provision of family planning services: a qualitative study in Southern Ghana. Reproductive health. 2013;10(1):36.

25. Ameyaw EK. Prevalence and correlates of unintended pregnancy in Ghana: Analysis of 2014 Ghana Demographic and Health Survey. Maternal health, neonatology and perinatology. 2018;4(1):17.

26. Nyarko SH. Unintended Pregnancy among Pregnant Women in Ghana: Prevalence and Predictors. Journal of pregnancy. 2019.

27. Grindlay K, Dako-Gyeke P, Ngo TD, Eva G, Gobah L, Reiger ST, … Blanchard K. Contraceptive use and unintended pregnancy among young women and men in Accra, Ghana. PloS one. 2018; 13(8):e0201663. doi: 10.1371/journal.pone.0201663 30118485

28. Abada T, Tenkorang EY. Women's autonomy and unintended pregnancies in the Philippines. Journal of biosocial science. 2012;44(6):703–18. doi: 10.1017/S0021932012000120 22980635

29. Eugène KY, Harvey AT, Orsot TE, Simplice DN. Correlates of Unintended Pregnancies in Ivory Coast: Results from a National Survey. Science. 2018;6(1):6–14.

30. Rahman M. Women’s autonomy and unintended pregnancy among currently pregnant women in Bangladesh. Maternal and child health journal. 2012;1;16(6):1206–14. doi: 10.1007/s10995-011-0897-3 21989677

31. Ahinkorah BO, Dickson KS, Seidu AA. Women decision-making capacity and intimate partner violence among women in sub-Saharan Africa. Archives of Public Health. 2018;76(1):5.

32. Vázquez-Nava F, Vázquez-Rodriguez CF, Saldívar-González AH, Vázquez-Rodríguez EM, Córdova-Fernández JA, Felizardo-Ávalos J, Sánchez-Márquez W. Unplanned pregnancy in adolescents: Association with family structure, employed mother, and female friends with health-risk habits and behaviors. Journal of Urban Health. 2014;1;91(1):176–85. doi: 10.1007/s11524-013-9819-6 23949273

33. Christofides NJ, Jewkes RK, Dunkle KL, McCarty F, Shai NJ, Nduna M, Sterk C. Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women. Global health action. 2014 1;7(1):23719.

34. Anand E, Unisa S, Singh J. Intimate partner violence and unintended pregnancy among adolescent and young adult married women in south Asia. Journal of biosocial science. 2017;49(2):206–21. doi: 10.1017/S0021932016000286 27324924

35. Yaya S, Amouzou A, Uthman OA, Ekholuenetale M, Bishwajit G, Udenigwe O, Hudani A, Shah V. Prevalence and determinants of terminated and unintended pregnancies among married women: analysis of pooled cross-sectional surveys in Nigeria. BMJ global health. 2018;3(2):e000707. doi: 10.1136/bmjgh-2018-000707 29713502

36. Calvert C, Baisley K, Doyle AM, Maganja K, Changalucha J, Watson-Jones D, Hayes RJ, Ross DA. Risk factors for unplanned pregnancy among young women in Tanzania. J Fam Plann Reprod Health Care. 2013 1;39(4):e2–. doi: 10.1136/jfprhc-2012-100389 23902713

37. Habib MA, Raynes-Greenow C, Nausheen S, Soofi SB, Sajid M, Bhutta ZA, Black KI. Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan. BMC pregnancy and childbirth. 2017 Dec;17(1):156. doi: 10.1186/s12884-017-1339-z 28558671

38. Hall JA, Barrett G, Phiri T, Copas A, Stephenson J. Prevalence and determinants of unintended pregnancy in Mchinji District, Malawi; using a conceptual hierarchy to inform analysis. PLoS One. 2016;31;11(10):e0165621. doi: 10.1371/journal.pone.0165621 27798710

39. Haffejee F, O’Connor L, Govender N, Reddy P, Sibiya MN, Ghuman S, Ngxongo T, Borg D. Factors associated with unintended pregnancy among women attending a public health facility in KwaZulu-Natal, South Africa. South African Family Practice. 2018;60(3):1–5.

40. Iveniuk J, O’Muircheartaigh C, Cagney KA. Religious influence on older Americans’ sexual lives: A nationally-representative profile. Archives of sexual behavior. 2016;45(1):121–31. doi: 10.1007/s10508-015-0534-0 26063533

41. Gyimah SO, Tenkorang EY, Takyi BK, Adjei J, Fosu G. Religion, HIV/AIDS and sexual risk-taking among men in Ghana. Journal of Biosocial science. 2010;42(4):531–47. doi: 10.1017/S0021932010000027 20211045

42. Haglund KA, Fehring RJ. The association of religiosity, sexual education, and parental factors with risky sexual behaviors among adolescents and young adults. Journal of religion and health. 2010;49(4):460–72. doi: 10.1007/s10943-009-9267-5 19565334

43. Hitchens C, editor. The portable atheist: Essential readings for the nonbeliever. Da Capo Press; 2007; 6.

44. Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, Phillips JF. Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reproductive health. 2014 Dec;11(1):63.

45. Palamuleni ME, Adebowale AS. Prevalence and determinants of unintended pregnancies in Malawi. African Population Studies. 2014 Apr 29;28(1):551–63.

46. Fite RO, Mohammedamin A, Abebe TW. Unintended pregnancy and associated factors among pregnant women in Arsi Negele Woreda, West Arsi Zone, Ethiopia. BMC research notes. 2018;11(1):671. doi: 10.1186/s13104-018-3778-7 30223872

47. Sanga K, Mola G, Wattimena J, Justesen A, I Black K. Unintended pregnancy amongst women attending antenatal clinics at the Port Moresby General Hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2014;54(4):360–5. doi: 10.1111/ajo.12219 24845534

48. Kassa N, Berhane Y, Worku A. Predictors of unintended pregnancy in Kersa, Eastern Ethiopia, 2010. Reproductive health. 2012;9(1):1.

49. Sabahelzain MM, Abdalla SM, Meraj SA, Mohamed E, Almansour MA, Medani KT, Awad FE. Prevalence and factors associated with unintended pregnancy among married women in an urban and rural community, Khartoum state Sudan. Global J Med Public Health. 2014;3(4):1–9.

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2019 Číslo 10
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