Over the past decade, adolescent sexual and reproductive health (ASRH) concerns have increasingly
been on the development agenda of the Government of Ghana. This concern has been driven by such
factors as early age of sexual debut, early childbearing and prevalence of HIV/AIDS among this subgroup
of the population. Increasingly, research and programme experiences have shown that it is
neither feasible nor productive to focus on one isolated behavioural indicator such as providing
adolescents with information and services on HIV/AIDS only without addressing the broader set of
adolescent sexual and reproductive health concerns. Understanding the nature and extent of individual
and group variations (for instance, place of residence and gender-based differences) and their causes,
correlates and consequences is essential for designing effective programmatic responses to meet the
diverse sexual and reproductive health needs of adolescents in Ghana.
The overall objective of the study was to generate evidence on the knowledge, perceptions and
practices regarding ASRH among slum communities in Ghana. The specific objectives were to: (1)
assess the reproductive health knowledge, behaviour and perceptions of adolescents living in slum
settings; and (2) examine the perceptions of parents, guardians and community members regarding
adolescent sexual and reproductive health. The study was conducted in March 2013 in four urban
slums in Ghana (two from the Greater Accra Region and another two from Brong Ahafo Region).
Structured interviews were conducted with 1,303 adolescents aged 13-19 years and 626
parents/guardians focus group discussions held with 42 community leaders drawn from schools, nongovernmental
organizations/community based organizations serving youth, assemblymen, women
leaders and chiefs.
Key Findings
• About one-third of the adolescents (32% of the males and 34% of the females) had ever had sexual
intercourse. The median age at first sex among adolescents in the study was 15 years among
males and 16 years among females. The proportion that had ever had sexual intercourse was
higher among those who were not attending school at the time of the survey than among those who
were at school (49% and 26% among males and 61% and 21% among females respectively).
• Slightly more than one-third of the adolescents who had ever had sex (32% of the males and 39%
of the females) reported that the first sexual intercourse was unplanned. In addition, 12% of the
males and 16% of the females who had ever had sex reported having experienced forced sex.
Thirteen per cent of the males and 24% of the females reported that they had ever been touched
on their private parts against their will.
• Although virtually every adolescent interviewed had heard of contraceptives, the proportion that
used a method to prevent pregnancy at first or last sexual activity was lower. In particular 46% of
the males and 49% of the females who had ever had sex used a method to prevent pregnancy at
first sexual encounter. In addition, 52% of the males and 51% of the females who had ever had sex
reported using a method to prevent pregnancy at last sexual intercourse.
• Among adolescents who had ever had sexual intercourse, 8% of the males reported having ever
made a girl pregnant while 26% of the females reported having ever been pregnant. For the
majority of adolescents who had ever been pregnant or made a girl pregnant, the most recent
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pregnancy was unintended (86% of the males and 74% of the females). In addition, 57% of the
males who had ever made a girl pregnant and 23% of the females who had ever been pregnant
reported that the last pregnancy resulted in abortion.
• For the majority of the adolescents, school was the major source of information on SRH issues
including puberty (79% of the males and 64% of the females) and reproduction (74% of the males
and 65% of the females). In addition, schools were one of the main preferred sources of information
on these topics (for puberty: 37% of males and 28% of females; for reproduction: 40% of males and
33% of females). Nonetheless, the majority of the adolescents reported that it was easy for them to
talk about important things with their parents, especially mothers (85% of males and 78% of
females).
• Nine out of ten (91%) parents/guardians were willing to allow their adolescent children to receive
reproductive health information and services. An equally high proportion of parents/guardians
(97%) wanted reproductive health information to be provided in schools although 87% reported that
they were comfortable discussing sexual-related matters with their adolescent children. The
majority (61%) reported that they ever discussed sexual matters with their adolescent children
although 66% indicated that they needed more information especially on family planning,
contraceptive use, sexually transmitted infections (STIs) and HIV/AIDS to enable them have
meaningful discussions.
• Most community opinion leaders approved the use of contraceptives by adolescents, mainly to
avoid teenage pregnancy (which they felt was quite prevalent in the community), abortion and the
risk of contracting sexually transmitted infections. They recommended various strategies for
improving SRH information and services for adolescents including: appropriate leadership role by
the Ghana Health Services; involvement of all stakeholders including government; traditional and
church leaders; engagement of community members in the mobilization of resources; ensuring that
information and services are available and accessible to adolescents; conducting information,
education and communication campaigns through various channels; encouraging adolescent social
networks on SRH issues; and formulating legislation to against individuals who make adolescent
girls pregnant.
Programmatic Implications
The findings of the study have the following implications for adolescent SRH programs:
• There is need to intensify efforts to inform and educate adolescents living in the slums about
responsible and healthy attitudes towards sexuality, delaying the onset of sexual activity and
reducing risky sexual behaviours.
• There is need to incorporate sex education appropriate for each educational level, to ensure that
information is communicated by individuals with appropriate training that takes into account the
special needs at different levels, and to develop appropriate curriculum methodologies and
materials that recognize gender differences in SRH knowledge, attitudes and practices.
• There is need to involve all stakeholders including parents/guardians and community leaders in
addressing adolescent SRH needs. This will, in turn, enhance community participation and address
cultural barriers and inhibitions to the optimum realization of ASRH.
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• Interventions that address sexual coercion and violence should be an integral component of current
adolescent reproductive health programs. Such interventions should empower adolescents to know
what coercion is and signs of violence, as well as where to seek services. They should also
promote public acknowledgment of the prevalence of sexual coercion and of the gender inequality
that fosters it.