In Ghana, despite a 38 percent decline in the total fertility rate from 1988 to
2008, unmet need for family planning among married women exposed to pregnancy
risk declined only modestly in this period: from 50 percent to 42 percent.
Examining data from the five DHS surveys conducted in Ghana during these
years, we find that the relative contribution to unmet need of lack of access
to contraceptive methods has diminished, whereas attitudinal resistance has
grown. In 2008, 45 percent of women with unmet need experienced no apparent
obstacles associated with access or attitude, 32 percent had access but an
unfavorable attitude, and 23 percent had no access. Concerns regarding health
as a reason for nonuse have been reported in greater numbers over these years
and are now the dominant reason, followed by infrequent sex. An enduring
resistance to hormonal methods, much of it based on prior experience of side
effects, may lead many Ghanaian women, particularly the educated in urban
areas, to use periodic abstinence or reduced coital frequency as an alternative to
modern contraception.