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Background: Poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. We sought to fill this gap by examining the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. Methods: A baseline cross-sectional household survey of 221 adolescents aged 10–19 years in 30 randomly selected communities was used. A well-structured questionnaire was developed. A multinomial logistic regression analysis was used to examine factors that significantly influenced communication between adolescents and their parents regarding sex. Results: Only 11.3% of adolescents had discussions on sexual issues with both parents while 27.6% of communicated sexual issues with only one parent in Adaklu district. Adolescent males (AOR = 0.21, CI = 0.06–0.75), those aged 10–14 years (AOR = 0.41, CI = 0.04–0.57), non-members of adolescent health clubs (AOR = 0.46, CI = 0.21–1.00), and those living with only a father (AOR = 0.19, CI = 0.06–0.61) had lower odds of communicating with their parents on sexual issues. Conclusions: Adolescent-parental communication on sexual issues in Adaklu district is very low. This situation requires more empowerment of adolescents to enable them to discuss sexual issues with their parents through increased engagement with adolescent health club activities and capacity building capacity of parents with the right information on sexual and reproductive health by health staff within the district. Additionally, parents need to be equipped with communication skills to enable them to communicate effectively with their children. Plain language summary: Parent-adolescent and older sibling adolescent communication on issues about sex is considered an important aspect of adolescent development and well-being, as it ensures informed decision making and good behavior and a protective factor for adolescent sexual health. However, poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. This paper, therefore, examines the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. It highlights individual, household, societal and sexual-related factors that predict communication on sexual issues between adolescents and their parents in an area with a high rate of teenage pregnancy among adolescent girls. The data on adolescent sexual and reproductive health in Adaklu district show poor communication on sexual issues between adolescents (aged 10–19 years) and their parents. Improving communication on sexual issues between adolescents and their parents in rural settings requires capacity building of parents (especially mothers) with the right information and communication skills for discussing sexual and reproductive health issues with their children. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. Methods: We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data. Results: Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies. Conclusion: Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. Plain Language Summary: Adolescent pregnancy is a major public health issue in low-and middle-income countries. Efforts to reduce adolescent pregnancy have become major health priorities globally. Several international organisations, including the United Nations, have adopted strategies such as those featured under the Sustainable Development Goal (SDG) 3.7. These strategies seek to ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes by 2030. Many countries have policies and programmes with implementation strategies aimed at reducing adolescent pregnancy; however, evidence of their impact is unclear. We explored the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. We conducted interviews among 30 key informants in Ghana. Few of the participants demonstrated awareness of policies aimed at reducing adolescent pregnancy and only two could elaborate on this. By contrast, most participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under them. Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. [ABSTRACT FROM AUTHOR]

Background: Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. Methods: A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables. Results: More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR = 0.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR = 0.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. Conclusion: The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms. Plain Language summary: Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had some form of sex education would likely utilize contraception more than those who have not. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691 girls/women aged 15–49 was considered. More than half (56.73%) of the women had never received some form of sex education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sex education had lower odds of ever using contraception and this persisted after controlling for the effect of demographic factors compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. In sum, the study revealed that while prevalence of sex education was relatively low among urban slum women, sex education generally increased the chances of ever use of contraception. These findings call for more and targeted sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking is a public health issue and has been implicated in adverse reproductive outcomes including semen quality. Available data however provides conflicting findings. The objective of this study was to evaluate the effect of tobacco smoking on semen quality among men in Ghana. Methods: In this study, a total of 140 subjects were recruited, comprising 95 smokers and 45 non-smokers. Smokers were further categorized into mild, moderate and heavy smokers. Semen parameters such as sperm concentration, motility, viability and normal morphology were measured according to the World Health Organisation criteria. Results: The study showed that smokers had significantly lower semen volume, sperm concentration, sperm motility, total sperm count, sperm morphology, free testosterone and follicle stimulating hormone (p <0.05 respectively), compared with non-smokers. Smokers were at a higher risk of developing oligospermia, asthenozoospermia and teratozoospermia (OR = 3.1,4.2 and, 4.7; p <0.05) than non-smokers. Conclusion: Results demonstrated a decline in semen quality in a dose dependent tobacco smoking manner. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy exposes female adolescents to medical, social and economic risks. In Ghana, adolescent mothers are more likely to experience complications during pregnancy and delivery as compared to older mothers. This study examined the competencies of adolescent girls to either proactively prevent teenage pregnancy or reactively cope effectively with it. Methods: A cross-sectional survey approach was used to interview 820 adolescent girls aged 15-19 years in Accra, Ghana. The main focus of the study was to examine how social capital (various kinds of valued relations with significant others), economic capital (command over economic resources, mainly cash and assets), cultural capital (personal dispositions and habits; knowledge and tradition stored in material forms and institutionalized) and symbolic capital (honour, recognition and prestige) contribute to the development of competencies of adolescents to deal with the threat of teenage pregnancy and childbirth. Results: Out of 820 adolescents interviewed, 128 (16 %) were pregnant or mothers. Adolescents in both groups (62 % never pregnant girls and 68 % pregnant/young mothers) have access to social support, especially from their parents. Parents are taking the place of aunts and grandmothers in providing sexual education to their adolescent girls due to changing social structures where extended families no longer reside together in most cases. More (79 %) pregnant girls and young mothers compared to never pregnant girls (38 %) have access to economic support (P = <0.001). Access to social, economic and cultural capitals was associated with high competence to either prevent or deal with pregnancy among adolescent girls. Conclusion: Findings showed that adolescent girls, especially those that get pregnant should not be viewed as weak and vulnerable because many of them have developed competencies to cope with pregnancy and childbirth effectively. Thus, focusing on developing the competencies of girls to access social, economic and cultural capitals may be an effective way of tackling the threat of teenage pregnancy than focusing only on their vulnerability and associated risks. [ABSTRACT FROM AUTHOR]

Background: Contraceptive uptake in Ghana, especially in the Ashanti region remains low.This may be partly due to products' characteristics and choice which are influenced by attribute utility trade-offs by consumers in determining which method offers the optimal combinations, given the needs and desires of the individuals making the choice. The study sought to determine how specific attributes of contraceptives influence artisanal auto mechanics' stated preferences for a hypothetical contraceptive use in the Tafo-Suame industrial area of Kumasi, Ghana. Methods: A discrete choice experiment was conducted with artisanal auto mechanics in the study area from May to September 2011. Based on the summary of the attributes from the focus group discussion and in-depth interviews preceded administration of structured questionnaire, a discrete choice experiment (DCE) was created. The attributes used were; side effects, reversibility, ease of use, ability to prevent both pregnancy and sexually transmitted infection (STI's), price and privacy in acquiring and attractiveness of the method. A total of 340 consented respondents aged 15 to 49 years participated in the study. Data were entered in Access and Sawtooth software SSI Web CAPi module and then exported to Stata for analysis. Results: The study showed a universal (99.4%) knowledge on contraception, ever used 87% and currently using a method, 58%. The study revealed that methods' reversibility ( β = 21.74; 95% CI: 20.17, 23.3), minimal allergic reaction ( β = 13.93; 95% CI: 12.8, 15.05) and no effect on blood pressure ( β = 12.71; 95% CI: 11.62, 13.79), were strongly associated with contraceptive preference and use. While contraceptives' ability to prevent “only pregnancy” ,( β = -15.13: 95% CI: -16.2, -14.02; “only STI's” )( β = -11.65; 95% CI: -11.84, -11.46); and interrupt during sexual activity ( β = -4.26; 95% CI: -5.19, -3.34), had large negative influence on contraceptive preference and use. Conclusion: The study has documented the magnitude of the effects of contraceptive attributes on informed choice, use, preference. It revealed that reversibility, side effects and ability to prevent both pregnancy and STI's are the major important attributes that. The findings have implications on contraceptive development, uptake and the implementation of other family planning programmes. [ABSTRACT FROM AUTHOR]

Background: Young people aged 10-24 years represent one-third of the Ghanaian population. Many are sexually active and are at considerable risk of negative health outcomes due to inadequate sexual and reproductive health knowledge. Although growing international evidence suggests that parent-child sexual communication has positive influence on young people’s sexual behaviours, this subject has been poorly studied among Ghanaian families. This study explored the extent and patterns of parent-child sexual communication, and the topics commonly discussed by parents. Methods: A cross-sectional design was used to sample 790 parent-child dyads through a two-stage cluster sampling technique with probability proportional to size. Interviewer-administered questionnaire method was used to gather quantitative data on parent-child communication about sex. Twenty sexual topics were investigated to describe the patterns and frequency of communication. The Pearson's chi-square and z-test for two-sample proportions were used to assess sexual communication differences between parents and young people. Qualitative data were used to flesh-out relevant issues which standard questionnaire could not cover satisfactorily. Results: About 82.3% of parents had at some point in time discussed sexual and reproductive health issues with their children; nonetheless, the discussions centered on a few topics. Whereas child-report indicated that 78.8% of mothers had discussed sexual communication with their children, 53.5% of fathers had done so. Parental discussions on the 20 sexual topics ranged from 5.2%-73.6%. Conversely, young people’s report indicates that mother-discussed topics ranged between 1.9%-69.5%, while father-discussed topics ranged from 0.4% to 46.0%. Sexual abstinence was the most frequently discussed topic (73.6%), followed by menstruation 63.3% and HIV/AIDS 61.5%; while condom (5.2%) and other contraceptive use (9.3%) were hardly discussed. The most common trigger of communication cited by parent-child dyads was parent's own initiation (59.1% vs. 62.6% p = 0.22). Conclusions: Parents in the Brong Ahafo region of Ghana do talk to children about sex, but their conversations cover limited topics. While abstinence is the most widely discussed sexual topic, condoms and contraception were rarely discussed. Sex educational programmes ought to encourage parents to expand sexual communication to cover more topics. [ABSTRACT FROM AUTHOR]

Background: Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. Methods: A cross-sectional qualitative study was conducted with WWDs aged 18–49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. Results: Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. Conclusion: Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services. [ABSTRACT FROM AUTHOR]

Background: Sex composition of living children within the context of "sex preference" and its association with various reproductive health outcomes has been extensively studied in South and South East Asia. Although sex preference has been observed in sub-Saharan Africa, there is paucity of research on sex composition of living children and its association with reproductive health behaviours and outcomes, particularly in a matrilineal inheritance system. The purpose of the study was to explore the existence of sex preference in a matrilineal inheritance system. Specifically, the study sought to better understand the issues by examining the sex composition of living children and how it is associated with reproductive outcomes such as pregnancy intendedness and intention to use postpartum family planning among women in a matrilineal area of Ghana. Methods: This was a cross sectional study conducted at four selected health facilities in the Mfantseman municipality of the Central Region of Ghana. Out of the 1914 pregnant women attending antenatal clinic selected using total enumeration, from 2nd January to 30th April 2012, 1091 with living children and complete socio-demographic data were recruited for this study. Descriptive, chi square and multivariate logistic regression analyses were conducted. Results: The mean age of the 1091 respondents in this study was 28.2 ± 6.0 years with mean gestational age of 26.7 ± 6.6 weeks. Whilst 78% of the women had at least a son, 71% had at least a daughter, with those having only sons exceeding those with only daughters by 6.3%. Also, majority of the women with more sons than daughters did not intend their current pregnancies. These observations, coupled with a sex ratio of 109 males to 100 females, inferred the existence of son preference. The levels of unintended pregnancy and intention to use postpartum family planning were high (70% and 78% respectively). There was an association between sex composition of living children and unintended pregnancy but no association between sex composition of living children and intention to use postpartum family planning. Women with only sons were 50% less likely to have unintended pregnancies compared to those with equal number of sons and daughters [AOR 0.5, 95% CI (0.3–0.8)]. Similarly, women over 30 years were 80% less likely to have unintended pregnancies compared to those 15–19 years [AOR 0.2, 95% CI (0.1–0.6)]. The women with parity of 5 or more and resident in Anomabo were more likely to have unintended pregnancy compared to those with parity of up to two [AOR 3.8, 95% CI (1.7–8.59)] and those resident in Saltpond [AOR 1.8, 95%CI (1.1–2.8), respectively. In addition, the women resident in Anomabo were more likely to have intention to use postpartum family planning compared to those in Saltpond [AOR 1.8, 95% CI (1.0–3.3)]. Conclusion: There was persistence of more sons than daughters born in a predominantly matrilineal inheritance system and sex composition of living children had significant association with pregnancy intendedness but not with intention to use postpartum family planning. [ABSTRACT FROM AUTHOR]

Background: The prevalence of exclusive breastfeeding (EBF) for the first six months of life has remained low worldwide and in Ghana, despite strong evidence in support of its practice. This study was aimed at assessing the knowledge and practice of exclusive breastfeeding among mothers in the Tamale metropolis of Ghana. Methods: In a descriptive cross-sectional study, 393 mother-infant pairs attending child welfare clinics from three health facilities in the Tamale Metropolis were surveyed. A structured item questionnaire was used to collect data on the socio-demographic Characteristics of the participants, their knowledge regarding breastfeeding and level of practice of exclusive breastfeeding (EBF). The results were presented in frequency counts, percentages and inferences were made using a contingency table and chi-square values were computed to check for the relationship between participants demographic characteristics, the Knowledge and the practice of EBF and P value was set at 0.05. Results: The Analysis of the data was done with SPSS version 20. The study surveyed a total of 393 mothers from Tamale metropolis, of whom 27.7% reported having exclusively breastfed their infant for the first 6 months of life. The socio-demographic of the participants showed that they all had some level of education. The study revealed that 39.4% initiated breastfeeding within one hour after birth. Majority of participants had heard of EBF 277 (70.5%), about 344 (87.5%) of participants believed that EBF should be practised for 5 months in their locality. Pearson Chi-square test of the association between sociodemographic characteristics associated and EBF showed a significant association between EBF and the sex of the child, X2 = 4.177, P =.041. Whiles, EBF and the Knowledge on child spacing was X2 = 17.769, P <.001 and EBF and knowledge on Breast cancer reduction was also significant X2 = 4.384, P =.036. Conclusions: Although all the participants had some level of education background, a majority did not have adequate knowledge on EBF and EBF practice was low in the study community. Thus, we suggest improved education at the child welfare clinics and the media should be used as a platform to educate women adequately about importance of EBF. [ABSTRACT FROM AUTHOR]