Contraception and Abortion Decision-Making in Accra, Ghana: The Lesser of Two Evils

Virginia Bowen, Johns Hopkins Bloomberg School of Public Health
Richard M. K. Adanu, University of Ghana

Modern contraceptive use in Ghana is declining while abortion rates are anecdotally increasing. There is concern that women may be ‘trading off’ contraception for abortion. This study identifies key reasons why Ghanaian women choose not to contracept and not to abort while examining the 'trade-off' hypothesis. 259 women were recruited from antenatal clinics in Accra. Women completed a survey and a vignette-based card-sorting exercise. One-third of respondents felt that young women were deterred from using contraception because of the likelihood of infertility, while older women were deterred from using contraception because partners disapproved of its use (14%) and because they do not like using “unnatural” products (14%). Abortion accessibility was the least cited reason for contraceptive non-use. Forty-three percent of respondents thought young women chose not to seek abortions because of a high “likelihood of death.” Abortion rationales pertaining to the fear of dying were similar (54%) for older women.