A Qualitative Exploration of Factors Explaining Non-Uptake of Hormonal Contraceptives Among Adolescent Girls in Rural Ghana: The Adolescent Girls’ Perspective

Ellen Abrafi Boamah-Kaali,1,2 Fraukje EF Mevissen,2,3 Seth Owusu-Agyei,1,4 Yeetey Enuameh,1,5 Kwaku Poku Asante,1 Robbert AC Ruiter2 1Kintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, Kintampo, Ghana; 2Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; 3Municipal Public Health Service Rotterdam-Rijnmond, Department of Public Health, Rotterdam, the Netherlands; 4Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana; 5Department of Epidemiology & Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaCorrespondence: Ellen Abrafi Boamah-KaaliKintampo Health Research Centre, Research and Development Division, Ghana Health Service Kintampo North Municipality, P.O Box 200, Kintampo, GhanaTel +233 248913802Email ellen.boamah@Kintampo-hrc.orgBackground: Adolescent pregnancy remains a public health concern globally. The use of hormonal contraceptive methods are proven ways of preventing pregnancies and in turn unsafe abortions. However, research shows that use of hormonal contraceptive methods is rather low among African adolescent girls, of which Ghana is no exception.Objective: This manuscript uses the socio-ecological model to guide our understanding of the factors associated with non-use of hormonal contraceptives among adolescent girls in Ghana.Methods: An explorative study was done using qualitative data collection methods. Two focus group discussions and sixteen in-depth interviews were conducted among adolescent girls aged 15– 19 years (N = 38) in the Kintampo area of Ghana to determine factors affecting uptake of hormonal contraceptives.Results: Adolescents showed a lack of in-depth knowledge related to the different hormonal contraceptive types. Negative attitudes towards adolescent hormonal contraceptive use, fear of real and perceived side effects of hormonal contraceptives, lack of self-efficacy to use contraceptives, fear of disclosure of use and fear of societal stigma related to sexual intercourse and its related issues among adolescents may explain why adolescent girls in this context do not use hormonal contraceptive methods.Conclusion: To promote hormonal contraceptives among adolescent girls, a combination of multifaceted social-psychological, personal and community level interventions are needed.Keywords: hormonal contraceptives, adolescents, Ghana, behavioral determinants, pregnancy prevention, qualitative researc