Determinants of modern contraceptive use among reproductive-aged women attending private sexual and reproductive health clinics in Greater Accra, Ghana: a cross-sectional survey

Abstract

Modern contraceptive use prevents unintended pregnancies and unsafe abortions. In Ghana, contraceptive prevalence is low, and determinants of use among women accessing private-sector sexual and reproductive health (SRH) services are understudied. This study examined these determinants among women attending private SRH clinics in Greater Accra. A facility-based, cross-sectional survey was conducted (July–September 2024) at three randomly selected Marie Stopes International clinics. We enrolled 200 women aged 15–49 years via systematic random sampling (92.6% response rate). Data were collected electronically. Descriptive statistics and a multivariable modified Poisson regression with robust variance were used to identify factors associated with current modern contraceptive use, reported as Adjusted Prevalence Rate Ratios (aPRR). An a priori interaction between employment and residence was assessed. Modern contraceptive prevalence was 39.0% (95% CI: 32.4–45.9%). Implants (20.5%) were most used. Use was higher among women with an abortion history (aPRR = 1.44, 95% CI: 1.32–1.57), those believing abortion should be legal (aPRR = 1.22, 95% CI: 1.09–1.36), and those with tertiary education (aPRR = 1.15, 95% CI: 1.01–1.31). Urban residence was associated with lower use (aPRR = 0.85, 95% CI: 0.74–0.99). Exploratory analysis of a marginally significant interaction (p = 0.085) suggested this urban disadvantage was specific to employed women. Among women at private clinics in Greater Accra, contraceptive use is modest and linked to abortion history, supportive legal attitudes, and education. The urban disadvantage among employed women suggests context-specific barriers. Programmes should integrate family planning into post-abortion care, enhance health literacy, and address urban access barriers. Strengthening private sector delivery is key for national strategy.