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Determinants of men’s perspectives on women contraceptive use in Ghana: an analysis of the 2022 Ghana demographic and health survey

Contraception and Reproductive Medicine volume 9, Article number: 35 (2024) Cite this article

Abstract

Background

Male dominance in reproductive health decision-making, specifically regarding family planning and contraceptive use among women, has been argued to have a significant influence on Africa’s fertility transition. However, there is a paucity of research evidence on the extent to which men influence contraceptive adoption and the factors shaping their perspectives on contraceptive use among women in Ghana. This study aims to examine the factors influencing men’s perspectives on women’s contraceptive use in Ghana.

Methods

Data for this study was obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 7,044 men aged 15–59 was extracted from the men’s data file. Data was analyzed with SPSS version 27, employing both descriptive and binary logistics regression modeling. Statistical significance was set at p < 0.05.

Results

The results indicate that 63% of men disagreed with the opinion that contraception is solely a woman’s concern, while 59% agreed with the view that contraceptive use encourages promiscuity among women. With factors that significantly influence men’s opinion on contraception being solely a woman’s concern, men with secondary (aOR = 0.69; C.I: 0.57–0.82) and higher education, residing in urban areas, belonging to other Christian faiths, Ga/Dangme, Ewe, and Mole-Dagbani men were less likely to agree with such opinions. Conversely, men dwelling in the Coastal zones were more likely to agree with that view. Men exposure to FP messages on radio and during community durbars had higher odds of agreeing with that opinion. Regarding the factors influencing men’s perspective on the perception that contraceptive use by women encourages promiscuity, men who are 20–24 (aOR = 1.51; C.I:1.12–2.03) and 35–39 years in Coastal and Middle Belt zones, cohabiting and formerly married men were more likely to agree with such opinions. Conversely, men with higher educational levels, in urban areas and unemployed had lower odds to agreeing with such perception.

Conclusions

The study underscores the importance of men’s socio-demographic characteristics and their exposure to FP messages in shaping their perspectives on women’s contraceptive use. Policy implications highlight the need to involve men in promoting safe sexual and reproductive health practices.

Background

Male engagement in sexual and reproductive health has historically been depicted as obstructive by impeding women’s decision-making on use of family planning, or non-existent among male partners who are absent altogether due to lack of interest in matters related to reproductive health [1, 2]. However, at the same time, men dominate decision-making regarding family size and their partner’s use of contraceptive methods in many traditionally patriarchal settings [3, 4]. Since the 1994 International Conference on Population and Development (ICPD), and the 1995 United Nations (UN) World Conference on Women in Beijing, interest in men’s involvement in reproductive health has increased [5,6,7]. There has also been a shift in objectives of male participation and concerns, from increasing contraceptive use and achieving demographic goals to achieving gender equality and fulfilling various reproductive responsibilities [7].

Globally, it is well documented that men’s general knowledge and attitude concerning the ideal family size, gender preference of children, ideal spacing between child births, and contraceptive methods greatly influence women’s preferences and opinions [8,9,10]. In many parts of the world, men play a major role in decision-making concerning women’s and children’s health; hence, male participation is critical in improving maternal and child health outcomes.

In sub-Saharan Africa (SSA), strong evidence through research indicates that men play a crucial role in the decision-making about the use of contraceptives among women [11, 12]. The use of any method of family planning (FP) by women is often influenced by their husbands [13]. Men have rarely been involved in either receiving or providing information on sexuality, reproductive health, or birth spacing. They have also been ignored or excluded in one way or the other from participating in many FP programs as FP is often viewed as a woman’s affair [14]. However, opposition from male partners has been identified as one of the main barriers to women’s contraceptive use [15].

Recent studies in the sub-Saharan African region have identified a variety of micro-level factors through which the male partner negatively influences family planning/contraceptive (FP/C) decision and use. These factors include male partners having negative personal beliefs about FP/C; limited access to FP/C information; myths and misconceptions; perceived side effects including decreased sexual pleasure; marital status; poor economic status; religious influences; limited male contraceptive choice; suspicion of female partner infidelity; and male preference for larger families as reasons to oppose FP/C use [15,16,17,18,19,20,21,22,23]. This implies that gender inequality, masculinity, religious beliefs, cultural and patriarchal practices are contributing factors to disempowerment of females, autonomy in contraception and barriers to male involvement in family planning in most African settings [24,25,26,27].

According to 2022 Ghana Demographic and Health Survey (GDHS) report, the proportion of currently married women aged 15–49 years who make their own informed decisions about sexual relations, contraceptive use and reproductive health care increased from 27% in 2014 to 52% in 2022. Consequently, there has been an increase in modern contraceptive prevalence rate among married women from 22% in 2014 to 28% in 2022 [28]. Additionally, according to the 2022 GDHS report, there had been a decrease in the proportion of men who solely make decisions on women contraceptive use from 22.5% in 2014 to 13.7% in 2022 [28]. This evidence suggests an improvement in the unmet need for contraception and contraception autonomy among women in Ghana, with implications for maternal sexual and reproductive health. Despite these positive signals, male dominance in reproductive health decision-making, specifically regarding FP/C use among women, has been argued to have a significant influence on Africa’s fertility transition [29,30,31,32]. Furthermore, some studies have measured attitudinal norms of men towards women’s contraceptive use and its implications on women’s contraceptive autonomy and their sexual and reproductive health, using statements such as ‘Contraception is a woman’s concern and a man should not have to worry about it’ and “Women who use contraception may become promiscuous’ as proxies [33,34,35,36,37,38,39]. However, there is a paucity of research evidence on the extent to which men influence contraceptive adoption and the socio-demographic and family planning-related factors shaping their perspectives on contraceptive use among women in Ghana. This study aims to examine the factors influencing men’s perspectives on women’s contraceptive use in Ghana.

Method

Study design and population

The study utilised data from the 2022 Ghana Demographic and Health Survey (GDHS), a nationally representative cross-sectional survey. The GDHS collects information on various topics, including housing characteristics, household population, marriage and sexuality, fertility and fertility preferences, family planning and contraception, infant and child mortality, maternal health, and child and early development, nutrition of children and women, malaria, Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) related knowledge, attitudes, and behaviour, HIV prevalence, adult health and lifestyle, women empowerment and demographic and health outcomes. This study specifically focuses on men aged 15–59 years. The rationale for focusing on men within this age group is to capture the perspectives of young, middle and old men on contraceptives use among women. This will provide a wholistic or general view of all categories of men on women use of contraception. This will have implications on policy formulation and implementation.

Sample size

The men’s data file use in this study was weighted, resulting in a sample of 7,044 men aged 15–59 years. The entire data was weighted to correct under sampling and over sampling errors, this was done by dividing the weight variable by 1,000,000 [v005/1,000,000).

Measurements

Outcome variables

The study’s outcome variables were men’s perspective on contraception being a woman’s concern, therefore men should not worry and contraceptive use makes women promiscuous. The measurement of these outcome variables relied on the following statements:

I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

  1. i.

    Contraception is a woman’s concern and a man should not have to worry about it.

  2. ii.

    Women who use contraception may become promiscuous.

Respondents provided either an “agree” or “disagree” response to these statements.

Predictor variables

We considered both individual socio-demographic and family planning-related factors. The rationale for the choice of these factors was based on their statistical association with contraception among women in previous studies [24, 40].

Individual socio-demographic factors

The individual socio-demographic factors included the age of men (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59), educational level (no education, primary, secondary, higher), place of residence (urban, rural), ecological zones of residence (coastal zone, middle belt, northern zone) and religion (Orthodox, Pentecostal/Charismatic, Other Christians [Jehova witness, Seven Day Adventist church], Islamic, Traditionalist/Spiritualist, no religion). Other factors include ethnicity (Akan, Ga/Dangme, Ewe, Mole-Dagbani, Grusi, others), marital status (never married, currently married, cohabiting, formerly married), and employment status (unemployed and employed).

Family planning related factors

We considered the following family planning (FP) related factors in the study: contraceptive use by method (no method, traditional method, modern method), discuss FP with health worker (no, yes), heard FP messages on radio (no, yes), seen FP message on television (no, yes), read FP messages in newspapers (no, yes), heard/received FP messages by text via mobile phone (no, yes), seen FP messages on social media platforms (no, yes). Other FP-related factors considered were seen FP messages on posters, and brochures (no, yes), seen FP messages on outdoor signs, billboards (no, yes) and, heard FP messages at community meetings (no, yes).

Data analysis

We analyzed the data with SPSS version 27. In analyzing the data, we followed three stages. The first stage was the use of simple descriptive statistics to describe the outcome and predictor variables. The second stage involved a cross-tabulation of all the individual socio-demographic and family planning-related factors against men’s perspective on contraceptive use by women. In the third stage, we developed two different models that involved binary logistic regression analyses to assess the effect of individual socio-demographic and family planning-related factors on men’s perspective on women’s contraceptive use. Model I analyzed the effect of men’s individual socio-demographic and family planning related factors on the opinion “Contraception is a woman’s concern, so men should not worry”. Model II examined the effect of men’s individual socio-demographic and family planning related factors on the opinion “Women who use contraception may become promiscuous”. For all the two models, we presented the adjusted odds ratios (aOR) and their associated 95% confidence intervals (CIs).

Result

Men’s perspectives on women’s contraceptive use

Figure 1 shows the proportion of men who either agree or disagree with the opinion that contraception is a woman’s concern and that men should not worry about it. A majority (63%) of these men disagree with the opinion that contraception is a woman’s concern while the rest 37% are in favour of such an opinion.

Fig. 1
figure 1

Men’s perspective on contraception as a woman’s concern Source Computed from 2022 Ghana Demographic and Health Survey (GDHS)

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Figure 2 also indicates the percentage of men who either agree or disagree with the opinion that women who use contraceptives become promiscuous. The result shows that a higher proportion of men agree with the perspective that women who use contraceptives become promiscuous while 41% disagreed.

Fig. 2
figure 2

Men’s perspective on contraceptive use making women become promiscuous Source Computed from 2022 Ghana Demographic and Health Survey (GDHS)

Full size image

Description of factors that influence men’s perspective on contraception use among women in Ghana

As shown in Table 1, approximately 20% of the respondents were 15–19 years old, constituting the highest proportion of men in the age categories. More than half (62.5%) had attained a secondary level of education and most of these men reside in the urban areas. With regard to residence, a higher proportion (41.5%) of men resided in the Coastal zone than in other ecological zones of the country. A higher proportion (34.4%) of men belong to the Pentecostal/Charismatic faith with 46% also belonging to the Akan ethnic group. Approximately 46% of these men are currently not married while the majority (84.2%) of them are employed.

Table 1 Individual socio-demographic and family planning characteristics of respondents
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Considering family planning related factors, approximately 7 out of 10 men are currently not using any contraceptive methods, and a majority (92.1%) of these men never discussed family planning issues with health workers. Additionally, 51% of men listen to FP messages on the radio, and about half (50.1%) also watch FP messages on television. The majority (91.3%) of men indicated that they have not read about FP messages in newspapers, whereas 89.3% of them received no FP text messages via their mobile phones. Similarly, approximately 69% indicated not reading FP messages on social media platforms, while 7 out of 10 men did not read about FP in brochures or posters. Additionally, approximately 68% indicated not reading FP messages on outdoor signs and billboards, while a similar proportion (69.3%) also have not heard about FP messages during community meetings and events.

Association between men’s individual family planning related factors and their opinion on contraceptives being a woman’s concern

Table 2 shows a chi-square analysis between individual and family planning related factors and their opinion on contraceptives being a woman’s concern, that men should not worry about. Individual socio-demographic factors such as; the age of men, their educational level, place of residence, ecological zone of residence, religion and ethnicity were significantly associated with men’s opinion of contraception among women in Ghana at p < 0.05.

Table 2 Association between socio-demographic and family planning-related factors and men’s perspective on contraception being a woman’s concern
Full size table

There was a significant difference [p < 0.001] in the opinion of men concerning contraception being a woman’s concern by their age. The results show that a higher proportion (42.2%) of men aged 50–54 years agree with the opinion that contraception is a woman’s issue compared to men aged 15–19 years (40.2%) and 30–34 years (32.1%). Again, men with no formal education (45.9%) had a higher proportion of those agreeing with the opinion that contraception is a woman’s issue relative to those with higher education (21.1%) at p < 0.05. The study also found that a higher proportion of men (41.9%) who reside in rural areas agreed with the assertion that contraception is a woman issue compared to men residing in urban areas (32.1%). The association between men’s ecological zone of residence and their opinion on women’s contraception use was significant at p < 0.001: thus, a higher proportion (39.8%) of men residing in coastal zones agreed that contraception is a woman “thing” compared to those dwelling in middle belt (31.9%) and northern zones (38.1%). A statistically significant association was established between the religious affiliation of men and their opinion on contraceptive use by women. A relatively higher proportion (47.4%) of men with no religious affiliation agreed with the notion that contraception is a woman’s issue compared to other men with religious affiliation. Again, a higher proportion (46.9%) of men who belong to other ethnic groups agreed with the assertion that contraception is a woman’s concern compared to men who belong to the Ga/Dangme (22.1%).

Family planning related factors such as current contraception use by method, access to FP messages through television, newspaper, social media, outdoor signs, billboards and community meetings or events were significantly associated with their opinion on contraception being a woman issue, of which men should not worry about at p < 0.001.

Concerning men’s current contraceptive use by method, men who reported that they are currently not using any method had a higher proportion (37.7%) agreeing to the notion that contraception is a woman’s concern compared to those using traditional (27.1%) and modern methods (33.4%). Again, men who reported not watching FP messages on television had a higher proportion (39.8%) agreeing to the assertion that contraception is a woman issue relative to those who have seen FP messages on television (33.3%) at a significant value of p < 0.001. Similarly, a higher proportion of men who did not read about FP messages in newspapers (37.3%), did not read FP messages on social media platforms (39. 4%) and have not seen FP messages on outdoor signboards (39%) will agree to the assertion that contraception is a woman issue compared to men who indicated accessing FP messages through these platforms at a significant value of p < 0.001.

Association between men’s individual, family planning related factors and their opinion on contraceptive use make a woman promiscuous.

Table 3 illustrates a chi-square analysis between men’s individual socio-demographic and family planning related factors and their opinion on contraceptive use making women become promiscuous in Ghana. Individual socio-demographic factors such as the age of men, their educational level, place of residence, ecological zone, ethnicity, marital status and employment status of men had a significant association with their opinion on women’s use of contraceptives at p < 0.05.

Table 3 Association between socio-demographic and family planning-related factors and men’s perspective on contraceptive use making women promiscuous
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There was a significant difference [p < 0.01] in the men’s opinion on contraceptive use making women indulge in promiscuous acts and their age. The results show that a high proportion of men aged 20–24 years (63.1%) agreed with the notion that women who use contraceptives could become promiscuous compared to men in other age categories. Furthermore, most men with secondary education (62.4%) agreed with the opinion that contraceptive use by women makes them promiscuous relative to men with other educational levels. The study also found that a higher proportion of men residing in rural areas (63.2%) agreed with the assertion that contraceptive use by women leads them into promiscuity compared to their urban counterparts (55.6%).

Men who reside in the middle belt zone (67.4%) tend to agree more with the opinion that contraceptive use among women makes them promiscuous relative to men residing in coastal (55.3%) and northern zones (51.7%). Again, men belonging to the Akan ethnic group (61.1%) agreed to the notion that contraception leads women into promiscuity compared to men belonging to other ethnic groups. Men who are currently cohabiting with their partners (73.8%) had higher proportion agreeing to the opinion that contraceptive use makes women become promiscuous compared to those currently married (55.2%), formerly married (70.3%) and never married (59.2%). A higher proportion of employed men (59.6%) agreed to this notion of high level of promiscuity among women who use contraceptives relative to unemployed men (56.1%). Family planning related factors such as current contraceptive use by method, discussed FP with health workers, heard FP messages on radios, via text on mobile phones, on posters and outdoor signboards were significantly associated with the opinion on contraceptive use makes women promiscuous at p < 0.05.

Binary logistics regression modeling of socio-demographic and family planning related predictors of men’s opinion on women’s contraceptive use

Table 4 illustrates the results of a binary logistics regression analysis of men’s socio-demographic and family planning predictors of opinions of women’s contraceptive use: “Contraception is a woman’s concern and a man should not have to worry about it” and “Women who use contraception may become promiscuous”. Model I examined the effect of individual socio-demographic and family planning related factors on men’s opinion on contraception being a woman’s concern in Ghana. Men’s educational level was significant in influencing their opinion on women’s contraceptive use. Compared with men with no formal education, those with secondary education are 31% (aOR = 0.69; C.I:0.57–0.82) and with higher education are 61% (aOR = 0.39; C.I: 0.30–0.49) less likely to agree to the assertion that contraception is a woman’s concern. Men who reside in the urban areas have lower odds (aOR = 0.77; C.I: 0.69–0.86) relative to agreeing with the opinion that contraception is a woman’s issue compared to their rural counterparts. Furthermore, men dwelling in the coastal ecological zone (aOR = 1.49; C.I: 1.25–1.78) have higher likelihood of agreeing to the notion that contraception is a woman’s issue compared to men living in the northern zone. Religious affiliations of men significantly influence their opinion on contraception among women. Men who belong to other Christian faiths were 39% less likely to agree to the opinion that contraception is a woman’s issue compared to men with no religious affiliation. Regarding ethnic background, men who are from Ga/Dangme (aOR = 0.36; C.I: 0.26–0.52), Ewe (aOR = 0.66; C.I: 0.48–0.89) and Mole-Dagbani (aOR = 0.66; C.I: 0.49–0.88) had lower probability of agreeing to the concept that contraception is a woman’s ‘thing’ compared to men belong to other ethnic groups.

Table 4 Binary logistic regression of factors influencing men’s opinion on contraceptive use by women in Ghana
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Concerning family planning related factors influencing men’s opinion on contraceptive use among women in Ghana. Men who heard about FP messages on the radio (aOR = 1.25; C.I: 1.12–1.41) had higher odds to agreeing with the perspective that contraception is a woman’s concern compared to those who reported not hearing FP messages on the radio. Again, men who indicated not seeing FP messages on television (aOR = 1.28; C.I: 1.13–1.44) were more likely to agree with the opinion that contraception is a woman’s issue compared to those who reported seeing FP messages on television. Furthermore, men who reported not receiving FP messages by text on their mobile phones (aOR = 0.69; C.I: 0.58–0.82) were less likely agree to the notion that contraception is a woman’s concern than men who indicated receiving such messages via text. Additionally, men who have not seen FP messages on social media (aOR = 1.15; C.I: 1.01–1.32), and have not seen FP messages on posters/brochures (aOR = 1.17; C.I: 1.02–1.32) were more likely to agree with the opinion that contraception is a woman’s issue compared to men who reported seeing FP messages on these platforms. Interestingly, men who reported hearing FP messages at community meetings or events had higher odds (aOR = 1.28; C.I: 1.14–1.43) of agreeing with the assertion that contraception is a woman issue compared to men who did not hear of FP messages at community events.

Model II examined the influence of men’s socio-demographic and family planning related factors on their opinion on contraception promoting promiscuity among women in Ghana. The results show that a higher probability of men agreeing to the assertion that contraceptive use among women makes them to become promiscuous was found among younger men aged 20–24 (aOR = 1.51; C.I: 1.12–2.03) and 35–39 years (aOR = 1.35; C.I: 1.03–1.76) relative to older men. Men with higher education had lower odds (aOR = 0.49; C.I: 0.39–0.61) of agreeing that contraceptive use makes women promiscuous compared to men with no formal education. Men who reside in urban areas are less likely (aOR = 0.77; C.I: 0.69–0.86) compared to their rural counterparts.

Furthermore, men who reside in coastal (aOR = 1.33; C.I: 1.12–1.58) and middle belt zones (aOR = 1.93; C.I: 1.64–2.28) had a higher likelihood of agreeing to the notion that contraceptive use promotes promiscuity among women in Ghana than men residing in the northern zone. Similarly, men who are cohabiting (aOR = 1.77; C.I: 1.39–2.25) and formerly married (aOR = 1.62; C.I: 1.21–2.15) have higher odds of agreeing to the opinion that contraceptive use makes women promiscuous compared to men who are not married. Additionally, men who are unemployed (aOR = 0.84; C.I: 0.71–0.98) were less likely to agree with the assertion that promiscuity is high among women who use contraceptives.

Regarding family planning related factors, men who reported discussing family planning issues with a health worker (aOR = 0.73; C.I:0.61–0.87) had lower odds of agreeing with the notion that contraceptive use makes women promiscuous compared to those who had no such discussion with a health worker. Further, men who indicated not seeing family planning messages on posters and brochures were less likely (aOR = 0.60; C.I: 0.52–0.69) to agree with the assertion of high promiscuity among women who use contraceptives relative to those who reported seeing such messages. Men who indicated not hearing family planning messages on television (aOR = 1.17; C.I: 1.04–1.31) and did not receive FP messages by text on mobile phones (aOR = 1.27; C.I: 1.07–1.50) have increased likelihood of agreeing to the opinion that contraception promotes promiscuity among women in Ghana compared to those who heard and received FP messages on these platforms. Interestingly, men who reported hearing family planning messages on the radio were more likely to support the notion of contraceptive use promoting promiscuity among women compared to men who reported not hearing FP messages on the radio.

Discussions

Understanding the perspectives of men and obtaining their support on women’s contraceptive use is crucial for increasing the uptake of contraception and FP services. Our study examined the factors influencing men’s perspectives on women’s contraceptive use in Ghana. The majority (63%) of men disagreed with the assertion that contraception is a woman’s concern and that men should not worry about it, while 37% agreed with the statement. It is noteworthy that a relatively higher proportion (73%) of men disagreed with this statement and 27% agreed with the statement as reported in the 2014 GDHS [41]. Thus, there has been a 10% increase in the proportion of men who agreed and a 10% decrease in the proportion of those who disagreed with the statement that contraception is a women’s concern between 2014 and 2022. Furthermore, the study revealed that the majority (59%) of men agreed with the statement that women who use contraception may become promiscuous, while 41% disagreed. Compared 2014 GDHS report, there has been a 13% increase in the proportion of men who agreed with this statement and an 8% decrease in the proportion of men who disagreed.

Factors influencing men’s opinion on contraception being a woman’s concern

Presented in Model I are the factors influencing men’s opinions on contraception being a woman’s concern. The study found a lower probability of agreeing with the statement that contraception is a woman’s issue among men with secondary and higher education levels compared to men with no formal education. The finding of this study is consistent with the findings of previous studies in Ethiopia [26, 27, 42], Zambia [22], the Democratic Republic of Congo [25] and other southern African countries [24]. These studies identified educational status as a significant positive influencer of male perception and involvement in women’s contraception and family planning. An increase in the educational status of men improves their perception, opinions and active involvement in contraception. The likely explanation for this phenomenon is that highly educated men may have a better understanding of contraception and its importance, which influences their opinions, support and engagement in FP use especially among women. Additionally, highly educated men may know the benefits of contraception, leading to more frequent spousal communication, promoting favorable attitudes towards contraception and accessing contraceptive information through various media platforms and programmes [43, 44]. Consequently, this understanding and support for women’s contraception may have a positive impact on couples’ reproductive health decisions and general fertility preferences. On the other hand, men with no formal education may hold misconceptions about contraceptive use among women, particularly regarding side effects, which may contribute to low male involvement and support. Therefore, attaining at least primary education is a critical intervention for improving male active engagement in women’s contraception and family planning.

Men residing in urban areas were less likely to agree with the statement that contraception is a woman’s business compared to men residing in rural areas, consistent with findings from previous studies [21, 26, 45,46,47]. Possible explanations for this include better access to education and healthcare services in urban areas, leading to increased awareness about gender equality and reproductive health. Men in urban areas may be more informed about contraception, positively shaping their opinions on its use and importance. Furthermore, urban settings often exhibit more diverse and complex gender dynamics compared to rural areas, where traditional gender roles may be more entrenched. Men in urban areas may be more liberal and open to challenging traditional gender norms, influencing the use of contraceptives and their roles in family planning. Further, high cost of living in urban areas, especially cost of caring for children may compel men living in these areas to discuss family planning and contraception with their partners in deciding on their ideal family size. Additionally, urban areas offer better access to contraception education programmes and services, further enhancing men’s understanding and support of contraceptive use among women and fostering a perception of contraception as a shared responsibility.

The results further show that men who lived in the coastal zones were more likely to agree with the notion that contraception is a woman’s concern, which men should not worry about, compared to men dwelling in northern zones. This interesting finding is in line with the findings of other studies [48, 49]. The plausible reason is the influence on family planning interventions, longitudinal research and programmes spearheaded by the Navorongo Health Research Centre in the northern part of the country. These initiatives may have improved the attitudes of men toward women’s contraception, liberalized cultural beliefs concerning women contraceptive use and increased spousal communication on contraception and family planning [50,51,52].

Studies have reported that religion shapes the attitudes, opinions, and behaviours of men toward women’s contraception [53,54,55]. Men who belong to the Other Christian faith were less likely to agree to the statement that contraception is solely a woman’s concern compared to men with no religious affiliations. Christian teachings vary depending on the denomination. Liberal protestant Christians encourage procreation and do not forbid any specific forms of contraception and family planning methods [56].

This study also found that men who belonged to the Ga/Dangme, Ewe and Mole-Dagbani Ethnic groups had a lower probability of agreeing with the statement that contraception is a woman’s issue compared to men who belong to other ethnic groups comprising Mande and Gurma ethnic groups among others. This suggests that each ethnic group in Ghana has its own set of gender roles and norms although there may be similarities. In some ethnic groups, such as the Ga/Dangme, Ewe and Mole-Dagbani, there may be more egalitarian views regarding gender roles in shared responsibilities. Consequently, men from these ethnic groups may be less likely to view contraception as solely a woman’s issue. Additionally, endorsing patriarchal or masculine gender norms ascribe contraception and FP as the domain of women.

Studies have established a significant relationship between men’s exposure to contraception and family planning and their attitudes toward contraceptive use among women [57,58,59,60]. These studies argue that media platforms such as television, radio, newspapers, billboards, magazines and other electronic and digital technologies play a crucial role in positively influencing men’s attitudes towards contraception and promoting behavioural change by combating misinformation and myths about contraceptive use and family planning methods. The study revealed that men who indicated not seeing FP messages on television, social media, posters were more likely to support the assertion that contraception only concerns women. Interestingly, this study found that men who reported hearing FP messages on the radio and listening to FP messages at community events had a higher likelihood of agreeing with the statement that contraception is a woman’s issue. The possible explanation for this is the differences in the content, timing, language use and types of FP messages given on the various media platforms which might either appropriately educate men or misinform them [57, 61]. This tends to influence men’s opinions and shape their attitudes towards contraception and family planning among women.

Factors influencing men’s opinion on contraceptive use making women promiscuous

Model II present factors influencing men’s opinions on contraceptive use promoting promiscuity among women. The study results indicate that men in relatively lower age categories (20–24 and 35–39 years) were more likely to agree to this compared to men 55–59 years. The reasons might be that younger men may have been exposed to different societal norms and attitudes towards sexuality and contraception compared to older men. They may be more influenced by contemporary cultural messages that associate contraception with promiscuity among women. On the other hand, older men may have had more exposure to comprehensive sexual education or public health campaigns promoting responsible contraceptive use among women, which could influence their perspectives on the relationship between contraception and promiscuity.

Additionally, the educational level of men significantly influenced their opinion on contraceptive use, with those who attained higher education having lower odds of agreeing to this assertion that it makes women promiscuous compared with those who had no formal education. This finding confirms those of earlier studies [62, 63]. The possible logical reason for this occurrence is that higher education often fosters critical thinking skills, which may lead people to question and challenge conventional beliefs or stereotypes. Men with higher education may be more likely to critically evaluate the assertion that contraceptive use inherently leads to promiscuity among women. Furthermore, higher education typically provides individuals with greater access to information, including accurate and comprehensive knowledge about contraception, sexuality and societal attitudes toward these issues. Therefore, men with higher education may be more attuned to the social, cultural and economic factors that influence women’s sexual behaviour, leading them to reject simplistic explanations like the idea that contraceptive use automatically promotes promiscuity among women.

The study also revealed that men residing in urban areas, compared to those living in rural areas, were less likely to agree with the notion that women who use contraceptives tend to become promiscuous. Similar findings were observed in previous studies [21, 62, 64], including that urban areas are more diverse in terms of demographics, cultures, and lifestyles. Men in urban areas interact with a wider range of people with varying attitudes towards sexuality and contraception leading to a broader understanding of human behaviour and a reduced tendency to stereotype women who use contraceptives as promiscuous. Moreover, urban environments often have more progressive social norms and greater acceptance of diverse sexual behaviours and lifestyles. As a result, men in urban areas may be more receptive and liberal towards women’s reproductive choices, decreasing the inclination to associate contraception with promiscuity.

Another important finding is that men dwelling in coastal and middle belt zones were more likely to agree with this statement compared with those living in the Northern zone. This could be attributed to the predominant Islamic culture in Northern zones, which often emphasizes conservative values regarding sexuality and contraception. Islamic teachings typically promote modesty and family values, which could lead to less agreement with the notion that contraceptive use promotes promiscuity.

The result further shows a higher probability of agreement by men who are cohabiting or have been formerly married (divorced, widowed, separated) that contraceptive use leads to promiscuity among women compared with those who had never married. The possible reason for this was that men who have been in previous relationships or marriages may have had firsthand experiences that influenced their perceptions of women’s behaviour. If they have encountered situations where contraceptive use coincided with increased sexual activity or infidelity, they may be more inclined to believe that contraception leads to promiscuity. Similarly, cohabiting and formerly men may perceive contraceptive use as a form of control over fertility and sexual activity. In some cases, this perception could lead to feelings of insecurity or mistrust, especially if they believe that women are using contraception to engage in sexual behaviour outside of the relationship.

Furthermore, compared to men in employment, those who are unemployed were less likely to agree that promiscuity is high among women who uses contraceptives. The possible explanation is that unemployed men may have different social circles and interactions compared to those who are employed. They may have less exposure to societal stereotypes or stigmas surrounding contraceptive use and promiscuity, leading to a lower likelihood of agreeing with such notions. Furthermore, unemployment can be associated with financial stress and may shift peoples’ priorities towards immediate concerns such as finding employment and meeting basic needs. As a result, unemployed men may be less preoccupied with moral judgment or stereotypes related to women’s contraceptive use and promiscuous lifestyle.

In terms of men’s exposure to FP education and messages on media platforms, the results show that men who indicated discussing FP with health workers and have seen FP messages on posters or brochures were less likely to agree to the notion that women who use contraceptives become promiscuous. However, men who heard FP messages on the radio, neither saw FP messages on television nor heard FP via text on their mobile phones had a higher likelihood of agreeing to the assertion that contraceptive use promotes promiscuity among women. This re-emphasizes the critical role exposure to FP information and education on media platforms play in influencing perception and shaping attitudes of men towards women’s contraceptive behaviour as reported by earlier studies [25, 58].

Study limitations and strengths

This study has some limitations. First, because of the cross-sectional nature of the data, we are unable to make any causal assessment from our findings. Second, our assessment of men’s attitudinal norms on women’s contraception is an approximation based on the aggregation of individual attitudes or beliefs. Furthermore, as the data were collected retrospectively there is a risk of recall bias, as well as other types of biases present in survey data collection including socially desirable responses. Again, considering the secondary nature of the data, the study could not examine the cultural, and socio-environmental factors and past experiences that might influence men’s attitudes and perceptions towards contraceptive use among women. Despite these limitations, this study using nationally representative data examines factors that influence men’s attitudes and perspectives towards women’s contraceptive use in Ghana. The results of this study can be generalized to all men in Ghana and other homogenous settings.

Conclusions

The study underscores the importance of men’s socio-demographic characteristics and their exposure to FP messages shape their perspectives and attitudes towards women’s contraceptive use. Men demonstrating positive attitudes towards women’s contraceptive use have the potential to improve the efficiency of family planning services in Ghana. Policy implications highlight the need to involve men in the role of promoting safe sexual and reproductive health decision-making and practices to achieve universal access to sexual and reproductive health services by 2030.

Data availability

Datasets used for this study are openly available and can be accessed through https://dhsprogram.com/

Abbreviations

AIDS:

Acquired Immunodeficiency Syndrome

aOR:

Adjusted Odds Ratio

CI:

Confidence Interval

FP/C:

Family Planning/Contraception

GDHS:

Ghana Demographic and Health Survey

HIV:

Human Immunodeficiency Virus

ICPD:

International Conference on Population and Development

SSA:

Sub-Saharan Africa

UN:

United Nations

WHO:

World Health Organisation

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Acknowledgements

The authors are grateful to the Demographic and Health Survey program under the Ghana Statistical Service in collaboration with USAID and other partners for making available this dataset for this study.

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Authors and Affiliations

  1. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana

    Desmond Klu

  2. Department of Sustainable Development and Policy, University of Environment and Sustainable Development, Somanya, Ghana

    Michael Larbi Odame

  3. Mental Health Unit, Family and Community Health Department, University of Health and Allied Sciences, Ho, Ghana

    Paapa Yaw Asante

  4. Education Service, Kotobabi TMA School, Tema West, Accra, Ghana

    Charity Akpene Dansu

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Contributions

DK as the main author contributed to the study’s conceptualization, data analysis, data interpretation and writing of the manuscript, MLO contributed to the study design, methodology and analysis, MLO, PYA and CAD critically reviewed the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Desmond Klu.

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The Institutional Review Board of the Informed Consent Form (ICF) and the Ethics Review Committee of the Ghana Health Service Ethics Review Committee approved the protocol for the 2022 GDHS. We obtained permission from the ICF for the use of the datasets, and the terms of use were strictly adhered to. Again, all methods used were carried out in accordance with relevant guidelines and procedures. Informed consent was obtained from the respondents before the interviews were conducted.

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Klu, D., Odame, M.L., Asante, P.Y. et al. Determinants of men’s perspectives on women contraceptive use in Ghana: an analysis of the 2022 Ghana demographic and health survey. Contracept Reprod Med 9, 35 (2024). https://doi.org/10.1186/s40834-024-00300-z

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Keywords

Contraception and Reproductive Medicine

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