Assessing geographical variation in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health Survey.

BACKGROUND: Sierra Leone has poor indicators of reproductive health and a high prevalence of unintended pregnancies. To date, no study has explored determinants of ovulatory cycle knowledge in Sierra Leone. We investigated geographic region to determine where the needs for improved ovulatory cycle knowledge are greatest in Sierra Leone. METHODS: This is a cross-sectional study of women of reproductive age (n = 15,574) based on the 2019 Sierra Leone Demographic and Health Survey. Geographic region and sociodemographic covariates were included in a multivariate logistic regression model predicting the odds that participants possessed accurate knowledge of when in the ovulatory cycle pregnancy initiation is most likely. RESULTS: In Sierra Leone, 39.8% (CI = 37.4-40.9) of 15-49-year-old women had accurate knowledge of the ovulatory cycle. Women in the Northern and Southern regions possessed the highest prevalence of correct knowledge (46.7%, CI = 43.1-50.3 and 45.1%, CI = 41.9-48.2, respectively). Women from the Northwestern (AOR = 0.29, CI = 0.22-0.38), Eastern (AOR = 0.55, CI = 0.41-0.72), and Western regions (AOR = 0.63, CI = 0.50-0.80) had significantly lower odds of accurate ovulatory cycle knowledge compared to others. Women aged 15-19, those with a primary school education, and participants with a parity of none all had the lowest odds of correct ovulatory cycle knowledge as well. CONCLUSION: Less than four in ten women in Sierra Leone had accurate knowledge of when in the ovulatory cycle pregnancy is most likely to occur. This suggests that family planning outreach programs should include education on the ovulatory cycle and the importance of understanding the implications of its timing. This can reduce the risk of unintended pregnancies throughout Sierra Leone, and can have an especially positive impact in the Northwestern, Eastern, and Western regions, where ovulatory cycle knowledge was significantly lower.

Towards prevention of new COVID-19 infections in institutions of higher education: factors influencing compliance with mask-wearing among public university students in Ghana.

BACKGROUND: Ghana's mask-wearing compliance with COVID-19 prevention protocols has not been as impressive among the general population. In this study, we examined factors influencing compliance with mask-wearing among public university students in Ghana to make recommendations for the prevention of new COVID-19 infections in public universities. METHODS: We conducted this Census in a public university in Ghana between January and December 2022. The study design was an exploratory-cross-sectional and online survey. Structured questionnaires developed by the authors were used to collect data from 3,272 students. Data were analyzed with Jeffreys's Amazing Statistics Program (JASP). Frequency distributions were used to summarize the data into tables and graphs whilst logistic regression analysis was done to examine the factors influencing compliance with mask-wearing among participants as well as their mask-wearing behaviors in school. RESULTS: Compliance with mask-wearing measures was high with 85.9% of the students wearing a nose mask always or often. Agreeing that the reusable masks do not last long was associated with a reduced chance of non-compliance (OR = 0.70, 95% CI = 0.57, 0.86). However, agreeing with some challenges was associated with increased chances of non-compliance. These included concerns that it is boring to mask after wearing makeup or having a haircut (OR = 1.71, 95% CI = 1.37, 2.14), and that masking is burdensome because it has to be removed when talking (OR = 1.26, 95% CI 1.01, 1.57), and that it is difficult to hear while masked (OR = 1.36, 95% CI = 1.04, 1.79). CONCLUSION: Cost-benefit analyses, opinions about one's look, and communication difficulties are the key factors influencing students' non-compliance with mask-wearing regulations. To encourage student compliance with mask-wearing regulations at Ghana's public universities, we recommend innovation in nose mask manufacture.

Toward contraception education in basic schools: Teachers' knowledge, perceptions, and attitudes regarding contraceptive use by basic school pupils in a Ghanaian Municipality.

Objectives: We examined teachers' knowledge, perceptions, and attitudes regarding contraception by basic school pupils in a Ghanaian Municipality. Methods: This was an explorative, analytical cross-sectional study using the mixed-method approach. Participants comprised 183 public and private basic school teachers and 20 school health coordinators in the study area. The statistical tests carried out were in two folds. Quantitative data were analyzed with a statistical package for social sciences version 20 to generate tables. A logistic regression model was used to examine associations between the predictor and the binary response variables. Adjusted odds ratio accounted for other predictor variables in the model. For the qualitative data, recorded interviews were transcribed and content analysis was done to identify themes, subthemes, and results presented as participants' direct quotations/paraphrased statements. Knowledge, perceptions, and attitudes were assessed using 3-Likert scale type questions developed by the author. Results: Participants' sociodemographic characteristics were associated with perceptions and attitudes toward contraception in basic schools. At 95% confidence intervals, the p-values were not significant for any of the variables tested. However, the adjusted odds ratio (aOR) showed positive perceptions among participants aged 35-39 (aOR = 7.24; p = 0.35), women (aOR = 4.22; p = 0.25), higher educated (aOR = 4.32; p = 0.56), work experience between 16 and 20 years (aOR = 6.65; p = 0.96), four or more children (aOR = 6.35; p = 0.96); divorcee (aOR = 10.12; p = 2.92); intrauterine contraceptive device (IUD) (aOR = 5.02; p = 2.43); or condoms users (aOR = 7.09; p = 0.32). Negative perceptions were noted among affiliates of other religions compared to Christians (aOR = 0.19; p = 0.01) and subject teachers (aOR = 0.39; p = 0.01). Participants' perceptions were directly influenced by attitudes toward contraception and knowledge (p = 0.081). The qualitative findings showed mixed feelings about contraceptive education in basic schools. Conclusions: Basic school teachers have challenges with contraceptive education which have implications for comprehensive sex education in Ghanaian basic schools. We recommend a similar study among parents of the pupils and a nationwide study to examine this concept further.

Stakeholders' perceptions of the trends in contraceptive prevalence rate and total fertility rate in Ghana.

BACKGROUND: Studies in Ghana have reported discrepancies between trends in Total Fertility Rate (TFR) and Contraceptive Prevalence Rate (CPR). Yet, there is limited empirical literature on stakeholders' perceptions on the trends in CPR and TFR in Ghana. We, therefore, examined the perceptions of key stakeholders about the documented trends in CPR and TFR in Ghana. METHODS: We adopted an exploratory (qualitative) research design with a qualitative approach of data collection from stakeholders in Ghana, focusing on the trends of the TFR and CPR. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist provided additional guidance for reporting the study results. We employed the Theory of Planned Behavior (TPB) as a theoretical framework/construct to explain and predict individual changes in health behaviors resulting in trends in CPR and TFR from stakeholders' perspectives and analyzed the data using framework analysis approach. RESULTS: Two main themes emerged from the data: contraceptive prevalence and total fertility ratio, with five sub-themes identified: barriers to contraception, motivations for contraception uptake, unmet need for family planning, induced abortion, and effectiveness of planning programs. Specifically, participants indicated that there is a discrepancy between the trends of CPR and TFR based on the Ghana Demographic and Health Survey, conducted between 1988 and 2014. The high unmet needs for contraceptives were attributed to CRP trends, whilst abstinence, infertility, and high demands for induced abortions were identified to impact the TFR trends significantly. CONCLUSION: The findings show that an extensive quantitative enquiry into the exact relationships between Ghana's CPR and TFR as well as the contributions of abstinence, infertility, and induced abortion are worth considering.

Sexual Coercion and Harassment of Students with Disabilities in a Public University in Ghana.

There is limited literature on sexual coercion/harassment of university students with disabilities, hence we, explored this phenomenon in Ghana, using a sequential explanatory-mixed method design that involved 119 (62 males and 57 females) students with various disabilities in the quantitative study and 12 (7 females and 5 males) students in the qualitative phase using questionnaire and interview guide for data collection respectively. We found that participants were not aware of the university's sexual coercion/harassment policy nor involved in its formulation/dissemination. Persistently asking for sexual relationships, pressurized for outings, attempted/forced kissing, being sexually looked at, engaging in uncomfortable sexual conversations, and sexually provocative touch were common. The main perpetrators of these acts included physically able people (24.4%), colleagues with disabilities (14.3%), and Lecturers/Administrative staff (10.9%). We recommend policies and programs' strengthening to protect students with disabilities from such unwarranted acts.

Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana.

BACKGROUND: We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. METHODS: A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. RESULTS: Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. CONCLUSION: Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

Prevalence, Trends, and Factors Associated with Teen Motherhood in Nigeria: An Analysis of the 2008-2018 Nigeria Demographic and Health Surveys.

Background: Teen pregnancy and childbearing are common in Nigeria, and understanding the complexities, such as sociodemographics and economic factors including sexual and reproductive health knowledge and awareness among adolescents over time can trigger innovative approaches and interventions. This study intends to capture the patterns and associated factors of teen motherhood among sexually active adolescents (15-19 years) between 2008 and 2018. Methods: The study data was extracted from 2008, 2013, and 2018 Nigeria Demographic and Health Surveys. Descriptive analysis was presented using frequencies and percentages; multivariable analysis was conducted using log-binomial logistic regression at a p-value <0.05. All analyses were performed using Stata 15.0, weighted and adjusted for the complex survey design and population size. Results: The prevalence of teen motherhood increased between the three successive survey waves (50.9% vs. 52.4% vs. 55.2%) from 2008, 2013, and 2018. Although, the pooled adjusted analysis revealed no significant change over the 10-year period. Knowledge of modern contraceptive methods, primary education, non-Catholic Christians, residing in the South-South region, and those currently or formerly married were associated with increased risk of teen motherhood. There was an inverse relationship between teen motherhood and wealth status; lower wealth status was associated with high adolescent pregnancy and childbearing. Conclusion: This study revealed an increase in the proportion of teen pregnancy and childbearing in Nigeria. Notably, there exist variations across age groups, geographic location, educational level, religious belief, marital and economic status. Interventions that ensure comprehensive sexuality education, girl child education, and economic empowerment especially for school dropouts are advocated to reduce teen motherhood.

'Towards prevention of COVID-19 among children in Ghana: Parents' views about children wearing nose masks in public gatherings.

Objectives: The authors examined parents' views about children nose-masking in public gatherings in Ghana between January and May 2021. Study design: This is exploratory sequential mixed methods study comprising qualitative and quantitative components. Methods: Four hundred and thirty-nine parents were interviewed using author-developed structured questionnaires and interview guides in a public University in Ghana. Ten respondents in the company of at least three children and of high academic status were further interviewed in-depth to obtain some qualitative information on the research topic. All interviews were conducted in English. Quantitative data were analyzed using Statistical Package for Social Sciences version 20 whiles qualitative data were analyzed thematically. Results: In Ghana, various types of nose masks are use in public gatherings. Profiles of respondents show that females (89%) with higher educational attainments (69%) supported children's nose masking. Mothers (91%) affirmed the relevance of nose masking by children aged 0-15 years as against 30% of male respondents who did not know the importance of nose masking among this age group. A strong Linear female correlation (0.018) backed by positive qualitative responses by mothers supported children's nose masking. A significant positive correlation (0.042) was also observed between respondents' educational attainment and perceptions of children nose masking. The authors further observed that materials used for producing children's nose masks and duration of wearing as key parental concerns. Conclusions: There is an urgent need by public health institutions for risk communication on the safety of masks for children, their efficacy in preventing COVID-19 infection as well as seeking collaborations with relevant nose mask producers to design appropriate child-friendly nose masks to ensure compliance for child safety.

Breastfeeding-friendly policies and programs in three public Universities in Ghana.

BACKGROUND: The United Nations through its Sustainable Development Goals (SDG) 3 and 5 has championed Women empowerment for exclusive breastfeeding through various action plans and expected the concept to be decentralized through locally mandatory implementation of various institutional policies and programs in member Countries. Using Kabeer's empowerment concept, the authors in this paper assessed availability and implementation of breastfeeding policies and programs in three public universities in Ghana. METHODS: The study design was an exploratory-descriptive-case study involving university employees and student mothers from three public universities in Ghana. The universities were selected via simple random approach whilst selection of participants was purposive. Data were collected between April and July 2018 using an unstructured interview guide developed by the authors, audio recordings, field notes and desktop review of documents. Manual thematic analysis of data was done to present results descriptively. The University of Cape-Coast Ethics Review Board approved the study. RESULTS: Thirty-six respondents participated in the study. Three main themes (Breastfeeding policy and programs, Institutional support, and views on Breastfeeding/Childcare support) emerged. Despite being gender/child friendly, none of the universities in this study has a formal breastfeeding/childcare policy/program and there are no immediate policy plans for on-campus facilities to enhance breastfeeding. Financial cost emerged as a major challenge hindering the universities from implementing a policy/program in this regard. On the part of student mothers, lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among nursing mothers has been a major setback for breastfeeding on campus, hence nursing mothers continue to make personal but challenging arrangements for breastfeeding on university campuses. CONCLUSIONS: The study findings reflect negative implications for childcare as it affects optimal child nutrition, hence impacting on achieving the SDGs 3 and 5 in Ghana. The authors recommend introducing formal breastfeeding-friendly policies/programs as one of the criteria for accreditation of universities in Ghana to enhance optimal childcare and sound maternal mind for studies and/or work once there is an assurance of child safety and proximity to breastfeed on demand.

Commercial sex work among university students: a case study of four public universities in Ghana.

BACKGROUND: Despite its criminalization in Ghana, commercial sex work dates back to ancient societies and occurs in various forms within communities. The authors examined commercial sex work in selected public Universities in Ghana to inform policy and program decisions for safer sex at the universities in Ghana. METHODS: The study was an exploratory-mixed-method design. Respondents were identified using purposive and snowballing techniques while semi-structured questionnaires and in-depth interviews were used for data collection between 2017and 2019. Quantitative data were analyzed using Statistical Package for Social Sciences version 23 and qualitative data analyzed thematically. RESULTS: Findings show that there is a proliferation of commercial sex work on university campuses in Ghana for financial, material, and emotional gains. Student sex workers have devised various strategies to combine academic work and sex work. Prospective customers are solicited by hanging out in drinking bars and nightclubs in and around university campuses at night and/or leaving contact details with pimps to be contacted for services. Brothels are also springing up in and around the university campuses in the form of movie houses and student sex workers convert their hostel rooms into brothels. Price negotiation is based on the environment, duration, the sex workers' perceived safety of the sexual act, customer's preferences for styles, and positions adopted for sex. CONCLUSION: There is a need for further studies in this area and a multi-sectoral approach for appropriate policy and program interventions to regulate the practice on campus.

Self-medication among pregnant women in two municipalities in the Central Region of Ghana.

Self-medication in pregnancy is a concern in Ghana. We assessed the practice among 136 pregnant women in Effutu and Agona West Municipalities using facility-based, cross-sectional design and mixed method approach of data collection. Our findings show that pregnant women of varying backgrounds self-medicate for sociocultural and economic reasons, with 69% prevalence, motivated by cheaper treatment cost (17%), minor ailments (29%) and positive outcomes (33%). Commonly used medications include antibiotics (23%), pain killers (20%) and herbal preparations (19%). We recommend further studies on pharmacological compositions of the medications used and effects on pregnancy outcomes to inform policy and programs decisions.

Contraceptive Use among Basic School Pupils in Ghana: A Case Study of a Municipality.

BACKGROUND: Ghana over the years strived to improve contraceptive services for young people through various policies and programs. Despite these efforts, contraceptive use among young people remains a challenge. In this study, contraceptive use among basic school pupils in a Ghanaian municipality was explored to inform policy and program decisions. METHODS: The research design was a cross-sectional and mixed-method survey involving four hundred and twenty-seven (427) respondents randomly selected from four hundred and eleven (411) basic schools (102 from private and 309 from public basic schools) within Effutu Municipality of Ghana. RESULTS: Basic school pupils in Ghana are generally sexually active but have high unmet needs for modern contraception due to sociocultural barriers, stigma, and misconceptions. Awareness and use are however more prevalent among junior high school pupils compared to those at the primary levels. Pupils who received contraceptive education from parents/guardians were, however, more likely to use modern contraceptives consistently than their counterparts who do not. CONCLUSIONS: Because young people in basic schools are becoming sexually active, there is a need for formalized contraceptive education in basic schools for correct information and education.

Experiences of commercial sex workers during COVID-19 restrictions in selected metropolises in Ghana.

The author examined experiences of Commercial Sex Workers (CSWs) in Accra, Kumasi and Kasoa metropolises following Ghana's imposition restrictive ACT since 21 March 2020. Three trained male field assistants posing as mystery clients, purposively selected and interviewed 35 CSWs using a combination of face-to-face and telephone interviews with consenting CSWs in the study area. Findings show declined activity and patronage of CSWs due to fear of contracting COVID-19. With no savings or other reliable sources of income, some CSWs have however devised various strategies to work safely and implored the government to support them financially during this crisis.

Examining working mothers' experience of exclusive breastfeeding in Ghana.

BACKGROUND: Although substantial evidence exists on factors that influence exclusive breastfeeding, there is a general lack of qualitative studies that examine how specific workplace factors constrain or promote exclusive breastfeeding among working mothers. The current study therefore examines working mothers' experience of exclusive breastfeeding, laying emphasis on the influence of workplace factors on working mothers' decision to exclusively breastfeed their babies. METHODS: The study uses a qualitative research approach and a three-stage purposive sampling procedure to select 20 mothers from 10 organizations in five industries for in-depth interviews on their exclusive breastfeeding experience. Data collected from the interviews were analysed using content analysis, with two major themes emerging for discussion. RESULTS: The results suggest that two major factors influence exclusive breastfeeding among working mothers: practice of exclusive breast feeding (knowledge and understanding of exclusive breastfeeding, and experience in exclusive breastfeeding) and workplace factors (length of maternity leave, closing time, absence of maternity policy in organizations, inadequate institutional support and family work-life balance). CONCLUSION: The results of the study suggest that workplace factors play an equally crucial role in the decision by mothers to exclusively breastfeed their babies. Thus, in the special case of working mothers where breastfeeding prevalence is low, the findings of this study can be crucial in evolving appropriate policies to support working mothers in their effort to exclusively breastfeed their babies.

Implications of self-medication in pregnancy for Safe Motherhood and Sustainable Development Goal-3 in selected Ghanaian communities.

Objectives: This study explored self-medication in pregnancy and its implications for achieving Safe Motherhood and Sustainable Development Goal-3 initiatives in some Ghanaian communities. Study design: A facility-based cross-sectional descriptive design using mixed method approach of data collection. Methods: Multi-staged simple random and purposive sampling techniques were used to select 136 pregnant women from public Antenatal Clinics in Efutu and Agona West municipalities in the Central Region of Ghana from June to August 2018. Quantitative data were collected using structured questionnaires and analyzed with Statistical Package for Social Sciences version 23.0 whilst interview guides were used to collect qualitative data via Focus Group Discussions and content analysis done. Results: Self-medication in the study area is a common practice among most (88%) pregnant women of all socioeconomic backgrounds, those in the first trimester of pregnancy (68.7%) and routine Antenatal clinic attendants (69%). Religion (p â€‹= â€‹0.003) and educational (p â€‹= â€‹0.004) backgrounds of respondents were significantly associated with self-medication in pregnancy and motivated by reproductive intentions, availability of medicines, time factor, media advertisements and societal influences relating to beliefs, fears, expectations and perceptions. Majority (90%) of respondents had no side effects. Conclusions: A nation-wide evaluation of public health education on the dangers of self-medication in pregnancy and implementation of drug regulatory policies are highly recommended in Ghana.

Pregnancy options counselling in Ghana: a case study of women with unintended pregnancies in Kumasi metropolis, Ghana.

BACKGROUND: Pregnancy crisis mismanagement has contributed to maternal deaths and illnesses globally and in Ghana due to absence/inadequate pregnancy options counselling for clients to make informed decisions. This study examines options counselling for abortion seekers in health facilities in Ghana. METHODS: Analytical cross-sectional study design was done in selected specialised public and NGO health facilities within Kumasi Metropolis of Ghana, using self-administered structured questionnaires for data collection from 1st January to 30th April, 2014. Participants were 442 women with unintended pregnancies seeking abortion services. Data was analysed using Epi-Info (7.1.1.14) and STATA 12 to generate descriptive statistics, Pearson chi-square and multivariable logistic regressions. The Kwame Nkrumah University of Science and Technology approved the study. RESULTS: Respondents had divergent reproductive and socio-demographic profiles. Majority (about 58%) of them had been pregnant more than twice, but about 53% of this population had no biological children. (Although about 90% of respondents held perceptions that the index and previous pregnancies were mistimed/unintended, the majority (72%) had no induced abortion history. Induced abortion (208, 49%) and parenting (216, 51%) were mentioned as the only available options to unintended pregnancy in hospitals. Exposure to options counselling was observed to be significantly associated with parity (P = < 0.001), gestational age (P = < 0.001), previous induced abortions (P = < 0.001), perception of pregnancy at conception (P = < 0.001) and level of education (P = 0.002). The logistic regression analysis also shows that higher education has statistically significant effect on being exposed to options counselling (P = < 0.001). Majority of respondents (95%) were not aware that giving a child up for adoption is an option to abortion in Ghana. CONCLUSIONS: Pregnancy options counselling remains a major challenge in comprehensive abortion care in Ghana. Although higher educational attainments significantly exposes women to options counselling for informed decisions, the less educated are disadvantaged in this regard. Further research on type and depth of counselling services provided to pregnant women in health facilities is required to inform health policy and program decisions.

Family planning among undergraduate university students: a CASE study of a public university in Ghana.

BACKGROUND: Globally, the rate of unplanned pregnancies among students at institutions of higher education, continue to increase annually despite the universal awareness and availability of contraceptives to the general population. This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards contraception in the University of Education Winneba. METHODS: The study was a descriptive cross-sectional survey using a structured self-administered questionnaire. One hundred undergraduate students from the University of Education Winneba were selected using a multistage simple random sampling technique. A Likert scale was used to assess the attitude of the respondents towards family planning methods. RESULTS: Findings show that the respondents had a positive attitude towards family planning with an average mean score of about 4.0 using a contraceptive attitude Likert scale. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma. CONCLUSION: The observation that levels of Family Planning awareness levels do not commensurate knowledge and usage levels calls for more innovative strategies for contraceptive promotion, and Education on the various university campus. The study recommends that public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning updates. In this regard, a nationwide mixed method study targeting other tertiary institutions including colleges of education in Ghana is required to explore the topic further to inform policy and programme decisions.

Institutional support for breastfeeding in Ghana: a case study of University of Education, Winneba.

OBJECTIVES: This study explored institutional support for breastfeeding student-mothers in the University of Education, Winneba, Ghana. It also examined challenges associated with combining academic work with breastfeeding and childcare. RESULTS: Findings show that although the University as an institution does not have any formal system in place to support breastfeeding among student-mothers, it does follow the provisions made for breastfeeding under the maternity protection section of the labor Act (Act, 651) for its employees. Consequently, breastfeeding student mothers use under trees, lobbies, and Junior Common Rooms of on-campus halls of residence as lactation sites which exposes their babies to risk of infection. The absence of support put student-mothers through stress, divided attention, and conflicting responsibilities between academic work and childcare. Further studies to investigate the situation on other university campuses are recommended to promote policy and interventions on breastfeeding and childcare in tertiary institutions in Ghana to enable students maintain a balance between breastfeeding, childcare and academic work.

Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana.

BACKGROUND: The intrauterine contraceptive device is one of the modern long-acting and reversible contraception that is very safe and effective. Yet, less than 2 % of women are using intrauterine devices in Ghana. This study therefore explored the experiences and barriers to intrauterine contraceptive device use and discontinuation in Greater Accra Region, Ghana. METHODS: Intrauterine contraceptive device users and providers were purposively selected from eight private family planning clinics in the Greater Accra Region. Semi-structured interview guides were used for in-depth interviews during data collection. The interviews were audio-taped to ascertain accurate accounts of the interviews and recordings replayed for analytical responses. Field assistants transcribed the interviews conducted themselves and read through the transcripts produced twice to increase familiarity with the dataset. A list of code labels was created and a series of categories for the main themes that emerged from the transcripts were developed. The transcribed data was organized, coded and manually thematically analysed in word. Study results were presented in tables and quotes from respondents. RESULTS: Results showed that key motivations for intrauterine contraceptive device use include effectiveness, benefits, and efficacy of the device, fertility regulation, peace of mind, contraceptive method switching, health provider effects, desire for long-acting contraceptive method, and partner characteristics. Intrauterine contraceptive device discontinuation was due to bleeding irregularities, vaginal infections, desire to increase fertility, physical features of the intrauterine device, and partner disapproval of use. Other reasons in both cases pertained to non-hormonal aspects of the intrauterine device, partner characteristics, and provider encouragement and influence. CONCLUSIONS: Several factors influence the use and discontinuation of intrauterine device in Ghana. Comprehensive contraceptive counselling on the intrauterine device is essential in promoting uptake and knowledge of the intrauterine device at the health facility level. Various targeted messages are also needed to dispel misconceptions at the community level.

Decision-Making for Induced Abortion in the Accra Metropolis, Ghana.

Decision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners' consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions.