Exploring the Role of Health Communication Campaigns on Youth Knowledge, Attitudes, and Use of Emergency Contraception in Ghana: A Multi-Methods Qualitative Study

Abstract

In 1996, the Government of Ghana introduced emergency contraception (EC) into its National Family Planning program, first through combined oral contraceptives and later through progestin-only emergency contraceptive pills (ECPs) and other modalities. Yet more than one-third of pregnancies in Ghana remain unintended, showing that women underutilize post-coital methods. We conducted a scoping review, an analysis of health communication campaigns, provider interviews, and youth-focused multi-method qualitative research to explore knowledge, attitudes, availability, accessibility, and utilization of EC in Ghana. The scoping review included 57 studies, most of which investigated students, urban dwellers, and unmarried women. Researchers consistently reported that knowledge centered almost exclusively on progestin-only ECPs, with women obtaining information from both formal and peer networks. Geographic and social barriers restricted access, and some women relied on ECPs as their primary method of pregnancy prevention. Our analysis of 12 health communication campaigns (2014–2022) showed that organizations emphasized progestin-only ECPs while rarely mentioning other regimens or intrauterine devices, limiting comprehensive understanding and informed choice. We conducted 30 semi-structured interviews with providers in Accra and Kumasi and found that although EC modalities were generally available, provider knowledge varied by setting. Pharmacies and drug shops served as the most common points of access. Providers recommended strengthening training and diversifying communication strategies. An online survey with 271 youth and 13 in-depth interviews with ever-users of EC showed that young people possessed limited knowledge, encountered stigma and provider bias, and lacked adequate information and educational materials at service delivery points. These findings confirm the need to strengthen provider training, broaden communication strategies, and deliver accurate, inclusive messaging to expand EC knowledge, access, and utilization in Ghana.