Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.
Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana.
BMC Womens Health. 2023 Aug 9;23(1):421. doi: 10.1186/s12905-023-02572-0.
Long-Acting Reversible Contraceptives (LARC) contribute significantly to a decline in unintended pregnancies globally. However, not much is known about women's sexual empowerment and their utilization of Long-Acting Reversible Contraceptives in Ghana. The main objective of this study was to examine the association between women's sexual empowerment and LARC utilization in Ghana.
We used data from 5116 sexually active women who participated in the 2014 Ghana Demographic and Health Survey. Women's sexual empowerment was defined as women's perception of their right to self-determination and equity in sexual relations, and their ability to express themselves in sexual decision-making. A sum of scores was created with four dichotomous items as sexual empowerment score (0 = low sexual empowerment; 1, 2, and 3 = medium sexual empowerment; and 4 = high sexual empowerment). Multivariable binary logistic regression analyses were performed to establish the association between women's sexual empowerment and the use of LARC. Pearson Chi-square test was used in data analysis. The results are presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs) at a statistical significance of p < 0.05.
The prevalence of LARC utilization among sexually active women in Ghana was 6%. Majority of the women had medium sexual empowerment (91%). Although not statistically significant, the likelihood of utilizing LARC was lowest among women with high level of sexual empowerment (aOR = 0.62; CI = 0.27-1.43). On the other hand, Utilization of LARC increased with an increase in age. Women with parity four or more had higher odds of utilizing LARC as compared to women with zero birth (aOR = 9.31; CI = 3.55-24.39). Across religion, women who belong to the Traditional religion (aOR = 0.17; CI = 0.04-0.71) and Islam religion (aOR = 0.52; CI = 0.36-0.76) had lower odds of LARC utilisation as compared to Christian women. Women who make health decisions with someone else (aOR = 1.52; CI = 1.12-2.09) had higher odds of LARC utilisation as compared to women who make health decision alone.
Age, health decision maker, parity and religion were found to have a significant relationship with LARC utilization. Specifically, uneducated women, unemployed women and women who practice traditional religion were less likely to utilise LARC. However, women's sexual empowerment did not have a significant relationship with LARC. There is therefore the need for planning interventions for LARC utilization in line with educating women on the benefits and potential side effects of LARC. Also, there is a need for interventions targeted at increasing access to LARC among sexually active women.
长效可逆避孕措施（LARC）对全球意外怀孕率的下降有显著贡献。然而，人们对加纳女性的性赋权以及她们对长效可逆避孕措施的利用情况知之甚少。本研究的主要目的是探讨加纳女性性赋权与长效可逆避孕措施利用之间的关联。
我们使用了 2014 年加纳人口与健康调查中 5116 名有性行为的女性的数据。女性的性赋权被定义为女性对自我决定权和性关系中平等的感知，以及她们在性决策中表达自己的能力。通过四个二分法项目创建了一个得分总和，作为性赋权得分（0=低性赋权；1、2 和 3=中等性赋权；4=高性赋权）。采用多变量二项逻辑回归分析来确定女性性赋权与 LARC 使用之间的关联。采用 Pearson Chi-square 检验进行数据分析。结果以调整后的优势比（aOR）及其相应的置信区间（CI）表示，统计学显著性水平为 p<0.05。
加纳有性行为的女性中 LARC 使用率为 6%。大多数女性具有中等性赋权（91%）。虽然没有统计学意义，但高水平性赋权的女性使用 LARC 的可能性最低（aOR=0.62；CI=0.27-1.43）。另一方面，LARC 的使用率随着年龄的增长而增加。与零胎次的女性相比，产次为四胎或以上的女性使用 LARC 的几率更高（aOR=9.31；CI=3.55-24.39）。在不同的宗教信仰中，与基督教女性相比，属于传统宗教（aOR=0.17；CI=0.04-0.71）和伊斯兰教（aOR=0.52；CI=0.36-0.76）的女性使用 LARC 的几率较低。与独自做出健康决策的女性相比，与他人共同做出健康决策的女性（aOR=1.52；CI=1.12-2.09）使用 LARC 的几率更高。
年龄、健康决策者、产次和宗教与 LARC 的使用有显著关系。具体来说，未受教育的女性、失业的女性和信奉传统宗教的女性使用 LARC 的可能性较低。然而，女性的性赋权与 LARC 之间没有显著关系。因此，有必要根据教育女性关于 LARC 的益处和潜在副作用的情况，规划 LARC 使用的干预措施。此外，还需要针对有性行为的女性增加 LARC 可及性的干预措施。
