Why are so many pregnancies still unintended in Ghana? A closer look at factors influencing reproductive autonomy

Unintended pregnancy remains a major public health challenge globally, with particularly high prevalence in sub-Saharan Africa. In Ghana, despite improvements in reproductive health service delivery, unintended pregnancies persist. This study examined the prevalence and factors influencing unintended pregnancy among sexually active women in Ghana. The study used data from the 2017 Ghana Maternal Health Survey (GMHS), focusing on 1,453 sexually active women aged 15–49 years. Descriptive statistics, chi-square tests, and logistic regression models were employed to assess the prevalence and factors associated with unintended pregnancy. The prevalence of unintended pregnancy among participants was reported to be 57.9%. Multivariable analysis revealed that women aged 20–39 years were significantly more likely to experience unintended pregnancy compared to those aged 15–19 years. Women with primary education were less likely to report unintended pregnancies as compared to those with no education (aOR = 0.59, 95% CI: 0.42–0.82). Living with a partner (aOR = 1.68, 95% CI: 1.27–2.23) and residing in the Savannah region (aOR = 5.52, 95% CI: 3.93–7.76) were associated with higher odds of unintended pregnancy. Conversely, internet use (aOR = 0.48, 95% CI: 0.30–0.66) showed protective effects against unintended pregnancies. The study concludes that unintended pregnancy was highly prevalent among sexually active women in Ghana. The findings highlight that public health interventions should be specifically targeted towards women above 20 years, those living with partners, and residents in the Savannah region. The findings also revealed that targeted interventions could leverage the protective effects of internet use by expanding access to reproductive health information via digital platforms and improving educational attainment to reduce the burden of unintended pregnancies among sexually active women.