Understanding contraceptive use behaviours among women with disabilities in low-resource settings in Ghana: a qualitative study.

Abstract

This qualitative study explores the contraceptive use behaviours among women with disabilities in low-resource settings in Ghana, a group whose reproductive health needs are often overlooked in mainstream family planning programmes. Sixteen women with visual, physical, and hearing impairments in Apam, Central Region, were purposively selected to participate in semi-structured in-depth interviews conducted in their preferred languages, including Ghanaian Sign Language. Reflexive thematic analysis was used to identify key patterns in the data, revealing four main themes: (1) pathways for acquiring contraceptive knowledge, which included institutional outreach, maternal health visits, and informal peer networks; (2) determinants of non-utilisation, such as fear of side effects, religious stigma, and the desire to have children for future caregiving support; (3) drivers of modern contraceptive uptake, including the pursuit of educational and vocational goals, partner support, and the desire to prevent obstetric trauma; and (4) structural and systemic health inequalities, characterised by communication barriers, inaccessible physical infrastructure, and inconsistent provider attitudes. The findings advance scientific knowledge by moving beyond a simple narrative of unmet need to illustrate how women with disabilities exercise reproductive agency within a complex landscape of intersecting personal, social, and structural constraints. The novel findings highlight the dual role of informal networks in disseminating both accurate information and persistent myths, as well as the nuanced ways in which fertility is viewed as a long-term survival strategy in the absence of robust social support. These insights inform policy by underscoring the urgent need for disability-inclusive family planning services. This requires a multi-pronged approach that includes accessible communication through sign language interpretation, disability-sensitivity training for healthcare workers, retrofitting health facilities to improve physical access, and linking contraceptive services with broader social protection programmes to address the root causes of non-use.