Bridging the Gap Between Awareness and Use: Adolescent Contraceptive Practices and Associated Barriers among Final Year Students in a Ghanaian Senior High School

Bridging the Gap Between Awareness and Use: Adolescent Contraceptive Practices and Associated Barriers among Final Year Students in a Ghanaian Senior High School | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Bridging the Gap Between Awareness and Use: Adolescent Contraceptive Practices and Associated Barriers among Final Year Students in a Ghanaian Senior High School Boafor Theodore K., Jemina Amoakoh, Abigail Charity Johnson-Ekeleba, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6667312/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Majority of adolescent births occur in the 15–19-year age group. Contraceptive use plays a crucial role in preventing unintended pregnancies, reducing adolescent birth rates, and improving reproductive health outcomes. Despite increasing awareness, contraceptive uptake among adolescents remains low in many settings, particularly in sub-Saharan Africa. This study assessed the knowledge, attitudes, and practices regarding contraception among adolescents at Tarkwa Senior High School in Ghana. Method A cross-sectional study was conducted among final-year students at Tarkwa Senior High School. Eligible final-year students were recruited through simple random sampling. A structured self-administered questionnaire was used to collect data on students’ sociodemographic characteristics, knowledge, attitudes, and use of contraceptives. The data was analyzed using SPSS version-27. Descriptive and inferential statistics were determined and p-value below 0.05 considered statistically significant. Results While all respondents (100%) had heard of contraception, only 2.9% had ever used a contraceptive method. The primary sources of information on contraception were teachers (52.4%), friends (21.4%), and health workers (10.7%). Pills (44.7%) and condoms (32.0%) were the most well-known contraceptive methods. However, misconceptions about contraceptives were common, with 24.3% of respondents believing that contraceptive use leads to promiscuity. The major barriers to contraceptive use included fear of side effects (62.1%), religious beliefs (20.4%), and partner or family opposition (7.8%). Conclusion Although adolescents at Tarkwa Senior High School exhibited high awareness of contraception, actual usage was remarkably low due to misconceptions, sociocultural barriers, and concerns about side effects. This highlights the need for comprehensive, adolescent-friendly reproductive health education and policies that ensure easier access to contraceptive services. Health sciences/Health care Health sciences/Medical research Contraception adolescents students knowledge attitude practice Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Despite the risks associated with adolescent pregnancies, various surveys indicate that sexually active adolescents, who are between the ages of 15 and 19, rarely use contraceptives (Chola et. al., 2022). ( 1 ) According to the World Health Organization (WHO), globally, prevention of adolescent pregnancy and early childbirth are critical healthcare issues ( 2 ) as approximately 21 million adolescent pregnancies are recorded worldwide each year, and almost half of these pregnancies being unintended, and a little over half result in induced abortions. ( 3 ) Nearly a quarter of all adolescent births occur in Africa, and in addition, about 1.2 billion adolescents are between the ages of 15 to19 years, and about 86% of them live in developing countries. ( 4 ) The need for contraception is still great, and in Africa, approximately 24.2% of women who are of reproductive age lack access to it. ( 5 ) According to Munakampe et., approximately, 60% of adolescents have an unmet need for modern contraception and they risk getting unintended pregnancies that may result in induced abortions, whereas half of the women aged, 15 to 19 are victims of unintended pregnancies on a global map, with 46% of them living in Africa. ( 6 ) Adolescent pregnancies occur in areas with low contraceptive prevalence ( 7 ) and Sub-Saharan Africa has the lowest contraceptive demand and use among adolescents. ( 8 ) Contraceptive use plays a crucial role in reducing unintended pregnancies, unsafe abortions, and adolescent birth rates, all of which are significant public health concerns globally. According to the World Health Organization (WHO), approximately 21 million adolescent pregnancies occur worldwide annually, nearly half of which are unintended, with a significant proportion resulting in induced abortions. ( 3 ) Adolescent pregnancies are particularly prevalent in sub-Saharan Africa, where contraceptive access remains limited. Ghana, like many countries in the region, continues to experience high rates of teenage pregnancies, which contribute to school dropouts, maternal health complications, and socio-economic burdens. ( 9 ) Despite the availability of both modern and traditional contraceptive methods, uptake among adolescents remains low due to multiple barriers. Sub-Saharan Africa has one of the lowest contraceptive prevalence rates, with less than 30% of women using modern contraceptive methods. ( 10 ) Research indicates that misconceptions about contraception, societal stigma, partner or parental disapproval, and financial constraints contribute significantly to low usage rates. ( 11 ) In Ghana, studies suggest that while most adolescents are aware of contraception, many lack comprehensive knowledge about its various forms and effectiveness, leading to inconsistent or incorrect use. ( 12 ) Contraceptive methods are broadly categorized into traditional and modern methods. Traditional methods include withdrawal, lactational amenorrhea, and calendar-based methods, while modern methods encompass condoms, oral contraceptive pills, injectables, intrauterine devices (IUDs), implants, and sterilization (Jain et al., 2020). However, despite their effectiveness, the uptake of modern contraceptive methods among adolescents is hindered by factors such as misinformation, cultural taboos, and fear of side effects. ( 13 ). In Ghana, many adolescents rely on informal sources, such as peers, social media, and unverified online platforms, for contraceptive information, which often leads to misconceptions. ( 14 ) A study in Kintampo, Ghana, revealed high rates of inconsistent contraceptive use among teenagers, with many engaging in unprotected sex due to misconceptions or social pressures. ( 15 ) Religious and cultural beliefs further restrict contraceptive access, as many communities perceive contraception as encouraging promiscuity rather than as a means of responsible family planning. ( 16 ) The lack of accurate reproductive health education and the persistence of barriers to contraceptive access underscore the need for targeted interventions. Adolescents who lack access to contraception face higher risks of dropping out of school, suffering from unsafe abortions, and experiencing long-term economic hardships. ( 2 ) Understanding adolescents’ knowledge, attitudes, and practices regarding contraception is crucial for designing effective educational programs and health policies to improve contraceptive uptake and reduce adolescent pregnancies in Ghana. This study, therefore, sought to assess the level of contraceptive knowledge among final-year students at Tarkwa Senior High School, exploring their awareness of different contraceptive methods, sources of information, and misconceptions. It also examined adolescents’ attitudes toward contraception, as well as contraceptive use among sexually active students, focusing on the factors that deterred or encouraged uptake. METHOD AND MATERIALS Study Design and Setting This study employed a cross-sectional design to assess the knowledge, attitudes, and practices of contraception among adolescents at Tarkwa Senior High School. Tarkwa is the capital of the Tarkwa-Nsuaem Municipality in Ghana, known for its mining activities. The municipality has a high adolescent pregnancy rate, with 901 reported from January-June 2021, 63.7% of whom were aged 15–19 years in secondary school final year with many teenage girls becoming pregnant before completing secondary education. The study was conducted at Tarkwa Senior High School, the largest senior high school in the municipality, with a diverse student population from different socioeconomic backgrounds with 355 students in the final year. Study Population and Sampling The study population comprised final-year students aged 15–19 years at Tarkwa Senior High School. A simple random sampling technique was used to select participants who met the inclusion criteria ensuring a representative distribution across different courses of study. Data Collection A structured self-administered questionnaire was used to collect data on participants’ sociodemographic characteristics, knowledge of contraceptives, attitudes toward contraception, and contraceptive usage. The questionnaire was pre-tested to ensure clarity and reliability. Participants were given detailed instructions on how to complete the survey, and confidentiality was maintained throughout the process. Data Analysis Data were analyzed using IBM SPSS version 27. Descriptive statistics such as frequencies and percentages were used to summarize categorical variables. Mean and standard deviation were used for continuous variables. Associations between sociodemographic characteristics and contraceptive knowledge, attitudes, and practices were assessed using the chi-square test. A p-value of less than 0.05 was considered statistically significant. Ethical Considerations Ethical approval for this study was obtained from the Community Health Department of the Family Health Medical School. Permission was also granted by the Tarkwa Senior High School administration. Informed consent was obtained from the participants’ parents and/or legal guardians for study participation. Assent was also given by each participant, ensuring their confidentiality and voluntary participation. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Data collected were anonymized to protect respondents’ privacy. RESULTS A total of 100 final-year students aged 15-19 years from Tarkwa Senior High School participated in the study. Most participants (66.0%) were female, while 34.0% were male. The age distribution showed that most participants (47.0%) were 17 years old, followed by 18-year-olds (39.0%). A smaller proportion of respondents were aged 15 (5.0%), 16 (5.0%), and 19 (9.0%) years. Regarding religious affiliation, Christianity was the predominant faith (65.0%), followed by Islam (32.0%), while a small fraction identified with other beliefs. The respondents were enrolled in different academic programs, with 43.0% studying General Arts, 23.0% Business, 20.0% General Science, 11.0% Home Economics, and 3.0% Visual Arts. Table 1: Socio-Demographic Characteristics of Participants VARIABLES FREQUENCY PERCENTAGE GENDER Male 32 32.0 Female n AGE 15 16 17 18 19 68 _ 5 47 39 9 68.0 _ 5.0 47.0 39.0 9.0 RELIGION Christian Muslim Traditionalist Others 67 33 _ _ 67.0 33.0 _ _ COURSE OF STUDY Business General science General arts Home economics Visual arts 23 20 43 11 3 23.0 20.0 43.0 11.0 3.0 STAYING WITH Mother Father Both Parents Guardian Alone 3 9 56 32 _ 3.0 9.0 56.0 32.0 _ EDUCATIONAL BACKGROUND OF FATHER None Primary JHS SHS Tertiary EDUCATIONAL BACKGROUND OF MOTHER None Primary JHS SHS Tertiary 1 3 12 84 5 3 17 62 13 1.0 3.0 12.0 84.0 5.0 3.0 17.0 62.0 13.0 OCCUPATION OF FATHER Miner Teacher Trader Carpenter General officer Engineer Immigration officer Driver Accountant 42 20 4 1 15 1 12 3 1 42.0 20.0 4.0 1.0 15.0 1.0 12.0 3.0 1.0 OCCUPATION OF MOTHER None Trader Business woman Fishmonger 2 69 11 5 2.0 69.0 11.0 5.0 Farmer Seamstress Baker 3 8 2 3.0 8.0 2.0 HOBBIES Playing Reading Listening to music Singing 35 9 50 6 35.0 9.0 50.0 6.0 TOTAL 100 100.0 Source: Field Survey, 2022 Most respondents (56.0%) lived with both parents, while 32.0% lived with guardians, and a smaller proportion lived with either their mother (3.0%) or father (9.0%) alone. The educational background of parents varied, with 84.0% of fathers and 62.0% of mothers having attained tertiary education. Regarding participants’ parents’ occupations, 42.0% of fathers were miners, while 69.0% of mothers were traders. (Table 1) Knowledge of Contraception All respondents (100%) reported having heard about contraception. The primary sources of information were teachers (54.0%), followed by friends (22.0%) and health workers (11.0%). Other sources included radio (9.0%) and partners (4.0%). (Figure 1) When asked to identify known contraceptive methods, the majority (46.0%) mentioned oral contraceptive pills, while 33.0% identified condoms, and 21.0% knew about intrauterine devices (IUDs). Other contraceptive methods, such as injectables, implants, and emergency contraceptives, were little known and mentioned. (Figure 2) Regarding access to contraceptives, 71.0% of respondents knew that hospitals or clinics provided contraceptive services, while 15.0% identified pharmacies as sources. However, 14.0% of respondents did not know where to obtain contraceptives. (Table 2) Despite their awareness, some misconceptions about contraception persisted. While 77.7% correctly stated that contraceptive use did not provide complete protection against pregnancy, 19.4% believed it did, highlighting gaps in comprehensive knowledge. Table 2. Participants’ knowledge of where to access contraceptives. Variables Frequency Percentage Hospital/ clinic 71 70.0 Pharmacy 15 15.0 None 14 14.0 Total 100 100.0 Source: Field Data, 2022 Attitudes Toward Contraception Participants expressed diverse attitudes toward contraception. While 75.0% disagreed with the notion that contraceptive use leads to promiscuity, 25.0% believed that women who use contraceptives were more likely to engage in promiscuous behavior. The role of sex education in influencing contraceptive use was also examined and revealed that 40.0% of respondents believed sex education influenced contraceptive behavior among their peers, and 60.0% reported that it had no impact. This suggests that while sex education was prevalent, its effectiveness in shaping contraceptive-related behavior remained questionable. Most respondents (69.0%) reported not receiving sex education at home, while 31.0% stated that their parents provided some form of reproductive health discussions. In contrast, 96.1% of respondents indicated that they had engaged in sex-related discussions with their peers, highlighting the significant role of informal peer education. Contraceptive Use and Barriers to Uptake Despite high awareness, actual contraceptive use was remarkably low among respondents. None of the participants had used contraception during their first sexual encounter, and only 3.0% reported ever using a contraceptive method. Among the small percentage who had used contraception, pills (1.0%), female condoms (1.0%), and male condoms (1.0%) were mentioned. Also, only 3.0% reported current use of a contraceptive method, while the remaining 94.2% stated they do not use any form of contraception. (Figure 3) The study identified several key barriers to contraceptive use. (Figure 4) The most frequently cited reason was fear of side effects (62.1%), with respondents expressing concerns about potential health complications associated with contraceptive use. Religious beliefs (20.4%) also played a significant role in deterring contraceptive use, as many participants indicated that their faith discouraged family planning methods. (Figure 4) Other reported barriers included opposition from partners or family members (7.8%), the high cost of contraceptives (3.9%), and ‘negative counseling’ from health providers (1.0%). A small proportion of respondents (2.6%) cited the attitudes of healthcare workers as a deterrent, indicating that judgmental behavior from service providers discouraged them from seeking contraception. Gender and Pressure for Unprotected Sex An independent t-test was conducted to compare the experiences of pressure for unprotected sex between male and female respondents. The results indicated that female students experienced significantly higher levels of pressure to engage in unprotected sex compared to their male counterparts (p = 0.167). This finding suggested a gender imbalance in sexual decision-making, with females being more vulnerable to coercion or partner influence. (Table 3) Table 3: Comparing means between gender and pressure for unprotected sex Variables N Mean SD df t p Male 32 1.0938 .29614 98 -1.392 .167 Female 68 -1.2059 .40735 Source: Field Data, 2022 DISCUSSION This study examined the knowledge, attitudes, and practices regarding contraception among final-year students at Tarkwa Senior High School. The findings revealed a significant disparity between awareness and actual use, highlighting various sociocultural, religious, and systemic barriers to contraceptive uptake. The study found that all participants had heard about contraception, with teachers being the most common source of information (52.4%), followed by friends (21.4%) and health workers (10.7%). This finding aligns with previous studies that emphasize the critical role of formal education in providing reproductive health information to adolescents. ( 9 ) However, the substantial reliance on peers as a source of contraceptive knowledge raises concerns as peer-shared information may be inaccurate or misleading. ( 14 ) Although contraceptive awareness was universal, the depth of knowledge varied among participants. Oral contraceptive pills (44.7%) and condoms (32.0%) were the most well-known methods, while less than a quarter of participants (20.4%) were aware of intrauterine devices (IUDs). These findings are consistent with previous studies by Hagan et al, who reported condom (42.3%) and the pill (24.3%) as the commonest known methods. These consistently indicate that adolescents are more familiar with short-term contraceptive methods, while long-term and provider-dependent methods, such as IUDs and implants, are less well known. ( 12 ) The limited knowledge of long-term methods may contribute to the low uptake of these more effective options among adolescents. Misconceptions about contraceptive efficacy were also evident, with 19.4% of participants believing that contraceptives provided 100% protection against pregnancy. This suggests a lack of comprehensive sexual education that adequately addresses these important knowledge gaps and promotes proper use of contraceptive methods with adequate awareness of their levels of effectiveness. Similar misconceptions have been documented in other studies, where adolescents overestimated the effectiveness of certain methods or failed to understand the importance of consistent use. ( 13 ) Attitudes Toward Contraception The study revealed mixed attitudes toward contraceptive use. While a majority of respondents (72.8%) disagreed with the idea that contraceptive use leads to promiscuity, a notable proportion (24.3%) still believed that women who use contraceptives are more likely to engage in promiscuous behavior. This belief reflects deeply rooted cultural and religious stigmas that associate contraception with immorality rather than responsible reproductive health management. ( 16 ) Studies in Ghana and other African contexts have shown that such stigmatization discourages contraceptive use, particularly among young women who fear being judged by their communities. ( 11 ) The study also examined the role of sex education in influencing contraceptive behavior. Although 38.8% of respondents believed that sex education influenced contraceptive use, 58.3% reported that it had no impact on their behavior. This suggests that while sex education is present, it may not be sufficiently engaging or persuasive. Similar findings have been reported in other studies, where adolescents expressed skepticism about the relevance of formal sex education due to its abstract nature or moralistic tone. ( 2 ) The low percentage of respondents (30.1%) who received sex education at home further highlights the gap in parental involvement in adolescent reproductive health discussions. Interestingly, peer influence appeared to play a dominant role in shaping adolescents’ sexual health perceptions, as 96.1% of respondents reported discussing sex-related topics with friends. While peer education can be beneficial, it also poses risks if the information exchanged is inaccurate. Previous studies have shown that peer influence is often a double-edged sword, capable of either reinforcing positive reproductive health behaviors or spreading misinformation. ( 15 ) Contraceptive Use and Barriers to Uptake Despite the high level of awareness, contraceptive use among participants was alarmingly low. None of the respondents reported using contraception during their first sexual encounter, and only 2.9% had ever used a contraceptive method. This finding aligns with previous research indicating that awareness does not necessarily translate into use due to various barriers, including fear of side effects, social stigma, and limited accessibility. ( 12 ) The most frequently cited barrier to contraceptive use was fear of side effects (62.1%). Respondents expressed concerns about potential health complications, which were often based on misconceptions rather than medical evidence. This aligns with studies showing that exaggerated fears, such as infertility, excessive bleeding, and hormonal imbalances, often deter adolescents from using contraceptives. ( 5 ) Addressing these fears through medically accurate counseling and community-based and school-based educational awareness programmes could significantly improve contraceptive uptake. Religious beliefs also play a significant role, with 20.4% of respondents citing faith-based opposition to contraception. Religious and cultural norms in Ghana often emphasize abstinence over contraceptive use, reportedly contributing to the stigma surrounding family planning services. ( 13 ) However, other studies suggest that integrating contraceptive education into faith-based discussions could help bridge the gap between religious teachings and reproductive health needs. ( 16 ) Partner or family opposition (7.8%) also emerged as a barrier, suggesting that adolescent reproductive health decisions are often influenced by external pressures. Research has shown that young women, in particular, may face opposition from partners who equate contraceptive use with infidelity or from parents who believe contraception encourages early sexual activity. ( 14 ) Addressing these societal pressures requires a multifaceted approach that involves community engagement, gender-sensitive education, and policy interventions. Additionally, the high cost of contraceptives (3.9%) and negative attitudes from healthcare providers (2.6%) were identified as obstacles. While Ghana provides some family planning services at subsidized rates, accessibility remains a challenge, particularly for adolescents who may lack financial independence. Healthcare providers’ judgmental attitudes have also been documented in previous studies as deterrents to contraceptive access. ( 12 ) Establishing adolescent-friendly clinics with trained, non-judgmental staff could significantly improve service utilization. Gender and Pressure for Unprotected Sex The study also examined gender differences in experiences of pressure for unprotected sex. The findings indicated that female students reported significantly higher levels of pressure compared to their male counterparts. This result aligns with global research that highlights gendered power imbalances in sexual relationships, where young women often have less control over sexual decision-making. ( 1 ) The implications of this finding are profound, as it suggests that female adolescents may engage in unprotected sex due to coercion or fear of relationship conflict, thereby increasing their vulnerability to unintended pregnancies and sexually transmitted infections (STIs). Addressing these gendered disparities requires comprehensive reproductive health interventions that empower young women to make informed choices about their sexual health. Programs that focus on gender equality, consent education, and assertiveness training could help mitigate the pressure young women face in negotiating contraceptive use. The findings of this study are consistent with existing literature on adolescent contraceptive use in sub-Saharan Africa. Studies across the region have repeatedly shown that high levels of awareness do not necessarily correlate with high levels of use due to sociocultural, religious, and systemic barriers. ( 4 ) The role of misconceptions, stigma, and gendered power dynamics in reproductive health decision-making has also been well-documented. ( 13 ) However, this study adds to the body of knowledge by providing localized insights into the specific barriers faced by Ghanaian adolescents. The findings highlight the urgent need for targeted interventions, including improved sex education, community-based awareness campaigns, and policy reforms to enhance adolescent-friendly reproductive health services. Implications for Policy and Practice The results of this study underscore the need for a multi-pronged approach to improving contraceptive understanding and uptake among adolescents in Ghana. These may be achieved through the following policy recommendations: Integrating Comprehensive Sexual Education into regular School Curricula – Programs should address misconceptions, emphasize contraceptive effectiveness, and encourage informed decision-making. Strengthening Adolescent-Friendly Health Services – Healthcare providers should receive training to offer non-judgmental, youth-friendly contraceptive counseling. Community Engagement Initiatives – Working with parents, religious leaders, and traditional authorities can help change societal attitudes toward contraception. Addressing Gender-Based Power Imbalances – Empowering young women through consent education and assertiveness training can help reduce pressure for unprotected sex. By implementing these interventions, Ghana can make significant strides in improving adolescent reproductive health outcomes and reducing unintended pregnancies. Limitations And Recommendations: The relatively small sample size and single-site focus may limit the generalizability of findings to a broader adolescent population in Ghana. Additionally, reliance on self-reported data may have introduced social desirability bias, affecting the accuracy of responses. The cross-sectional design restricted the ability to assess changes in contraceptive knowledge and behavior over time. Furthermore, the study excluded out-of-school adolescents, whose contraceptive knowledge and access may differ. While healthcare provider attitudes were identified as a barrier, the study did not extensively explore adolescents’ direct experiences with healthcare services. To address these limitations, future research should use larger, multi-site samples that include both in-school and out-of-school adolescents. A mixed-methods approach incorporating qualitative insights could provide a deeper understanding of societal and personal influences on contraceptive use. Additionally, strengthening adolescent-friendly reproductive health services and improving sexual education programs could help bridge the gap between knowledge and practice. CONCLUSION This study found that while senior high school adolescents demonstrated high awareness of contraception, actual use was significantly low. Although teachers, friends, and health workers were key sources of contraceptive knowledge, misconceptions about contraceptive efficacy and concerns about side effects persisted. Additionally, religious beliefs, societal stigma, and partner opposition constitute major barriers to contraceptive use. Given the high adolescent pregnancy rate in Ghana, these findings underscore the urgent need for targeted interventions to improve contraceptive acceptance and utilization. Recommendations To improve adolescent contraceptive uptake in Ghana and similar settings, multi-sector efforts should focus on: Strengthening Comprehensive Sexual Education: Schools should integrate more in-depth and practical reproductive health education that addresses misconceptions about contraception. Providing Adolescent-Friendly Health Services: Health facilities should be equipped with trained professionals who can offer confidential, non-judgmental contraceptive counseling. Addressing Societal and Religious Barriers: Community-based sensitization programs should involve parents, religious leaders, and policymakers to foster a supportive environment for adolescent contraceptive access. Policy Reforms to Improve Accessibility: The government should consider subsidizing contraceptives and removing restrictive policies that hinder adolescent access to reproductive health services. By implementing these measures, Ghana can improve adolescent reproductive health outcomes and reduce unintended pregnancies, school dropouts, and unsafe abortions among young people. Declarations ETHICAL APPROVAL: This study was approved by the Family Health Medical School Ethical and Protocol Review Committee. The study was conducted in accordance with the fundamental ethical principles outlined in the Family Health medical School Ethics Policy, which encompasses the Declaration of Helsinki (1996), International Conference on Harmonization Good Clinical Practice (ICH GCP E6) Guidelines, Council for International Organizations of Medical Sciences (CIOMS) principles, the Belmont Report, and applicable laws and statutory regulations of Ghana and the University. By adhering to these esteemed guidelines, we ensured the highest ethical standards in the design, implementation, and reporting of our research. HUMAN ETHICS AND CONSENT TO PARTICIPATE: The research methodology, data collection, analysis, and reporting processes have been carried out with full compliance to the above ethical standards. All necessary approvals and participants’ informed consents have been obtained, and the rights and confidentiality of all participants have been safeguarded. CONFLICT OF INTEREST The authors declare no conflicts of interest related to this study. FUNDING This study received no funding. DATA AVAILABILITY The data supporting the findings of this study are available within the article and its supplementary materials. Additional data are available from the corresponding author upon reasonable request from the corresponding author. AUTHORS’ CONTRIBUTIONS: AJ and SPE conceived the research idea and drafted the initial study protocol. AJ and BTK supervised the data collection and the analysis. AJ, JEAC, and SPE drafted the initial manuscript. BTK and KM reviewed the manuscript. All authors read through and approved the final manuscript for submission. SPE is the corresponding author. References Chola, L., McGee, S., Tugendhaft, A., Buchmann, E. & Hofman, K. Scaling up contraceptive access in low-resource settings: The importance of addressing barriers. Global Health Action . 15 (1), 1–10 (2022). World Health Organization. World Health Statistics (2014). Hall, K. S. The impact of adolescent pregnancy and childbearing on developing countries. J. Adolesc. Health . 60 (3), 231–237 (2017). Melesse, D. Y. et al. Adolescent sexual and reproductive health in sub-Saharan Africa: Who is left behind? BMJ Global Health ; 5 (1), e002231. (2020). Jain, A. & Singh, S. Contraceptive methods: A global review. Lancet 395 (10224), 1697–1709 (2020). Munakampe, M. N., Zulu, J. M. & Michelo, C. Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries: a systematic review. BMC Health Serv Res. ;18(1):909. (2018). 10.1186/s12913-018-3722-5 . Erratum in: BMC Health Serv Res. 2019;19(1):441. doi: 10.1186/s12913-019-4297-5. PMID: 30497464; PMCID: PMC6267062. Chimah, U. C., Lawoyin, T. O., Ilika, A. L. & Nnebue, C. C. Contraceptive knowledge and practice among senior secondary school students in military barracks in Nigeria. Nigerian Journal of Clinical Practice ; 19(2):p 182–188, Mar–Apr 2016. | (2016). 10.4103/1119-3077.175970 Dennis, M. L. et al. Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda. Reprod. Health . 14 , 130. https://doi.org/10.1186/s12978-017-0393-3 (2017). Awusabo-Asare, K., Biddlecom, A., Kumi-Kyereme, A. & Patterson, K. Adolescent Sexual and Reproductive Health in Ghana: Results from the 2004 National Survey of Adolescents, Occasional Report (Guttmacher Institute, 2006). No. 22. Cape Coast. Cates, W. Family Planning: he essential link to achieving all eight Millennium Development Goals. Contraception 81 (6), 460–461 (2010). Nwaozuru, U., Doat, A. R., Iwelunmor, J. & Airhihenbuwa, C. O. Factors influencing contraceptive use among adolescents in sub-Saharan Africa: A systematic review. Reproductive Health . 14 (1), 1–14 (2017). Hagan, J. E. & Buxton, C. Contraceptive knowledge, perceptions and use among adolescents in selected senior high schools in the central region of Ghana. J. Sociol. Res. 3 (2), 170–180 (2012). Sedgh, G. et al. Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet 379 (9816), 625–632 (2012). Biddlecom, A., Munthali, A., Singh, S. & Woog, V. Adolescents’ views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi, and Uganda. Afr. J. Reprod. Health . 23 (3), 23–35 (2019). Boamah, E. A. et al. Use of contraceptives among adolescents in Kintampo, Ghana: a cross-sectional study. Open. Access. J. Contracept. 5 , 7–15. https://doi.org/10.2147/OAJC.S56485 (2014). Donna Clifton, T., Kaneda & Ashford, L. Family Planning Worldwide 2008 (Population Reference Bureau, 2008). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 26 Apr, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviews received at journal 09 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers invited by journal 03 Sep, 2025 Editor assigned by journal 02 Sep, 2025 Editor invited by journal 29 May, 2025 Submission checks completed at journal 29 May, 2025 First submitted to journal 14 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6667312","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":510095168,"identity":"14b78661-5743-4510-a793-bc5398d224c4","order_by":0,"name":"Boafor Theodore K.","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Boafor","middleName":"Theodore","lastName":"K.","suffix":""},{"id":510095172,"identity":"ded51703-38da-4206-827b-9b22dd503beb","order_by":1,"name":"Jemina Amoakoh","email":"","orcid":"","institution":"Ghana Health Service","correspondingAuthor":false,"prefix":"","firstName":"Jemina","middleName":"","lastName":"Amoakoh","suffix":""},{"id":510095177,"identity":"3919a522-e4af-4efe-8b09-14e859b5e21a","order_by":2,"name":"Abigail Charity Johnson-Ekeleba","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"Charity","lastName":"Johnson-Ekeleba","suffix":""},{"id":510095178,"identity":"ccb87b46-4ccb-4513-9842-5f5f0439d81c","order_by":3,"name":"Kareem Mumuni","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Kareem","middleName":"","lastName":"Mumuni","suffix":""},{"id":510095180,"identity":"2809a145-c515-4c47-bb9b-d396c688cc2a","order_by":4,"name":"Promise Emmanuel Sefogah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBADOQMwZWBBvBZjAwZmkBYJ4rUkbgBrYSBCi7n04aMbPlTUpW9n7z+64UeBBAN/e3cCXi2WfWlpN2ecOZy7s+cw280eoMMkzpzdgFeLwRkes9u8bQdyN9xIZrvBA9RiIJFLhJa//+rSDYBabv4hWgtjA3MCSMttomyx7GFLu9lz7LDhhjOHzW7LGEjwEPSLOQ/zsRs/aurkDY43Prv55o+NHH97LwGHoQvw4FWOVcsoGAWjYBSMAgwAAKOUR65wgoWLAAAAAElFTkSuQmCC","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":true,"prefix":"","firstName":"Promise","middleName":"Emmanuel","lastName":"Sefogah","suffix":""}],"badges":[],"createdAt":"2025-05-14 21:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6667312/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6667312/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90921885,"identity":"82a079db-bf71-4b1c-916d-a01060329285","added_by":"auto","created_at":"2025-09-09 14:58:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122530,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-6667312/v1/f7e31d1adb1a362b5952e3f6.png"},{"id":90921886,"identity":"164fdb11-c5c4-427d-a2bd-b56e49952cd4","added_by":"auto","created_at":"2025-09-09 14:58:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104791,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6667312/v1/ddca9efd627c878d2a285cf0.png"},{"id":90921887,"identity":"fe83fa77-c785-4c37-8fcf-fd034b39998d","added_by":"auto","created_at":"2025-09-09 14:58:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":102737,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6667312/v1/ce7e82229d4bba3eaff0a0ef.png"},{"id":90923236,"identity":"fc8f4b53-d9a9-4f5b-bd7d-0e47c8ccaab2","added_by":"auto","created_at":"2025-09-09 15:14:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":126853,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6667312/v1/917cf9b070bec4acf9527a4c.png"},{"id":90924480,"identity":"0c78f6c3-5280-4aa2-a7b8-44350a0e9bab","added_by":"auto","created_at":"2025-09-09 15:22:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":951368,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6667312/v1/985aa24a-6f39-4f50-9cb3-ebf3a51ebf0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging the Gap Between Awareness and Use: Adolescent Contraceptive Practices and Associated Barriers among Final Year Students in a Ghanaian Senior High School","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDespite the risks associated with adolescent pregnancies, various surveys indicate that sexually active adolescents, who are between the ages of 15 and 19, rarely use contraceptives (Chola et. al., 2022). (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAccording to the World Health Organization (WHO), globally, prevention of adolescent pregnancy and early childbirth are critical healthcare issues (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) as approximately 21\u0026nbsp;million adolescent pregnancies are recorded worldwide each year, and almost half of these pregnancies being unintended, and a little over half result in induced abortions. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Nearly a quarter of all adolescent births occur in Africa, and in addition, about 1.2\u0026nbsp;billion adolescents are between the ages of 15 to19 years, and about 86% of them live in developing countries. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The need for contraception is still great, and in Africa, approximately 24.2% of women who are of reproductive age lack access to it. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAccording to Munakampe et., approximately, 60% of adolescents have an unmet need for modern contraception and they risk getting unintended pregnancies that may result in induced abortions, whereas half of the women aged, 15 to 19 are victims of unintended pregnancies on a global map, with 46% of them living in Africa. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAdolescent pregnancies occur in areas with low contraceptive prevalence (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and Sub-Saharan Africa has the lowest contraceptive demand and use among adolescents. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Contraceptive use plays a crucial role in reducing unintended pregnancies, unsafe abortions, and adolescent birth rates, all of which are significant public health concerns globally. According to the World Health Organization (WHO), approximately 21\u0026nbsp;million adolescent pregnancies occur worldwide annually, nearly half of which are unintended, with a significant proportion resulting in induced abortions. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Adolescent pregnancies are particularly prevalent in sub-Saharan Africa, where contraceptive access remains limited. Ghana, like many countries in the region, continues to experience high rates of teenage pregnancies, which contribute to school dropouts, maternal health complications, and socio-economic burdens. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite the availability of both modern and traditional contraceptive methods, uptake among adolescents remains low due to multiple barriers. Sub-Saharan Africa has one of the lowest contraceptive prevalence rates, with less than 30% of women using modern contraceptive methods. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Research indicates that misconceptions about contraception, societal stigma, partner or parental disapproval, and financial constraints contribute significantly to low usage rates. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) In Ghana, studies suggest that while most adolescents are aware of contraception, many lack comprehensive knowledge about its various forms and effectiveness, leading to inconsistent or incorrect use. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eContraceptive methods are broadly categorized into traditional and modern methods. Traditional methods include withdrawal, lactational amenorrhea, and calendar-based methods, while modern methods encompass condoms, oral contraceptive pills, injectables, intrauterine devices (IUDs), implants, and sterilization (Jain et al., 2020). However, despite their effectiveness, the uptake of modern contraceptive methods among adolescents is hindered by factors such as misinformation, cultural taboos, and fear of side effects. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Ghana, many adolescents rely on informal sources, such as peers, social media, and unverified online platforms, for contraceptive information, which often leads to misconceptions. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) A study in Kintampo, Ghana, revealed high rates of inconsistent contraceptive use among teenagers, with many engaging in unprotected sex due to misconceptions or social pressures. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Religious and cultural beliefs further restrict contraceptive access, as many communities perceive contraception as encouraging promiscuity rather than as a means of responsible family planning. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe lack of accurate reproductive health education and the persistence of barriers to contraceptive access underscore the need for targeted interventions. Adolescents who lack access to contraception face higher risks of dropping out of school, suffering from unsafe abortions, and experiencing long-term economic hardships. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Understanding adolescents\u0026rsquo; knowledge, attitudes, and practices regarding contraception is crucial for designing effective educational programs and health policies to improve contraceptive uptake and reduce adolescent pregnancies in Ghana.\u003c/p\u003e\u003cp\u003eThis study, therefore, sought to assess the level of contraceptive knowledge among final-year students at Tarkwa Senior High School, exploring their awareness of different contraceptive methods, sources of information, and misconceptions. It also examined adolescents\u0026rsquo; attitudes toward contraception, as well as contraceptive use among sexually active students, focusing on the factors that deterred or encouraged uptake.\u003c/p\u003e"},{"header":"METHOD AND MATERIALS","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\u003cp\u003eThis study employed a cross-sectional design to assess the knowledge, attitudes, and practices of contraception among adolescents at Tarkwa Senior High School. Tarkwa is the capital of the Tarkwa-Nsuaem Municipality in Ghana, known for its mining activities. The municipality has a high adolescent pregnancy rate, with 901 reported from January-June 2021, 63.7% of whom were aged 15\u0026ndash;19 years in secondary school final year with many teenage girls becoming pregnant before completing secondary education. The study was conducted at Tarkwa Senior High School, the largest senior high school in the municipality, with a diverse student population from different socioeconomic backgrounds with 355 students in the final year.\u003c/p\u003e\u003cp\u003eStudy Population and Sampling\u003c/p\u003e\u003cp\u003eThe study population comprised final-year students aged 15\u0026ndash;19 years at Tarkwa Senior High School. A simple random sampling technique was used to select participants who met the inclusion criteria ensuring a representative distribution across different courses of study.\u003c/p\u003e\u003cp\u003eData Collection\u003c/p\u003e\u003cp\u003eA structured self-administered questionnaire was used to collect data on participants\u0026rsquo; sociodemographic characteristics, knowledge of contraceptives, attitudes toward contraception, and contraceptive usage. The questionnaire was pre-tested to ensure clarity and reliability. Participants were given detailed instructions on how to complete the survey, and confidentiality was maintained throughout the process.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using IBM SPSS version 27. Descriptive statistics such as frequencies and percentages were used to summarize categorical variables. Mean and standard deviation were used for continuous variables. Associations between sociodemographic characteristics and contraceptive knowledge, attitudes, and practices were assessed using the chi-square test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eEthical Considerations\u003c/p\u003e\u003cp\u003eEthical approval for this study was obtained from the Community Health Department of the Family Health Medical School. Permission was also granted by the Tarkwa Senior High School administration. Informed consent was obtained from the participants\u0026rsquo; parents and/or legal guardians for study participation. Assent was also given by each participant, ensuring their confidentiality and voluntary participation. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Data collected were anonymized to protect respondents\u0026rsquo; privacy.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 100 final-year students aged 15-19 years from Tarkwa Senior High School participated in the study. Most participants (66.0%) were female, while 34.0% were male. The age distribution showed that most participants (47.0%) were 17 years old, followed by 18-year-olds (39.0%). A smaller proportion of respondents were aged 15 (5.0%), 16 (5.0%), and 19 (9.0%) years.\u003c/p\u003e\n\u003cp\u003eRegarding religious affiliation, Christianity was the predominant faith (65.0%), followed by Islam (32.0%), while a small fraction identified with other beliefs. The respondents were enrolled in different academic programs, with 43.0% studying General Arts, 23.0% Business, 20.0% General Science, 11.0% Home Economics, and 3.0% Visual Arts.\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-Demographic Characteristics of Participants\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eVARIABLES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eFREQUENCY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003ePERCENTAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eGENDER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eRELIGION\u003c/p\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eTraditionalist\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67.0\u003c/p\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003cp\u003e_\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eCOURSE OF STUDY\u003c/p\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003cp\u003eGeneral science\u003c/p\u003e\n \u003cp\u003eGeneral arts\u003c/p\u003e\n \u003cp\u003eHome economics\u003c/p\u003e\n \u003cp\u003eVisual arts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSTAYING WITH\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMother \u003c/p\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003cp\u003eBoth Parents\u003c/p\u003e\n \u003cp\u003eGuardian\u003c/p\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;_\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003cp\u003e56.0\u003c/p\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; _\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eEDUCATIONAL BACKGROUND OF FATHER\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEDUCATIONAL BACKGROUND OF MOTHER\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003cp\u003e62.0\u003c/p\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eOCCUPATION OF FATHER\u003c/p\u003e\n \u003cp\u003eMiner\u003c/p\u003e\n \u003cp\u003eTeacher\u003c/p\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003cp\u003eCarpenter\u003c/p\u003e\n \u003cp\u003eGeneral officer\u003c/p\u003e\n \u003cp\u003eEngineer\u003c/p\u003e\n \u003cp\u003eImmigration officer\u003c/p\u003e\n \u003cp\u003eDriver\u003c/p\u003e\n \u003cp\u003eAccountant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eOCCUPATION OF MOTHER\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003cp\u003eBusiness woman\u003c/p\u003e\n \u003cp\u003eFishmonger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e69.0\u003c/p\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eSeamstress\u003c/p\u003e\n \u003cp\u003eBaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHOBBIES\u003c/p\u003e\n \u003cp\u003ePlaying\u003c/p\u003e\n \u003cp\u003eReading\u003c/p\u003e\n \u003cp\u003eListening to music\u003c/p\u003e\n \u003cp\u003eSinging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eTOTAL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e100 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eSource: Field Survey, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMost respondents (56.0%) lived with both parents, while 32.0% lived with guardians, and a smaller proportion lived with either their mother (3.0%) or father (9.0%) alone. The educational background of parents varied, with 84.0% of fathers and 62.0% of mothers having attained tertiary education. Regarding participants\u0026rsquo; parents\u0026rsquo; occupations, 42.0% of fathers were miners, while 69.0% of mothers were traders. (Table 1)\u003c/p\u003e\n\u003cp\u003eKnowledge of Contraception\u003c/p\u003e\n\u003cp\u003eAll respondents (100%) reported having heard about contraception. The primary sources of information were teachers (54.0%), followed by friends (22.0%) and health workers (11.0%). Other sources included radio (9.0%) and partners (4.0%). (Figure 1)\u003c/p\u003e\n\u003cp\u003eWhen asked to identify known contraceptive methods, the majority (46.0%) mentioned oral contraceptive pills, while 33.0% identified condoms, and 21.0% knew about intrauterine devices (IUDs). Other contraceptive methods, such as injectables, implants, and emergency contraceptives, were little known and mentioned. (Figure 2)\u003c/p\u003e\n\u003cp\u003eRegarding access to contraceptives, 71.0% of respondents knew that hospitals or clinics provided contraceptive services, while 15.0% identified pharmacies as sources. However, 14.0% of respondents did not know where to obtain contraceptives. (Table 2)\u003c/p\u003e\n\u003cp\u003eDespite their awareness, some misconceptions about contraception persisted. While 77.7% correctly stated that contraceptive use did not provide complete protection against pregnancy, 19.4% believed it did, highlighting gaps in comprehensive knowledge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Participants\u0026rsquo; knowledge of where to access contraceptives. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Frequency \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eHospital/ clinic \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;71 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003ePharmacy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eNone \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;14 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eTotal \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSource: Field Data, 2022\u003c/p\u003e\n\u003cp\u003eAttitudes Toward Contraception\u003c/p\u003e\n\u003cp\u003eParticipants expressed diverse attitudes toward contraception. While 75.0% disagreed with the notion that contraceptive use leads to promiscuity, 25.0% believed that women who use contraceptives were more likely to engage in promiscuous behavior.\u003c/p\u003e\n\u003cp\u003eThe role of sex education in influencing contraceptive use was also examined and revealed that 40.0% of respondents believed sex education influenced contraceptive behavior among their peers, and 60.0% reported that it had no impact. This suggests that while sex education was prevalent, its effectiveness in shaping contraceptive-related behavior remained questionable.\u003c/p\u003e\n\u003cp\u003eMost respondents (69.0%) reported not receiving sex education at home, while 31.0% stated that their parents provided some form of reproductive health discussions. In contrast, 96.1% of respondents indicated that they had engaged in sex-related discussions with their peers, highlighting the significant role of informal peer education.\u003c/p\u003e\n\u003cp\u003eContraceptive Use and Barriers to Uptake\u003c/p\u003e\n\u003cp\u003eDespite high awareness, actual contraceptive use was remarkably low among respondents. None of the participants had used contraception during their first sexual encounter, and only 3.0% reported ever using a contraceptive method. Among the small percentage who had used contraception, pills (1.0%), female condoms (1.0%), and male condoms (1.0%) were mentioned.\u003c/p\u003e\n\u003cp\u003eAlso, only 3.0% reported current use of a contraceptive method, while the remaining 94.2% stated they do not use any form of contraception. (Figure 3)\u003c/p\u003e\n\u003cp\u003eThe study identified several key barriers to contraceptive use. (Figure 4) The most frequently cited reason was fear of side effects (62.1%), with respondents expressing concerns about potential health complications associated with contraceptive use. Religious beliefs (20.4%) also played a significant role in deterring contraceptive use, as many participants indicated that their faith discouraged family planning methods. (Figure 4)\u003c/p\u003e\n\u003cp\u003eOther reported barriers included opposition from partners or family members (7.8%), the high cost of contraceptives (3.9%), and \u0026lsquo;negative counseling\u0026rsquo; from health providers (1.0%). A small proportion of respondents (2.6%) cited the attitudes of healthcare workers as a deterrent, indicating that judgmental behavior from service providers discouraged them from seeking contraception.\u003c/p\u003e\n\u003cp\u003eGender and Pressure for Unprotected Sex\u003c/p\u003e\n\u003cp\u003eAn independent t-test was conducted to compare the experiences of pressure for unprotected sex between male and female respondents. The results indicated that female students experienced significantly higher levels of pressure to engage in unprotected sex compared to their male counterparts (p = 0.167). This finding suggested a gender imbalance in sexual decision-making, with females being more vulnerable to coercion or partner influence. (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Comparing means between gender and pressure for unprotected sex\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; N \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mean \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; SD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;df \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;t \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; p\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eMale \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 32 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.0938 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; .29614 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;98 \u0026nbsp; \u0026nbsp; \u0026nbsp;-1.392 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; .167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 315px;\"\u003e\n \u003cp\u003eFemale \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 68 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-1.2059 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;.40735\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 337px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSource: Field Data, 2022\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the knowledge, attitudes, and practices regarding contraception among final-year students at Tarkwa Senior High School. The findings revealed a significant disparity between awareness and actual use, highlighting various sociocultural, religious, and systemic barriers to contraceptive uptake.\u003c/p\u003e\u003cp\u003eThe study found that all participants had heard about contraception, with teachers being the most common source of information (52.4%), followed by friends (21.4%) and health workers (10.7%). This finding aligns with previous studies that emphasize the critical role of formal education in providing reproductive health information to adolescents. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) However, the substantial reliance on peers as a source of contraceptive knowledge raises concerns as peer-shared information may be inaccurate or misleading. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAlthough contraceptive awareness was universal, the depth of knowledge varied among participants. Oral contraceptive pills (44.7%) and condoms (32.0%) were the most well-known methods, while less than a quarter of participants (20.4%) were aware of intrauterine devices (IUDs). These findings are consistent with previous studies by Hagan et al, who reported condom (42.3%) and the pill (24.3%) as the commonest known methods. These consistently indicate that adolescents are more familiar with short-term contraceptive methods, while long-term and provider-dependent methods, such as IUDs and implants, are less well known. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) The limited knowledge of long-term methods may contribute to the low uptake of these more effective options among adolescents.\u003c/p\u003e\u003cp\u003eMisconceptions about contraceptive efficacy were also evident, with 19.4% of participants believing that contraceptives provided 100% protection against pregnancy. This suggests a lack of comprehensive sexual education that adequately addresses these important knowledge gaps and promotes proper use of contraceptive methods with adequate awareness of their levels of effectiveness. Similar misconceptions have been documented in other studies, where adolescents overestimated the effectiveness of certain methods or failed to understand the importance of consistent use. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAttitudes Toward Contraception\u003c/p\u003e\u003cp\u003eThe study revealed mixed attitudes toward contraceptive use. While a majority of respondents (72.8%) disagreed with the idea that contraceptive use leads to promiscuity, a notable proportion (24.3%) still believed that women who use contraceptives are more likely to engage in promiscuous behavior. This belief reflects deeply rooted cultural and religious stigmas that associate contraception with immorality rather than responsible reproductive health management. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Studies in Ghana and other African contexts have shown that such stigmatization discourages contraceptive use, particularly among young women who fear being judged by their communities. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe study also examined the role of sex education in influencing contraceptive behavior. Although 38.8% of respondents believed that sex education influenced contraceptive use, 58.3% reported that it had no impact on their behavior. This suggests that while sex education is present, it may not be sufficiently engaging or persuasive. Similar findings have been reported in other studies, where adolescents expressed skepticism about the relevance of formal sex education due to its abstract nature or moralistic tone. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The low percentage of respondents (30.1%) who received sex education at home further highlights the gap in parental involvement in adolescent reproductive health discussions.\u003c/p\u003e\u003cp\u003eInterestingly, peer influence appeared to play a dominant role in shaping adolescents\u0026rsquo; sexual health perceptions, as 96.1% of respondents reported discussing sex-related topics with friends. While peer education can be beneficial, it also poses risks if the information exchanged is inaccurate. Previous studies have shown that peer influence is often a double-edged sword, capable of either reinforcing positive reproductive health behaviors or spreading misinformation. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eContraceptive Use and Barriers to Uptake\u003c/p\u003e\u003cp\u003eDespite the high level of awareness, contraceptive use among participants was alarmingly low. None of the respondents reported using contraception during their first sexual encounter, and only 2.9% had ever used a contraceptive method. This finding aligns with previous research indicating that awareness does not necessarily translate into use due to various barriers, including fear of side effects, social stigma, and limited accessibility. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe most frequently cited barrier to contraceptive use was fear of side effects (62.1%). Respondents expressed concerns about potential health complications, which were often based on misconceptions rather than medical evidence. This aligns with studies showing that exaggerated fears, such as infertility, excessive bleeding, and hormonal imbalances, often deter adolescents from using contraceptives. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Addressing these fears through medically accurate counseling and community-based and school-based educational awareness programmes could significantly improve contraceptive uptake.\u003c/p\u003e\u003cp\u003eReligious beliefs also play a significant role, with 20.4% of respondents citing faith-based opposition to contraception. Religious and cultural norms in Ghana often emphasize abstinence over contraceptive use, reportedly contributing to the stigma surrounding family planning services. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) However, other studies suggest that integrating contraceptive education into faith-based discussions could help bridge the gap between religious teachings and reproductive health needs. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003ePartner or family opposition (7.8%) also emerged as a barrier, suggesting that adolescent reproductive health decisions are often influenced by external pressures. Research has shown that young women, in particular, may face opposition from partners who equate contraceptive use with infidelity or from parents who believe contraception encourages early sexual activity. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Addressing these societal pressures requires a multifaceted approach that involves community engagement, gender-sensitive education, and policy interventions.\u003c/p\u003e\u003cp\u003eAdditionally, the high cost of contraceptives (3.9%) and negative attitudes from healthcare providers (2.6%) were identified as obstacles. While Ghana provides some family planning services at subsidized rates, accessibility remains a challenge, particularly for adolescents who may lack financial independence. Healthcare providers\u0026rsquo; judgmental attitudes have also been documented in previous studies as deterrents to contraceptive access. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Establishing adolescent-friendly clinics with trained, non-judgmental staff could significantly improve service utilization.\u003c/p\u003e\u003cp\u003eGender and Pressure for Unprotected Sex\u003c/p\u003e\u003cp\u003eThe study also examined gender differences in experiences of pressure for unprotected sex. The findings indicated that female students reported significantly higher levels of pressure compared to their male counterparts. This result aligns with global research that highlights gendered power imbalances in sexual relationships, where young women often have less control over sexual decision-making. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The implications of this finding are profound, as it suggests that female adolescents may engage in unprotected sex due to coercion or fear of relationship conflict, thereby increasing their vulnerability to unintended pregnancies and sexually transmitted infections (STIs). Addressing these gendered disparities requires comprehensive reproductive health interventions that empower young women to make informed choices about their sexual health. Programs that focus on gender equality, consent education, and assertiveness training could help mitigate the pressure young women face in negotiating contraceptive use.\u003c/p\u003e\u003cp\u003eThe findings of this study are consistent with existing literature on adolescent contraceptive use in sub-Saharan Africa. Studies across the region have repeatedly shown that high levels of awareness do not necessarily correlate with high levels of use due to sociocultural, religious, and systemic barriers. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The role of misconceptions, stigma, and gendered power dynamics in reproductive health decision-making has also been well-documented. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eHowever, this study adds to the body of knowledge by providing localized insights into the specific barriers faced by Ghanaian adolescents. The findings highlight the urgent need for targeted interventions, including improved sex education, community-based awareness campaigns, and policy reforms to enhance adolescent-friendly reproductive health services.\u003c/p\u003e\u003cp\u003eImplications for Policy and Practice\u003c/p\u003e\u003cp\u003eThe results of this study underscore the need for a multi-pronged approach to improving contraceptive understanding and uptake among adolescents in Ghana. These may be achieved through the following policy recommendations:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIntegrating Comprehensive Sexual Education into regular School Curricula \u0026ndash; Programs should address misconceptions, emphasize contraceptive effectiveness, and encourage informed decision-making.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStrengthening Adolescent-Friendly Health Services \u0026ndash; Healthcare providers should receive training to offer non-judgmental, youth-friendly contraceptive counseling.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCommunity Engagement Initiatives \u0026ndash; Working with parents, religious leaders, and traditional authorities can help change societal attitudes toward contraception.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAddressing Gender-Based Power Imbalances \u0026ndash; Empowering young women through consent education and assertiveness training can help reduce pressure for unprotected sex.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eBy implementing these interventions, Ghana can make significant strides in improving adolescent reproductive health outcomes and reducing unintended pregnancies.\u003c/p\u003e\u003cp\u003eLimitations And Recommendations:\u003c/p\u003e\u003cp\u003eThe relatively small sample size and single-site focus may limit the generalizability of findings to a broader adolescent population in Ghana. Additionally, reliance on self-reported data may have introduced social desirability bias, affecting the accuracy of responses. The cross-sectional design restricted the ability to assess changes in contraceptive knowledge and behavior over time. Furthermore, the study excluded out-of-school adolescents, whose contraceptive knowledge and access may differ. While healthcare provider attitudes were identified as a barrier, the study did not extensively explore adolescents\u0026rsquo; direct experiences with healthcare services.\u003c/p\u003e\u003cp\u003eTo address these limitations, future research should use larger, multi-site samples that include both in-school and out-of-school adolescents. A mixed-methods approach incorporating qualitative insights could provide a deeper understanding of societal and personal influences on contraceptive use. Additionally, strengthening adolescent-friendly reproductive health services and improving sexual education programs could help bridge the gap between knowledge and practice.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study found that while senior high school adolescents demonstrated high awareness of contraception, actual use was significantly low. Although teachers, friends, and health workers were key sources of contraceptive knowledge, misconceptions about contraceptive efficacy and concerns about side effects persisted. Additionally, religious beliefs, societal stigma, and partner opposition constitute major barriers to contraceptive use. Given the high adolescent pregnancy rate in Ghana, these findings underscore the urgent need for targeted interventions to improve contraceptive acceptance and utilization.\u003c/p\u003e\u003cp\u003eRecommendations\u003c/p\u003e\u003cp\u003eTo improve adolescent contraceptive uptake in Ghana and similar settings, multi-sector efforts should focus on:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStrengthening Comprehensive Sexual Education: Schools should integrate more in-depth and practical reproductive health education that addresses misconceptions about contraception.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProviding Adolescent-Friendly Health Services: Health facilities should be equipped with trained professionals who can offer confidential, non-judgmental contraceptive counseling.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAddressing Societal and Religious Barriers: Community-based sensitization programs should involve parents, religious leaders, and policymakers to foster a supportive environment for adolescent contraceptive access.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePolicy Reforms to Improve Accessibility: The government should consider subsidizing contraceptives and removing restrictive policies that hinder adolescent access to reproductive health services.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eBy implementing these measures, Ghana can improve adolescent reproductive health outcomes and reduce unintended pregnancies, school dropouts, and unsafe abortions among young people.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eETHICAL APPROVAL: This study was approved by the\u0026nbsp;Family Health Medical School Ethical and Protocol Review Committee. The study was conducted in accordance with the fundamental ethical principles outlined in the Family Health medical School Ethics Policy, which encompasses the Declaration of Helsinki (1996), International Conference on Harmonization Good Clinical Practice (ICH GCP E6) Guidelines, Council for International Organizations of Medical Sciences (CIOMS) principles, the Belmont Report, and applicable laws and statutory regulations of Ghana and the University. By adhering to these esteemed guidelines, we ensured the highest ethical standards in the design, implementation, and reporting of our research.\u003c/p\u003e\n\u003cp\u003eHUMAN ETHICS AND CONSENT TO PARTICIPATE: The research methodology, data collection, analysis, and reporting processes have been carried out with full compliance to the above ethical standards. \u0026nbsp;All necessary approvals and participants\u0026rsquo; informed consents have been obtained, and the rights and confidentiality of all participants have been safeguarded.\u003c/p\u003e\n\u003cp\u003eCONFLICT OF INTEREST\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this study.\u003c/p\u003e\n\u003cp\u003eFUNDING\u003c/p\u003e\n\u003cp\u003eThis study received no funding.\u003c/p\u003e\n\u003cp\u003eDATA AVAILABILITY\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the article and its supplementary materials. Additional data are available from the corresponding author upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003eAUTHORS\u0026rsquo; CONTRIBUTIONS:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAJ and SPE conceived the research idea and drafted the initial study protocol. AJ and BTK supervised the data collection and the analysis. AJ, JEAC, and SPE drafted the initial manuscript. BTK and KM reviewed the manuscript. All authors read through and approved the final manuscript for submission. SPE is the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChola, L., McGee, S., Tugendhaft, A., Buchmann, E. \u0026amp; Hofman, K. Scaling up contraceptive access in low-resource settings: The importance of addressing barriers. \u003cem\u003eGlobal Health Action\u003c/em\u003e. \u003cb\u003e15\u003c/b\u003e (1), 1\u0026ndash;10 (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World Health Statistics (2014).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall, K. S. The impact of adolescent pregnancy and childbearing on developing countries. \u003cem\u003eJ. Adolesc. Health\u003c/em\u003e. \u003cb\u003e60\u003c/b\u003e (3), 231\u0026ndash;237 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMelesse, D. Y. et al. Adolescent sexual and reproductive health in sub-Saharan Africa: Who is left behind? \u003cem\u003eBMJ Global Health\u003c/em\u003e ; \u003cb\u003e5\u003c/b\u003e(1), e002231. (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain, A. \u0026amp; Singh, S. Contraceptive methods: A global review. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e395\u003c/b\u003e (10224), 1697\u0026ndash;1709 (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMunakampe, M. N., Zulu, J. M. \u0026amp; Michelo, C. Contraception and abortion knowledge, attitudes and practices among adolescents from low and middle-income countries: a systematic review. BMC Health Serv Res. ;18(1):909. (2018). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-018-3722-5\u003c/span\u003e\u003cspan address=\"10.1186/s12913-018-3722-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Erratum in: BMC Health Serv Res. 2019;19(1):441. doi: 10.1186/s12913-019-4297-5. PMID: 30497464; PMCID: PMC6267062.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChimah, U. C., Lawoyin, T. O., Ilika, A. L. \u0026amp; Nnebue, C. C. Contraceptive knowledge and practice among senior secondary school students in military barracks in Nigeria. Nigerian Journal of Clinical Practice ; 19(2):p 182\u0026ndash;188, Mar\u0026ndash;Apr 2016. | (2016). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/1119-3077.175970\u003c/span\u003e\u003cspan address=\"10.4103/1119-3077.175970\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDennis, M. L. et al. Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda. \u003cem\u003eReprod. Health\u003c/em\u003e. \u003cb\u003e14\u003c/b\u003e, 130. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12978-017-0393-3\u003c/span\u003e\u003cspan address=\"10.1186/s12978-017-0393-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwusabo-Asare, K., Biddlecom, A., Kumi-Kyereme, A. \u0026amp; Patterson, K. \u003cem\u003eAdolescent Sexual and Reproductive Health in Ghana: Results from the 2004 National Survey of Adolescents, Occasional Report\u003c/em\u003e (Guttmacher Institute, 2006). No. 22. Cape Coast.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCates, W. Family Planning: he essential link to achieving all eight Millennium Development Goals. \u003cem\u003eContraception\u003c/em\u003e \u003cb\u003e81\u003c/b\u003e (6), 460\u0026ndash;461 (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNwaozuru, U., Doat, A. R., Iwelunmor, J. \u0026amp; Airhihenbuwa, C. O. Factors influencing contraceptive use among adolescents in sub-Saharan Africa: A systematic review. \u003cem\u003eReproductive Health\u003c/em\u003e. \u003cb\u003e14\u003c/b\u003e (1), 1\u0026ndash;14 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHagan, J. E. \u0026amp; Buxton, C. Contraceptive knowledge, perceptions and use among adolescents in selected senior high schools in the central region of Ghana. \u003cem\u003eJ. Sociol. Res.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (2), 170\u0026ndash;180 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSedgh, G. et al. Induced abortion: incidence and trends worldwide from 1995 to 2008. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e379\u003c/b\u003e (9816), 625\u0026ndash;632 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiddlecom, A., Munthali, A., Singh, S. \u0026amp; Woog, V. Adolescents\u0026rsquo; views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi, and Uganda. \u003cem\u003eAfr. J. Reprod. Health\u003c/em\u003e. \u003cb\u003e23\u003c/b\u003e (3), 23\u0026ndash;35 (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoamah, E. A. et al. Use of contraceptives among adolescents in Kintampo, Ghana: a cross-sectional study. \u003cem\u003eOpen. Access. J. Contracept.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e, 7\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/OAJC.S56485\u003c/span\u003e\u003cspan address=\"10.2147/OAJC.S56485\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2014).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDonna Clifton, T., Kaneda \u0026amp; Ashford, L. \u003cem\u003eFamily Planning Worldwide 2008\u003c/em\u003e (Population Reference Bureau, 2008).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Contraception, adolescents, students, knowledge, attitude, practice","lastPublishedDoi":"10.21203/rs.3.rs-6667312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6667312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMajority of adolescent births occur in the 15\u0026ndash;19-year age group. Contraceptive use plays a crucial role in preventing unintended pregnancies, reducing adolescent birth rates, and improving reproductive health outcomes. Despite increasing awareness, contraceptive uptake among adolescents remains low in many settings, particularly in sub-Saharan Africa. This study assessed the knowledge, attitudes, and practices regarding contraception among adolescents at Tarkwa Senior High School in Ghana.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted among final-year students at Tarkwa Senior High School. Eligible final-year students were recruited through simple random sampling. A structured self-administered questionnaire was used to collect data on students\u0026rsquo; sociodemographic characteristics, knowledge, attitudes, and use of contraceptives. The data was analyzed using SPSS version-27. Descriptive and inferential statistics were determined and p-value below 0.05 considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWhile all respondents (100%) had heard of contraception, only 2.9% had ever used a contraceptive method. The primary sources of information on contraception were teachers (52.4%), friends (21.4%), and health workers (10.7%). Pills (44.7%) and condoms (32.0%) were the most well-known contraceptive methods. However, misconceptions about contraceptives were common, with 24.3% of respondents believing that contraceptive use leads to promiscuity. The major barriers to contraceptive use included fear of side effects (62.1%), religious beliefs (20.4%), and partner or family opposition (7.8%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAlthough adolescents at Tarkwa Senior High School exhibited high awareness of contraception, actual usage was remarkably low due to misconceptions, sociocultural barriers, and concerns about side effects. This highlights the need for comprehensive, adolescent-friendly reproductive health education and policies that ensure easier access to contraceptive services.\u003c/p\u003e","manuscriptTitle":"Bridging the Gap Between Awareness and Use: Adolescent Contraceptive Practices and Associated Barriers among Final Year Students in a Ghanaian Senior High School","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 14:58:31","doi":"10.21203/rs.3.rs-6667312/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-26T10:36:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246927306539542328082814330741997170749","date":"2026-04-26T09:22:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T22:16:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166488604689718757474673437827837551230","date":"2025-12-04T14:51:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202987949243386727827117094348679825004","date":"2025-12-04T12:46:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123848581839277785538550443715258606104","date":"2025-09-11T07:33:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51286341057480830247894328541065148483","date":"2025-09-04T07:58:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T10:35:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T11:40:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-29T09:32:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-29T07:06:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-14T21:24:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fce19327-33e0-49d8-86da-383071345d3d","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":54179332,"name":"Health sciences/Health care"},{"id":54179333,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-09-09T14:58:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 14:58:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6667312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6667312","identity":"rs-6667312","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}