Accessibility and Contraceptive Preferences Among Adolescents and Young Adults in Tema West Municipality, Ghana

Abstract

Background: Adolescent reproductive health remains a concern in Ghana, where increased availability of family planning services has not translated into corresponding utilisation among young people. Barriers such as limited youth-friendly services, concerns about confidentiality, and provider attitudes continue to affect access. In peri-urban areas like Tema West Municipality, gaps persist between service availability, accessibility, and adolescents’ contraceptive preferences. This study examines accessibility and contraceptive preferences among adolescents in Tema West Municipality to inform targeted interventions. Aim: The aim of the study was to examine the accessibility and Contraceptive Preferences among Adolescents in Tema West Municipality, Ghana Methodology: A analytical cross-sectional design was employed, involving 264 adolescents aged 10–25 years. Data were collected using a structured questionnaire adapted from a validated instrument and analyzed using IBM SPSS version 25 for descriptive and bivariate analyses, while multinomial logistic regression was conducted in R to identify predictors of contraceptive preference. Statistical significance was set at p < 0.05. Results: Among 264 adolescents and young adults, accessibility to family planning services was limited despite high awareness (92.8%), with only 64.0% able to identify a specific service delivery point and 89.4% reporting low perceived availability. While affordability (73.1%), confidentiality (75.0%), and proximity (76.2%) were rated moderately, structural barriers particularly inconvenient service hours (mean = 2.37 ± 1.00) constrained effective access, and pharmacies or chemical shops emerged as the main access points (12.1%). Contraceptive use was low, with 61.0% reporting no prior use and 75.0% not currently using any method. Barrier methods were the most preferred (35.6%), followed by hormonal methods (15.5%), while 25.8% reported no clear preference and preference for long-acting reversible contraceptives remained low (4.5%). Convenience (25.4%) and perceived effectiveness (20.9%) were the primary drivers of method choice. Contraceptive use was significantly associated with age (χ² = 27.563, p < 0.001), religion (χ² = 9.969, p = 0.019), relationship status (χ² = 54.372, p < 0.001), education (χ² = 23.075, p < 0.001), schooling status (χ² = 16.715, p < 0.001), living arrangement (χ² = 40.171, p < 0.001), employment (χ² = 22.752, p < 0.001), and income (χ² = 20.975, p < 0.001), but not gender (p = 0.280). Multinomial regression showed that males had higher odds of preferring barrier methods (aOR = 4.13, 95% CI: 1.73–9.89) but lower odds of preferring modern methods (aOR = 0.15, 95% CI: 0.05–0.44), while being in a relationship and being out of school increased the likelihood of preference across method categories. Key influencing factors included media exposure (mean = 2.81 ± 0.72), limited family communication (mean = 2.78 ± 0.87), infertility concerns (mean = 2.61 ± 0.86), and fear of provider judgment (mean = 2.58 ± 0.87), whereas cost was less influential. Conclusion: The study showed that, accessibility barriers are driven less by awareness and cost, and more by structural and social factors, including service convenience, provider attitudes, and communication gaps. The findings support the Andersen Behavioral Model, demonstrating that contraceptive behavior among adolescents and young adults is shaped by predisposing factors (age, education), enabling factors (service accessibility, provider attitudes), and perceived need, with social and informational influences playing a central role.