Abstract

BACKGROUND: Emergency contraception (EC) is an important option for preventing unintended pregnancy after unprotected intercourse or contraceptive failure. In urban Ghana, easy over-the-counter access may coexist with incomplete knowledge, misconceptions about regular contraception, and repeated EC use. This study examined the prevalence and correlates of repeated EC use among young women in La-Nkwantanang Madina Municipality, Greater Accra Region.

METHODS: A quantitative cross-sectional survey was conducted among 302 sexually active women aged 16–29 years who reported prior EC use. Participants were recruited from public locations using time-based systematic sampling and completed a structured, tablet-administered questionnaire. The study operationalized repeated EC use as more than three uses in the preceding 12 months. Descriptive statistics and multivariable logistic regression were used to examine associations with EC knowledge, attitudes toward regular contraception, sociodemographic characteristics, and socio-behavioural factors.

RESULTS: Participants had a mean age of 23.6 years (SD 3.8). Among the recruited prior EC users, 42.1% reported more than three uses in the previous year. Pharmacies were the main source of EC (82.8%). Although 72.5% identified the 72-hour timing window and 85.4% reported the correct dosage, 81.1% were classified as having low overall knowledge using the study scoring approach. In the adjusted model, each unit increase in knowledge score was associated with higher odds of repeated EC use (adjusted odds ratio [AOR] 1.28, 95% CI 1.10–1.49; p=0.001), as was the attitude score (AOR 1.44, 95% CI 1.08–1.93; p=0.01). Divorced/widowed respondents had lower odds than the reference group (AOR 0.06, 95% CI 0.01–0.52; p=0.01). Other measured socio-behavioural factors were not statistically significant in the multivariable model.

CONCLUSION: Repeated EC use was common in this urban sample and occurred alongside high pharmacy access and persistent gaps in comprehensive contraceptive knowledge. The findings support integrating brief contraceptive counselling into pharmacy-based EC provision and expanding confidential, youth-friendly access to regular contraceptive options. Because the study was cross-sectional and based on self-report, the findings should be interpreted as associations rather than causal effects.

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