Determinants of emergency contraceptive use among female senior high school students in the Akuapem south municipality, Ghana
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly cultural, religious, and moral expectations—play a critical role in shaping adolescents’ contraceptive behaviors by discouraging emergency contraceptive (EC) use despite high awareness. While subjective norms influenced intentions, they were less important than individual attitudes and perceived control in determining actual use, indicating that social disapproval creates hesitation but does not fully prevent behavior when agency and access are strong. Interventions must therefore address both normative stigma and individual-level empowerment to close the intention–behavior gap.
Objectives This study aimed to assess knowledge, awareness, and use of emergency contraceptives among female senior high school students in the Akuapem South Municipality of Ghana, and to examine how Theory of Planned Behaviour (TPB) constructs—attitudes, subjective norms, and perceived behavioural control—influence intention and actual EC use.
Methods A cross-sectional quantitative study was conducted with 300 female students using a structured, self-administered questionnaire based on TPB constructs. Data were analyzed using descriptive statistics and regression models to assess predictors of intention and actual EC use. Social norms were measured through the “subjective norms” construct, capturing perceived approval or disapproval from peers, family, and religious influences.
Results Awareness of EC was very high (98–100%), but actual use was moderate (50%). Attitudes (β=0.46, p<0.001) and subjective norms (β=0.24, p<0.001) significantly predicted intention, while perceived behavioural control predicted actual use (AOR=2.14). Attitudes were the strongest predictor of both intention and behavior. Subjective norms influenced intention but were not a significant predictor of actual use. Cultural, religious, and moral concerns, as well as fear of side effects, were key barriers. Despite high awareness, most respondents demonstrated low intention and non-adoptive behavior toward EC use. Conclusions: The study concludes that while awareness of emergency contraception is widespread, social and cultural norms continue to constrain its use, contributing to a gap between knowledge and behavior. Attitudes and perceived behavioural control are more influential than social norms in driving actual use, highlighting the importance of strengthening individual agency and access. Addressing misconceptions, reducing stigma, and promoting supportive environments are essential to improving contraceptive uptake and reducing unintended pregnancies among adolescents in Ghana.
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