Spatial patterns and multilevel analysis of modern contraceptive utilization among ever sexually active ghanaian women: Evidence from the 2022 Ghana demographic and Health Survey
Julius Kwabena Karikari, Sheneil Agyemang, Sulemana Baba Abdulai, Emmanuel Konadu, Mercy Addae, Muftawu Mohammed Saani, Olivetta Dela Alomenu, Obed Kwabena Offe Amponsah, Douglas Aninng OpokuBackground
Modern contraceptive use remains a major public health priority in Ghana, yet geographic inequalities and contextual determinants of utilization among ever sexually active women are not fully understood.
Objectives
This study aimed to examine the prevalence, spatial distribution, and determinants of modern contraceptive use among ever sexually active Ghanaian women using data from the 2022 Ghana Demographic and Health Survey (GDHS).
Design
A cross-sectional study design with multilevel and spatial analysis.
Methods
The study included 10,415 ever sexually active women aged 15–49 years from the 2022 GDHS. Descriptive statistics and Pearson’s chi-square tests were performed. Multilevel mixed-effects logistic regression models were fitted to identify individual- and community-level factors associated with modern contraceptive use. Spatial analyses, including Global Moran’s I, Local Moran’s I, and Getis-Ord Gi * hotspot analysis, were conducted to assess geographic clustering and spatial patterns. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.
Results
The prevalence of modern contraceptive use among women with a history of sexual intercourse was 31.4% (95% CI: 30.1–32.7). Modern contraceptive use demonstrated significant spatial clustering across Ghana (Global Moran’s I = 0.218, p = 0.036). Western North emerged as a significant hotspot, whereas Northern and Savannah regions were identified as cold spots of low utilization. Women aged 40–49 years (aOR = 0.55; 95% CI: 0.42–0.73), Muslims (aOR = 0.73; 95% CI: 0.58–0.90), breastfeeding women (aOR = 0.77; 95% CI: 0.63–0.94), and women currently abstaining from sex (aOR = 0.12; 95% CI: 0.09–0.17) had lower odds of using modern contraceptives. Conversely, HIV testing history, recent births, exposure to family planning media messages, and larger household size were associated with higher odds of utilization.
Conclusions
Modern contraceptive use among ever sexually active Ghanaian women remains relatively low and spatially clustered. Targeted, culturally sensitive, and geographically focused reproductive health interventions are needed to address regional inequalities and improve contraceptive uptake in Ghana.