Determinants of Contraceptive Use among Adolescents in Ghana: A systematic review

Adolescents are among the most vulnerable groups in the global reproductive health landscape (Leena & Vijayalakshmi, 2024) but their contraceptive needs remain inadequately addressed (Kantorová et al., 2021). Complications from pregnancy and childbirth are among the leading causes of death for adolescent girls aged 15–19 years worldwide (WHO, 2024). Globally, contraceptive use among adolescents lags behind that of adult women, contributing to high rates of unintended pregnancies and unsafe abortions (Bellizzi et al., 2019; Ilugbami et al., 2023). Estimates suggest that more than 200 million women of reproductive age in low- and middle-income countries had an unmet need for modern contraception, a burden that disproportionately affects adolescents (Pillai & Nagoshi, 2023). Although high-income countries have achieved reductions in adolescent fertility through access to contraception and comprehensive sexuality education (Chandra-Mouli & Akwara, 2020), disparities remain stark. In sub-Saharan Africa (SSA), adolescent fertility rates are among the highest globally, while modern contraceptive use remains among the lowest (Michael et al., 2024). Only about 20% of sexually active adolescent girls in SSA use a modern contraceptive method (Boadu, 2022). Poverty, stigma around premarital sex, and limited youth-friendly services exacerbate these gaps (Aventin et al., 2021). Sociocultural and religious norms further restrict discussion of sexuality (Challa et al., 2018), leaving many adolescents without the support needed to make informed choices. A recent systematic review of qualitative studies in SSA by Bain et al. (2021) highlighted these issues. The review reported that myths and misconceptions, stigma, financial constraints and negative provider attitudes were major barriers to contraceptive use. On the other hand, peer support, confidentiality, affordability and access were reported as motivators. However, this review combined adolescents with older youth (10–24 years), limiting its ability to capture adolescent-specific determinants. In Ghana, adolescent fertility and contraceptive use mirror regional challenges. The 2014 Ghana Demographic and Health Survey reported that 14% of adolescent girls aged 15–19 had begun childbearing, while modern contraceptive prevalence remained below 20% (GSS, GHS, and ICF, 2015). Preliminary findings from the 2022 GDHS and a UNICEF report on Ghanaian adolescents suggest slight improvements in awareness and contraceptive use, although substantial gaps in use and unmet need persist (GSS & GHS, 2022; UNICEF, 2018). Evidence from Ethiopia demonstrates the value of national-level systematic reviews. Mekonnen et al. (2022) synthesized determinants of adolescent contraceptive uptake and found that individual characteristics such as age, schooling and family income, sociocultural influences such as family communication, partner pressure and harmful traditional practices, healthcare service quality and knowledge levels all shaped contraceptive use. This review consolidated fragmented findings and provided policymakers with actionable evidence. Despite similar challenges, Ghana lacks such a synthesis. While several primary studies have examined adolescent contraceptive use in Ghana, their findings are inconsistent across populations and regions, making it difficult to develop a comprehensive national picture. The absence of a systematic review leaves policymakers and practitioners without a consolidated evidence base to guide interventions. This review addresses that gap by synthesizing available evidence on the determinants of contraceptive use among adolescents in Ghana. By consolidating existing knowledge, it aims to inform policy, strengthen youth-friendly sexual and reproductive health services, and guide future research. This systematic review seeks to address this gap by examining and synthesizing existing literature on the determinants of contraceptive use among adolescents in Ghana. By consolidating existing knowledge, it aims to inform national policies, strengthen adolescent-friendly sexual and reproductive health services and guide future research. Ultimately, the review contributes to broader global development goals, including Sustainable Development Goal (SDG) 3.7 on universal access to sexual and reproductive health-care services, SDG 5.6 on reproductive rights and gender equality, and SDG 3.1 on reducing maternal mortality. By reducing unintended adolescent pregnancies, the review also indirectly supports SDG 4 by helping keep more girls in school.