Reproductive Health Self-Care in Ghana: A Qualitative Analysis of Factors Influencing Practice

BackgroundGhana has adopted self-care approaches to address challenges with sexual and reproductive health, yet there is limited contextual information on the enablers and constraints associated with self-care approaches. This study sought to generate context-specific evidence on factors influencing the uptake of reproductive self-care services.MethodsIn total, 19 professionals, comprising health providers, program managers, digital referral agents, and community facilitators, and 29 end-users from Accra, Tamale, Cape Coast, and Sunyani, participated in qualitative interviews spanning six (6) reproductive health domains - namely, family planning, abortion, HIV/STI, maternal and child health, general SRHR, and cervical cancer. Instrument design and data extraction were underscored by Levesque’s framework of health care access. Data was organised and coded in Dedoose and analysed using thematic analysis.ResultsKey facilitators identified include: Access to trusted, culturally attuned knowledge systems (Approachability); Open, vocal support for services by community and religious leaders (Acceptability); Convenience of technology-enabled remote support (Availability and Accommodation); Service affordability, aided by waivers and discounts (Affordability); Remote pathway reduces end-users’ experience of stigma (Appropriateness). Key barriers identified include: Public awareness done in fewer languages (Approachability); Myths and misconceptions, reinforced by religious and socio-cultural norms (Acceptability); Poor end-user experience resulting from immature facility systems (Availability and Accommodation); Additional costs with remote access, notably including courier services (Affordability); Inequitable treatment of end-users due to administrative and socio-cultural constraints (Appropriateness).ConclusionReproductive-health self-care is a viable alternative to conventional models, but stakeholders must recognise its unique enablers and constraints, and design context-specific solutions to facilitate its scale.