1 Introduction 

This study explores the strategies used by adolescent girls living in urban Accra, Ghana 

to cope with unintended pregnancies. It examines the processes leading to pregnancy and 

compares the strategy of terminating the pregnancy to that of carrying the child to term. The 

study is initiated in response to the findings of the 1998 Ghana Demographic and Health Survey 

(GDHS), which found early pregnancy loss among girls age 15 to 19 to be approximately twice 

as high as in other age groups. In urban areas, pregnancy loss among teens was more than twice 

as high as in rural areas. Most of these losses seem to be induced abortions. A high incidence of 

abortion among teenage girls poses numerous social and health concerns for public health 

professionals. For example, one may ask whether or not adolescent pregnancies are intended. If 

they are not, what practices are leading to unintended pregnancies? Are girls using unsafe 

methods to terminate unwanted or mistimed pregnancies?  Are their futures adversely affected 

by becoming pregnant and/or by having an abortion?  The health survey based studies from 

Ghana provide some insight into these questions. 

The 1998 Demographic and Health Survey found that sexual activity generally begins 

before marriage in Ghana; the average age at first sex being 18 while the average age at first 

marriage was 20.  Other smaller, targeted surveys of adolescent sexual activity in Ghana found 

that the sexual initiation of many adolescents starts much earlier and varies according to their 

residence and education (Agyei and Hill, 1997; Nabila and Fayorsey, 1996; Adomako, 1991; 

Ankomah and Ford, 1994; Anarfi, 1997). Researchers have identified a whole gamut of reasons 

for initiation to sex before marriage. For example, some look to adolescents as the cause, citing 

peer pressure, deception by partners, experimentation, and desire (Adomako, 1991). Some cite 

the loss of puberty initiation practices, once quite extensive and consistently practiced in Ghana, 

and the resulting lack of knowledge and guidance (Tagoe Darko, 1997). Yet, others blame early 

sexual initiation or poverty and the resulting  sugar daddy  phenomenon (exchange of gifts for 

sex), the lack of supervision or support from parents, or the moral degeneration of the younger 

generation (Nabila and Fayorsey, 1996). Regardless of the dynamics of sexual initiation, most 

surveys find that adolescents in Ghana do not tend to use modern contraception regularly to 

prevent pregnancy. 

The recent demographic and health survey found that among sexually active adolescents 

age 15 to 19 who reported having had intercourse during the preceding month, 79 percent said 

that they were not using any contraceptive method (GSS and MI, 1999). The GDHS, like other 

studies of contraceptive use among teens, found that although knowledge and approval of the use 

of modern contraceptives was high, contraceptive use was low (Agyei and Hill, 1997). Periodic 

abstinence appeared to be the most used method among teens (PIP, 1995) and condoms were the 

most used modern method of contraception (Adomako, 1991; Ankomah, 1998). A countrywide 

analysis of family planning points found that most providers will not provide short term 

contraceptive methods to women with fewer than 2 children or long term methods to women 

with fewer than 3 to 4 children, which also affects contraceptive use by teens (GSS, 1997; 

Stanback and Twum Baah, 2001).  Not surprisingly, about half of the girls who got pregnant 

during their teens, whether married or not, said that the pregnancy was mistimed (GSS and 

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