Exploring the different facets of stigma relating to family planning among couples in Northern Ghana

Despite the well-documented benefits of family planning for maternal and child health, modern contraceptive uptake in Northern Ghana remains among the lowest in the country.One important factor contributing to this low uptake is stigma surrounding family planning. However, the specific forms that this stigma takes among couples and the mechanisms through which it influences contraceptive use remain poorly understood. Drawing on Erving Goffman’s stigma theory, this study explored different forms of family planning-related stigma among couples in Northern Ghana. A sequential explanatory mixed-methods design was employed. Quantitative data were collected for 508 couples ( N = 1016 participants) using structured questionnaires from two districts. Qualitative data were collected through nine focus group discussions, nine key informant interviews, four in-depth interviews, and four rapid assessment procedures. Qualitative data were analyzed using content analysis. High enacted stigma was reported by 42.8% of respondents, while 38.0% reported high self-stigma, with significant sex differences. Qualitative data revealed that self-stigma manifested as internalized shame, fear of judgment, and anticipation of gossip, leading many to conceal their contraceptive use or avoid services. Enacted stigma occurred in the form of community mockery, accusations of immorality or challenges to male authority, and negative treatment from health workers. Reducing family planning stigma requires multilevel interventions that address internalized shame, engage men and community leaders in redefining reproductive health norms, and strengthen privacy and confidentiality within health facilities. These efforts may contribute to promoting reproductive autonomy and increasing contraceptive uptake in socially and culturally conservative settings.