From negotiation to secrecy: women’s reproductive decision-making in Peri-Urban Ghana

Background: While extensive research documents the relationship between cultural practices, such as bridewealth payments and reproductive decision-making in sub-Saharan Africa, limited empirical evidence exists on women’s actual experiences and strategies in peri-urban contexts where multiple cultural systems intersect. This study examines how women make reproductive decisions in peri-urban Ghana by documenting the factors that influence their choices and the strategies they employ to exercise agency within cultural constraints.Methods: This study involved in-depth interviews with 49 women from matrilineal and patrilineal lineage systems in five peri-urban communities in Ghana’s middle belt between April and August 2023. Thematic analysis was used to examine patterns in women’s reproductive experiences and decision-making.Findings: Women’s reproductive decisions are shaped by social fertility expectations, economic pressures, cultural and religious beliefs, gendered blame patterns, and male-dominated power structures. Despite these constraints, women demonstrate agency through negotiation, persistent communication, strategic timing, and covert contraceptive use. This study reveals a spectrum of strategies employed by women, from open dialogue with partners to secretive family planning, depending on their circumstances and relationship dynamics. These findings highlight the importance of understanding women’s actual experiences and adaptive strategies when designing reproductive health interventions in culturally diverse settings.