The situation of

adolescents in Ghana
 This report was prepared by
hera - right to health and development
under direction of the UNICEF Ghana Country Office
and with financial support from KOICA.

Authors and contributors to the report were:

Josef Decosas, Michèle Dramaix, Gloria Odei Obeng-Amoako,
Heiko Decosas, Marieke Devillé and Alice Behrendt

Support and guidance from UNICEF Ghana were provided by:

Yoshimi Nishino (Chief Social Policy), Jovana Bazerkovska, Mayeso

Zenengeya, Moses Y. Korbli, Wendy Henry, Samuel Asumah Yelpien,
Samuel Debrah Osei Amakye and Ruth Pappoe
Contents

Definition of terms ................................................. 4

Key Findings........................................................... 5
Introduction.............................................................. 8
Context................................................................... 10
The 2017/18 Multiple Cluster Survey (MICS6)....... 14
The Situation of Adolescents in Ghana ................. 16
Conclusions and Recommendations ..................... 61
References............................................................. 66

3
Definition of terms
Adolescent birth rate Number of births to adolescent girls aged 15-19 per 1,000 girls in this age group.
Adolescent modern
Percentage of adolescent girls who are currently using, or whose sexual partner is currently using, at least one modern
contraceptive
method of contraception.
prevalence
The age of 10 to 19 years is defined by the United Nations as the age of adolescence divided into early adolescence from
10 to 14 years and late adolescence from 15 to 19. This is also the definition adopted by the Government of Ghana in
its Adolescent Health Service Policy and Strategy (2016-2020).1 Many studies and surveys, however, use different age
Adolescents:
categories, including the category of teenagers (13 to 19) and young people (up to age 24 with varying lower age limits).
While this report adheres to the official Ghanaian definition, the different categorisation used in other surveys and reports
makes it at times difficult to compare data.

Women and adolescent girls who have a blood haemoglobin level below 12.0 g/dl (11.9 g/dl if pregnant) are considered
Anaemia
anaemic. Severe anaemia is diagnosed when the haemoglobin level is below 7.0 g/dl.

The BMI is an approximate measure of whether someone is over- or underweight. It is calculated by dividing their weight in
kilograms by the square of their height in metres.
Among adolescents, over-nutrition is defined as having a BMI-for-age z score (BMIZ) that is more than one standard
Body mass index (BMI)
deviation above the median value for that age group (overweight) or more than two standard deviations (obese)
Under-nutrition is defined as having a BMIZ that is more than one standard deviation below the median value for that age
group (moderately thin) or more than two standard deviations (thin)

Comprehensive HIV Determined by 1) being able to correctly identify two ways of preventing HIV infection; 2) knowing that a healthy-looking
knowledge person can have HIV; and 3) rejecting the two most common misconceptions about HIV transmission.

A demographic dividend is the accelerated economic growth that can result from improved reproductive health, a rapid
Demographic dividend
decline in fertility, and the subsequent shift in population age structure.

The death of a woman while pregnant or within two months of delivery or termination of pregnancy, irrespective of the cause
Pregnancy-related death
of death.
Intergenerational sex A sexual partnership between a young woman (15-24 years) and a man who is 10 or more years older.
Unmet need for Percentage of adolescent girls and women who want to stop or delay childbearing but are not using any method of
contraception contraception.

4
Key Findings
Every adolescent survives and thrives
The median age of sexual debut is 18 years for adolescent girls and
19 years for adolescent boys. Sex before the age of 15 years as well
as sex with a partner who is at least 10 years older are reported by
one girl out of ten.
Most adolescents (72%) do not use condoms during intercourse with
a non-marital or non-cohabiting partner. Boys report condom use
more often than girls.
Adolescent girls aged 15 to 19 are the age cohort with the highest
unmet need for contraception. Two out of three unmarried sexually
active girls and more than half of married adolescents report that they
want to stop or delay childbearing but are not using any method of
contraception.
Among adolescent girls aged 15 to 19, 14% have had a live birth or
are currently pregnant with their first child. Girls in the poorest wealth
quintile are five time more likely to give birth before the age of 20 than
those in the richest.
The proportion of adolescents who are knowledgeable about HIV
prevention is low. Girls with low educational achievements are
particularly unlikely to access relevant information on HIV prevention.
Discriminatory attitudes towards people living with HIV are widespread
among adolescent boys and girls.
Only 7% of adolescent girls and 2% of adolescent boys have been
tested for HIV within the past 12 months and know their results.
Access to appropriate menstrual hygiene materials is high (over 90%).
That notwithstanding, two out of ten girls did not participate in social
activities, school, or work during their last menstruation.
Use of tobacco, cannabis and other drugs are not common. Alcohol
use is more common and is reported by 9% of boys and 5% of girls.
UNICEF Situation of Adolescents in Ghana 2021
Most adolescent girls and boys have a healthy body weight. However,
undernutrition is common among rural adolescent boys (32%) and
overnutrition affects a considerable number of urban adolescent girls,
especially in Greater Accra and those in the highest wealth quintile (22%).
Almost half of all adolescent girls aged 15 to 19 (48%) are anaemic,
although severe anaemia is rare (0.3%).
Every adolescent learns
Most adolescent girls and boys aged 10 – 14 years (96%) are in school.
Among 15 to 19 year old adolescents, the school attendance rate drops
to 71%. Due to delays in starting schooling and because of repetitions,
many adolescents attend grades that are lower than those designed for
their age. This is more common among boys than among girls.
Less than half (47%) of Ghanaian adolescents, more girls than boys,
complete basic education (up to grade nine). Only about a third (35%)
complete secondary education (up to grade 12) with little difference
between boys and girls. There are large differences in education
completion rates by wealth quintile, urban and rural residence, and
among regions.
Among adolescents aged 10 to 14, only 30% have primary school grade
3 level reading skills and only 21% have grade 3 level numeracy skills.
More girls than boys have reading skills while more boys have numeracy
skills. There are large differences in skills development by wealth quintile,
urban and rural residence, and among regions.
About half of Ghanaian adolescents regularly listen to the radio and
watch television. More boys than girls listen to the radio, while more girls
watch television.
There is at least one mobile phone in almost all households in Ghana,
however less than half of adolescents aged 15 to 19 use it regularly. More
boys than girls have access to a mobile phone.
5
Household ownership of a computer is low, and fewer women than
men own a computer. Only 6% of adolescents regularly use a
computer, 5% of girls and 9% of boys. Skills among regular users are
about equal, but when computer access is taken into consideration,
boys have about twice the skill level as girls and there are large
differences in skills between regions, urban and rural residents and
between wealth quintiles.
Internet use by adolescents is twice as common as computer use but
it is still low at only 13%. The same wealth and gender gaps in internet
use are observed as for computer use.
Every adolescent is protected from violence and
exploitation
More than one third of adolescent girls and more than one fifth of boys
agree with at least one justification for wife beating. Acceptance of
wife beating is higher among adolescents than among adults.
Adolescents in Ghana experience several forms of violence inside
and outside their homes. Boys are more exposed to physical violence,
however in the domestic environment girls experience physical
violence nearly twice as often as boys. One in five girls reported that
she experienced sexual violence within the past 12 months, including
rape and sexual coercion. While sexual violence in the domestic
environment was less common, it almost always involved rape and
sexual coercion.
The exposure to violent discipline (psychological and physical) is
nearly universal among adolescents aged 10 to 14 without apparent
gender differences. Boys were somewhat more likely to receive
physical punishment and one in five adolescents was subjected to
severe physical punishment within the past month.
About 13% of young adolescents in Ghana are working in the home
or in the economy above the threshold that defines child labour.
Child labour is less common among older adolescents. In both age
groups, girls are much more likely to work in the household above the
threshold defined as child labour.
Child marriage among girls is common in all regions except for the
Greater Accra Region. It is twice as common in rural than in urban
areas. Girls in households of the lower wealth quintiles are more likely
to be married by the age of 18. Boys are rarely married by that age.
Female genital mutilation/cutting (FGM/C) is illegal in Ghana and a
practice that is slowly disappearing. Among adolescent girls aged 15
to 19, about 6/1,000 had undergone FGM/C, almost all of them in the
Upper West Region where it is still practiced in some minority ethnic
communities.
Every adolescent lives in a safe and clean environment
Less than 60% of adolescents in Ghana have access to improved
sanitation with large regional differences. Household wealth is an
important determinant of access, as well as residence in rural or urban
areas.
More than 85% of adolescents in Ghana have access to water from an
improved source, although this often involves buying drinking water in
small sachets. In most cases, water must be collected from a public
source that may be more than three hours away. This task is most
often allocated to adolescent girls.
About half of adolescents in Ghana have access to a hand washing
facility in their home where water and soap are available.
Most households use wood, charcoal or other solid fuel for cooking.
Nine out of ten adolescent girls are potentially exposed to indoor air
pollution that risks damaging their future health.
About a quarter (24%) of adolescents slept under an insecticide
treated bed net in the night preceding the survey.
6
Every adolescent has an equitable chance in life
Social inequalities in Ghana are the main barriers for adolescents to
the achievement of equitable opportunities for realising their potential.
The inequalities exist across geographic regions and between rural
and urban residents. They are clearly demonstrated by the gaps in
almost all indicators of adolescent health and well-being between
those who live in wealthier and those in less wealthy households.
Adolescents who have functional difficulties in any of nine domains,
including physical, mental, emotional, and behavioural parameters
are more likely to be out of school and are also disadvantaged
in other areas. The differences to their peers who are without
functional difficulty are small. However, when the nine domains are
disaggregated, greater gaps in inclusion may become evident. This
would require more targeted studies.
For adolescent girls, the main barrier to an equitable chance in life are
multiple violations of their sexual and reproductive rights ranging from
sexual coercion and violence to early pregnancy and child marriage.
More girls than boys complete the nine years of basic education, but
after age 15, more of them are out of school. Nevertheless, secondary
school completion rates among girls are only slightly lower than
among boys. Girls are only half as likely as boys to access computers
and develop ICT skills. They are also much more likely to be engaged
in household chores that meet the definition of child labour.

The effects of COVID-19

The COVID-19 pandemic and the measures to control its spread have
affected the lives of adolescents in many domains. The effects of the
disruption of education services and the coping strategies are well
documented, although it is too early to assess the impact. In other
areas of adolescent life, inferences can be made based on evidence
generated in other countries, however no evidence has as yet been
documented in Ghana.

7
1. Introduction
Why collect data on adolescents? such as malaria, HIV, and most recently COVID-19. Information
about adolescents is, in these cases, filtered through these lenses,
Within the past 50 years, the population of adolescents in Africa has often leaving the impression that educational statistics and data
increased almost four-fold, from about 80 million in 1970 to nearly 300 on adolescent sexual and reproductive health are sufficient for
million in 2020. Over the same time, the percentage of the world’s responding to their rights and needs.
adolescents living in Africa has more than doubled from 10.4% in 1970
to 23.8% in 2020, largely reflecting overall global trends in population Adolescence, however, is a distinct period in a person’s life, forming a
growth.2 bridge between childhood and early adulthood. It is a critical life stage
for developments in cognition, attitudes, behaviours, and resilience
Figure 1. Adolescent population in Africa that will affect each person’s future health and wellbeing, and thereby
also the future of society. Furthermore, as fertility rates in Ghana are
gradually decreasing, the age structure of the Ghanaian population
300 million is shifting, with today’s adolescents becoming part of a growing
number of the working population while the number of dependent
children is decreasing in relative terms. This increase of people in
the labour force provides Ghana with an opportunity to benefit from a
demographic dividend that can drive economic growth if policies and
programmes are implemented that provide today’s adolescents with
the capacity and opportunity to grow into the challenges of adult life.
15-19 years old
For a contribution to the development of peaceful, cohesive, equitable
80 million and productive societies, there is a need to better understand the
life stresses, disparities, and support needs of adolescents based on
evidence that goes beyond tracking educational outcomes and sexual
0-14 years old behaviours. This must also include an understanding that adolescents
are not a homogeneous group, and that vulnerabilities and support
needs differ between girls and boys, between those growing up in rich
1970 1995 2020 and in poor households, and between those living in rural and in urban
Source: UN Department of Economic and Social Affairs. World Population Prospects 2019 communities.
https://population.un.org/wpp/
There is increasing recognition of the importance of comprehensive
National governments and international development programmes information about the situation of adolescents for national and
address the health and wellbeing of children and adults. In low- international policy development although the data to generate it must
income and lower middle-income countries, the data that drive health still be dug out of multiple surveys and studies, each using different
programmes and policies are often dominated by data on child survival time frames and age categories.
and development, pregnancy and maternity, and priority health issues

8
Recent reports on the situations of adolescents in adolescents aged 10 to 19 in each of the ten regions, in total 7,377
Ghana girls and 7,542 boys. Wherever relevant, for instance to explore
trends, to deepen the analysis, or to fill data gaps, data from earlier
In 2017, the Ghana Health Service published the Adolescent Health surveys and studies, primarily the GDHS 2014,3 the Ghana Living
Service Policy and Strategy 2016-2020.1 It aimed at providing strategic Standards Survey 2016/17 (GLSS7),13 and the Ghana Maternal Health
directions for adolescent health and development services. The Survey 2017 (GMHS)14 are also presented. For more recent studies
strategy was based on evidence generated in studies that covered on the impact of COVID-19 on adolescents, no databases were
a broad perspective of adolescent health issues, including the 2014 available, but information was extracted from published reports.
Ghana Demographic Health Survey (GDHS)3 and studies on child
labour,4 domestic violence,5 mental health,6 disabilities,7 and causes of
adolescent deaths.8
A few months prior to the launching of the Ghana Adolescent Health
Service Policy and Strategy in 2017, UNFPA published a situational
analysis of adolescent girls and young women in Ghana.9 The analysis
used data from many sources including those already mentioned as
well as older studies such as the 2004 Ghana National Survey of
Adolescents10 which focused on sexual and reproductive health and
generated data for 32 research publications examining various aspects
and risks of adolescent sexuality and reproductive behaviour.11 In
addition, the UNFPA study conducted key informant interviews as well
as focus group discussions with adolescent girls and young women
aged 12 to 24. The report provides trend data as well as information
on national policies regarding adolescent sexual debut, marriage,
contraception, abortion, pregnancy, motherhood, gender-based
violence, access to education and educational achievement.

Objectives of this report

Based on data collected for the Multiple Indicator Cluster Survey
2017/18 (MICS6)12 the report provides an updated analysis of the
situation of adolescents in Ghana to generate evidence for policy,
advocacy, planning, budgeting, and programming. MICS6 did not
specifically survey adolescents in Ghana and did not include all the
survey questions that would be relevant for a comprehensive situational
analysis, but it did collect data of between one and two thousand

9
2. Context
Ghana
Ghana is a multi-ethnic country with an estimated population of nearly
31 million, about 57% living in urban areas with an increasing trend
of urbanisation.15 Until 2019 Ghana was politically divided into ten
administrative regions. Following a referendum in 2018 four of the
original regions were divided, increasing the total number of regions
to 16. However, all available surveys still present data disaggregated
according to the previous regional divisions which is therefore used in
this report.
Figure 2. Ghana’s administrative regions
prior to 2019 after 2019
Ghana is classified by the World Bank as a Lower Middle-Income
Country (LMIC) with a per person Gross National Income (GNI) of
US$ 2,200.16 There are, however, large urban/rural and regional
wealth inequities. The average annual household income is highest
in the Ashanti and Greater Accra Regions and lowest in Eastern and
the three Northern Regions as documented in the latest Ghana
Living Standards Survey.13
FIGURE 3. Average household income in Ghana Cedis by region
Source: Ghana Living Standards Survey 2016/17
Ghana’s society is characterised by its longstanding peaceful
coexistence of religious and ethnic groups, each with its own
system of traditional governance. About 90% of Ghana’s population
has its roots in four major ethno-linguistic groups: the Akan, Mole-
Dagbani, Ewe, and Ga-Adangbe; about 71% of the population is
Christian and 18% Muslim. The traditional system of kings and
chiefs is well articulated with a stable national government that has
been democratically and peacefully legitimised in seven successive
parliamentary elections since the country returned to constitutional
rule following a referendum in 1992.
10
In the context of a stable political environment and progressive
reforms to strengthen the country’s institutions, Ghana has
implemented a series of national development plans. The latest,
adopted in 2017 under the title ‘An agenda for jobs: creating prosperity
and equal opportunity for all 2018-2021’, provides a framework for the
overall economic and social development of the country.17 However,
unstable global prices for gold, cocoa and oil which are Ghana’s main
export commodities, the reduced demand for Ghana’s traditional
exports, slow growth of the agriculture and manufacturing sectors
and rationing of electricity have negatively affected the government’s
capacity to achieve the country’s economic and social development
ambitions.
The annual Ghanaian GDP growth rate at constant prices increased
between 2014 and 2017 from 2.9% to 8.1% but then dropped back
to 6.5% in 2019 and is projected to only reach about 1% in 2020
due to the effects of the COVID-19 pandemic.18,19 The growth of the
GDP in the first half of the last decade did, however, only contribute
to a minimal reduction in poverty levels from 24.2% of the population
living below the poverty line in 2012/13 to 23.4% in 2016/17. During
this period rural poverty levels decreased by 1.6 percentage points,
but poverty increased by 2.8 percentage points in urban areas. The
large proportion of the rural population living below the line of extreme
poverty in the three northern regions increased further from 27.3% in
2012/13 to 36.1% in 2016/17.20 In 2011, UNICEF estimated that nearly
half of the population living below the poverty line were children under
the age of 18 years.21
The 2021 World Economic Forum’s Global Gender Gap Report ranked
Ghana in position 117 among 156 countries. Since the scoring of the
gender gap was introduced in 2006, the gap in Ghana has narrowed
slightly for educational attainment, health and survival, and political
empowerment, but it has widened for economic participation and
opportunity. The overall score barely changed over the 15 years and in
the regional comparison Ghana slipped from position nine to position
23 in the African ranking table.22

11
Adolescents in Ghana
Ghana has a young population. According to population projections for 2020, nearly half of the population (49%) is below the age of 20 and 22% are
adolescents aged 10 to 19. The proportion of adolescents differs by region and is lowest in Greater Accra with 19% and highest in the Upper West
Region with 24%. The largest number of adolescents, more than 1.3 million, live in the Ashanti Region. In the Upper West Region, male adolescents
outnumber female adolescents by 13%, while there are 10% more females than males in Greater Accra.23
Figure 4. Ghana population profile
0.5% 80+ 0.8%
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
5.4% 15-19 5.2%
6.0% 10-14 5.8%
5-9
7.1% 0-4 6.7%
Male Age Female

Table 1. Ghana total and adolescent population by region Source: Ghana Statistical Service. Population Projections 2020

Region Total Pop Male Female Adolescents % Male Female M/F

Ashanti 5,924,498 2,915,061 3,009,437 1,353,768 22.90% 681,003 672,765 1.01
Greater Accra 5,055,883 2,487,672 2,568,211 976,230 19.30% 466,439 509,791 0.91
Eastern 3,318,853 1,632,992 1,685,861 759,936 22.90% 394,456 365,480 1.08
Western 3,163,754 1,556,682 1,607,072 716,830 22.70% 357,526 359,304 1
Northern 3,132,425 1,541,264 1,591,161 703,709 22.50% 369,793 333,916 1.11
Brong Ahafo 2,915,624 1,434,588 1,481,036 690,541 23.70% 352,737 337,804 1.04
Volta 2,667,478 1,312,496 1,354,982 595,260 22.30% 314,448 280,812 1.12
Central 2,605,492 1,281,998 1,323,494 615,584 23.60% 315,885 299,699 1.05
Upper East 1,302,718 640,981 661,737 315,324 24.20% 166,776 148,548 1.12
Upper West 868,479 427,323 441,156 210,788 24.30% 112,040 98,748 1.13
Ghana Total 30,955,204 15,231,057 15,724,147 6,937,970 22.40% 3,531,103 3,406,867 1.04
Source: Ghana Statistical Service. Population Projections 2020

12
In December 2020, the Ministry of Health launched Ghana’s adolescent unemployment and under-employment, or about children
Reproductive, Maternal, Newborn, Child and Adolescent Health and engaged in hazardous forms of labour which, according to UNICEF
Nutrition Strategic Plan 2020-2025. Other recent national policies Ghana, affects 14% of all children aged 5 to 17.28
and strategies that directly affect the lives of adolescents include the
National Strategic Framework on Ending Child Marriage 2017-2026,24 The COVID-19 pandemic has raised many challenges for Ghanaian
and the Five-year Strategic Plan to Address Adolescent Pregnancy in adolescents in terms of schooling and employment that are still
Ghana 2018-2022.25 unfolding at the time of writing this report. The effects of the pandemic
are amplifying underlying challenges of household poverty and
Education in Ghana is compulsory up to the age of 14 years economic inequities, gender inequality, limited access to digital
comprising six years of primary and three years of Junior High School technology in the context of an increasing global digital divide, child
(JHS). School attendance rates at these levels are generally high marriage, adolescent pregnancy, limited ability of adolescents to
although there are regional differences and differences according to exercise their sexual and reproductive rights, effects of environmental
household wealth. pollution, exposure to violence including sexual violence, nutritional
disorders including anaemia, over- and under-nutrition, and often
The 1998 Children’s Act of Ghana stipulates that the minimum age neglected adolescent health issues such as depression which in one
for admission of a child to employment shall be 15 years, while the study was found to affect 39% of Ghanaian university students with
minimum age for engagement in ‘light work’ is set at age 13. Light 8% having symptoms of severe depression.29
work is defined as ‘work which is not likely to be harmful to the health
or development of the child and does not affect the child’s attendance
at school or the capacity of the child to benefit from schoolwork’.26
The 2010 Population and Housing Census found that 29% of male
adolescents aged 15 to 19 and 29% of females were economically
active, defined as having been engaged in ‘any activity for pay (cash
or kind) or profit or family gain for at least one hour during the seven
days preceding census night’. This rate had decreased steadily since
1960 with a corresponding increase in the proportion of adolescents
who were reported to be students.27 More recent statistics are
available for children aged 5 to 14 from the 2016/17 Ghana Living
Standards Survey, including the younger adolescent age group of 10
to 14. Among these children, 13% were reported to be in the labour
force, with a slightly higher proportion among males than among
females. Most (74%) were working in agriculture and fishery with a
male to female ratio of 1.3/1, followed by work in services and sales
(15%) where girls were more represented with a female to male ratio
of 2.4/1.13 These statistics, however, do not provide information about
unpaid household labour by children and adolescents, nor about

13
3. The 2017/18 Multiple Cluster Survey (MICS6)
The Ghana MICS6 collected information on many indicators Household questionnaire: (adolescents 10-19)
in stratified samples of urban and rural areas in the ten former
administrative regions of Ghana. Six questionnaires were Adolescents
Households Age Male Female Total
aged 10-19
used in the survey 1) a household questionnaire to collect
basic demographic information on all household members, 10-14 4,358 4,345 8,703
12,886 14,919
the household, and the dwelling; 2) a water quality testing 15-19 3,184 3,032 6,216
questionnaire administered in five households in each cluster of the
Education; Household Characteristics; Household Energy Use; Water and
sample; 3) a questionnaire for individual women administered in Sanitation; Education; Adolescents living with Disability
each household to all women age 15-49 years; 4) a questionnaire
for individual men administered in every second household to all
men age 15-49 years; 5) an under-5 questionnaire, administered Questionnaire for Women aged 15-49:
to mothers (or caretakers) of all children under 5 living in the Women
household; and 6) a questionnaire for children age 5-17 years, Age Women Total
interviewed
administered to the mother (or caretaker) of one randomly selected 15-19 2,974
child age 5-17 years living in the household. 14,374 5836
20-24 2,862
For the secondary analysis of the situation of adolescents, all data
Female Genital Mutilation; Attitudes towards Domestic Violence; HIV/AIDS;
for the relevant age group were extracted from four questionnaire Mass Media and ICT; Tobacco and Alcohol Use; Life Satisfaction
databases and analysed disaggregated by sex, region, and
rural/urban residence. The data availability differed among the
databases. While the household questionnaire database included Questionnaire for Men aged 15-49:
data for all adolescents aged 10 to 19, the individual databases for
men and women only included the age range from 15 to 19, and Men interviewed Age Total
the questionnaire database for children only the age range from 10
5,323 15-19 1,527
to 17. For some analyses on sexual and reproductive health data
for young women aged 20 to 24 were extracted from the individual Sexual Behaviour; Marriage; Attitudes towards Domestic Violence; HIV/
questionnaire database. AIDS; Circumcision; Mass Media and ICT; Tobacco and Alcohol Use; Life
Satisfaction
MICS6 oversampled women aged 20-24 to increase the precision
of child marriage indicators. This did not affect the secondary
Questionnaire for Children aged 5 to 17:
analysis. However, in calculating rates and ratios, MICS6 applied
several weighting procedures, adjusting survey data for differences Mothers/caretakers Age Women Total
interviewed
in the number of households by region and for differential response
rates. For the secondary analysis, the same sample weights were Mothers of girls 10-17 2,532
8,946 5836
applied. A detailed description is available in Annex A of the MICS6 Mothers of boys 10-17 2,575
report. Child Labour; Child Discipline; Child Functioning; Foundational Learning
Skills
14
To fill data gaps, explore trends or strengthen the narrative, data were also sourced from other reports such as the 2014 Ghana Demographic and
Health Survey, the 2016 Survey on Domestic Violence in Ghana, the 2017 Ghana Maternal Health Survey, the 2019 Ghana Living Standards Survey,
the 2020 Household Survey on ICT in Ghana and two sequential telephone surveys for the COVID-19 Households and Jobs Tracker in 2020. All data
in this report that were not extracted from the MICS6 database are referenced.

Table 2 and table 3 present the distribution of all adolescent households members included in the household survey, as well as the wealth distribution
of the households. Table 3 and figure 3 illustrate the large regional wealth disparities, with 75% of adolescents in the Upper East Region living in
households that are in the poorest quintile, while in Greater Accra it is less than three percent.

Table 2. Weighted number of adolescents 10-19 included in the Table 3. Percentage distribution of adolescents 10-19 in households
household survey by wealth quintile

Region Male Female Total % Male % Female Region Poorest Second Middle Fourth Richest
Western 700 744 1,444 48.5% 51.5% Greater Accra 2.4% 8.5% 17.1% 30.7% 41.4%
Central 715 741 1,456 49.1% 50.9% Central 8.4% 28.6% 26.9% 19.8% 16.3%
Greater Accra 630 705 1,335 47.2% 52.8% Eastern 12.2% 23.3% 25.2% 21.6% 17.7%
Volta 651 605 1,256 51.8% 48.2% Ashanti 12.9% 20.5% 19.9% 28.8% 18.1%
Eastern 907 961 1,868 48.6% 51.4% Western 12.9% 22.2% 22.4% 23.3% 19.3%
Ashanti 1,704 1,640 3,344 51.0% 49.0% Volta 25.8% 32.3% 23.4% 11.7% 6.9%
Brong Ahafo 747 683 1,430 52.2% 47.8% Brong Ahafo 27.1% 22.0% 25.0% 14.2% 11.7%
Northern 880 772 1,652 53.3% 46.7% Northern 47.1% 25.7% 50%
14.6% 7.8% 4.8%
Upper East 267 242 509 52.5% 47.5% Upper West 60.2% 18.4% 11.1% 5.5% 4.8%
Upper West 221 187 408 54.2% 45.8% Upper East 74.7% 11.6% 6.1% 4.5% 3.1%

Total 7,422 7,280 14,702 50.5% 49.5% All 21.2% 22.1% 20.7% 19.9% 16.1%

Poorest Second Middle Fourth Richest

Upper East
Upper West
Northern
FIGURE 5. Percentage distribution of adolescents 10-19 Brong Ahafo
in household by wealth quintile Volta
Western
Ashanti
Eastern
Central
Greater Accra
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
15
4. The Situation of Adolescents in Ghana
Health
Findings
Key Findings
The median age of sexual debut is 18 years for adolescent girls and 19 years for
adolescent boys. Sex before the age of 15 years as well as sex with a partner
who is at least 10 years older are reported by one girl out of ten.
Most adolescents (72%) do not use condoms during intercourse with a non-
marital or non-cohabiting partner. Boys report condom use more often than girls.
Adolescent girls aged 15 to 19 are the age cohort with the highest unmet need
for contraception. Two out of three unmarried sexually active girls and more than
half of married adolescents report that they want to stop or delay childbearing but
are not using any method of contraception.
Among adolescent girls aged 15 to 19, 14% have had a live birth or are currently
pregnant with their first child. Girls in the poorest wealth quintile are five time
more likely to give birth before the age of 20 than those in the richest.
The proportion of adolescents who are knowledgeable about HIV prevention is
generally low. Girls with low educational achievements are particularly unlikely to
access relevant information on HIV prevention. At the same time, discriminatory
attitudes towards people living with HIV are widespread among adolescent boys
and girls.
Young people tend to take risks and/or adopt risky sexual behaviours
including unprotected sex that expose them to unwanted pregnancy,
unsafe abortion, sexually transmitted infections (STIs) including HIV,
and other risks to their health and well-being. Certain behaviours
increase the risks for STIs such as sex with multiple partners, sex
at an early age and intergenerational sex, meaning girls and young
women having sex with older men.30
The percentage of never-married adolescents and young people
aged 15 to 24 years who ever had sex is 45% for females and 38%
for males. The percentage is higher for young women in rural areas
(48%) compared to urban areas (43%). Among young men it is
inversed with 44% in urban and 33% in rural areas. About 31% of
never married adolescent girls age 15 to 19 ever had sex compared
to 21% of adolescent boys. The median age of first sexual intercourse
reported by young women aged 20 to 24 increased during the 1990s
from 17 to 18.4 years but has not changed since 2003. Among young
men it was reported at 19.4 years.3
FIGURE 6. Median age of first sexual intercourse (women aged 20-24)

Only 7% of adolescent girls and 2% of adolescent boys have been tested for HIV 19
within the past 12 months and know their results. 18.5
18.4 18.4
18.5
Access to appropriate menstrual hygiene materials is high (over 90%). That
notwithstanding, two out of ten girls did not participate in social activities, school,
18
or work during their last menstruation.

Median Age
17.5
Use of tobacco, cannabis and other drugs are not common. Alcohol use is more 17.5
common and is reported by 9% of boys and 5% of girls.
16.9
17
Most adolescent girls and boys have a healthy body weight. However,
undernutrition is common among rural adolescent boys (32%) and overnutrition
16.5
affects a considerable number of urban adolescent girls, especially in Greater
Accra and those in the highest wealth quintile (22%).
16
Almost half of all adolescent girls aged 15 to 19 (48%) are anaemic, although 1993 1998 2003 2008 2014
severe anaemia is rare (0.3%). Source: UNFPA (2016). Situational analysis of adolescent girls andYear
young women in Ghana

16
The percentage of adolescents aged 15 to 19 years who had sex
before the age of 15 years is 10% for girls and slightly lower for boys
(7%). Girls in the poorest wealth quintile are significantly more likely
to have had sex before the age of 15 years (14%) than those of
the highest quintile (5%) but this difference is not observed among
adolescent boys. Girls in rural areas are more likely to engage in
sexual activities before the age of 15 years (12%) than in urban areas
(8%) while for boys this relationship is inversed (9% urban vs. 5%
rural). There are regional variations with early sexual debut for girls
being highest in the Volta and Northern Regions and for boys in the
Ashanti Region.
TABLE 4. Sex before the age of 15 years
Sex with more than one partner is rare among Ghanaian adolescents
aged 15 to 19 years at 2% for boys and girls. There is no difference
between adolescents living rural and urban areas and no clear pattern
according to wealth.
About 28% of adolescents reported that they used a condom during
their last intercourse with a non-marital or non-cohabiting partner (26%
girls and 34% boys). Condom use was more common among girls
in urban areas (31%) than rural areas (23%). The difference was far
less for boys (36% vs. 33%). There are large regional differences in
reported condom use, however the rates in some regions are based on
small samples and are therefore not stable.

% of females 15-19 TABLE 5. Condom use

% of males 15-19 who Both
who had sex before
had sex before age 15 15-19
age 15 % of males15-19 who
% of females 15-19 who
report condom use
Western 7.5% 0.0% 5.2% report condom use during
during last intercourse
last intercourse with non-
with non-marital, non-
Both
Central 6.6% 6.3% 6.5% marital, non-cohabiting
cohabiting partner in last
Greater Accra 6.2% 5.2% 5.9% partner in last 12 months
12 months
Volta 16.5% 6.3% 12.7% Western 24.7% 4.1% 20.5%
Eastern 12.6% 8.4% 11.1%
Region Central 20.6% 52.6% 27.6%
Ashanti 9.0% 15.2% 11.1%
Greater Accra 33.7% 46.6% 35.6%
Brong Ahafo 9.1% 1.6% 6.5%
Volta 35.7% 17.5% 31.9%
Northern 14.6% 1.1% 9.2%
Eastern 30.0% 70.6% 42.4%
Upper East 9.1% 5.3% 7.8% Region
Ashanti 17.4% 19.1% 17.8%
Upper West 10.1% 3.6% 7.4%
Brong Ahafo 30.9% 18.1% 28.2%
Urban 7.6% 9.3% 8.1%
Area Northern 27.2% 36.0% 28.9%
Rural 12.1% 5.1% 9.6%
Upper East 52.4% 67.1% 57.4%
Poorest 14.1% 4.9% 10.6%
Upper West 17.4% 22.4% 19.9%
Second 11.6% 4.1% 9.0%
Wealth Urban 31.3% 35.6% 32.3%
Middle 10.6% 9.7% 10.3% Area
quintile Rural 22.5% 32.7% 24.7%
Fourth 8.7% 9.6% 9.0%
Poorest 25.2% 28.7% 26.0%
Richest 4.5% 4.9% 4.5%
Second 22.7% 36.1% 25.8%
Ever married/in Wealth
32.0% 38.9% 32.3% Middle 26.7% 27.2% 26.8%
Marrige union quintile
status Never married/ Fourth 23.7% 45.3% 27.8%
in union 7.7% 6.6% 7.3%
Richest 39.5% 41.1% 39.8%
Total 9.9% 6.9% 8.9% Total 26.3% 34.1% 28.1%
17
The percentage of adolescent girls who had sex with a man who Contraception
was at least 10 years older was 11%. Intergenerational sex is
more common in rural areas (10%) than in urban areas (6%). More than half of sexually active adolescent girls in Ghana who
There are large regional differences with the highest proportion of want to avoid or delay childbearing are not using any contraceptive
intergenerational sexual relationships reported in the Upper West method. Among those who are married and in union, this unmet need
Region and the lowest in the Upper East Region. The frequency is 52% and for those who are currently unmarried or not in union it
profile of intergenerational sex is also reflected in the frequency of is as high as 68%. These proportions are considerably higher than
marriage of adolescent girls with men who are ten or more years among older cohorts, for comparison, among women aged 35 to 39
older. Here the difference between rural and urban residence is more these proportions are 33% and 36% respectively. The sample among
pronounced (5% urban vs. 26% rural). adolescents is too small for further disaggregation, but unmet needs
among all women are somewhat higher in the lower wealth than the
TABLE 6. Intergenerational sex and marriage upper wealth quintiles with only minor differences between rural and
urban residence.
% of adolescent girls who % of married
The proportion of married adolescents who use, or whose partner
had sex in the past 12 adolescent girls whose
months with a partner who partner is 10 or more uses, a modern contraceptive method is 22% while it is only 18%
was at least 10 years older years older among unmarried sexually active adolescent girls. The contraceptive
prevalence rate rises with age and is highest among women in their
Western 9.7% 39.4%
twenties with the highest level of 42% among unmarried women aged
Central 7.9% 12.1% 25 to 29. There is, however, no clear relationship with household
Greater Accra 14.2% 5.6% wealth. As for the data on unmet need, the sample among adolescents
Volta 13.1% 23.0% is too small for further disaggregation.
Eastern 10.5% 22.2%
Region FIGURE 7. Contraceptive Prevalence and Unmet Need
Ashanti 7.9% 13.5%
Brong Ahafo 9.4% 17.1% Mo dern contraceptive prevalence
Contraceptive among among
prevalence 15-19
year15-19
olds not 17.8%
Northern 17.7% 39.8% yearinold
union
girls not in union
Upper East 4.9% 4.6% Mo dern contraceptive prevalence among among
15-19
Contraceptive prevalence
Upper West 18.3% 25.7% year olds in year
unionold girls in union 22.2%
15-19
Urban 6.9% 5.4%
Area
Rural 10.1% 25.6%
Poorest 11.6% 19.6%
Unmet need Unmet
amongcontraceptive
sexually active15-19 year
need among
Second 9.7% 12.7% olds notyear
in union 67.8%
15-19 old girls not in union
Wealth
Middle 13.4% 31.5%
quintile Unmet contraceptive need among
Fourth 9.3% 14.6% Unmet need among 15-19
15-19 year
year oldolds
girlsininunion
union 51.5%
Richest 6.1% 36.4%
20% 40% 60% 80% 100%
Total 10.6% 19.5%

18
 FIGURE 8. Percentage of women who gave birth before age 18 and
Unsafe abortion before age 15 by age cohort
The 2017 Maternal Health Survey reported that 3% of the adolescent
girls aged 15 to 19 years had undergone an induced abortion.14 50%
Rural
Successive Demographic and Health survey reports do not indicate a 45%
clear trend but rather a fluctuation around the 3% mark since 1998.3 40% Urban
The reported rate is, however, likely to be an underestimate due 35% Both
to underreporting because of the high stigma associated with the <18 years old
30%
issue.31 Almost 30% of women who reported that they had an induced
abortion at age 20 or younger used an unsafe abortion method. 25%
The main stated reason for the abortion was the feeling of being too 20%
young to have children (29%) followed by the desire to continue going 15%
to school (23%). Partners were mostly favourable of their decision 10% <15 years old
(55%), while 18% opposed the decision for an abortion, 8% had a
5%
neutral attitude and 16% had not been made aware of the pregnancy.
0%
Pregnancy and delivery 45-49 40-44 35-39 30-34 25-29 20-24 18-19
Age cohorts
The adolescent birth rate (the number of births to adolescent girls
aged 15-19 per 1,000) in Ghana is estimated as 75 which is lower Among adolescent girls aged 15 to 19, 14% have had a live birth or
than the average of 102 estimated for the African region.32 Although are currently pregnant with their first child. The proportion is almost
the rate has changed very little over the past ten years, there has twice as high in rural compared to urban areas, and almost five times
been a gradual decrease in early childbearing as indicated by the higher among adolescents in the lowest wealth quintile households
percentage of women in different age groups who reported that they compared to the highest. There is also some regional variation with
had a live birth before the age of 18 years and 15 years. Fatherhood the highest rate in the Volta Region. Fatherhood among adolescent
before the age 18 is, however, uncommon in Ghana and was reported boys (age 15 to 19) is not common.
by less than 2% of men aged 20-24.

19
TABLE 7. Adolescent pregnancy and fatherhood TABLE 8. Pregnancy and maternity care

% of females 15-19 who Skilled birth Facility

% of males 15-19 Antenatal care attendance delivery
have had a live birth or
who have fathered a % of females
are pregnant with their % of females 15- % of females
live birth aged 15-19
first child 19 with live birth 15-19 with live with live birth
in last 2 years birth in last 2
Western 14.6% 1.3% in last 2 years
and 4 or more years that was who delivered
Central 15.0% 0.2% antenatal visits to assisted by a in a health
any provider skilled provider
Greater Accra 11.3% 0.0% facility
Volta 18.8% 0.6% Western 85.6% 63.4% 63.4%
Eastern 17.8% 2.0% Central 86.6% 75.5% 75.4%
Region Greater
Ashanti 14.0% 0.0% 91.6% 95.6% 95.6%
Accra
Brong Ahafo 16.3% 0.0%
Volta 74.5% 66.9% 65.4%
Northern 8.8% 0.2%
Eastern 69.6% 78.4% 77.9%
Upper East 9.8% 1.0%
Upper West 10.5% 0.3% Region Ashanti 80.5% 75.4% 75.4%
Brong
Urban 10.0% 0.1% 81.8% 98.9% 97.0%
Area Ahafo
Rural 18.3% 0.8% Northern 86.4% 73.7% 73.7%
Poorest 19.0% 0.4% Upper
86.6% 97.1% 97.1%
Second 18.1% 1.4% East
Wealth
Middle 15.3% 0.5% Upper
quintile 62.8% 86.7% 79.1%
Fourth 14.6% 0.0% West

Richest 4.0% 0.0% Urban 87.0% 89.1% 88.3%

Area
Total 14.3% 0.5% Rural 76.8% 72.7% 72.3%
Poorest 67.0% 73.0% 72.0%
The access of adolescent girls aged 15 to 19 to pregnancy and Second 85.4% 67.9% 67.3%
maternity care is not substantially different from the access among all Wealth
Middle 75.8% 80.0% 79.5%
quintile
women, including the same level of inequity by wealth and by urban Fourth 92.5% 91.1% 91.1%
versus rural residence. Across all three indicators of quality care, 1) Richest 92.1% 93.9% 93.9%
at least four antenatal visits, 2) delivery by a skilled provider and 3)
Total 80.0% 77.9% 77.4%
delivery in a health facility, the same pattern is observed with around
70% achievement in rural areas and among the lowest wealth quintile,
and around 90% in urban areas and among the highest wealth
quintile.
20
The risk of dying from a complication of pregnancy and childbirth is higher among adolescent girls than among young women aged 20 to 24, but lower
than for women after age 30 when the risk starts to increase steeply with age.33 The largest number of maternal deaths occurs in the age groups from
20 to 34 because these are the ages at which women are most likely to give birth. Pregnancy-related deaths among adolescent girls are rare, but they
are, together with suicide, the leading global cause of death among girls in this age group. 34
In Ghana the mortality from pregnancy-related causes was estimated by the Maternal Health Surveys in 2007 and 2017, each time for a seven-year
period preceding the survey.14 During this time, the mortality among all women of reproductive age decreased by 33% and among adolescent girls by
54%. Among all deaths among women of reproductive age, 12% were due to pregnancy-related causes, while among adolescent girls it was 7%.
While adolescent girls face a less than average risk of death from pregnancy and childbirth related causes, the children born to adolescent mothers
have a higher than average risk of death in early childhood.

FIGURE 9. Pregnancy related deaths

% of deaths due to pregnancy- Pregnancy-related mortality per

% of deaths duecauses
related to pregnancy- Pregnancy-related mortality per
1,000
related causes 1,000
0.64

16%
All women of 14% 0.43
reproductive age 12%

0.26
Adolescent girls 15-19 7%

0.12

Source: Maternal Health 2007 2017 2007 2017

Surveys 2007 and 2017 2007 2017 2007 2017
Adolescent girls 15-19 All women of reproductive age

21
HIV TABLE 9. Comprehensive HIV knowledge

The HIV prevalence in Ghana was surveyed in the 2014 Demographic Comprehensive knowledge
and Health Survey and reported at 2% among the general population
% of females % of males
and 0.8% among adolescents and young people aged 15 to 24. HIV 15-19 15-19
both
infection is more prevalent among women than among men in general
(2.8% vs. 1.1%) and among adolescents (0.3% among girls and Western 10.5% 10.7% 10.5%
0.2% among boys).3 In comparison to an earlier survey in 2003, the Central 10.9% 10.1% 10.7%
prevalence of HIV infection among adolescents has not changed.
Greater Accra 20.5% 23.8% 21.4%
The percentage of adolescent girls and boys aged 15-19 years who
correctly identify two ways of preventing HIV infection, know that Volta 12.6% 18.7% 14.8%
a healthy-looking person can have HIV, and reject the two most Region Eastern 9.6% 9.2% 9.5%
common misconceptions about HIV transmission is 12% for girls
Ashanti 10.0% 12.1% 10.7%
and 14% for boys. The area of residency plays an important role:
adolescent girls and boys are more likely to have comprehensive Brong Ahafo 14.1% 11.5% 13.2%
knowledge on HIV in urban areas (15% for girls and 18% for boys) Northern 7.5% 17.8% 11.5%
than in rural areas where only 9% of the girls and 11% of the boys Upper East 18.2% 24.5% 20.2%
have comprehensive knowledge. There are also important differences Upper West 15.1% 12.3% 13.9%
among the regions. In the Greater Accra and the Upper East Regions Urban 15.4% 17.7% 16.1%
more than 20% of adolescents have comprehensive knowledge Area
Rural 8.8% 11.1% 9.6%
while in the Eastern Region it is less than 10%. The percentage
Poorest 8.1% 8.9% 8.4%
of adolescent girls with comprehensive knowledge on HIV is twice
as high among the richest wealth quintile (17%) compared to the Second 8.3% 12.3% 9.7%
Wealth Middle 11.3% 9.0% 10.5%
poorest wealth quintile (8%). Among boys the difference is even more quintile
pronounced. Fourth 15.2% 18.6% 16.4%
Richest 17.1% 26.4% 19.3%
The largest differences are, however, related to educational
Pre-primary 3.7% 16.7% 7.3%
achievement. Among adolescents with no education or only primary
Primary 4.4% 2.2% 3.6%
education the level of knowledge is well below 10% and among girls
below 5%, while about a third of adolescents with higher education School Middle 10.3% 11.0% 10.5%
have comprehensive knowledge. But even among the best-informed Secondary 21.4% 28.5% 23.7%
group of adolescent girls in higher education, only a third (35%) have Higher 34.8% 28.8% 33.0%
comprehensive knowledge about HIV. Total 12.0% 13.9% 12.6%

22
When asked whether they would buy fresh vegetables from a TABLE 10. Discriminatory attitudes towards people living with HIV
shopkeeper or vendor who is HIV-positive and whether they think
Discriminatory attitudes towards people living with HIV
children living with HIV should be allowed to attend school with
those who do not have HIV, a high percentage of adolescent girls % of females
% of males 15-19 Both
15-19
and boys aged 15-19 years express discriminatory attitudes (82%
for girls and 79% for boys). While fewer adolescent boys than girls Western 79.4% 75.2% 78.1%
would discriminate against people living with HIV in most regions, the Central 89.5% 80.4% 86.5%
ratio is inversed in the Ashanti Region and the Upper East Region. Greater 79.7% 69.8% 77.0%
Discriminatory attitudes are more common in rural than in urban areas Accra
and among adolescents in the poorest households compared to the Volta 81.8% 80.7% 81.4%
richest reflecting the differences in comprehensive knowledge about Region Eastern 83.3% 78.0% 81.5%
HIV among these groups. Discriminatory attitudes are, however, only Ashanti 81.6% 83.6% 82.3%
somewhat less common among adolescents with higher than with Brong Ahafo 79.7% 76.2% 78.4%
lower educational achievements with a much smaller difference than Northern 84.0% 78.4% 82.0%
would be assumed by the large gap in knowledge.
Upper East 79.5% 85.0% 81.3%
Upper West 82.9% 82.9% 82.9%
Urban 78.1% 77.7% 78.0%
Area
Rural 86.5% 80.3% 84.2%
Poorest 87.8% 86.0% 87.1%
Second 88.3% 82.0% 86.1%
Wealth
Middle 81.5% 81.9% 81.6%
quintile
Fourth 81.8% 76.0% 79.7%
Richest 72.9% 64.8% 70.9%
Pre-primary 82.0% 87.3% 84.0%
Primary 90.4% 88.0% 89.6%
School Middle 85.0% 81.5% 83.8%
Secondary 72.1% 68.7% 71.0%
Higher 67.7% 62.0% 66.0%
Total 82.3% 79.2% 81.2%

23
Parental consent is required for HIV testing of adolescents younger Somewhat higher levels of testing among girls were reported from the
than 16 years. Sexually active or married adolescents who are Western Region (15%) and Greater Accra Region (14%). The number
younger than 16 years are, however, considered ‘mature minors’ and of sexually active boys was too small to calculate stable testing rates
do not require parental consent for HIV testing.35 Among 15 to 19 year for each region.
old adolescents, 30% of girls and 14% of boys reported that they had
sex within the past 12 months. Few of the sexually active adolescents, Menstrual hygiene
however, were tested for HIV within the past 12 months and knew
Menstrual health has emerged as an important yet neglected entry
their results, more of them girls (7%) and very few boys (2%).
point to discuss puberty, gender, reproductive health, and sexuality
TABLE 11. HIV Testing
issues with young women. Globally, knowledge and understanding
% of sexually active adolescents who have been of menstruation are often low among adolescent girls.36 In Ghana,
tested for HIV in the last 12 months and know more than 90% of adolescent girls aged 15 to 19 have a private place
results in their home to wash and change and use appropriate menstrual
hygiene materials such as sanitary pads or tampons. While there
females 15-19 males 15-19 both are no large regional differences, nor differences according to wealth
and educational achievement in the use of appropriate materials nor
Western 15.3% 12.5% access to a private place to wash and change, about 6% of girls also
Central 0.8% 1.7% use reusable materials such as cloth or reusable sanitary pads at least
some of the time. The use of reusable materials is highest among
Greater Accra 13.9% 11.1%
girls of the poorest wealth quintile (18%), among those with the lowest
Volta 8.8% 8.7%
educational achievements (33%) and among girls in the Northern and
Eastern 3.1% 2.3% Upper West Regions (28% and 17%).
Region
Ashanti 6.5% 5.0%
Despite the apparent high level of access to menstrual hygiene, about
Brong Ahafo 9.4% 8.2%
one fifth of the adolescents (22%) reported that they did not participate
Northern 4.9% 4.2%
in a social activity, school, or work during their last menstruation.
Upper East 9.1% 8.4% This was less frequently reported by girls in the highest wealth
Upper West 5.9% 4.3% quintile households and those with higher education. It was much
Urban 8.0% 2.4% 6.5% most frequently reported by girls in secondary school and by those
Area
Rural 6.9% 1.9% 5.9% in the second and middle wealth quintile. There were also regional
Poorest 5.4% 1.7% 4.6%
differences with adolescents in the Ashanti and Brong Ahafo Regions
being about three times more likely to avoid social contacts during
Second 6.8% 3.1% 6.1%
Wealth menstruation than girls in the Eastern and Western Regions.
Middle 7.3% 0.0% 5.4%
quintile
Fourth 10.9% 3.6% 9.3%
Richest 5.7% 4.3% 5.3%
Total 7.3% 2.1% 6.2%

24
TABLE 12. Menstrual hygiene

% of females 15-19 using % of females 15-19

appropriate menstrual who did not participate
hygiene materials with in social activities,
a private place to wash school or work due to
and change while at their last menstruation
home in last 12 months
Western 93.7% 12.5%
Central 94.7% 21.6%
Greater Accra 96.7% 14.3%
Volta 85.8% 23.2%
Eastern 94.2% 8.5%
Region
Ashanti 86.2% 32.1%
Brong Ahafo 97.5% 31.0%
Northern 86.8% 24.9%
Upper East 96.9% 15.8%
Upper West 87.6% 23.2%
Urban 93.2% 21.9%
Area
Rural 89.8% 22.2%
Poorest 91.0% 20.1%
Second 92.9% 26.2%
Wealth
Middle 89.2% 25.6%
quintile
Fourth 92.0% 20.2%
Richest 92.4% 17.3%
Pre-primary 87.2% 12.7%
Primary 88.2% 22.5%
School Middle 92.0% 22.4%
Secondary 92.5% 22.6%
Higher 93.7% 1.6%
Total 91.5% 22.0%

25
Substance use TABLE 13. Use of tobacco and alcohol

Substance use among adolescents, particularly use of tobacco and Adolescents who smoked Adolescents who had at
cigarettes, or used smoked least one alcoholic drink
alcohol, is a public health concern and is linked to chronic health or smokeless tobacco at any time during the
problems later in life. In 2003, a survey of 1,500 adolescents and products at any time during last one month
youth aged 15 to 24 years in six districts of Ghana reported that the last one month
25.3% had ever used alcohol and 8.7% had ever smoked cigarettes. % of % of % of % of
The most frequent age of first use was 18 years. Ever use of cannabis females males15-19 females males
was reported much lower at 1.7% while ever use of tranquilisers, 15-19 15-19 15-19
amphetamines, opiates, and hallucinogens were reported by 0.3% or Western 0.0% 1.3% 4.5% 6.3%
fewer. 37 Tobacco use among adolescents surveyed in 2017/18 was Central 0.0% 0.0% 3.4% 3.5%
very low with 0.2% among girls aged 15 to 19 and 0.5% among boys. Greater Accra 0.6% 0.3% 5.1% 11.5%
There is no clear pattern according to residence or wealth. Alcohol Volta 0.0% 0.0% 7.6% 13.6%
use is more common and was reported by 5% of girls and 9% of boys. Eastern 0.0% 1.3% 5.8% 10.3%
Girls in rural areas and those in the lowest wealth quintile are more Region
Ashanti 0.4% 0.0% 4.1% 8.2%
likely to drink alcohol while this pattern is not as clearly observed
Brong Ahafo 0.0% 0.4% 1.7% 13.9%
among boys. Alcohol consumption among adolescents is highest in
the Upper West Region. Northern 0.0% 0.7% 8.6% 2.3%
Upper East 0.0% 0.0% 3.3% 6.1%
Upper West 0.0% 0.9% 16.7% 25.0%
Urban 0.3% 0.4% 4.0% 9.5%
Area
Rural 0.0% 0.5% 6.2% 8.6%
Poorest 0.0% 0.5% 8.1% 10.7%
Second 0.0% 0.3% 4.3% 3.8%
Wealth
Middle 0.0% 0.8% 5.6% 9.5%
quintile
Fourth 0.5% 0.4% 4.0% 9.3%
Richest 0.3% 0.0% 3.8% 13.5%
Total 0.2% 0.5% 5.1% 8.9%

26
Nutrition
TABLE 14. Nutritional Status
The MICS 2017/18 survey collected data on nutrition among children
up to five years of age. Data on over- and under-nutrition as well as Mean BMI (kg/m²) % thin or % overweight or
moderately thin obese
on anaemia among adolescents were last reported in the 2014 Ghana
Demographic Health Survey (GDHS).3 Consecutive surveys since Females Males Females Males Females Males
15-19 15-19 15-19 15-19 15-19 15-19
2003 found that over a ten-year period the prevalence of undernutrition
among Ghanaian women decreased from 9% to 6% while there was Western 21.8 19.5 8.5% 33.8% 17.0% 0.6%
a marked increase in overnutrition from 25% to 40%. Among men,
Central 21.5 19.7 10.5% 31.3% 11.0% 2.6%
obesity and overweight was less common (16%) while a higher
proportion of men than women (10%) were found to be underweight. Greater
21.9 20.6 14.2% 14.2% 16.3% 8.5%
Accra
Among adolescents aged 15 to 19, obesity is defined as having a body Volta 21.1 19.5 13.5% 28.9% 11.9% 0.0%
mass index for age z score (BMIZ) that is more than two standard
deviations above the median, and thinness by a BMIZ below two Eastern 20.7 19.6 23.8% 60.6% 10.4% 0.8%
standard deviations. The mean BMIZ for girls in the survey was 21.3 Region Ashanti 21.4 19.5 7.2% 38.2% 12.5% 0.6%
kg/m2 and for boys 19.8 kg/m2. Few adolescents (1% girls and 0.2% Brong
21.5 20 5.8% 27.9% 12.0% 1.5%
boys) were obese, while 1.7% girls and 5.4% boys were found to be Ahafo
thin. Northern 20.5 19.6 17.2% 32.8% 3.5% 0.4%

Overweight and moderate thinness are defined by BMIZ values that Upper
20.8 19.4 15.0% 70.8% 5.1% 0.8%
East
are one standard deviation above and below the median. To assess
Upper
the status of under- and over-nutrition, thinness and moderate West
21.2 19.9 8.0% 23.1% 10.2% 0.8%
thinness as well as overweight and obesity were combined. Overall,
76% of girls and 68% of boys were in the normal BMI range whereby Urban 21.8 20.0 11.1% 26.9% 17.7% 3.9%
Area
among girls an equal percentage (12%) were under and overweight. Rural 20.9 19.6 12.4% 32.4% 6.1% 0.6%
Among boys, overweight was rare (2%) while almost a third (30%)
Poorest 20.6 19.6 14.8% 30.6% 4.8% 0.8%
were underweight. There were regional differences for all nutrition
parameters, however without a clear pattern. Under-nutrition was Second 20.6 19.2 12.0% 40.6% 4.2% 0.1%
slightly more common among urban adolescents. Among boys, it Wealth
Middle 21.6 19.7 8.1% 26.1% 11.4% 0.9%
was more common among those in the lowest two wealth quintiles. quintile
This was, however, not observed among girls. For over-nutrition, the Fourth 21.8 20.3 13.2% 25.3% 20.7% 2.7%
distribution pattern was more marked. Urban girls were three times Richest 22.4 20.2 10.1% 25.3% 22.3% 8.0%
more likely to be overweight than girls in rural areas and urban boys
six times more likely than their rural peers. Adolescents in Greater Total 21.3 19.8 11.7% 29.8% 12.0% 2.2%
Accra had the highest prevalence of over-nutrition while the lowest
values were recorded in the three northern regions. Over-nutrition was Source: Ghana Demographic and Health Survey 2014

relatively rare among adolescents in the lowest two wealth quintiles

compared to those in the highest two wealth quintiles.
27
Anaemia is the result of one of the most prevalent micronutrient TABLE 15. Anaemia (adolescent girls 15-19)
deficiencies, most commonly caused by a deficiency in iron or folate.
In the 2014 GDHS survey, blood samples were analysed to assess Mean Hb (g/dl) % of anaemia
the prevalence of anaemia among women. Women and girls who
were not pregnant and had a blood haemoglobin level below 12.0 g/ Western 11.9 44.2%
dl (11.9 g/dl if pregnant) were considered to be anaemic; if the level Central 11.7 59.2%
was below 7.0 g/dl they were considered severely anaemic. Among Greater Accra 11.8 45.7%
all age groups, adolescent girls age 15-19 had the highest prevalence Volta 11.5 55.3%
of anaemia (48%). Severe anaemia, however, was more common Eastern 11.9 39.1%
among older women than among adolescents (1.2% among 40-49 Region
Ashanti 11.7 49.4%
years vs. 0.3% among 15-19 years). The prevalence of anaemia was
Brong Ahafo 12.1 43.8%
higher in rural than in urban areas, but there was no clear distribution
pattern between regions or wealth quintiles. Of note is that the mean Northern 11.6 52.0%
haemoglobin levels of 878 girls surveyed in 2014 were at the margin or Upper East 12.0 44.3%
below the lower normal range except in two regions and in the fourth Upper West 11.9 38.9%
wealth quintile group. Urban 11.9 46.0%
Area
Rural 11.7 49.5%
Poorest 11.9 45.9%
Second 11.5 58.4%
Wealth
Middle 11.9 45.7%
quintile
Fourth 12.1 38.1%
Richest 11.7 48.3%
Total 11.8 47.7%

Source: Ghana Demographic and Health Survey 2014

28
Education FIGURE 10. Ghana’s education system

Key Findings Polytechnic University College

(3 years) (4 years) (3 years)
Most adolescent girls and boys aged 10 – 14 years (96%) are
in school. Among 15 to 19 year old adolescents, the school
attendance rate drops to 71%. In this age group, more girls (32%) Third terminal point
than boys (24%) are out of school, especially in rural areas. Higher Education
(3 or 4 years)
Less than half (47%) of Ghanaian adolescents, more girls than 18-20 or 21 years
boys, complete basic education (up to grade nine). Only about a
third (35%) complete secondary education (up to grade 12) with Second terminal point
35% completion rate
little difference between boys and girls. There are large differences Technical & Senior High
in education completion rates by wealth quintile, urban and rural Vocational
(3 years) (3 years)
residence, and among regions.
Among adolescents aged 10 to 14, only 30% have primary school Senior Secondary
grade 3 level reading skills and only 21% have grade 3 level
15-17 years
numeracy skills. More girls than boys have reading skills while more
boys have numeracy skills. There are large differences in skills First terminal point
development by wealth quintile, urban and rural residence, and Basic
71% completion rate 47% completion rate

among regions. School Primary Junior High

(6 years) (3 years)
6-11 years 12-14 years

Pre-school
Following early childhood education at the age of 3-5 years, Ghanaian (3 years)
children enter an education system with three terminal points. The 3-5 years
first point is reached after nine years of basic or compulsory education
Most Ghanaian adolescents aged 10 to 14 are in school; only 4% are
including six years on primary school and three years in Junior
out of school. There are only small differences in school attendance
High School (JHS). The next point is no longer compulsory and is
among the regions, between rural and urban residence, or by wealth.
reached after three years of Senior High School (SHS) or technical
Girls have a slightly higher school attendance rate than boys. Among
and vocational training. After that, students can progress to higher
those 15 to 19 year old, only 71% are still in school or in technical
education in a college, university or polytechnic.
or vocational training, 68% girls and 76% boys. With the widening
gender gap, the differences among regions, between rural and urban
areas and by wealth are also more pronounced. Early pregnancy and
child marriage likely contribute to the widening gender gap in later
adolescence.
Lorem

29
TABLE 16. School attendance including technical and vocational training Another reason for the gender gap in school
attendance are schooling delays that are common
in Ghana and especially among boys. In the last
Adolescents 10-14 currently Adolescents 15-19 currently three years of basic schooling, in Junior High
attending school at any level attending school at any level School, 40% of boys and 29% of girls are two or
Adolescents Females Males Adolescents Females Males more years older than the official age for the grade
10-14 10-14 10-14 15-19 15-19 15-19 they are attending. Due to delayed school entry
or repetition of classes they are well into their late
Western 97.8% 98.1% 97.4% 69.4% 69.3% 69.6% adolescence when they complete basic education.
Central 93.1% 96.0% 89.5% 72.0% 65.2% 87.0% There are regional differences in schooling delays;
Greater Accra 98.4% 98.9% 97.9% 69.1% 69.7% 67.5% they are twice as common in the three northern
regions as in Greater Accra, and three times more
Volta 99.2% 98.7% 99.5% 74.9% 74.4% 75.8%
common among adolescents from poor than from
Eastern 99.3% 99.9% 98.6% 67.6% 65.1% 72.5%
Region rich households.
Ashanti 96.2% 97.4% 95.0% 70.3% 67.0% 76.9%
Brong Ahafo 92.4% 93.7% 91.3% 66.1% 60.1% 77.4% Girls are more likely to complete basic schooling
than boys and less likely to be more than two
Northern 92.7% 91.9% 93.5% 74.4% 71.0% 79.4%
years over age in Junior High School classes.
Upper East 96.6% 98.3% 95.3% 78.2% 76.9% 81.1%
Overall completion rates for basic education are
Upper West 94.4% 95.3% 93.6% 78.8% 81.8% 74.6% only 47% but they are 50% for girls and 45% for
Urban 96.1% 97.2% 94.4% 72.7% 71.5% 75.5% boys. Although boys in late adolescence (15 to 19)
Area
Rural 96.1% 96.7% 95.5% 69.1% 64.6% 76.8% are more likely than girls to be in school, technical
Poorest 93.2% 93.7% 92.7% 69.7% 64.0% 79.1% or vocational training, the gender difference in
Second 97.7% 97.6% 97.8% 68.9% 64.7% 76.7%
completion rates is small. Completion rates for
Wealth secondary education are 35% for girls and 37%
Middle 96.4% 98.4% 94.5% 70.5% 70.5% 70.6%
quintile for boys. At each level of the education system
Fourth 96.5% 98.8% 93.7% 71.6% 67.1% 79.3% the wealth gap in completion rates widens; only
Richest 96.6% 95.4% 98.0% 73.7% 73.1% 75.7% 10% of adolescents in the poorest wealth quintile
Total 96.1% 96.9% 95.3% 70.8% 68.0% 76.3% complete secondary education compared to
73% in the richest. There are also large regional
differences. In only three regions more than half
of adolescents complete their basic schooling up
to grade 9 (Greater Accra Region: 66%, Ashanti
Region: 69% and Eastern Region: 54%), and only
in Greater Accra more than half of adolescents
(61%) complete secondary education up to grade
12.
30
TABLE 17. Schooling delays and school completion rates

Completion
% JHS Completion of secondary
students who of basic education (SHS
are >2 years education & Technical
over-age (JHS) / Vocational
Training)
Western 27.0% 45.3% 29.6%

Central 37.7% 47.0% 30.7%

Greater Accra 24.3% 66.2% 61.1%
Volta 52.8% 30.0% 16.0%
Eastern 28.7% 53.6% 33.0%
Region
Ashanti 29.2% 69.2% 40.7%
Brong Ahafo 35.7% 44.9% 34.9%
Northern 45.6% 29.0% 27.2%
Upper East 47.2% 30.5% 24.7%
Upper West 53.1% 14.6% 13.0%
Urban 27.9% 60.8% 49.1%
Area
Rural 40.4% 36.4% 23.0%
Poorest 50.1% 23.1% 10.1%
Second 44.3% 27.3% 20.4%
Wealth
Middle 35.2% 46.5% 29.4%
quintile
Fourth 27.4% 64.5% 39.7%
Richest 17.0% 80.6% 73.1%
Male 39.7% 44.9% 36.8%
Sex
Female 29.2% 50.2% 35.3%
Total 34.5% 47.4% 35.0%

School attendance does not assure that basic reading and numeracy
skills are acquired. The extent to which 10-14 year old adolescents
have acquired these skills at the primary school grade 3 level was
tested in three skill tests of reading and understanding a text, and four
skill tests of understanding numbers and making simple additions.

31
Although all surveyed adolescence were above TABLE 18. Learning skills
the official age for grade 3 primary school, only
30% correctly completed the literacy test indicating Adolescents 10-14 who demonstrate Adolescents 10-14 who demonstrate
foundational reading skills foundational numeracy skills
that they had acquired basic reading skills. The
proportion was somewhat higher among girls Adolescents Females Males Adolescents Females Males
(31% girls vs. 29% boys), it was more than twice 10-14 10-14 10-14 10-14 10-14 10-14
as high in urban compared to rural areas (45% vs.
19%) and it varied across wealth quintiles from Western 40.6% 49.1% 31.0% 30.1% 29.7% 30.6%
a low of 8% in the poorest quintile to 64% in the Central 25.0% 23.6% 26.6% 18.5% 15.5% 21.9%
richest. There were also considerable regional Greater Accra 63.2% 67.2% 59.9% 38.3% 35.7% 40.7%
variations with the largest proportion of successful Volta 26.3% 32.7% 20.9% 12.8% 12.4% 13.2%
performance in Greater Accra and very low scores Eastern 30.6% 26.6% 35.3% 21.3% 19.9% 22.9%
in the three northern regions. Region
Ashanti 36.7% 33.8% 39.4% 25.2% 17.9% 32.3%
Numeracy skills were even lower with only 21% Brong Ahafo 20.5% 20.7% 20.2% 15.7% 14.4% 16.8%
successfully completing the four tasks. More boys Northern 8.7% 11.4% 5.8% 7.2% 5.0% 9.4%
than girls were found to have basic numeracy Upper East 17.4% 27.6% 10.2% 16.5% 21.0% 13.4%
skills (23% boys vs. 18% girls). Learning gaps in Upper West 12.7% 15.6% 10.2% 13.7% 14.2% 13.2%
numeracy across wealth quintiles, between rural Urban 45.4% 46.1% 44.6% 27.1% 25.5% 28.8%
and urban residence and among regions were Area
Rural 18.7% 19.1% 18.3% 16.3% 12.7% 19.6%
similarly distributed as for literacy, but not quite as Poorest 8.2% 9.0% 7.5% 9.0% 6.9% 10.6%
large.
Second 17.8% 17.6% 18.1% 15.5% 10.4% 20.4%
Wealth
Middle 29.8% 31.4% 28.2% 19.8% 16.5% 23.0%
quintile
Fourth 38.7% 38.3% 39.3% 28.6% 24.7% 32.9%
Richest 64.1% 63.7% 64.5% 36.4% 36.6% 36.3%
Total 29.8% 31.0% 28.7% 20.8% 18.4% 23.2%

32
Mass media and ICT
Key Findings
About half of Ghanaian adolescents regularly listen to the radio and
watch television. More boys than girls listen to the radio, while more
girls watch television.
There is at least one mobile phone in almost all households in
Ghana, however less than half of adolescents aged 15 to 19 use it
regularly. More boys than girls have access to a mobile phone.
Household ownership of a computer is low, and fewer women
than men own a computer. Only 6% of adolescents regularly use
a computer, 5% of girls and 9% of boys. Skills among regular
users are about equal, but when computer access is taken into
consideration, boys have about twice the skill level as girls and
there are large differences in skills between regions, urban and
rural residents and between wealth quintiles.
Internet use by adolescents is twice as common as computer use
but it is still low at only 13%. The same wealth and gender gaps in
internet use are observed as for computer use.

More than half of households in Ghana have a radio (57%) and

slightly more own a television set (60%). While there are no major
differences among regions and urban versus rural residence in the
household ownership of radios, the difference in the ownership of
television sets is more marked. While the difference in radio ownership
between households in the lowest and the highest wealth quintile is
about 29 percentage points, it is 91 percentage points for ownership of
a television set. Regional differences in ownership of a television also
reflect the household connection to the electricity grid. Connection is
lowest among households in the Upper East Region (45%), Upper
West Region (62%) and Northern Region (69%) which are also the
three regions with the lowest level of television ownership.

33
Adolescents are more likely to watch television than listen to the radio at least once per week (62% vs. 46%). While more adolescent boys than girls
are regular radio listeners, both are about equally likely to watch television. An exception is the Upper West Region where boys are almost three
times more likely to be regular radio listeners and more than two times more likely to regularly watch television.
TABLE 19. Radio and television use

% of adolescents 15-19 who listen % of adolescents 15-19 who

to the radio at least once per week watch TV at least once per week
% of households % of households with
with a radio a television set
females males females males
Both Both
15-19 15-19 15-19 15-19

Western 56.7% 32.4% 63.1% 41.8% 68.5% 68.4% 72.4% 69.6%

Central 51.0% 44.6% 36.5% 42.0% 59.2% 72.2% 60.2% 68.4%
Greater Accra 56.1% 43.2% 60.1% 47.7% 83.1% 80.4% 78.7% 79.9%
Volta 53.2% 53.9% 57.7% 55.3% 45.0% 51.5% 54.7% 52.6%
Eastern 65.3% 47.6% 76.9% 57.7% 60.5% 59.9% 70.1% 63.5%
Region
Ashanti 64.9% 41.5% 59.7% 47.7% 64.5% 64.7% 63.1% 64.2%
Brong Ahafo 53.7% 44.3% 47.3% 45.3% 52.0% 69.8% 57.9% 65.7%
Northern 45.9% 25.4% 31.2% 27.7% 44.0% 42.5% 47.2% 44.3%
Upper East 51.2% 41.0% 53.1% 44.9% 32.9% 31.5% 35.1% 32.7%
Upper West 47.1% 20.9% 58.7% 36.6% 38.3% 25.7% 53.8% 37.3%
Urban 59.0% 44.7% 56.8% 48.6% 74.8% 72.2% 71.3% 71.9%
Area
Rural 55.2% 38.1% 53.7% 43.8% 45.6% 53.1% 54.3% 43.5%
Poorest 42.3% 35.6% 51.6% 41.5% 6.1% 26.4% 32.8% 28.8%
Second 48.0% 37.1% 50.8% 41.9% 29.2% 57.7% 52.3% 55.8%
Wealth
Middle 50.8% 42.5% 53.3% 46.2% 64.6% 66.3% 71.3% 68.0%
quintile
Fourth 62.5% 43.1% 59.9% 49.3% 75.6% 75.3% 75.5% 49.3%
Richest 76.0% 47.8% 62.6% 51.4% 97.0% 83.3% 84.3% 83.6%
Total 57.2% 41.3% 55.0% 45.9% 60.4% 62.3% 61.4% 62.0%

At least one mobile phone can be found in almost all Ghanaian households (93%). Mobile phones, however, are not generally shared among
household members and ownership by individuals is much lower. In 2019, the Ghana Statistical Service surveyed the personal ownership of mobile
phones in Ghana.38 The survey found that 54% of Ghanaians who are five years or older owned a mobile phone, with differences according to sex
and rural or urban residence. Ownership among women and girls was lower than among men and boys (52% vs. 56%) and it was also lower in rural
compared to urban areas (45% vs. 63%).

34
Given that the statistics on individual ownership of mobile phones also include children as young as five years who make up the largest demographic
segment and who are least likely to own a personal phone, the regular use (at least once per week) among older adolescents is quite low with 54%
personal ownership among all adults and children and 46% regular use among adolescents aged 15 to 19. Adolescent boys are more likely to use
phones than girls although this pattern is not uniform. The gender gap in the use of mobile phones is especially large in the Upper West Region and it
is negligible or non-existent in urban areas, in Greater Accra and the Ashanti Region. It is reversed in the Central Region.

TABLE 20. Mobile phone ownership and use

% of adolescents who used a
mobile phone at least once a
week in the past 3 months Household ownership of a desktop or laptop computer in
% of % personal
Ghana is low at 15% and only almost half of households in
households mobile phone females males the top wealth quintile (48%) have a computer. The GSS ICT
Both
with a mobile ownership(> 5 15-19 15-19 survey of individuals five years or older reported that laptops
phone years)* were the most commonly owned computer equipment (5.1%)
Western 92.3% 47.4% - 49.3% 32.1% 53.7% 38.8% followed by tablets (1.6%) and desktops (1.2%). Computer
Central 88.2% 58.2% 52.3% 45.8% 50.3% ownership is much higher among males than females by a
Greater Accra 97.8% 73.7% 62.2% 63.8% 62.7% ratio of more than 5/1 for desktops, almost 3/1 for laptops and
Volta 88.6% 42.2% - 52.7% 43.6% 51.9% 46.6%
1.5/1 for tablets.38
Eastern 92.7% 52.2% 46.8% 51.7% 48.5% Only 6% of adolescents aged 15 to 19 use a computer
Region
Ashanti 96.4% 54.5% 44.2% 44.3% 44.3% regularly, defined as having it used at least once a week
Brong Ahafo 89.2% 48.3% - 55.9% 43.3% 52.4% 46.5% during the last three months. Regular use is more than twice
Northern 91.4% 37.2% - 47.7% 34.2% 45.3% 38.5% as high in urban compared to rural environments, and almost
Upper East 87.0% 43.9% 33.7% 44.8% 37.3% 22 times more likely in households of the richest wealth
Upper West 79.2% 36.3% 17.9% 58.8% 34.9% quintile compared to the poorest. There is also a large gender
gap with about twice as many regular users among males
Urban 96.5% 63.2% 51.2% 53.6% 52.0%
Area than among females. In the Northern Region, and especially
Rural 88.3% 44.8% 37.6% 47.1% 41.1%
in the Upper West Region, however, more girls than boys are
Poorest 76.7% 31.6% 40.8% 35.1%
regular computer users. Household computer ownership in
Second 89.7% 37.3% 47.7% 40.9% these two regions is very low (7% and 8% respectively) which
Wealth
Middle 95.2% 44.7% 44.9% 44.5% may suggest that adolescents in these regions primarily use
quintile
Fourth 97.9% 49.1% 49.9% 49.4% computers in a work environment such as an office job or work
Richest 98.9% 58.6% 79.8% 63.7% in a communications centre.
Total 92.5% 54.1% 44.2% 49.8% 46.1%

* Data from the 2019 GSS Household Survey on ICT. (The survey used the new regional demarcation of Ghana. Data for
the 4 subdivided regions are therefore presented as ranges)

35
TABLE 21. Computer ownership and use Table 22. Computer skills among adolescents who have used a
computer within the past 3 months
% of adolescents who used a % of adolescents 15-19 who have done this on a computer
% of computer at least once a week in
households the past 3 months male 15-19 female % total
Has ever
with a 15-19 adolescents
computer females males
Both Wrote a computer programme in any
15-19 15-19 1.0% 3.6% 2.2%
programming language
Western 13.3% 2.9% 11.9% 5.7%
Transferred a file between a computer
and other device
49.1% 27.8% 38.9%
Central 14.5% 2.5% 9.4% 4.6%
Greater Accra 27.6% 11.1% 19.7% 13.4% Created and electronic presentation
with presentation software including 5.2% 9.9% 7.5%
Volta 7.6% 3.0% 4.2% 3.5% text, sound, video or charts
Eastern 13.9% 2.8% 10.4% 5.4% Found, downloaded installed and
Region 38.1% 28.0% 33.3%
Ashanti 17.5% 7.6% 13.8% 9.7% configured software
Brong Ahafo 12.8% 3.4% 5.8% 4.2% Connected and installed a new device,
such as a modem, camera or printer
28.5% 29.3% 28.9%
Northern 6.7% 2.9% 2.1% 2.6%
Used a basic arithmetic formula in a
Upper East 7.2% 2.8% 3.6% 3.1%
spreadsheet
12.5% 24.1% 18.0%
Upper West 8.2% 2.1% 0.3% 1.3%
Sent an e-mail with a file (document,
Urban 22.3% 7.5% 12.7% 9.1% picture or video)
27.4% 33.9% 30.5%
Area
Rural 7.6% 2.4% 7.0% 4.1% Used copy and paste duplicate or
moved information in a document
53.0% 46.1% 49.7%
Poorest 0.5% 0.6% 1.2% 0.8%
Second 2.4% 1.8% 4.6% 2.8% Copied or moved a file or folder 67.2% 55.8% 61.8%
Wealth Has done any of the 9 activities on a
Middle 4.6% 3.1% 7.4% 4.5% 86.2% 81.6% 84.0%
quintile computer
Fourth 12.4% 6.3% 13.3% 8.9%
Richest 47.5% 13.0% 29.9% 17.1%
Total 15.0% 4.9% 9.4% 6.4% Although there is little difference in the overall level of ICT skills
among boys and girls who regular use a computer, the access and
The computer skills among those adolescents who used a computer use of computers differs with the effect that twice as many boys than
during the last three months vary. While half of them have copied girls have computer skills at the level of having performed at least one
and pasted information, only two percent have written a programme of the nine activities listed in Table 22. When access and skills levels
in any computer language. Adolescent girls were more likely are combined, large regional differences are also revealed (between
to have applied the less common skills such as programming, 1% in the Upper West Region and 12% in the Greater Accra Region)
creating presentations or using spreadsheets, suggesting primarily as well as differences by wealth quintile (from less than 1% among
professional applications. Boys were more likely to have used the the poorest to 15% among the richest) and differences between urban
more common procedures such as transferring or copying files. and rural areas (3% in rural and 8% in urban areas).

36
TABLE 23. Adolescent computer skills Access to the internet at home among Ghanaian households is
higher than household computer ownership suggesting that many
% adolescent
% adolescents
regular households access the internet over the mobile phone network.
who used a More than twice as many 15 to 19 year old adolescents accessed
computer users
computer at least Effective
once per week
who have ever
computer skills the internet in the past three months than used a computer during
done any of 9 this time (13% vs. 6%). The same wealth and gender gaps in internet
within the past 3
activities on a
months
computer
use are observed as for computer use, with about twice the number
of boys accessing the internet than girls, and about 15 times more
Western 5.7% 87.0% 4.9%
adolescents in households of the richest wealth quintile compared to
Central 4.6% 72.7% 3.4% those in the poorest.
Greater Accra 13.4% 88.0% 11.8%
TABLE 24. Internet access
Volta 3.5% 81.1% 2.8%
% of % of adolescents who used the internet
Region Eastern 5.4% 72.8% 4.0%
households at least once in the past 3 months
Ashanti 9.7% 93.7% 9.1% with access to
the internet at females males
Brong Ahafo 4.2% 84.2% 3.6% Both
home 15-19 15-19
Northern 2.6% 83.8% 2.2%
Western 24.1% 6.9% 18.8% 10.5%
Upper East 3.1% 47.6% 1.5%
Upper West 1.3% 69.0% 0.9% Central 21.3% 8.1% 10.1% 8.7%

Urban 9.1% 88.9% 8.1% Greater

37.7% 23.3% 46.5% 29.6%
Area Accra
Rural 4.1% 75.9% 3.1%
Volta 14.2% 6.2% 8.5% 7.1%
Poorest 0.8% 77.4% 0.6%
Region Eastern 16.8% 13.4% 26.4% 17.9%
Second 2.8% 78.4% 2.2%
Wealth Ashanti 27.3% 12.9% 24.6% 16.8%
Middle 4.5% 80.3% 3.6%
quintile Brong Ahafo 18.7% 8.9% 24.0% 14.1%
Fourth 8.9% 86.5% 7.7%
Northern 10.2% 2.1% 4.4% 3.0%
Richest 17.1% 87.1% 14.9%
Upper East 14.3% 1.6% 3.3% 2.2%
Male 9.4% 84.0% 7.9%
Sex Upper West 9.3% 2.8% 0.7% 1.9%
Female 4.9% 81.6% 4.0%
Urban 32.0% 17.1% 31.9% 21.6%
Total 6.4% 84.0% 5.4% Area
Rural 12.5% 4.2% 10.1% 6.3%
Poorest 2.8% 1.2% 3.7% 2.2%
Second 6.6% 1.7% 6.8% 3.5%
Wealth
Middle 12.2% 9.0% 15.2% 11.1%
quintile
Fourth 25.2% 16.9% 30.1% 21.7%
Richest 55.8% 23.5% 57.2% 31.6%
Total 22.4% 10.4% 19.2% 13.4%

37
Protection from violence and exploitation Attitudes to domestic violence and experience of
violence
Key Findings Women and girls who have experienced physical abuse or who live
More than one third of adolescent girls and more than one fifth of in environments were domestic violence is common are more likely
boys agree with at least one justification for wife beating. Acceptance to normalise it and express acceptance of the right of a husband to
of wife beating is higher among adolescents than among adults.
beat his wife.39 Acceptance by women is therefore a proxy indicator
Adolescents in Ghana experience several forms of violence inside that cannot be translated directly, but that can indicate differences in
and outside their homes. Boys are more exposed to physical prevalence of violence among households in different environments.
violence, however in the domestic environment girls experience The MICS6 questionnaire asked for agreement or disagreement with
physical violence nearly twice as often as boys. One in five girls the statement that a husband is justified in beating his wife for any of
reported that she experienced sexual violence within the past 12 the five reasons: (1) she goes out without telling him, (2) she neglects
months, including rape and sexual coercion. While sexual violence the children, (3) she argues with him, (4) she refuses sex with him,
in the domestic environment was less common, it almost always
or (5) she burns the food. More than one third (37%) of adolescent
involved rape and sexual coercion.
girls and more than one fifth of boys (22%) agree with at least one of
The exposure to violent discipline (psychological and physical) is these statements. These levels of agreement are higher than among
nearly universal among adolescents aged 10 to 14 without apparent adult women (32%) and men (17%). Acceptance of wife beating by
gender differences. Boys were somewhat more likely to receive girls is particularly high in the Northern Region (58%) while it is only
physical punishment and one in five adolescents was subjected to 6% among boys in the same region. It is higher among adolescents
severe physical punishment within the past month. currently married and higher in rural than in urban areas. Among girls,
About 13% of young adolescents in Ghana are working in the home acceptance of wife beating decreases with increasing household
or in the economy above the threshold that defines child labour. wealth, while among boys this relationship is less evident.
Child labour is less common among older adolescents. In both age
groups, girls are much more likely to work in the household above
the threshold defined as child labour.
Child marriage among girls is common in all regions except for the
Greater Accra Region. It is twice as common in rural than in urban
areas. Girls in households of the lower wealth quintiles are more
likely to be married by the age of 18. Boys are rarely married by that
age.
Female genital mutilation/cutting (FGM/C) is illegal in Ghana and a
practice that is slowly disappearing. Among adolescent girls aged
15 to 19, about 6/1,000 had undergone FGM/C, almost all of them
in the Upper West Region where it is still practiced in some minority
ethnic communities.

38
TABLE 25. Adolescent attitudes to domestic violence
Agreement with at least one of five the statements that a husband is
justified in beating his wife if (1) she goes out without telling him, (2) she
neglects the children, (3) she argues with him, (4) she refuses sex with
him, (5) she burns the food
Girls aged 15-19 Boys aged 15-19
The prevalence of domestic and non-domestic violence in Ghana was
surveyed in 2016.5 The experience of physical violence within the
12 months prior to the survey, ranging from being slapped to being
attacked with a weapon, was reported by 28% of adolescent girls and
31% of boys. However, in the domestic environment, girls were almost
twice as likely to have experienced physical violence than boys.

Western 35.6% 27.2%

More than one in five adolescent girls reported that they experienced
sexual violence within the past 12 months, primarily sexual touch
Central 47.5% 44.9% (15%) followed by sexual comments (12%) and being physically
Greater Accra 15.4% 20.2% forced to have sex (3%). Sexual violence in the domestic environment
was less common (4%) but in almost all instances (83%) involved
Volta 29.3% 14.2%
some form of sexual coercion, including rape. Sexual violence was
Region Eastern 18.2% 19.9% also reported by adolescent boys, primarily sexual comments and
Ashanti 42.3% 26.8% touch, and never in the domestic environment.
Brong Ahafo 47.9% 10.4%
Psychological violence was the most common type of violence
Northern 58.1% 3.4%
reported by 39% of adolescent boys and girls. By far the most
Upper East 38.6% 6.1% common form was to be insulted, humiliated, or belittled. Over 15%
Upper West 42.3% 44.5% of adolescent girls and 9% of adolescent boys reported that they had
Urban 30.9% 18.4% experienced psychological violence in their homes.
Area
Rural 42.8% 24.1%
The percentage of adolescent girls and boys who experienced
Poorest 48.9% 16.5% economic domestic violence was similarly high for girls and for boys
Second 47.2% 25.6% (17% vs. 19%). The most common form of economic violence was
Wealth
quintile
Middle 34.3% 27.5% being denied pocket money for both boys and girls followed by being
Fourth 37.6% 19.2% denied food for girls and by having belongings being controlled for
Richest 17.2% 17.5% boys.
Currently married/
54.5% 40.9%
Marital in union
status Never married/in
35.7% 21.6%
union
Total 37.1% 21.7%

39
 Domestic and non-domestic Domestic violence
violence
TABLE 26. Experience of Type of violence Sub-types Girls (15-19) Boys (15-19) Girls (15-19) Boys (15-19)
violence by adolescents
Slapped or thrown things at 17.7% 18.6% 10.4% 6.4%
15 to 19 within the past
12 months Pushed or shoved 7.8% 14.9% 1.5% 0.7%
Hit 6.1% 7.8% 1.2% 0.5%
Kicked, dragged or beaten up 7.8% 3.3% 4.9% 0.7%
Physical violence
Choked or strangled 1.7% 3.1% 1.3% 0.0%
Burnt 1.1% 0.8% 1.1% 0.8%
Attacked with a weapon 1.1% 2.0% 1.1% 0.0%
Any physical violence 28.0% 30.6% 15.2% 8.6%
Sexual comment 11.9% 10.8% 0.0% 0.7%
Sexual touch 15.4% 4.8% 0.7% 0.0%
Physically forced to have sex 3.1% 1.9% 1.5% 0.0%
Otherwise forced to have sex 0.9% 0.8% 0.0% 0.0%
Sexual violence
Sex without consent 0.4% 0.8% 0.4% 0.0%
Sex without protection 0.5% 0.7% 1.6% 0.0%
Sex because afraid 1.6% 0.0% 0.5% 0.0%
Any sexual violence 22.1% 14.5% 4.3% 0.7%
Insulted, humiliated or belittled 37.0% 36.1% 20.0% 11.5%
Ignored or threatened to be abandoned 7.7% 4.0% 6.8% 3.2%
Psychological Scared or intimidated on purpose 1.9% 2.4% 1.4% 0.7%
violence Threatened with the use of a weapon 1.0% 1.2% 1.0% 0.0%
Threatened to be hurt 0.0% 0.8% 0.0% 0.0%
Any psychological violence 38.8% 38.9% 15.2% 8.5%
Denied pocket money 15.0% 15.1% 12.9% 14.3%
Cash taken out 1.4% 3.4% 0.6% 1.2%
Belongings controlled 1.6% 3.5% 1.6% 2.9%
Economic Property damaged 0.9% 3.1% 0.2% 0.9%
violence Prohibited from working 0.4% 0.5% 0.0% 0.5%
Forced to work 2.8% 3.8% 1.5% 2.4%
Denied food 5.5% 2.9% 5.5% 1.6%
Source: IDH & GSS (2016).
Domestic Violence in Ghana Any economic violence 20.4% 23.3% 17.2% 19.0%

40
Violent discipline
Parents use child discipline to teach children self-control and
acceptable behaviour. Positive parenting practices involve providing
guidance on how to handle emotions or conflicts in ways that
encourage judgment and responsibility and preserve children’s self-
esteem, physical and psychological integrity, and dignity. Often,
however, parents also use punitive methods that rely on the use of
physical force or verbal intimidation. Exposing children to violent
discipline has harmful consequences ranging from immediate impacts
to long-term harm that children carry forward into adult life. Violence
hampers children’s development, learning abilities and school
performance; it inhibits positive relationships, provokes low self-
esteem, emotional distress, and depression; and, at times, it leads to
risk taking and self-harm.40
Almost all adolescents aged 10 to 14 (95%) experienced some form
of violent discipline within the month before the survey. There were
no differences between boys and girls, rural or urban residence or
household wealth. Regional differences were only marginal with a
range from 91% to 96%. In almost all cases, the punishment involved
psychological aggression. Physical punishment was also very
common and experienced by about two thirds (65%) of adolescents,
somewhat more frequently by boys than by girls. About 19% of
adolescents experienced severe physical punishment.
Child labour
Adolescents are classified as child labourers when they are either too
young to work or are involved in work that compromises their physical,
mental, social or educational development. They are protected by
Article 32 of the UN Convention on the Right of the Child as well as
the ILO Convention on the Worst Forms of Child Labour (182), both
ratified by Ghana and committing the government to preventing the
engagement of children in work that harms their health or safety. 41,42
The minimum age for admission to employment in Ghana is 15 years,
however young adolescents at the age of 13 can be involved in light
work.
The MICS6 used age-specific thresholds to define child labour. For
adolescents aged 12 to 14 these are 14 hours or more per week of
paid or unpaid engagement in economic activities such as agriculture,
fishing, manufacture or sales, and 28 hours or more of performing
household chores including cooking, childcare, cleaning and collecting
water or firewood. For older adolescents aged 15 to 17, the thresholds
for both types of activities are 43 hours per week. Information about
the week preceding the survey was collected.
Approximately 15% of adolescents aged 12 to 14 are involved in child
labour, 8% in economic activities and 7% in household work. Girls are
twice as likely to do household work as boys, while boys are somewhat
more frequently engaged in other forms of child labour. Adolescents
in rural areas are more frequently working as child labourers than
in urban areas, and there are also large differences according to
household wealth. Child labour in the household and in economic
activities is more common in the northern regions than in the rest of the
country.
Among 15 to 17 year old adolescents, 6% are involved in child labour
according to the defined threshold of working 43 hours or more
per week, most in household work (5%) and only 1% in economic
activities. The same patterns of distribution are observed as for the
younger cohort with an even greater difference between girls (8%) and
boys (2%).
41
TABLE 27. Child labour

Adolescents 12-14 years Adolescents 15-17 years

> 28 hours > 14 hours > 43 hours > 43 hours
household economic household economic
chores activities chores activities
Western 1.7% 4.3% 2.5% 0.0%
Central 7.7% 12.0% 6.4% 0.5%
Greater
Accra 0.0% 0.8% 0.8% 0.4%
Volta 3.6% 9.4% 2.0% 0.6%
Region Eastern 0.4% 3.2% 0.7% 0.1%
Ashanti 3.8% 2.0% 5.8% 0.6%
Brong Ahafo 4.0% 7.3% 1.0% 1.5%
Northern 19.6% 21.2% 16.5% 2.1%
Upper East 14.6% 14.9% 8.0% 5.6%
Upper West 12.0% 16.3% 6.4% 1.6%
Urban 2.4% 4.9% 1.6% 0.8%
Area
Rural 7.8% 9.4% 7.8% 0.9%
Poorest 13.2% 15.5% 8.2% 2.1%
Second 7.6% 7.7% 7.7% 0.4%
Wealth
Middle 3.5% 4.1% 6.3% 1.1%
quintile
Fourth 2.0% 6.3% 1.2% 0.5%
Richest 0.0% 3.3% 0.7% 0.0%
Male 3.6% 7.8% 2.3% 1.2%
Sex
Female 7.8% 7.2% 8.0% 0.5%
Total 5.6% 7.5% 5.1% 0.9%

42
Child marriage Child marriage among girls is common in all regions of Ghana
apart from the Greater Accra Region. It is twice as common in rural
Marriage before the age of 18 is a violation of the right to ‘free and compared to urban areas and varies according to household wealth
full’ consent to marriage as recognised in the Universal Declaration from 5% among the richest to 33% among the poorest. The profile of
of Human Rights, with the recognition that consent cannot be ‘free very early child marriage by age 15 is similar although it is somewhat
and full’ when one of the parties involved is not sufficiently mature to more differentiated by region.
make an informed decision about a life partner. In the Sustainable
Development Agenda, child marriage is identified as a harmful Child marriage among adolescent boys also occurs. Marriage by age
practice which the world should aim to eliminate by 2030. 15 is rare and was only reported occasionally by men aged 20-24.
Marriage by age 18 is somewhat more common and was reported by
A mixed method study of child marriage in Ghana identified the 4% of men, primarily in rural areas.
education level as a predictive factor for child marriage among
adolescent girls. Other drivers for the practice were early pregnancy,
TABLE 28. Child marriage
betrothal marriage and the exchange of girls for marriage. Adolescent
girls in rural areas in the north of the country reported mockeries and a % of women age % of men age
% of women age
lower status of unmarried girls as a motivation to get married.43 20-24 who were 20-24 who were
20-24 who were
married before married before
married before 15
By the age of 15, about 5% of adolescent girls in Ghana are married, 18 18
increasing to 19% when they reach the age of 18. The incidence of Western 7.0% 22.9% 5.5%
child marriage has been declining as documented in the analysis of Central 5.6% 22.0% 6.1%
child marriages reported by women in successive age cohorts, but the
Greater Accra 0.4% 7.9% 1.3%
rate of decline has been slow.
Volta 7.1% 23.9% 4.8%
FIGURE 11. Child marriage trends Eastern 8.2% 22.9% 2.3%
Region
30.0%
40% Ashanti 3.8% 16.7% 5.1%
Brong Ahafo 1.6% 16.8% 0.0%
married
25.0% Northern 9.4% 27.8% 4.2%
before age 18
Upper East 5.9% 27.5% 4.9%
20.0%
20% Upper West 7.2% 22.2% 4.7%
Urban 2.8% 12.5% 1.1%
15.0% Area
Rural 7.3% 26.6% 6.6%
Poorest 8.8% 32.6% 3.2%
10%
10.0%
Second 8.4% 28.1% 4.3%
Wealth
married Middle 5.7% 21.3% 6.3%
5.0% quintile
before age 15 Fourth 3.0% 14.7% 2.1%

0.0%
Richest 0.7% 4.5% 3.7%
0%
45-49 40-44 35-39 30-34 25-29 20-24 Total 5.0% 19.0% 3.9%
Before ageAge
15 cohortBefore age 18

43
Female genital mutilation/cutting
Female genital mutilation/cutting (FGM/C) is a serious violation of
girls’ rights. It is illegal and not a cultural practice in the southern
parts of Ghana. It is, however, still practiced in some minority ethnic
communities, almost exclusively in the Upper West Region. The
overall prevalence of FGM/C among women of reproductive age
in Ghana is 2%. It is 33% in the Upper West Region, where the
practice, however, has also been in decline. A qualitative study on the
persistence of FGM/C in northern Ghana reported that adolescent
girls who have not undergone FGM/C were considered less suitable
for marriage and less respected by their in-laws.44
According to mothers interviewed for MICS6, only 0.1% of girls below
the age 14 had undergone any form of FGM/C, almost all of them
in the Upper West Region. Among adolescents aged 15 to 19, the
national prevalence of any form of FGM/C was 0.6%, but it was as
high as 14% in the Upper West Region. These findings are somewhat
at odds with the expressed opinions by women and adolescent girls
that the practice should be continued. More adolescent girls than adult
women expressed favourable attitudes to FGM/C (4% vs. 3%), and
there is no clear regional pattern or pattern according to residence
or wealth. Support for FGM/C among adolescents was highest in the
Ashanti and Brong Ahafo Regions where FGM/C is not practiced.
TABLE 29. Attitudes to FGM/C

FIGURE 12. Proportion of women who have undergone any form of

% women who believe that the practice of FGM/C
FGM/C by age cohort should be continued

aged 15-49 aged 15-19

6.0%
Western 2.4% 4.7%
5.0% Central 3.6% 5.3%
Greater Accra 1.2% 1.3%
4.0% Volta 1.2% 2.0%
Eastern 1.7% 2.3%
Region
3.0% Ashanti 3.3% 6.8%
Brong Ahafo 2.9% 5.3%
2.0% Northern 2.3% 2.1%
Upper East 2.6% 2.1%
1.0% Upper West 7.3% 4.1%
Urban 2.2% 4.0%
0.0%
Area
Rural 3.2% 4.4%
45-49 40-44 35-39 30-34 25-29 20-24 15-19
Poorest 3.6% 3.9%
Age
Anycohort
form of FGM
Second 3.3% 4.5%
Wealth
Middle 3.8% 7.7%
quintile
Fourth 2.6% 2.9%
Richest 1.0% 1.8%
Total 2.6% 4.2%
44
A safe and clean environment
Key Findings
Less than 60% of adolescents in Ghana have access to improved
sanitation with large regional differences. Household wealth is an
important determinant of access, as well as residence in rural or
urban areas.
More than 85% of adolescents in Ghana have access to water
from an improved source, although this often involves buying
drinking water in small sachets. In most cases, water must be
collected from a public source that may be more than three hours
away. This task is most often allocated to adolescent girls.
About half of adolescents in Ghana have access to a hand
washing facility in their home where water and soap are available.
Most households use wood, charcoal or other solid fuel for
cooking. Nine out of ten adolescent girls are potentially exposed
to indoor air pollution that risks damaging their future health.
About a quarter (24%) of adolescents slept under an insecticide
treated bed net in the night preceding the survey.
A safe and clean environment is a condition for adolescents to thrive
and to develop their full potential. The access to safe drinking water,
improved sanitation and hygiene is essential for the ability of children and
adolescents to realise their right to the highest possible standard of health
as guaranteed in Articles 25 of the UN Convention on the Right of the
Child.41 There are large disparities between regions and between rural and
urban residence in the access of adolescents to improved sources of water,
improved sanitation facilities and on-site handwashing facilities with soap
and water.
An improved sanitation facility is defined as one that hygienically
separates human excreta from human contact. Those who do not
have access to such a facility either use open pit latrines or toilets
that flush into open drains, or they have no facility and practice
open defecation in the bush or field. Less than 60% of adolescents
in Ghana have access to improved sanitation with large regional
differences. More than 80% in Greater Accra have access and less
than 25% in the Upper West and Upper East Regions. Household
wealth is an important determinant of access to improved sanitation,
as well as residence in rural or urban areas.
Overall, more than 85% of adolescents in Ghana have access to
water from an improved source, however in the Volta and Northern
Region it is less than one third. Water from an improved source is
not necessarily safe for drinking, but it is at least not collected from
a stream or pond or from an unprotected well or spring. For almost
a quarter of adolescents, drinking water from an improved source
means buying water in plastic sachets. As with improved sanitation,
water from an improved source is less likely to be available in rural
than in urban areas and for adolescents living in poor as compared to
rich households.
Ready access to hand washing facilities is essential for preventing
infectious diseases and, since the start of the COVID-19 pandemic,
has gained even more importance. About three quarters of
adolescents in Ghana (72%) have access to a facility in their home.
About one third of these (32%) are fixed tanks or standpipes while the
other two thirds are buckets, basins or other mobile arrangements.
Having a facility for handwashing does not always mean that water
and soap are also available. Among the adolescents included in
the household survey, less than half (48%) had access to water
and soap for washing their hands, even fewer among those living in
rural areas (42%). Among the regions, access ranged from 23% in
the Upper West Region to 66% in the Eastern Region. Adolescents
in households of the richest quintile were twice as likely to have
access to a handwashing facility with water and soap than those in
households of the poorest quintile.
45
TABLE 30. Access to water and sanitation

% adolescents
% of adolescents % of adolescents living in
living in living in households with
households with households a handwashing
access to drinking with access facitily where
water from an to improved water and soap/
improved source sanitation detergent was
present
Western 81.9% 54.0% 57.7%
Central 92.8% 58.8% 57.4%
Greater
Accra
99.2% 80.5% 47.1%
Volta 64.1% 40.5% 33.8%
Region Eastern 86.0% 72.9% 66.4%
Ashanti 93.2% 71.9% 51.3%
Brong Ahafo 91.2% 70.5% 36.6%
Northern 63.7% 29.6% 32.0%
Upper East 89.6% 21.0% 32.4%
Upper West 95.1% 24.0% 23.4%
Urban 95.9% 74.0% 55.1%
Area
Rural 77.6% 47.5% 41.7%
Poorest 63.1% 31.9% 32.9%
Second 80.6% 47.0% 42.7%
Wealth
Middle 91.9% 58.3% 46.0%
quintile
Fourth 97.2% 78.5% 52.2%
Richest 99.7% 88.5% 69.8%
Total 85.6% 59.1% 47.6%

46
Having access to water from an improved source means in the minority of cases (6%) that it is piped into the house or compound. For all others, it must be
collected from a public standpipe, borehole, tanker truck or other shared water source that may, in some case, be more than three hours away. In about a
third of the households, the task of carrying water is assigned to adolescents, almost twice as often to girls than to boys (27% to girls compared to 16% to
boys). In the Northern and Upper West Region, where water sources are more than one hour away for 43% and 38% of households respectively, girls are
more than ten times more likely than boys to be the carriers of water.

TABLE 31. Collecting water

How long does it take to collect water if it is not available on the

Who collects the water?
premises?
more than 180 Adolescent Adolescent
<30 minutes 31-60 minutes 61-180 minutes
minutes boys 10-19 girls 10-19
Western 66.2% 19.6% 11.6% 2.0% 20.6% 27.1%
Central 65.6% 15.9% 15,5% 2.1% 19.4% 27.1%
Greater Accra 84.6% 7.9% 6.1% 0.4% 14.3% 23.1%
Volta 50.3% 15.0% 16.4% 17.5% 10.3% 24.4%
Eastern 53.2% 23.1% 20.8% 2.7% 23.2% 31.0%
Region
Ashanti 54.0% 21.8% 20.3% 3.5% 22.3% 28.2%
Brong Ahafo 68.0% 13.1% 14.0% 3.0% 13.2% 28.0%
Northern 37.3% 19.1% 35.1% 8.0% 2.2% 26.0%
Upper East 26.3% 23.2% 37.9% 12.4% 8.4% 27.1%
Upper West 41.3% 20.4% 28.9% 9.0% 1.7% 27.1%
Urban 71.3% 15.8% 10.8% 1.6% 15.1% 27.5%
Area
Rural 47.4% 19.8% 25.0% 7.1% 16.0% 27.1%
Poorest 39.4% 19.9% 30.6% 9.6% 11.6% 26.5%
Second 52.8% 20.3% 20.5% 5.6% 15.3% 31.1%
Wealth
Middle 60.9% 18.6% 16.4% 3.6% 17.6% 27.8%
quintile
Fourth 68.4% 15.4% 13.0% 2.3% 20.7% 24.3%
Richest 75.5% 13.4% 9.6% 0.6% 12.8% 23.8%
Total 56.0% 18.3% 19.8% 5.1% 15.7% 27.2%

47
Indoor air pollution from the use of solid fuels for cooking is recognised
as a major cause of acute respiratory diseases among children and of
chronic lung and cardiovascular diseases that manifest later in life.45 In
Ghana, almost 85% of households use wood, charcoal or other solid fuel for
cooking, with some differences between regions and urban / rural residence,
but primarily by household wealth. Only adolescents living in the richest
households are less likely to be exposed to indoor air pollution because
clean fuels such as electricity and gas are used in 62% of their households.
While the most serious health effects of pollution from cooking with solid
fuels are observed in newborn infants among whom it is estimated to be
responsible for between 4% and 14% of deaths in Ghana, the cumulative ill
health effects of long-term exposure are established in early adolescence
and are responsible for a steep rise in attributable premature deaths among
women in early and mid-adulthood. 46

FIGURE 13. Percentage of adolescent girls in households that use

Greater Accra clean fuels for cooking 36.2%
Greater Accra
Western 16.0% 36.2%
Western
Central 16.0%
13.7%
Central
Eastern 13.7%
12.0%
Eastern
Ashanti 12.0%
11.9%
Ashanti
Volta 6.7% 11.9%
Volta
Brong Ahafo 6.7%
6.6%
Brong
UpperAhafo
West 3.4%6.6%
Upper
UpperWest
East 3.4%
2.5%
Upper East
Nothe rn 2.5%
1.1%
Nothe rn 1.1%
Urban 22.1%
Urban
Rural 3.9% 22.1%
Rural 3.9%
Richest 57.0%
Richest
Third 8.9% 57.0%
Third
Middle 1.4% 8.9%
Middle
Second 1.4%
0.1%
Second
Poorest 0.1%
0.0%
Poorest 0.0%
Total 12.3%
Total 12.3%
48
Malaria infection is a major environmental hazard in Ghana with TABLE 32. Use of insecticide-treated bed nets
an estimated 6.7 million infections and 11 thousand deaths in 2018
% of household members who slept under an
accounting for about 6% of the total number of malaria cases in
ITN in the previous night
West Africa. The entire country is classified as a high transmission
All Adolecents
area.47 Sleeping under an insecticide-treated net (ITN), treated during Adolescent Adolescent
household 10 to 19
fabrication, is effective for the prevention of malaria. The MICS6 members years
girls boys
household survey found that 61% of all household members had Western 26.2% 22.9% 24.6% 21.1%
access to an ITN and could have slept under it if each ITN in the
Central 27.5% 21.4% 23.6% 19.0%
household were used by up to two people. However only 28% slept
under an ITN the night preceding the survey, less than half of those Greater Accra 17.1% 17.0% 17.1% 16.8%
who had access. More women than men used ITNs (29% vs. 27%), Volta 31.9% 29.1% 30.0% 28.2%
more rural than urban residents (35% vs. 19%) and more persons in Eastern 25.2% 21.9% 23.1% 20.7%
Region
households of the poorest than in those of the richest wealth quintile Ashanti 31.5% 26.2% 25.0% 27.3%
(36% vs. 16%). Adolescents were somewhat less likely to sleep under Brong Ahafo 29.1% 23.6% 26.1% 21.3%
an ITN with a distribution profile that mirrored the use of ITNs in the
Northern 23.6% 19.3% 18.6% 19.9%
households in general.
Upper East 31.6% 28.5% 29.3% 27.8%
Upper West 51.3% 45.5% 44.7% 46.1%
Urban 19.1% 15.8% 15.8% 15.8%
Area
Rural 35.1% 30.3% 31.5% 29.1%
Poorest 35.8% 30.3% 32.2% 28.7%
Second 36.8% 31.1% 33.1% 29.1%
Wealth
Middle 28.5% 23.7% 24.3% 23.1%
quintile
Fourth 21.2% 18.4% 17.6% 29.1%
Richest 16.4% 12.9% 12.2% 13.8%
Total 27.7% 23.9% 24.3% 23.6%

49
An equitable chance of life
Key Findings
Social inequalities in Ghana are the main barriers for adolescents
to the achievement of equitable opportunities for realising their
potential. The inequalities exist across geographic regions and
between rural and urban residents. They are clearly demonstrated
by the gaps in almost all indicators of adolescent health and
well-being between those who live in wealthier and those in less
wealthy households.
Adolescents who have functional difficulties in any of nine
domains, including physical, mental, emotional, and behavioural
parameters are more likely to be out of school and are also
disadvantaged in other areas. The differences to their peers who
are without functional difficulty are small. However, when the
nine domains are disaggregated, greater gaps in inclusion may
become evident. This would require more targeted studies.
For adolescent girls, the main barrier to an equitable chance in
life are multiple violations of their sexual and reproductive rights
ranging from sexual coercion and violence to early pregnancy and
child marriage. More girls than boys complete the nine years of
basic education, but after age 15, more of them are out of school.
Nevertheless, secondary school completion rates among girls are
only slightly lower than among boys. Girls are only half as likely
as boys to access computers and develop ICT skills. They are
also much more likely to be engaged in household chores that
meet the definition of child labour.
Poverty
For practically all indicators on adolescent well-being collected in
MICS6, large differences are observed by region, by rural or urban
residence and by household wealth. The differences document that
not all adolescents in Ghana have an equitable chance of life. Many
regional and rural/urban differences can be attributed to unequal
development of the physical and social infrastructure. In a few
cases, such as the prevalence of FGM/C or early marriage, regional
differences may also be related to the predominant ethnicity of a
region. The level of poverty, however, is a dominant determining factor
of equitable opportunity, applying to all regions and environments.
Poverty is not equally distributed throughout the country. The Ghana
Statistical Service estimated in 2016/17, that 23% of the Ghanaian
population lived below the official income poverty line of GHC 1,314
per year. In the Greater Accra Metropolitan Area, it was only 2%,
while in rural areas of the three Northern regions it was 68%. The
incidence of poverty is presented in the Poverty Profile Report by
ecological region and rural/urban environment, whereby ‘Savannah’
refers to the Northern, Upper East and Upper West Regions; ‘Forest’
to the Ashanti, Brong Ahafo and Eastern Region; and ‘Coastal’ to
the Western, Central, Volta and Greater Accra Regions. Separate
statistics are provided for the Greater Accra Metropolitan Area.48
FIGURE 14. Percentage of population living below the poverty line
of GHC 1,314 per year (2016/17)
Rural Savannah 67.70%
Rural Forest 24.10%
Rural Coastal 29.90%
Urban Savannah 24.90%
Urban Forest 6.10%
Urban Coastal 8.30%
Greater Accra
2.00%
Metropolitan Area Source: Ghana Statistical Service 2018
50
 FIGURE 15. Wealth gap
Two highest wealth quintiles
To document how wealth inequities affect the lives of adolescents, the following graphics illustrate the gaps in
different aspects of adolescent lives between adolescents living in households of the two lowest wealth quintiles Two lowest wealth quintiles
and those of the two highest.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% of girls 15-19 who had sex before age 15 6.6 12.9

% of girls 15-19 who report condom use during last intercourse 24.0 31.6%
with non-marital, non-cohabiting partner in last 12 months
% of boys 15-19 who report condom use during last intercourse 32.4 43.2
with non-marital, non-cohabiting partner in last 12 months
% of girls 15-19 who have had a live birth or are pregnant with 9.3 18.6
their first child
% of girls 15-19 with live birth in last 2 years and 4 or more 76.2 92.3
Health antenatal visits to any provider
% of girls 15-19 with live birth in last 2 years that was assisted 70.5 92.5
by a skilled provider
% of girls 15-19 with live birth in last 2 years who 69.7 92.5
delivered in a health facility
% of adolescents aged 15-19 who have comprehensive 5.5 28.4%
knowledge about HIV
% of sexually active adolescents aged 15-19 who have been 5.4 7.3%
tested for HIV in the last 12 months and know results
% of girls aged 15-19 using appropriate menstrual hygiene 87.7 93.1
materials with a private place to wash and change while at home

UNICEF Situation of Adolescents in Ghana Summary Report 51

FIGURE 15 (CONT.) Wealth gap

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
% of adolscents who have completed basic education 25.2 72.6
(9 years)
% of adolescents who have completed secondary 15.3 56.4
education (12 years)
% of adolescents 10-14 who have foundational reading 13.0 51.4
skills
Education
% of adolescents 10-14 who have foundational 12.3 32.5
numeracy skills
and access
to media % of adolescents 15-19 who listen to the radio at least 41.7 50.4
and ICT once a week
% of adolescents 15-19 who watch television at least 42.3 76.9
once per week
% of adolescents 15-19 who used a mobile phone at 38.0 56.6
least once a week in the past 3 months
% of adolescents 15-19 who used the internet at least 1.8 13.0
once a week in the past 3 months
% of adolescents 15-19 who used a computer at least 2.9 26.7
once a week in the past 3 months
% of adolescents who have effective computer skills 1.4 11.3

% of adolescents living in households with access to 71.9 98.5

A clean safe drinking water
and healthy
environment % of adolescents living in households with access to 39.5 83.5
improved sanitation
% of adolescents living in households with a handwashing 37.8 61.0
facility where water and soap/detergent was present
% of girls 10-19 in households that use clean fuels for 0 33
cooking

% of adolescents 12-14 years engaged in child labour 5.8 22

% of adolescents 15-17 years engaged in child labour 1.2 5.3

Child labour
and early
marriage % of women aged 20-24 who were married before 15 1.9 8.6

% of women aged 20-24 who were married before 18 9.6 30.4

UNICEF Situation of Adolescents in Ghana Summary Report 52

Inclusion
For adolescents, the assurance of an equitable chance of life includes an assurance of the full enjoyment of rights and opportunities irrespective of
functional difficulties, physical and mental disabilities as well as emotional problems and difficulties in social interaction. The MICS6 survey collected
information on 13 functional domains in interviews with mothers of children aged 5 to 17. One in five adolescents (10-17) in this group was reported
to have difficulties in at least one domain, most frequently learning and behavioural difficulties (6%) followed by emotional difficulties, primarily anxiety
(4%). Severe physical disabilities in vision, hearing and mobility were reported by 0.5%, 0.3% and 0.9% of adolescents respectively. There are no
distinct patterns of distribution of reported frequencies of difficulties by region, sex, or wealth.

TABLE 33. Percentage of adolescents 10-17 years who have functional difficulty by domain

Difficulty
Accepting Controlling Making in at
Seeing Hearing Walking Self-care Communication Learning Remembering Concentrating Anxiety Depression
Change Behaviour Friends least one
domain

Western 0.8% 0.2% 0.1% 0.0% 0.2% 5.5% 4.2% 1.9% 2.2% 5.1% 1.7% 5.9% 5.6% 21.0%
Central 0.6% 0.0% 1.6% 0.4% 0.5% 10.4% 2.3% 1.7% 3.7% 4.0% 0.8% 2.6% 2.3% 18.3%
Greater
Accra
0.2% 0.6% 0.9% 0.1% 0.1% 2.9% 0.9% 0.4% 0.9% 3.1% 0.6% 5.1% 4.2% 13.1%

Volta 0.4% 1.3% 1.8% 1.3% 2.4% 8.3% 8.8% 5.5% 7.2% 6.3% 8.3% 5.6% 3.6% 31.7%
Region Eastern 0.1% 0.3% 0.0% 0.1% 0.4% 7.7% 5.6% 1.7% 6.5% 10.4% 4.2% 0.4% 0.4% 23.9%
Ashanti 0.4% 0.0% 1.4% 0.0% 2.7% 6.0% 3.8% 3.0% 2.0% 8.0% 2.8% 6.3% 5.0% 23.9%
Brong Ahafo 0.9% 0.3% 0.9% 0.0% 0.2% 7.1% 5.9% 2.2% 3.9% 5.9% 0.7% 1.0% 0.9% 18.4%
Northern 0.5% 0.6% 0.4% 0.3% 0.1% 0.9% 0.8% 0.5% 1.7% 1.9% 0.4% 4.0% 1.9% 9.1%
Upper East 0.2% 0.2% 0.4% 0.5% 0.9% 2.4% 1.6% 0.9% 2.5% 1.1% 2.3% 5.6% 3.0% 12.8%
Upper West 0.0% 0.1% 2.2% 0.5% 0.0% 1.9% 1.8% 0.8% 0.3% 3.3% 0.5% 12.7% 3.2% 20.4%
Male 0.3% 0.4% 0.7% 0.4% 0.9% 6.1% 3.8% 2.1% 3.8% 6.1% 2.2% 4.2% 3.1% 20.0%
Sex
Female 0.5% 0.3% 1.2% 0.0% 1.0% 5.6% 3.9% 2.0% 2.7% 5.4% 2.5% 4.4% 3.1% 20.1%
Urban 0.3% 0.2% 1.3% 0.1% 0.4% 6.0% 3.6% 1.7% 3.6% 4.6% 2.3% 3.6% 3.1% 18.7%
Area
Rural 0.6% 0.4% 0.7% 0.3% 1.4% 5.7% 4.0% 2.3% 3.0% 6.6% 2.4% 4.8% 3.1% 21.0%
Poorest 0.7% 0.4% 1.0% 0.3% 0.4% 4.1% 3.4% 1.7% 3.3% 6.3% 2.0% 4.5% 2.6% 19.5%
Second 0.2% 0.4% 0.4% 0.5% 0.5% 4.6% 3.9% 2.2% 3.0% 5.0% 2.2% 4.1% 3.2% 18.3%
Wealth
Middle 0.3% 0.0% 0.8% 0.0% 2.1% 7.2% 4.1% 3.5% 3.4% 7.2% 2.6% 5.8% 4.9% 22.8%
quintile
Fourth 0.9% 0.5% 0.8% 0.0% 1.2% 7.5% 3.8% 1.8% 3.4% 5.7% 2.2% 3.3% 2.8% 22.5%
Richest 0.1% 0.2% 2.0% 0.3% 0.5% 5.1% 3.8% 0.5% 3.1% 4.2% 3.0% 3.6% 1.6% 16.2%
Total 0.5% 0.3% 0.9% 0.2% 1.0% 5.8% 3.8% 2.0% 3.2% 5.8% 2.4% 4.3% 3.1% 20.0%

53
Adolescents aged 10 to 17 who have at least one functional difficulty
are more likely to be out of school. The difference is somewhat larger
among girls than among boys. Similar equity differences are also
observed for other indicators, for instance for child labour. However,
these data do not fully capture the situation of inclusion because of
the very wide definition of ‘any functional difficulty’. A disaggregated
analysis of inclusion for adolescents whose ability is impaired by
specific physical, mental or emotional disabilities would provide a more
differentiated picture but would also require a more targeted study with
precise definitions and a sufficiently large sample.
FIGURE 16. Adolescents 10-17 years who are out of school
without functional difficulty (boys) 4.9%
with functional difficulty (boys) 6.9%
without functional difficulty (girls) 6.1%
with functional difficulty (girls) 7.7%
without functional difficulty (all) 6.9%
with functional difficulty (alll) 8.5%
Gender gap
Adolescent girls in Ghana are more likely than boys to engage in
sexual intercourse at an early age, and they are less likely to protect
themselves by using a condom. They face, in fact, many violations of
their sexual and reproductive health rights ranging from sexual violence
and coercion to limited ability to prevent early pregnancy by the use of
contraception. The adolescent birth rate in Ghana has been declining,
however, one in five adolescent girls still gives birth before she reaches
the age of 18. Early pregnancy is one of the drivers for child marriage
which is also frequent in Ghana with 19% of young women aged 20 to
24 reporting that they were married before the age of 18 years and
5% before age 15. In one in five marriages of adolescent girls, the
husband is at least ten years older. The violations of girls’ sexual and
reproductive rights that are only just outlined by these statistics are a
major limitation of girls’ ability to have an equitable chance in life.
Other gender-based inequities can be more readily illustrated in a gap
analysis. While girls are more likely to have access to HIV testing than
boys, primarily related to routine testing during the antenatal period,
fewer girls than boys have comprehensive knowledge about HIV and
more of them have discriminatory attitudes to people living with HIV.
Most young adolescents aged 10 to 14 in Ghana are in school. The
proportion is a little higher among girls but the gender difference is
small. However, a much higher proportion of boys in the final years
of basic education (in Junior High School) are over-age by two or
more years, and more girls than boys complete Junior High School.
Reading skills among this young group are higher among girls, but
numeracy skills are higher among boys. Among older adolescents
from 15 to 19, more boys than girls are in school, but almost as many
girls as boys complete secondary education (Senior High School).
Adolescents who are not equipped with ICT skills face difficulties in
accessing critical information regarding all areas of their life, notably
in light of the importance of remote learning during the COVID-19
pandemic. Adolescent boys aged 15 to 19 have better access to
media, to mobile telephones to computers and to the internet. Among
those adolescents who regularly use computers, the skill levels
among girls are only slightly lower than among boys, but because of
differences in access, only half as many girls as boys have ICT skills.
Gender gaps are also evident in the area of child labour. Heavy
domestic work that meets the definition of child labour is much more
commonly assigned to adolescent girls than boys. Girls are also twice
as likely as boys to be assigned the task of carrying water, which, in
some rural areas, may be more than one hour away. Child labour in
economic activities such as farming, fisheries, sales and manufacture
is slightly more common among boys than among girls, but the
difference is small.
54
FIGURE 17. Gender gap

% Girls % Boys

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% of adolescents 15-19 who had sex before age 15 6.9 9.9

Health % of adolescents 15-19 who report condom use during last intercourse 26.3 34.1
with non-marital, non-cohabiting partner in last 12 months

% of adolescents aged 15-19 who have comprehensive knowledge 12 13.9

about HIV
% of adolescents 15-19 currently attending school at any level 68
(including technical/vocational training) 76.3
Education
and % of adolescents 17-19 years of age who have completed basic
access to education (9 years) 44.9 50.2
media and % of young adults 20-22 years of age who have completed secondary 35.3 36.8
ICT education (11 years)

% of adolescents 15-19 who used a computer at least once a week in

the past 3 months 4.9 9.4

% of adolescents 15-19 who have effective computer skills 4.0 7.9

% of adolescents 15-19 who used the internet at least once a week in

10.4 19.2
the past 3 months
% of adolescents 12-14 years who work >28 hours per week in the
household 3.6 7.8

Child % of adolescents 10-19 who are charged with carrying water to the
labour household 15.7 27.2

% of adolescents 15-17 years who work >43 hours per week in the
household 2.3 8.0

UNICEF Situation of Adolescents in Ghana Summary Report 55

The Impact of COVID-19
Findings
Key Findings
The COVID-19 pandemic and the measures to control its spread
have affected the lives of adolescents in many domains. The
effects of the disruption of education services and the coping
strategies are well documented, although it is too early to assess
the impact. In other areas of adolescent life, inferences can be
made based on evidence generated in other countries, however
no evidence has as yet been documented in Ghana.
Evidence of the impact of the COVID-19 pandemic on the health and
well-being of adolescents is still being generated. The direct ill health
effects of COVID-19 have, until now, been primarily observed among
older age groups although this may change as the profile of the
pandemic evolves. School closures and social distancing measures
have, however, had a major impact on the lives of adolescents. A
study of 12 to 18 year old students in China, where very stringent
social distancing measures were implemented, reported a high
prevalence of symptoms of depression (44%) and anxiety (37%).49
Other publications focused on the negative effects of the pandemic
on adolescent learning, increased vulnerability to domestic violence,
increased risk of child marriage, increased child labour, as well as the
negative effects of decreased household incomes and increased food
insecurity on the nutrition of adolescents.
By mid-April 2021, Ghana had reported more than 92,000 confirmed
cases of COVID-19 but only about three percent of the population had
ever been tested and a very high number of infections may therefore
have not been diagnosed.50 Measures to contain the spread of the
infection were initiated in March 2020 and the effects on the lives of
Ghanaians has since been monitored by the Ghana Statistical Service
in repeated national telephone surveys. The results of two surveys
conducted in June and September 2020 were published,51,52 and
survey data were also analysed by UNICEF Ghana in two bulletins
focusing on the primary and secondary impact of COVID-19 on
women and children,53,54 as well as in a more detailed report on the
impact on children.55
Among the measures to control the spread of COVID-19, school
closures have had the most severe impact on the lives of adolescents
because 96% of those aged 10 to 14 and 71% in the 15 to 19 age
group are registered in school. All schools in Ghana closed on
March 16th, 2020. For final year Junior High School and Senior High
School students, they reopened three months later in June 2020.
Between March 2020 and February 2021, schools at all levels were
closed for 50 days and only partially open for most of the remaining
days depending on location and grade. On average, each child and
adolescent in Ghana had lost 168 in-person instruction days due to
school closures by February 2021.56
56
Health
Access to and utilisation of health services was disrupted during the
first COVID-19 lockdown from March to June 2020, primarily because
of fear of infection. Utilisation of health services had improved by
September. Nevertheless, the period of limited access to contraceptive
counselling and commodities, to antenatal care and facility delivery,
HIV testing and treatment and other services that are essential for
the sexual and reproductive health of adolescents may have had an
impact that is, however, not documented.
More information is available from the COVID-19 tracker surveys
on the effects of school closures and other epidemic containment
measures on the mental and emotional health of children aged 6
to 17. Like other information from this source, it includes but is not
specific to the adolescent age group. During the initial lockdown
period, an increase in feelings of sadness and an increase in anxiety
was reported by parents of 30% and 26% of children respectively.
These and other emotional changes were less frequently reported in
September after schools had reopened.
More than half of the households surveyed in September 2020
indicated that they reduced food consumption to cope with falling
incomes and rising food prices since the start of COVID-19
containment measures. Added to this was the decreased access to
school meals which are, however, only routinely provided to students
up to primary grade six and only affected the very youngest group of
adolescents. Collection stations for school meals were organised, but
the frequency of access was reduced. In the June 2020 survey, 11%
of households reported that children aged 6 months to 15 years were
almost daily provided with fewer meals than usual, and an additional
11% percent reported fewer meals three or four times per week.
It is again difficult to draw inferences from this information on the
nutritional impact on adolescents.
Education
It is too early to assess the effect of school closures and the loss of
in-person schooling on learning outcomes although it is evident that
considerable educational deficits have accumulated and continue
to do so. By June 2020, more than one third (35%) of adolescents
who attended basic schooling at the Primary School or Junior High
School level prior to the lockdown had not engaged in any learning
activity since March; among students at the secondary level the
share was a little lower (28%). Some improvement was registered in
September 2020 with 29% of students in basic education and 20% at
the secondary level reporting no participation in any learning activity.
However, the reported frequency of learning activities was as low in
September as it was in June. About 40% of basic level students and
about 30% of secondary level students engaged a maximum of three
times per week in learning, and some even less. A small percentage
expressed that they did not intend to return to school after COVID-19
restrictions ended.
By September 2020, private lessons had become the most common
measure to mitigate the loss of in-person schooling used by 40%
of basic level and 49% by senior level students. Paying for private
lessons during a time of decreased household income is likely to
have further stressed the economy of households in the lower wealth
quintiles. Educational television programmes, home assignments
by teachers or sessions with the teacher were the most frequently
mentioned learning activities by basic level students while educational
learning apps were also used by secondary level students; 18% in
June and 14% in September. Educational television programmes,
mobile learning apps and e-learning were more frequently used in
urban environments while adolescents in rural areas were more likely
to use educational radio programmes.
57
TABLE 34. Learning activities during COVID-19 restrictions having any internet access, poor connectivity reported by 17% of
secondary students in June means that almost all who had access
Primary School /Junior Senior High School
High School to the internet experienced connectivity problems. Lack of traditional
learning materials such as textbooks affected at least one in five
June September June September
students. Although disaggregated data by household wealth are
Is not likely to return to
school after restrictions 4.0% 2.9% 2.0% 1.4% not available, and although households in the lower wealth quintiles
ease
were likely somewhat under-sampled in a telephone survey, it is
Does not participate in plausible that the types of difficulties reported were disproportionally
37.8% 28.7% 28.0% 20.2%
any learning activity
Engages in learning three
experienced by poorer households. The effect is a further increase
42.3% 41.0% 33.8% 29.1%
times per week or less in the already large inequities that exist in Ghana between
Types of learning activities adolescents growing up in poorer compared to richer households
Complete assignments 12.3% 12.1% 11.1% 8.6%
in terms of participation in educational activities and in educational
provided by teachers
achievement. The fact that girls have less access to computers and
Use of mobile learning less opportunities to develop ICT skills was documented in surveys
8.2% 6.9% 18.2% 14.1%
app
Watch educational
conducted prior to 2020. This would also have decreased the access
23.1% 27.9% 29.5% 35.8%
television programmes of girls to digital learning during COVID-19 restrictions, potentially
Listen to educational radio 5.3% 6.3% 7.4% 11.5%
reversing progress that had been achieved in closing the gender gap
programmes
in secondary education.
Teaching sessions with 16.1% 21.0% 13.5% 15.6%
teacher or tutor
Teaching sessions with 4.2% 0.0% 0.7% 0.0% TABLE 35. Difficulties in participating in learning activities during
parent or sibling COVID-19 school closures
E-learning 0.0% 3.6% 0.0% 5.8%
Private lessons 0.0% 39.9% 0.0% 48.5% Primary School / Junior Senior High School
High School
Source: GSS 2020. COVID-19 Tracker Wave 2
June September June September
Although the stated intention to abandon schooling was not high and Home environment is not 0.0% 29.0% 0.0% 31.5%
in the range of one to four percent, adolescents were increasingly conducive for learning
disinterest in learning activities. Disinterest increased between the Lack of basic tools like 24.0% 21.8% 31.4% 33.4%
computers or telephones
June and September surveys from 17% to 20% among students in
basic education and from 12% to 15% among those in secondary Lack of learning materials 22.5% 26.4% 21.9% 29.3%
including textbooks
education. Almost one third mentioned that they had a home Poor internet connectivity 10.9% 9.6% 17.0% 10.2%
environment that was not conducive to learning, and about an equal
Lack of interest in studying 16.8% 20.3% 12.3% 14.5%
percentage mentioned that they were constrained because they
lacked a computer or a mobile phone. Poor internet connectivity was
mentioned less often, but with only 22% of households in Ghana

58
Protection FIGURE 18. Physical punishment and parental irritability during COVID 19

In June 2020, 13% of surveyed households agreed or strongly 50.0% 46.7%

45.1%
agreed with the statement that violence among household members 45.0%
had increased since the first lockdown on March 16th. In September, 40.0%
34.8%
a further 9% agreed that there had been an increase since June. 35.0%
The most common type of intra-household violence reported in 30.0%
June was verbal assault (90%) followed by physical assault (19%) 25.0% 23.1%
24.4%
and other types of violence including rape (0.6%) and sexual
20.0% 16.3%
harassments (0.6%). There is anecdotal evidence suggesting that
15.0%
deteriorating household economies led to increased vulnerabilities
10.0%
of adolescent girls to child marriage as well as to sexual exploitation
5.0%
including transactional sex for economic survival. The increased
risk environment for the exposure of adolescents to violence is well 0.0%
Before March 16 Before June survey Before September survey
documented but there are not yet any reliable data that document an
Children and adolescents (0-17) who were very often, often, or som ewhat often
increased experience of violence. physically punished in the past 30 days
Parents who reported that they were very often, often, or som ewhat often irritated with
Physical punishment of children below 17 years of age increased their children in the past 30 days
throughout the monitoring period although it is not clear whether this
trend also applied to the adolescent age group. While 39% of children An increase in child labour due to school closures and deteriorating
had not experienced any physical punishment in the month prior to household incomes was expected and observed during the first
the lockdown on March 16th, it was only 31% in the month prior to three months of COVID-19 lockdowns. In June, the share of children
the September survey. The share that was exposed very often, often, under 17 who engaged very often, often, or somewhat often in selling
and somewhat often increased from 18% before March to 26% by things or other non-domestic work increased from 15% at baseline to
June and 29% by September. The increased frequency of physical 18%, but by September it had fallen to 11%, considerably below the
punishment is mirrored by an increased irritability of parents with their baseline level. These statistics on child labour are not comparable to
children. The data from the COVID-19 tracker by the Ghana Statistical those collected in MICS6 because different age groups and definitions
Service were again collected among parents of children under 17 of child labour were used. A similar increase in child participation in
years of age but they are likely to apply to adolescents even more household work was registered in June with a subsequent decline in
than to younger children. September that was, however, still about six percentage points higher
than at baseline.

59
FIGURE 19. Child labour during the COVID-19 pandemic
71.5%
61.3%
17.7%
15.2%
Before March 16 Before June survey
Children and adolescents (0-17) who sold godds or otherwise worked very often, often, or somewhat often
Children and adolescents (0-17) who engaged in domestic chores very often, often, or somewhat often
Safe and clean environment
Frequent and regular handwashing is one of the key methods to
contain the spread of COVID-19. Awareness about this is high, but,
as documented by data from MICS6, less than half of households in
Ghana have ready access to handwashing facilities with soap and
water. Measures to mitigate the secondary effects of the pandemic by
the Government of Ghana have included an exemption from water bill
payments and the delivery of water in tankers to rural communities.
There is, however, no documentation if and how this has affected the
lives of adolescents.
Equitable chance of life
Poverty is the main source of inequity in opportunities for adolescents
to thrive and attain an equitable chance in life. In a model exercise,
66.8%
the COVID-19 containment measures instituted in March 2020 were
estimated to have resulted in an additional 3.8 million Ghanaians
falling below the poverty threshold, at least temporarily.57 In the
first survey for the GSS COVID-19 tracker in June 2020, 77% of
households reported that household income was less than prior to the
pandemic. By September, after lockdown restrictions had eased for
almost two months, 66% still reported a reduced income compared
to pre-COVID-19 times. The economic losses were not experienced
equally in all regions, ranging from a low of 22% in the (new) North
East Region to a high of 80% in the Western Region. The impact was
11.4%
likely less pronounced in poor rural agrarian households that relied
more extensively on a non-monetary economy. Households that relied
on non-farm business as their main source of livelihood reported the
largest loss of income.
Before September survey
The differential impact on household economies can also be inferred
from developments in the prevalence of food insecurity which, at
national level, was lower in September 2020 than the prevalence
estimated in 2016/17 by the Ghana Living Standards Survey: 6% for
severe food insecurity as compared to 8% in 2016/17. In rural areas,
which generally have a higher prevalence of food insecurity than
urban areas, the prevalence of severe food insecurity fell from 11%
to 7% while it increased in urban areas from 4% to 6% over the same
period.
The short-term effects of the economic downturn on the well-being of
adolescents are, for now, primarily documented or inferred in domains
such as health, education, and protection. The full extent to which they
have increased inequities in these areas is not known although the
widening social gap is invariably mirrored by growing inequities among
adolescents in these domains. The long-term effects of girls and boys
in lower-income and rural households being left behind because of
reduced opportunities for entering into secondary education as well
as technical or vocational training in a stressed economy will depend
to some extent on the speed of post-COVID-19 recovery and will only
declare themselves in future years.
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5. Conclusions and Recommendations
Promoting and assuring the health, protection and well-being by the COVID-19 pandemic. Since wealth in Ghana is unequally
of adolescents is an obligation that the Government of Ghana distributed among the regions, the wealth-related gaps are also
has committed to uphold when it ratified the UN Convention on reflected in gaps among regions. The three (former) northern regions
the Rights of the Child in 1990. Furthermore, with decreasing and the Volta region trail in several of the indicators that define the
births rates, today’s adolescents will grow into a society in conditions of adolescent well-being.
which the working population will increase in proportional terms,
creating opportunities for Ghana’s future economic growth. This Ghana ratified the UN Convention on the Rights of Persons with
demographic dividend, however, will only be realised if adolescents Disabilities in 2012, but little is known about the extent to which
are equipped with the knowledge and skills to compete in an disabled adolescents can realise their rights. Little is also known
increasingly globalised economy. about the extent to which adolescents in Ghana are able to realise
their right to participation and to have their voices heard in the family,
Ghana has the policies and strategies to address many of the the education system, and other social institutions that govern their
issues that constrain adolescent well-being, such as the National lives. There are, as yet no systematic efforts to monitor advances in
Strategic Framework on Ending Child Marriage 2017-2026, the participation of adolescents in social institutions, nor in the inclusion of
Five-year Strategic Plan to Address Adolescent Pregnancy in disabled adolescents in this process.
Ghana 2018-2022, and the Adolescent Health Service Policy and
Strategy 2016-2020. Ghana has also achieved gender parity in
education completion rates, albeit at low overall levels of school
completion despite high rates of school attendance. Much progress
has also been achieved in eliminating female genital mutilation/
cutting and, while little progress has been achieved in reducing
adolescent pregnancies, adolescent girls receive pregnancy and
maternity care of the same standard as adult women.
There are issues that constrain adolescent development and
well-being on a national scale such as continued high rates of
child marriage and adolescent pregnancy, low access and use
of contraception, low levels of knowledge about HIV prevention,
low levels of access to water, sanitation and hygiene, overall
low education completion rates, low access to computers and
low levels of ICT skills, as well as persistence of child labour
and physical punishment. There are large gender gaps that
disadvantage girls in some of these areas, for instance in computer
access and in child labour. The biggest gaps, however, are related
to the unequal distribution of wealth. There are concerns that
these gaps will widen as the economies of households are affected

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Recommendations
The launching of the Ghana Reproductive, Maternal, Newborn,
Child and Adolescent Health and Nutrition Strategic Plan 2020-
2025 presents an opportunity for the Government of Ghana and
its international partners to address priority issues that affect the
well-being of Ghana’s adolescents. The country is entering into a
demographic transition with the potential of reaping the dividend of a
falling birth rate and dependency ratio. Today’s adolescents are, in this
context, the drivers for the future economic and social development of
Ghana. The findings of the 2017/18 MICS can help the Government of
Ghana in sharpening the focus on adolescents in the implementation
of the national strategic plan, and inform the support to the strategy
provided by UNICEF under its 2021/22 Country Programme. In this
sense, we recommend that:
The Government of Ghana with support of UNICEF and other
international partners should, within the framework of the 2020-2025
Ghana Reproductive, Maternal, Newborn, Child and Adolescent
Health and Nutrition Strategic Plan, promote the health and well-being
of adolescents in a joint effort uniting the Ministry of Health, the Ghana
Health Service, the Ministry of Education, the Ministry of Youth and
Sports, the Ministry of Gender, Children and Social Protection, and the
Ministry of Justice, as well as other relevant ministries such as those
charged with rural and Zongo development. The following issues
that affect the well-being of adolescents should be addressed when
implementing the strategy:
Every adolescent survives and thrives
1. | Early pregnancy and intergenerational sex: Increase the efforts
in communication for social and behaviour change in schools,
communities and through national media directed at adolescent
girls and boys, as well as at families and adult men, especially
targeting rural areas and poor households, to further reduce
the rate of adolescent pregnancies and to address the issue of
older men using their position of power for the sexual coercion of
adolescent girls.
2. | Access to and use of contraception: In the context of offering
adolescent-friendly health services, as well as in the context
of health education in schools, efforts should be increased to
provide sexually active adolescent girls with accurate information,
counselling, and access to effective contraception.
3. | HIV knowledge and prevention: Adolescents in Ghana continue
to be infected with HIV at a level that has not decreased over
years, while HIV testing rates, HIV knowledge and condom use
among adolescents are low and discriminatory attitudes towards
people living with HIV are high. The multisector efforts to respond
to HIV should therefore be renewed with focus on the health and
education sectors, especially because past achievements of the
response to HIV may be threatened by the current focus on the
containment of COVID-19. The Ghana Health Service should
assure that messaging on COVID-19 is balanced with attention to
other communicable diseases, including HIV infection.
4. | Over- and under-nutrition: More information is required about the
persistent high prevalence of under-nutrition among Ghanaian
adolescent boys in rural areas, while the growing incidence
of over-nutrition among girls in urban areas appears to be an
established trend. A healthy nutrition programme for adolescents
should be developed and implemented based on evidence from
targeted studies that explore the causes and consequences of
nutritional deficiencies in different adolescent groups and regions
of the country.
5. | Adolescent mental health: Little is known about the status of
mental health of adolescents in Ghana, especially about the
prevalence of depression that has apparently risen in the context
of COVID-19 containment efforts, as well as about the contribution
of suicide to the pregnancy-related mortality rate among
adolescent girls. Implementation research should be conducted
to better understand the issue, determine the extent, and develop
effective programmes to prevent and mitigate the impact of
depression, anxiety, and other mental health conditions among
adolescents in Ghana.
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Every adolescent learns
6. | Schooling delays and educational performance levels: The high
incidence of delayed entry, the delayed completion, the low
completion rates, and the low levels of learning skills among basic
education students (grade 1-9) in Ghana should be addressed,
especially among boys. This will require a comprehensive review
and investments in improving the quality of Primary and Junior
High School education, including infrastructure, learning materials,
staffing levels and staff capacity in the education sector, as well as
developing second-chance education opportunities for boys who
are left behind and do not complete basic education. This should
focus on the northern regions in the country that are trailing in the
national performance statistics.
7. | Secondary education and technical/vocational training for girls:
While secondary school completion rates among adolescent
girls are almost equal to those of boys, many more girls drop
out of the education system after the completion of basic
education. The reasons are multifaceted and include early
pregnancy, child marriage, and household labour. One of the
pillars for addressing this issue, however, should be to increase
the opportunities and access for girls to technical or vocational
training by the development and implementation of a strategy
to maintain girls who successfully completed basic education in
the secondary education system or to facilitate their entry into
technical or vocational training, including in non-traditionally female
occupations and especially in information technology.
8. | School absenteeism among girls during menstruation: While the
MICS survey found that most adolescent girls use appropriate
menstrual hygiene products and access hygiene facilities at
home, it also found that many among them do not participate
in social activities, including educational activities, during
menstruation. Absenteeism from school during menstruation limits
girls’ opportunities for educational achievement and should be
addressed by providing gender-segregated sanitary facilities that
assure privacy, and by addressing gaps in knowledge and attitudes
about menstruation, especially in the Ashanti and Brong Ahafo
regions where almost one third of all girls report social withdrawal
during menstruation.
9. | Digital technology: Providing adolescents with access and skills
in digital technology is key for Ghana to reverse the trend of
being left behind in a widening global digital gap that threatens
the future economic development of the country. A strategy for
ICT access and training of adolescents should be developed and
implemented to overcome skills and access gaps between boys
and girls, rural and urban areas, and between regions, while at
the same time striving to increase ICT access and skills levels
among adolescents nationally to keep pace with global trends in
digitalisation.
Every adolescent is protected from violence and
exploitation
10. | Domestic violence including wife beating: The acceptance of wife
beating is high among adolescents in Ghana, and adolescent
girls are exposed to physical violence, including sexual violence
in the domestic environment more often than boys. This requires
a strategy for transformative social change including a change in
negative gender norms to gradually decrease the tolerance for
and incidence of wife beating and domestic violence that should
be implemented in schools and communities, starting among
children of preschool age.
11. | Violent discipline: Psychological and physical punishment of
children and adolescents is almost universal in Ghana. The
tolerance of this practice should be addressed in the framework of
a strategy against domestic violence.
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12. | Child labour: While Ghana has a policy to eliminate child labour,
there are still gaps in the implementation of the policy, especially
regarding domestic labour among adolescent girls. Further steps
should be taken to fully implement existing laws and regulations.
13. | Child marriage: Child marriage, especially among girls from poor
households and those living in rural areas is common despite legal
prohibitions. Strategies should be developed and implemented to
improve the implementation of the legal framework which should
include the assurance of universal birth registration to assure that
the legal prohibition of child marriage can be effectively applied by
knowing the real age of marriage applicants.
14. | Female genital cutting/mutilation: While female genital cutting/
mutilation is well on the way towards elimination in Ghana,
remaining pockets of this practice, especially in the Upper West
Region, still require attention. Indications that among adolescents
in other regions this practice is viewed as acceptable should also
be addressed, including by the education system.
Every adolescent lives in a safe and clean environment
15. | Water and sanitation: Improving access and use of improved
water, sanitation, and hygiene facilities in rural areas and in some
regions of Ghana is not necessarily viewed as a strategy for
adolescent well-being. However, inadequate access affects the
lives of adolescents including the important role of adolescent girls
as carriers of water for the household. Access to adequate water
and sanitation is also critical in respect to dignified menstrual
hygiene management and therefore a key strategy in efforts to
empower adolescent girls. While general improvements in the
availability of water, sanitation and hand washing facilities are part
of a Ghanaian development strategy, adolescents could play an
important role in driving behavioural components of this strategy,
for instance in promoting and implementing total community-led
sanitation in rural areas.
16. | Indoor air pollution: Little is known about the health effects of
indoor air pollution through the use of solid fuels for cooking in
Ghana. In addition to the negative effects on the environment, the
long-term health consequences of exposure to smoke from solid
fuel cooking stoves among girls and young women should be
better documented and effective alternatives promoted.
17. | Malaria protection: Malaria continues to be the main threat to the
health of Ghanaians, including adolescents. While the access to
insecticide-treated bed nets is high, the use is still not optimal and
further increase should be promoted. Adolescents who acquire the
habit of sleeping under a bed net are more likely to continue doing
so when their risk of serious complications of malaria are highest,
for instance during pregnancy.
Every adolescent has an equitable chance in life
18. | Narrowing wealth, urban/rural, and regional gaps: There are
wide gaps in all indicators of adolescent opportunities and well-
being between the poorest and the richest Ghanaian households,
between those living in rural and in urban areas, and among
regions with the northern and north-eastern parts of the country
lagging on many indicators of health, education, and protection. A
strategy for adolescents should therefore integrate the evidence
of those gaps and explicitly focus implementation on those
areas and populations where the highest levels of inequities are
observed.
19. | Inclusion of adolescents living with disabilities: Little is known
about the inclusion of adolescents living with disabilities in
education and in the social life in Ghana. The situation should be
further explored in implementation research to better describe
the extent and the barriers to inclusion faced by adolescents who
are blind, hearing impaired, who have restricted mobility, or who
suffer from epilepsy or serious mental health conditions, with the
aim of developing and implementing functional approaches to
overcoming these barriers.
64
20. | Closing the gender gap: Adolescent girls in Ghana are
disadvantaged by the persistence of unequal gender norms and
practices ranging from child marriage, limited agency and voice
and views about girls’ role in the household to social acceptance
of wife beating. Many of the observed gender inequalities, for
instance in access to education and occupational training as
well as in ICT skills and in child labour have their origin in these
unequal gender norms. An adolescent strategy should explicitly
address prevalent norms about the role of women in society, but it
should also focus more directly on closing major gaps where they
are observed, for instance in access to secondary education and
vocational training and in ICT skills development.

65
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 Contact details:
UNICEF Ghana Country Office
4 -8th Rangoon Close, Cantonments,
Accra
Website: https://www.unicef.org/ghana
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