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CONTEXT: According to Demographic and Health Survey (DHS) data, highly educated urban women in some West African countries simultaneously have low rates of both contraceptive use and fertility—suggesting that the DHS may not be capturing a complete picture of women's contraceptive practices.

METHODS: Individual in-depth interviews and focus group discussions were conducted with a total of 48 women aged 18–49 in Accra, Ghana, who had at least a secondary education to explore their reproductive lives and relationships, and their views on and use of fertility regulation strategies. Data were analyzed using iterative thematic techniques.

RESULTS: Women commonly reported using combinations of contraceptive methods, including “counting days” (using a calendar and the date of one's last menstrual period to estimate “unsafe” days—those on which the risk of conception is high), as well as …