Ghana is witnessing an increase in the construction of coastal flood defence walls on its coast but the effects of the coastal defence on people have not been well documented. This paper explores two issues: (1) indigenous strategies for preventing sea erosion and (2) the effects the modern coastal flood defence structures constructed along the southeastern coast of Ghana are having on the people. This study provides new insights into the understanding of indigenous methods that were used to address coastal flooding in the eastern section of Ghana and the effects the modern coastal defence structures are having on the people. Through multiphase sampling, a sample of 282 residents living in 17 communities affected by sea erosion in the Keta, Anloga, and Ada East District Assemblies where coastal defence structures were constructed were selected. Questionnaires were administered to these 282 respondents. Focus Group Discussions (FGDs) were also held in three communities, namely Keta, Atorkor and Totepe where coastal defence structures were constructed. The planning officers of the 3 district assemblies, the chief fishermen in the 3 communities where the FGDs were held, leaders of salt winners and 3 elders in each community were the key informants. Using descriptive statistics, the study revealed that, indigenous strategies like filling the beach with sand, building away from the seashore, and raising the foundations of buildings were used to protect the houses and communities from sea erosion but these strategies are no longer working thereby forcing the government to construct ‘modern’ coastal flood defence wallson the coast. The ‘modern’ coastal defence structures are in some places protecting the people and the land since they no longer experience sea erosion on a large scale. However, in places where armour rocks are used to protect the land, people now see them as preventing them from enjoying the natural beach as they used to and as a hindrance to their livelihoods of fishing. It is recommended that, as far as possible, soft engineering strategies like beach nourishment or sand dunes which are in line with the indigenous methods be used since they can lead to easy adaptation for sustainability.