Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: A multi-country analysis of demographic and health surveys

Identifying promising or priority effective adolescent, sexual and reproductive health interventions in Ghana: what frameworks should guide the selection of interventions?

BACKGROUND

Adolescent sexual and reproductive health (ASRH) is an integral part of the global health agenda. It is strongly featured in the universal health coverage (UHC) agenda of the sustainable development goals (SDGs). The need to expand ASRH services to accelerate progress on UHC is urgent in Africa, compared to other regions, given its youthful population and unmet ASRH needs. Limited access to ASRH services increases the risk and vulnerability of adolescents to poor health outcomes such as unintended pregnancies, high adolescent birth rate, poor birth outcomes, high maternal and neonatal mortalities and high exposure to sexually transmitted infections. The unavailability and inaccessibility of ASRH interventions to adolescents and young adults in most African countries, including Ghana, arise from several limitations, including inadequate funding of interventions, cultural barriers and norms, lack of education, and inadequate supplies of ASRH services and commodities, among others. However, gains from investments in ASRH interventions, especially following the implementation of the Millennium Development Goals, highlight the importance of identifying and prioritising adequate funding for effective ASRH interventions. This paper identifies priority ASRH interventions that can potentially advance the sexual and reproductive health (SRH) needs of adolescents in Ghana to accelerate progress towards UHC.

METHODS

Qualitative descriptive methods, combining literature review and stakeholder engagement, were used for this study. A literature review complemented by stakeholder engagement ensured the listing, ranking and validation of interventions.

RESULTS

Adapting an established framework designed by the West African Health Organization (WAHO) through stakeholders' engagement process, the paper identifies four of seven priority interventions ranked and validated by stakeholders for addressing the SRH needs of adolescents in Ghana. Consistent with the literature, several interventions exist to address ASRH needs. The most effective priority or promising four interventions in Ghana, according to stakeholders, include adolescent health clubs programmes, girls' empowerment programmes through comprehensive sexuality education, national capacity-building programmes to deliver high-quality integrated family planning and comprehensive maternal health services, and electronic health (eHealth)/digital health programmes.

CONCLUSION

Identifying effective priority interventions for addressing the SRH needs of adolescents is a consultative process facilitated by proven and valid frameworks adapted to align with specific country contexts.

Multipurpose prevention technologies for the prevention of unintended pregnancy, HIV, and other sexually transmitted infections: regulatory pathways and challenges

Multipurpose prevention technologies (MPTs) are multi-indication products commonly focusing on the prevention of unintended pregnancy, HIV, and/or other sexually transmitted infections (STIs). MPTs have the potential to simplify product use and service delivery with reduced clinic visits, thus supporting improved product uptake, effective use, and cost-effectiveness. MPTs are complex products that typically include multiple active pharmaceutical ingredients (APIs), with two or more indications, and often use a device to deliver these APIs. These complexities create challenges when seeking regulatory approval. Products with previously approved APIs may be able to rely on bioequivalence (BE) studies, but still face challenges in formulation variation, drug-drug interaction, and fulfilling strict standards. MPTs that use new APIs and devices cannot rely on BE studies for approval and thus face further uncertainty, including clinical trial design for products with multiple indications and outcomes of interest. Efficacious standards of care for HIV prevention and contraception also necessitate active-control designs for registrational clinical trials, thus innovative trial designs may be needed. Compounding these challenges are special regulatory requirements for combination products, in addition to standards applied to individual API and device. Possible approval pathways for combination products exist within the US Food and Drug Administration and other global regulatory authorities, but their complexities and challenges are untested for MPTs. They are highlighted in this article to raise awareness around regulatory pathways for MPTs. In Sub-Saharan Africa, women of reproductive age are the largest percentage of new HIV infections. This, in combination with considerable rates of unintended pregnancy and rising sexually transmitted infection (STI) rates, highlights the need for products that address these complex sexual and reproductive health needs. Multipurpose prevention technologies (MPTs) commonly focus on the prevention of unintended pregnancy, HIV, and/or other STIs in one product. MPTs combine the use of multiple pharmaceutical drugs and often a medical device to address these interrelated challenges. This creates complications in the design of studies for MPTs and in understanding the process of approval from regulatory authorities. Regulatory authorities are responsible for ensuring the safety and effectiveness of health products, and in MPTs this is complicated by targeting the prevention of multiple indications, with differing study designs and challenges, in one product. There are mechanisms in place at some regulatory authorities to evaluate MPTs, but these pathways are untested by product developers and regulatory authorities alike. Some of these pathways are highlighted below. Collaboration between diverse stakeholders like regulators, academics, product developers, and community members is necessary to build consensus on the best steps to address these challenges. MPTs are a potential tool to successfully prevent interrelated sexual and reproductive health concerns, but regulatory challenges must be addressed for safe and effective products to reach those who need them most.

Factors associated with unintended pregnancies in India among married women over the past one and half decade (2005-2021): a multivariable decomposition analysis

BACKGROUND

Along with other low- and middle-income countries unintended pregnancies are a matter of grave concern for India as well as world. Preventing unintended pregnancy can significantly reduce fertility as well as population health.

METHODS

Our study used data from three recent rounds of national family health survey (NFHS) which were conducted in 2005-06 (NFHS-3), 2015-16 (NFHS-4) and 2019-21 (NFHS-5). In union, currently married and pregnant women who have given birth to at least one child in last five years were taken into consideration for study. Dependent variable was unintended pregnancy (current pregnancy) which included mistimed as well as unwanted pregnancy. Univariate, bivariate analysis with point-to-point change was done to know aboutdependent variable. To know about important covariate of change in unintended pregnancy logistic regression has been used followed by multivariable decomposition analysis.

RESULTS

Over all three - survey rounds considered in our study; prevalence of unintended pregnancy declined from 31.76% (NFHS-3) to 15.87% (NFHS-5). Highest percentage decline of 23.02% from NFHS-3 (39.01%) to NFHS-5 (15.99%) in unintended pregnancy was in the women of Muslim religion. Women of rural area have 19% lower chance of unintended pregnancy with adjusted odds ratio 0.81. Odds of having current unintended pregnancy were about 8 times in women whose last birth was unwanted. Women with incorrect knowledge of ovulatory cycle have 20% higher chance of having unintended pregnancy. After analysis it was found that out of total change in unintended pregnancies was proximately 23% due to compositional change and about 77% change was due to behavioural change.

CONCLUSIONS

Over the time prevalence of unintended pregnancies declining which can be helpful for better health to both child and women. Important factors leading to a decline in unintended pregnancy were young age groups, high education level, unwanted last birth, no and negative fertility gap, no intention to contraceptive use and incorrect knowledge of the ovulatory cycle. Most of decline in unintended pregnancies was due to behavioural change of women considered in our study.

Quality of post-abortion care services in the greater Accra region: connecting the perspectives of service providers and experiences of clients

BACKGROUND

Access to quality abortion services will not only help to reach SDG Target 3.1 and Goal 3 of Agenda 2063 but will also enhance maternal health in sub-Saharan Africa. Post-abortion care was thus introduced as a key component in managing complications from abortion. However, not much is known about the quality of post-abortion care services and practices. The main objective of this study was to examine the connecting experiences of clients and service providers perspectives on the quality of post-abortion care services.

METHODS

An in-depth interview technique was used to collect data from 18 purposively selected post-abortion care clients and 13 post-abortion care service providers from selected health facilities in urban Accra. Data were analysed using NVivo 12 software using a quantitative thematic analysis technique.

RESULTS

We noted that the providers' perspectives and clients' experiences or narratives about PAC quality converged around interpersonal and technical quality. Apart from the consensus on what quality meant and what clients received, there were subtle divergences or variations in quality perspectives. Specifically, while the clients considered quality communication to be concerned with behaviour and mannerisms, service providers perceived it as patient-centred. Also, while clients considered quality treatment to be the immediate outcome of treatment, service providers perceived it as one with no adverse event. We also found that the quality of PAC services at health facilities could be improved by making consumables readily available and the provision of separate treatment rooms.

CONCLUSION

Although PAC services are generally considered high quality in the Greater Accra region, there is still room for improvement. The private health facility owners, the Ministry of Health and the Ghana Health Services could take pragmatic steps to enhance synchronisation of notions of quality PAC services through sensitisation and education based on existing PAC protocol requirements.

Determinants of pressure to conceive among reproductive age women in Sub-Saharan Africa: A multilevel analysis of recent Demographic and Health Surveys in five countries

Globally, 40% of pregnancies are unplanned, with higher rates in Sub-Saharan Africa, often ending in abortion. Women face pressure from spouses/families to conceive, leading to unintended pregnancies and violations of reproductive rights, jeopardizing women's autonomy and well-being. Respecting individual decisions is crucial during this pivotal life stage. The study conducted a secondary data analysis using information from the latest Demographic and Health Surveys, encompassing five Sub-Saharan African nations from 2021 to 2023. The research focused on a weighted sample of 97,350 married women of reproductive age. Data analysis was performed using Stata 14, employing a multilevel mixed-effects logistic regression model to uncover the factors contributing to the pressure exerted by husbands and families on women to conceive. The study highlights that in Sub-Saharan Africa, approximately one in ten women experience pressure to conceive. Factors like age (20-35 years; AOR = 1.6, 95% CI: 1.46, 1.87), socioeconomic status (middle/affluent; AOR = 1.12, 95% CI: 1.04, 1.2 and AOR = 1.12, 95% CI: 1.03, 1.21), parity (childless; AOR = 4.65, 95% CI: 4.1, 5.2), and community literacy (low; AOR = 1.44, 95% CI: 1.25, 1.66) significantly influence this pressure. Notably, women in Tanzania have a 55% lower risk (AOR = 0.45, 95% CI: 0.41, 0.49), while those in Mozambique face a 1.88 times higher risk. The study highlights the substantial pressure faced by reproductive-age women to conceive in Sub-Saharan Africa. Addressing these challenges through targeted policies and interventions is crucial to empower women and promote their reproductive autonomy.

Determinants of family planning services uptake among women within the reproductive age in the Yendi municipality in Northern Ghana

The study investigated the prevalence and determinants of family planning services uptake among women of reproductive age (15 to 49 years) in the Yendi municipality in the northern region of Ghana. A health facility-based cross-sectional study was conducted among 396 reproductive-aged women, sampled from 6 randomly selected health facilities in the Yendi municipality. The child welfare clinic (CWC) served as the point for the sampling of study respondents. Data was collected with questionnaires adapted from previously validated tools. Data was analysed using SPSS v27 in descriptive and inferential statistics. More than half of the respondents (54.3%) said they had ever used a family planning method and almost half of them said they were still using a family planning method. The desire to control pregnancy was a key factor for wanting family planning (79.3%). Most respondents (80.6%) had high knowledge of family planning services and injectables (37.1%) and condoms (24.7%) were the preferred family planning methods. The significant sociodemographic determinants of family planning uptake were religion (Christians (aOR: 7.51; 95%CI: 1.48-38.00:; p = 0.015), traditionalist (aOR: 12.1; 95%CI: 1.90-78.36; p = 0.009)), education (secondary education (aOR: 84.99; 95%CI: 20.02-360.84:; p = 0.000), tertiary education (aOR: 158.74; 95%CI: 33.71-747.52; p = 0.000), no formal education (aOR: 11.83; 95%CI: 2.10-46.76:; p = 0.000)), occupation (farmers (aOR: 12.30; 95%CI: 3.21-47.03; p = 0.000)), and marital status (married (aOR: 0.13; 95%CI: 0.03-0.57; p = 0.007)). Factors that made women less likely to use family planning were unfriendly service providers (aOR: 2.33; 95%CI: 1.28-4.21; p = 0.005), fear of side effects (aOR: 2.19; 95%CI: 1.19-4.05; p = 0.012), and lack of knowledge about available FP services (aOR: 0.45; 95%CI: 0.26-0.77; p = 0.004). Though the knowledge of family planning was high, current uptake of family planning services was modest and there are still sociodemographic and health-related barriers to family planning utilization. Highlighting the need for training programs and policy interventions to improve uptake, reduce financial barriers, and foster a supportive environment.

Contraceptive experience and factors associated with desire for postpartum family planning among pregnant women of the nkongsamba health district, Littoral Region, Cameroon

BACKGROUND

The postpartum period remains a very important period during which contraceptive needs can be met and a significant reduction of maternal and foetal morbi-mortality achieved. This study aimed to evaluate past contraceptive experience and identify factors associated with the desire for postpartum family planning among women in late pregnancy.

METHODS

We conducted a cross-sectional survey from September 2020 to December 2021 in four major health facilities of the Nkongsamba Health District, Cameroon, and consecutively included all pregnant women in late pregnancy, who came for antenatal follow-up in these health facilities. Data were collected using a semi-structured interviewer-administered questionnaire. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for the factors associated with desire for postpartum family planning. Two-tailed p-values < 0.05 were considered statistically significant.

RESULTS

Among the 1074 participants, 41.71% [95% CI: 38.78-44.70] reported a future desire for modern postpartum contraception. The self-reported prevalence of use of modern contraception in the past in the study population was 48.87% [95%CI: 45.86-51.88]. Only 17.64% [95%CI: 14.59-21.16] of women had adopted a modern contraceptive method other than the barrier methods in the past. Among pregnant women who had used modern contraception in the past, 11.50% [95%CI: 9.02-14.55] reported to have had their modern contraceptive experience with long-acting reversible contraceptives (LARCs). The prevalence of unintended pregnancy (current pregnancy) was 40.04% [37.15-43.00], with 11.55% being unwanted, and 28.49% mistimed. Compared to their respective counterparts, participants ≤ 30 years old (AOR = 0.71[0.52-0.99]), with monthly revenue below 100 thousand FCFA (AOR = 0.45[0.32-0.62]), who were single (AOR = 0.38[0.27-0.54]), had lower odds for desire of postpartum family planning. In contrast, women who were Christians (AOR = 2.13[1.27-3.58]), with a history of use of modern contraception before conception (AOR = 2.80[2.02-3.90]), and had a current unintended term pregnancy had higher odds of desiring postpartum contraception (AOR = 2.91[2.13-3.99]).

CONCLUSION

The desire for postpartum family planning is still low among pregnant women. This desire for postpartum family planning depends on sociodemographic factors and past contraceptive practices.

Prevalence and determinants of unintended pregnancy among rural reproductive age women in Ethiopia

Despite growing utilization of family planning in Ethiopia, many pregnancies in rural areas are still unintended and unintended pregnancy remains a major global challenge in public and reproductive health, with devastating impact on women and child health, and the general public. Hence, this study was aimed to determine the prevalence and associated factors of unintended pregnancy in rural women of Ethiopia. This study used a 2016 Ethiopian Demography and Health Survey data. A total weighted samples of 974 reproductive-aged rural women were included in this analysis. Multilevel mixed logistic regression analysis was employed to consider the effect of hierarchal nature of EDHS data using Stata version 14 to determine individual and community level factors. Variables significantly associated with unintended pregnancy were declared at p-value < 0.05 with adjusted odds ratio and 95% confidence interval (CI). The prevalence of unintended pregnancy in rural women was 31.66% ( 95%CI 28.8%, 34.66%). Never had media exposure (AOR: 2.67, 95%CI 1.48, 4.83), don't have work (AOR: 0.33, 95%CI 0.21, 0.52), being from household size of one to three (AOR: 0.44 95%CI 0.2, 0.96), being primiparous (AOR: 0.41, 95%CI 0.17, 0.99), women from poor families (AOR: 2.4, 95%CI 1.24, 4.56), lacking the intention to use contraceptive (AOR: 0.24, 95%CI 0.14, 0.44) were individual-level factors significantly associated with unintended pregnancy. Women from large central region (AOR: 4.2, 95%CI 1.19, 14.62) and being from poor community wealth status (AOR: 4.3, 95%CI 1.85, 10.22) were community-level factors statistically associated with unintended pregnancy. The present study prevalence of unintended pregnancy in rural women was relatively high. Maternal occupation, household size, media exposure, parity, women wealth, intention to use contraceptive, region and community level wealth were factors statistically associated with unintended pregnancy. Hence, demographer and public health practitioners has to give great emphasis on designing an intervention with implementation strategies to increase accessibility of media for reproductive-age women's and improve women financial capacity, and strengthen maternal health services. These strategies helps to decrease adverse birth outcomes associated with unintended pregnancy in rural areas.

Provincial distribution of unintended pregnancy and its associated factors in Sierra Leone

BACKGROUND

Unintended pregnancy is a significant public health concern in Sierra Leone, with far-reaching consequences for both mothers and children. This issue impacts individual well-being, strains healthcare systems, and hinders socioeconomic development. This study examined the prevalence and factors associated with unintended pregnancy in Sierra Leone.

METHODS

Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Provincial variations in the prevalence of unintended pregnancy was presented using a spatial map. A mixed-effect multilevel binary logistic regression models was fitted to examine the factors associated with unintended pregnancy. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intra-cluster correlation coefficients.

RESULTS

In Sierra Leone, the national prevalence of unintended pregnancy was 16.4% in 2019. Women aged 20-49 exhibit lower odds of unintended pregnancy compared to those aged 15-19, with the lowest odds found among those aged 30-34. Factors associated with decreased odds include being employed, married or cohabiting, and belonging to the Fullah tribe, while living in various provinces outside the Western area also correlates with lower odds. Conversely, women with secondary education, listened to the radio, those with more children (5+), contraceptive users, larger household sizes (six or more), and those in the middle wealth index had increased odds of unintended pregnancies.

CONCLUSION

The results from Sierra Leone indicate that various socio-economic and demographic factors significantly influence the prevalence of unintended pregnancies, suggesting critical areas for intervention. For women in the 20-49 age group, the lower odds of unintended pregnancies compared to younger women suggest that targeted educational and health initiatives could further enhance their reproductive health outcomes. The protective factors associated with employment, marital status, and tribal affiliation highlight the importance of promoting stable family structures and economic opportunities. Also, women living in the Eastern, Northwestern, Northern, and Southern provinces, the results imply a need for province-specific interventions. These areas may require tailored outreach programs that address cultural and socio-economic barriers to contraceptive use and reproductive health education. The increased odds linked to secondary education, listening to radio, those with more children, contraceptive users, and larger household sizes suggest that educational initiatives should also address family planning and reproductive health. A focused approach that considers the unique needs of these women could lead to more effective strategies in reducing unintended pregnancies in Sierra Leone.

Prevalence and factors associated with female genital mutilation/cutting among Tanzanian women who gave birth in the five years prior to the survey: A population-based study

BACKGROUND

Female Genital Mutilation/Cutting (FGM/C) poses a significant public health challenge in developing countries, leading to increased risks of adverse obstetric outcomes such as caesarean section, postpartum hemorrhage, episiotomy, difficult labor, obstetric tears/lacerations, instrumental delivery, prolonged labor, and extended maternal hospital stays. The study aimed to determine the prevalence and factors associated with FGM/C among Tanzanian women who had given birth within five years preceding the Survey.

METHOD

This study utilized an analytical cross-sectional design based on data from the 2015-2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey (TDHS-MIS). A total of 5,777 women who had given birth within the five years preceding the survey and who provided responses to questions regarding female circumcision were included in the analysis. Descriptive analysis was employed to examine the prevalence of FGM/C among women in Tanzania. Additionally, multiple logistic regression was used to identify factors associated with FGM/C within this population.

RESULTS

The prevalence of FGM/C was 12.1% at 95%CI of 11.3% to 13%. Factors associated with FGM/C were marital status [married (AOR = 3.141 at 95%CI = 1.757-5.616,p<0.001), living with male partners (AOR = 2.001 at 95%CI = 1.082-3.699, p = 0.027), widowed (AOR = 2.922 at 95%CI = 1.201-7.111, p = 0.03)] never in union a reference population; wealth index [poorest (AOR = 2.329 at 95% CI = 1.442-3.763, p = 0.001), middle (AOR = 1.722 at 95% CI = 1.075-2.758, p = 0.024), richer (AOR = 1.831 at 95%CI = 1.205-2.781, p = 0.005)] in reference to richest women; zones [Northern zone, (AOR = 91.787 at 95%CI = 28.41-296.546, p<0.001), central zone, (AOR = 215.07 at 95%CI = 67.093-689.423,p<0.001), southern highlands, (AOR = 12.005 at 95% CI = 3.49-41.298, p<0.001), lake zone (AOR = 13.927 at 95%CI = 4.338-44.714,p<0.001), eastern zone, (AOR = 24.167 at 95% CI = 7.299-80.017, p<0.001)]; place of childbirth [outside health facility (AOR = 1.616 at 95%CI = 1.287-2.03, p<0.001)] in reference to health facility childbirth; parity [para 5+ (AOR = 2.204 at 95% CI = 1.477-3.288,p<0.001)] para one a reference population; and opinion on whether FGM/C stopped or continued [continued (AOR = 8.884 at 95% CI = 5.636-14.003, p<0.001).

CONCLUSION

This study underscores the persistent issue of FGM/C in Tanzania, particularly among married women, those from lower-income households, and those living in regions with high prevalence. Women giving birth outside health facilities and those with multiple children are at higher risk. The study emphasizes the need for targeted interventions addressing socio-cultural factors, alongside providing legal, healthcare, and psychological support to those affected. Educational campaigns and community engagement, especially with traditional and religious leaders, are crucial for challenging cultural beliefs and reducing FGM/C's prevalence.

Unintended pregnancy among women living with HIV and its predictors in East Africa, 2024. A systematic review and meta-analysis

INTRODUCTION

An unintended pregnancy refers to a situation where a pregnancy occurs either when there is no desire for a child (unwanted) or when it takes place at a time that was not anticipated (mistimed). Pregnant women infected with HIV face a two to tenfold increased risk of mortality during both pregnancy and the postpartum period compared to those who are not infected. A national level cohort study has identified that about 70 babies born HIV positive, 60% of them were from unplanned pregnancy. In pregnant women living with HIV and on antiretroviral therapy, preterm birth and low birth weight have been reported. A systematic review and meta-analysis were conducted on the rate of vertical transmission of HIV in East Africa and revealed the pooled prevalence of 7.68% (ranges from 1.58-32.1%), which is far from the desired target of WHO, which is below 5%.

METHODS

Appropriate and comprehensive searches of PubMed, MEDLINE, EMBASE, Google Scholar, HINARI, and Scopus have been performed. The electronic literature search was last performed on December 28/2023. All observational study designs were eligible in this SRMA (systematic review and meta-analysis). Primary studies lacking the outcome of interest, were excluded from the SRMA. The extracted Microsoft Excel spreadsheet data were imported into the STATA software version 17 (STATA Corporation, Texas, USA) for analysis. A random-effects model was used to estimate the pooled prevalence of unintended pregnancy among women living with HIV in East Africa. The Cochrane Q-test and I2 statistics were computed to assess the heterogeneity among the studies included in the SRMA.

RESULT

A total of 2140 articles were found by using our search strategies and finally ten studies were included in the SRMA, comprised of 4319 participants. The pooled prevalence of unintended pregnancy among women living with HIV in East Africa was 40.98% (95% CI: 28.75, 53.20%). The finding of this subgroup analysis by study country showed that the pooled prevalence of unintended pregnancy among women living with HIV was lower in Ethiopia (28.38%; 95% CI: 15.54, 41.21%) and higher in Rwanda (62.7%; 95% CI: 58.71, 66.69%). Unemployment (AOR = 2.75, 95% CI: 1.82, 4.16), high parity (AOR = 3.16, 95% CI: 2.34, 4.36) and no formal education (AOR = 2.04, 95% CI: 1.23, 3.38) were significantly associated with unintended pregnancy among women living with HIV in East Africa.

CONCLUSION

The findings of this SRMA suggest a substantial need for concerted efforts to reduce unintended pregnancies among women living with HIV. It underscores the importance of continuous and rigorous initiatives to enhance women's empowerment, focusing on improving both employment and educational status. Additionally, all stakeholders are urged to diligently implement the WHO recommendations, particularly emphasizing a four-pronged approach to a comprehensive PMTCT strategy and the prevention of unintended pregnancies.

Prevalence of unintended pregnancy and associated factors among pregnant women with disabilities in Ethiopia: from the social model of disability perspective

Background

In low-income countries, women with disabilities face numerous challenges in accessing sexual and reproductive health services and experience high unintended pregnancy rates and adverse pregnancy outcomes, with 42% of cases ending in abortion. However, little is known about unintended pregnancy among women with disabilities in Ethiopia. Therefore, this study aimed to assess the prevalence of unintended pregnancy and associated factors among women with disabilities in the Central Regional State of Ethiopia.

Methods

A community-based cross-sectional study was conducted from December 2023 to February 2024, and multistage random sampling was used to enroll 572 study participants. The sample size was proportionally allocated to each zone, district and kebele. The Kobo Toolbox was used for data collection and cleaning, and the Statistical Package for Social Science version 26 was used for analysis. The multivariable analysis was used to identify the factors significantly associated with unintended pregnancy using an adjusted odds ratio (AOR), a 95% confidence interval (CI), and a p-value less than 0.05.

Results

The prevalence of unintended pregnancy was 43.8% (95% CI: 39.5, 47.8) in the Central Ethiopia Regional State, Ethiopia. The significantly associated factors were household size (AOR = 4.6, 95% CI: 2.6, 7.9), awareness of pregnancy intention (AOR = 2.4, 95% CI:1.4, 4.1), domestic violence (AOR = 5.9, 95% CI: 3.4, 10.4), accessibility of service (AOR = 2.4, 95% CI: 1.2, 5.4), discrimination by care providers (AOR = 2.1, 95% CI: 1.5, 2.9), disability-unfriendly health facility structure (AOR = 1.5, 95% CI: 1.2, 2.40), and negative community attitudes (AOR = 2.7, 95% CI: 1.7, 4.3). The overall direction of the associated variables' effect was positive.

Conclusion

This study sheds light on the need for disability-inclusive and sensitive healthcare services. Therefore, to achieve universal access to sexual and reproductive healthcare targeted under the Sustainable Development Goals, the Minister of Women and Social Affairs, Ministry of Health, Regional Health Bureau, and health facilities authorities should pay attention to improving awareness on pregnancy intention and domestic violence and ensuring accessible, inclusive, and equitable maternal health care for women with disabilities.

Magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in low- and middle-income countries: An umbrella review of systematic review and meta-analysis

Background

To date, findings from systematic reviews and meta-analyses on unintended pregnancies in low-income and middle-income countries (LMICs) are inconsistent, posing challenges for preventive efforts. Therefore, the aim of this study is to determine the magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in LMICs: an umbrella review of systematic review and meta-analysis.

Methods

PubMed, Scopus, Science Direct, Web of Science, as well as databases specific to systematic reviews, such as the Cochrane Database, have investigated the magnitude, risk factors, and adverse outcomes of unintended pregnancy in LMICs. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates from the included studies regarding the magnitude and predictors of unintended pregnancy were then pooled and summarised using random-effects meta-analysis models.

Results

We included 13 systematic review and meta-analysis (SRM) studies involving 1 446 122 women. The summary estimate for the magnitude of unintended pregnancy was 28.38% (95% CI = 23.06-33.7%, I2 = 100%). From the umbrella review, the reported factors and complications of statistical significance were as follows: maternal illiteracy (AOR = 3.79; 95% CI = 1.36-8.94), being unmarried (AOR = 12.98; 95% CI = 1.88-27.85), lack of communication with the husband about family planning (AOR = 3.43; 95% CI = 1.68-5.19), inability to attend antenatal care (AOR = 1.4; 95% CI = 0.62-2.17), never using family planning (AOR = 1.4; 95% CI = 0.62-2.17), maternal depression (AOR = 1.72; 95% CI = 0.81-2.64), stunting (AOR = 1.76; 95% CI = 1.25-2.48), and parity 3.83 (AOR = 1.3; 95% CI = 1.3-11.3).

Conclusions

The pooled magnitude of unintended pregnancies in LMICs was high. Therefore, it is crucial to integrate family planning and maternal health care services to prevent unintended pregnancy. Additionally, interventions targeting rural, unmarried, less-educated, and adolescent women are important for preventing unintended pregnancies in LMICs.

Contraceptive use and determinants among sexually active unmarried adolescents and young women (aged 15-24 years) in East Africa: insights from Demographic and Health Survey data

BACKGROUND

Low contraception usage among adolescents is a significant public health issue, leading to a rise in unintended pregnancies and adolescent childbearing in sub-Saharan Africa. Despite global efforts to improve access to contraception, sexually active adolescents and young women in East Africa are often overlooked, exposing them to substantial health risks. This study explored the factors influencing contraceptive use among unmarried and sexually active adolescents and young women in East African countries.

METHODS

National representative data from the 2016 Demographic and Health Survey for eight East African countries were used in the analysis. Data processing and analysis were performed using STATA 17 software. A multilevel mixed-effect logistic regression was used to identify determinants of contraceptive use at p<0.05.

RESULTS

A total of 7813 sexually active unmarried adolescents and young women were considered for the final analysis. Among these young women, 24.9% were using a contraceptive method. Age, place of residence, knowledge of contraceptive methods, employment status and educational attainment were identified as significant determining factors of contraceptive use among sexually active unmarried adolescents and young women (aged 15-24 y) in East Africa.

CONCLUSIONS

Contraceptive utilization among sexually active unmarried adolescents and young women was relatively low in East African countries. Addressing the existing inequalities in access to contraceptive services for rural adolescents and young women in East African countries is crucial. Prioritizing policies that implement comprehensive sexual education is essential to enhance their knowledge of contraceptives and empower them to make informed decisions.

Cultural practices supporting early motherhood in a Ghanaian community

Cultural practices help constitute a 'normal' way of life within a specific community and set the standard that members of the community are expected to adhere to. Some of these practices may have a short- and long-term influence on young people in ways supportive of teenage motherhood. This study explored cultural practices and beliefs in a study area in Ghana that encourage teenage girls into motherhood unintendedly. An exploratory design was used. Thirty teenage mothers and twenty-two opinion leaders participated in fieldwork conducted between October 2018 and February 2019. Data were analysed using an inductive approach. Four themes became apparent: fear of being cursed for having an abortion; sleeping arrangements; funerals and wakes; and practices of cohabitation in the study area. Cultural practices contribute to teenage motherhood in the Adaklu District of Ghana. Programmes, interventions and policies should be designed to take into consideration the needs, contexts, and backgrounds of teenagers. Future programmes to enhance teenagers ability to avoid teenage pregnancy and motherhood should consider factors such as the family, the person, the community, institutions, and national and international influences.

Socioeconomic inequality in postnatal care utilisation among reproductive age women in sub-Saharan African countries with high maternal mortality: a decomposition analysis

OBJECTIVE

To assess the socioeconomic inequality in postnatal care (PNC) utilisation and its contributors among women in 14 sub-Saharan African countries with high maternal mortality.

DESIGN

Community-based cross-sectional study using Demographic Health Survey SETTING: Africa countries with the highest maternal mortality ratio (14 countries) PARTICIPANTS: All women who had given birth within 2 years prior to the survey (n=64 912) PRIMARY OUTCOMES: Postnatal care utilisation RESULTS: The percentage of women who had PNC utilisation was lowest in Ethiopia (23.4%: 95% CI: 22.1%, 24.7%) and highest in The Gambia (91.5%: 95% CI: 90.6%, 92.4%). There was statistically significant pro-rich inequality in the PNC utilisation in all countries except Liberia, meaning PNC utilisation was disproportionately concentrated among women from wealthier households. The weighted Erreygers Normalized Concentration Index (ECI) ranged from 0.0398 in The Gambia to 0.476 in Nigeria; the second-highest inequality was in Cameroon (0.382), followed by Guinea (0.344). The decomposition analysis revealed that the wealth index was the largest contributor to inequality in PNC utilisation in seven countries: Benin, Burundi, The Gambia, Guinea, Nigeria, Sierra Leone, Tanzania. In contrast, educational status emerged as the primary contibutor in Cameroon and Zimbabwe, media exposure in Mali and Mauritania, and distance to healthcare facilities in Ethiopia. However, in Liberia, the weighted ECI of 0.0012 with a p value of 0.96 indicate that there is no significant socioeconomic inequality in PNC utilisation, suggesting that the distribution of PNC utilisation is almost equal across different socioeconomic groups.

CONCLUSION

Our study revealed a pro-rich inequality in PNC utilisation across all included sub-Saharan African countries with high maternal mortality, except Liberia. This implies that PNC utilisation disproportionately favours the wealthy. Therefore, financially better-off women are more likely to utilise PNC services compared to those who are poor. Addressing the identified contributors of socioeconomic inequalities in PNC utilisation in each country remains crucial for achieving equity in PNC utilisation.

Determinants of unmet need for contraceptive method among young married women in Ethiopia: Multilevel analysis of Ethiopia Demographic and Health Survey 2016

BACKGROUND

The notion of unmet need for family planning indicates the gap between women's contraceptive practice and their reproductive intention. Although universal access to sexual and reproductive health services including contraceptive methods is a bedrock for sustainable development goals, the unmet need for contraception is high among young women in low-income countries including Ethiopia. The unmet need for contraception is associated with unintended pregnancy which most of the time end in unsafe abortion. Hence, this study aimed to assess the determinants of unmet need for family planning among young married women in Ethiopia using nationally representative data.

METHOD

This study utilized secondary data collected in the 2016 Ethiopia Demographic and Health Survey (EDHS). A two-stage cluster sampling method was used. The analysis included a total of 2444 sexually active married young women (15-24 years). Multilevel logistic regression analysis was conducted to identify individual and community level factors associated with unmet need for contraceptives and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses.

RESULTS

In this study, the prevalence of unmet need for contraceptive method among married young women was 18.4% [95% CI: (16.9, 20.0)]. Female head of the household [AOR: 1.62, CI (1.25, 2.11)], primary level of education [AOR: 1.53, CI: (1.16, 2.03)], family size ≥5 [AOR: 1.53, 95%CI: (1.22, 1.93)], undecided to have child [AOR: 2.86, 95%CI: (1.58, 5.20)] and infecund [AOR: 1.54, 95%CI: (1.08, 2.20)] were factors positively associated with unmet need for family planning. Whereas the odds of unmet need for contraceptive method was lower among women-initiated sex between 15-17 years and >17 years [AOR:0.72, 95%CI (0.53, 0.98)] and [AOR: 0.58, 95%CI: (0.40, 0.85)] respectively and community with high proportion of poverty [AOR: 0.68, 95%CI: (0.46, 0.99)].

CONCLUSION

The prevalence of unmet need for contraceptive methods among young married women was relatively high. Being female household head, age at first sexual intercourse, educational status of the woman, family size, desire for more children, and community poverty were significantly associated with unmet need for family planning. Hence, interventions targeting these special populations at the individual and community level would play a paramount role in meeting the unmet need for contraception among young married women in Ethiopia.

Prevalence, distribution and factors associated with modern contraceptive use among women of reproductive age in Uganda: evidence from UDHS 2016

BACKGROUND

Unintended pregnancies pose significant health risks, particularly in sub-Saharan Africa, where millions of cases are recorded annually, disproportionately affecting adolescent women. Utilization of modern contraceptives is crucial in managing fertility and reducing unintended pregnancies, abortions, and associated health complications. This study aimed to assess the prevalence, distribution and factors associated with modern contraceptives utilization among women aged 15-49 in Uganda.

METHODS

The study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study sample comprise of 9,235 women aged 15-49 who used any method to prevent pregnancy in the five years preceding 2016 UDHS survey. The outcome variable for this study is utilization of modern contraceptives. Univariate, bivariate, and multilevel binary logistic regression was used to examine the relationship between individual and contextual factors on the modern contraceptive use among women aged 15-49 in Uganda. Choropleth mapping and network analysis in ArcGIS 10.8.2 was used to visualize spatial distribution of modern contraceptive use and measure community access to health facilities respectively.

RESULTS

The prevalence of modern contraceptive use was 53.19% (n = 4,919) in Uganda, with significant spatial variation by district. Higher prevalence (23.18%) was observed among women aged 20-29 compared to adolescents (4.1%). Only 21.9% of married women reported using modern contraceptives. At the individual-level, the factors that positively influenced use of modern contraceptives included: women's marital status, wealth index and level of education while sex of the household head, ever terminated a pregnancy and religion negatively affected the use of modern contraceptives. At community-level, community access to health facilities was found to have negative influence on the use of modern contraceptives among women. In communities where women frequently visited health facilities in the 12 months preceding the survey, the use of modern contraceptives reduced by 3.9%. Accessibility analysis revealed challenges, with women in northeastern districts (rural districts) facing travel times exceeding four hours to reach health facilities.

CONCLUSION

Utilization of modern contraceptives are essential for promoting women's health and well-being, particularly concerning maternal healthcare. This study highlights disparities in modern contraceptive use across age groups and the districts, emphasizing the need for targeted interventions. Policymakers and stakeholders must prioritize strategies that promote utilization of modern contraceptives and maternal healthcare services to address these disparities effectively. Such efforts are crucial for improving reproductive health outcomes and reducing the burden of unintended pregnancies and related complications in Uganda.

Evaluation of the participation of community pharmacists in family planning services: A nonrandomized controlled trial

BACKGROUND

Community pharmacists (CPs) are increasingly participating in family planning services (FPS) in different health systems but the underpinnings of effectiveness in these services remain poorly understood and rarely documented. Objectives This study examined knowledge, attitude and practice (KAP) of FPS among CPs and assessed the impact of an intervention on these indices.

METHODS

A nonrandomized controlled trial was conducted using two equivalent groups (n = 61 each) of randomly-selected CPs in Southwestern Nigeria. Intervention comprised a training package for the intervention group followed by a 2-month monitoring of participants' practices. Pre- and post-intervention data were collected using validated questionnaire and analyzed using appropriate descriptive (frequency, percentages, mean) and inferential statistics including chi-square test to examine association between categorical variables, and t-test to compare differences between means at alpha level of 0.05 for all statistical tests.

RESULTS

Pre-intervention knowledge of FPS in both groups was poor with no significant difference in their mean scores [t (120) = 0.34; p = 0.74]. Post-intervention, 79% of intervention group demonstrated good knowledge (controls remained poor), with significant difference in mean knowledge scores across the groups [t (120) = -33.59; p < 0.05*]. Pre-intervention attitude in both control (97%) and intervention group (95%) were negative. Post-intervention, 93% of intervention group exhibited positive attitude (controls remained negative), Mean difference 72.8 [t (120) = -77.21; p < 0.05*]. Preintervention practice scores were poor in control (92%) and intervention (90%) groups. Post-intervention, 83.6% of intervention group had good practice scores (controls remained poor), Mean difference 48.9 [t (120) = -31.0; p < 0.05*].

CONCLUSION

Pre-intervention scores for KAP of FPS were poor among respondents. All the indices were significantly improved by the study intervention. Policy reforms are recommended to train CPs in the provision of FPS for enhanced reproductive health services.

Assessment of the Trends and Factors Associated With Unintended Pregnancy Among Women of Reproductive Age: An Analysis of the Nigerian Demographic Health Survey Between 2008 to 2018

Background

Unintended pregnancy is a global public health issue with significant adverse effects which include health and economic consequences. Globally, there were 121 million unintended pregnancies annually between 2015 and 2019 among women of reproductive age between 15 and 49 mainly due to the non-uptake of modern contraceptives, harmful norms, stigma and lack of sexual and reproductive health care and information.

Methods

We extracted information from the Nigeria Demographic Health Survey conducted in 2008, 2013, and 2018 to assess the trends and factors associated with unintended pregnancies among women of reproductive-aged 15-49. The descriptive summaries were presented using percentages and binomial logistic regressions for the inferential analysis. All analyses were computed using Stata 15.0 at a 5% level of significance and accounted for the complex survey nature as well as the population size.

Results

The study included a total of 63,040 women of reproductive age. The prevalence of unintended pregnancy was highest among adolescents aged 15-19 years (15.1%, 95% CI: 13.9-16.5) and decreased with increasing age. The pooled adjusted model revealed that women had 11% lower odds of reporting unintended pregnancies in 2013 compared to 2008. Adolescent girls (aOR 2.48; 95%CI: 2.14-2.89) and young adults (aOR 1.86; 95%CI: 1.69-2.04) have higher odds of reporting unintended pregnancies compared to older women. Also, unmarried women had 9.8 times higher odds of reporting unintended pregnancies compared to ever-married women.

Conclusions

The findings from this study highlight the need for further family planning educational programs and initiatives that support the uptake of effective contraceptive methods to reduce the likelihood of unintended pregnancy and improve women's sexual and reproductive health while considering regional variations within the country to ensure tailored interventions that address specific needs within each region.

Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa

BACKGROUND

Improving women's access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women's receipt of quality contraceptive counselling and its associated factors in SSA.

METHODS

Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling.

RESULTS

Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20-24 (AOR = 1.48, CI: 1.32-1.67), those with primary (AOR = 1.32, CI: 1.11-1.57) and secondary or higher education (AOR = 1.31, CI: 1.09-1.58), and those married (AOR = 1.32, CI: 1.15-1.52), cohabiting (AOR = 1.47, CI: 1.23-1.76), and previously married (AOR = 1.48, CI: 1.20-1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09-1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21-1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52-1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86-6.51), Eastern (AOR = 2.54, CI: 1.96-3.30), and Western (AOR = 4.09, CI: 3.19-5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups.

CONCLUSION

Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women's access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women's access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.

Determinants of unintended pregnancy and induced abortion among adolescent women in Ethiopia: Evidence from multilevel mixed-effects decomposition analysis of 2000-2016 Ethiopian demographic and health survey data

BACKGROUND

Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades.

METHODS

Trends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents.

RESULTS

The trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion.

CONCLUSION

The trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.

Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018)

BACKGROUND

Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia.

METHODS

This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15-49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software.

RESULTS

Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25-29 years and 30-34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies.

CONCLUSIONS

The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.

Reproductive autonomy and the experience of later-than-desired pregnancy: results from a cross-sectional survey of reproductive-aged women in Uganda

BACKGROUND

The focus of reproductive autonomy research has historically been on the experience of unintended pregnancy and use of contraceptive methods. However, this has led to the neglect of a different group of women who suffer from constraints on their reproductive autonomy-women who experience pregnancies later than they desire or who are unable to become pregnant. This study examines the extent of later-than-desired pregnancy among women and evaluates the sociodemographic and reproductive factors associated with this experience in Uganda.

METHODS

We use data from the Performance Monitoring for Action Uganda 2022 female survey. We restricted the nationally representative sample of reproductive-aged women to those who were currently pregnant or who had ever given birth (n = 3311). We compared the characteristics of women across fertility intention categories (wanted pregnancy earlier, then, later, or not at all) of their current or most recent birth and used multivariable logistic regression to examine factors independently associated with having a pregnancy later than desired compared to at a desired time.

RESULTS

Overall, 28.3% of women had a later-than-desired pregnancy. Nearly all sociodemographic and reproductive characteristics were associated with the desired pregnancy timing of women's current or most recent pregnancy. Having higher education [adjusted odds ratio (aOR) 2.41, 95% confidence interval (CI) 1.13-5.13], having sought care for difficulties getting pregnant (aOR 2.12, 95% CI 1.30-3.46), and having less than very good self-rated health (good health aOR 1.74, 95% CI 1.12-2.71; moderate health aOR 1.77, 95% CI 1.09-2.86; very bad health aOR 4.32, 95% CI 1.15-16.26) were all independently significantly associated with increased odds of having a later-than-desired pregnancy. Being nulliparous (aOR 1.98, 95% CI 0.99-3.95) was also borderline significantly associated with having a later-than-desired pregnancy.

CONCLUSIONS

Identifying those who have later-than-desired pregnancies is essential if we seek to make progress towards supporting women and couples in achieving their reproductive goals, not just preventing pregnancies. Research on desired pregnancy timing in sub-Saharan Africa should be expanded to capture later-than-desired pregnancies, a population which is invisible in existing data. This work has public health implications due to commonalities in the factors associated with mistimed and unintended pregnancies and their link to poorer health and potentially poorer pregnancy outcomes.

Unplanned pregnancy and risk of peripartum depression: a prospective cohort study in Saudi pregnant women attending antenatal care clinic

Background

Few studies have been conducted on unintended pregnancies and peripartum depression in Saudi Arabia. This study aimed to evaluate the relationship between unplanned pregnancies and peripartum depression among pregnant women in Jeddah, Saudi Arabia.

Methods

This prospective cohort study included pregnant women attending an antenatal care clinic in 2021. The London Measure of Unplanned Pregnancy was used to assess the prevalence of unplanned pregnancy, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal and postnatal depression.

Results

A total of 236 participants were included, of which 25.8% had unplanned pregnancies, 36.0% had ambivalent pregnancies, and 38.1% had planned pregnancies. EPDS results revealed that 77.5% and 73.35% of the females were negative for antenatal and postnatal depression, respectively. A history of stressful events (P=0.001), husband (P=0.020), and family support (P=0.007) was significantly associated with antenatal EPDS score, whereas age (P=0.005), type of delivery (P=0.019), and family support (P=0.031) were significantly associated with the postnatal score.

Conclusion

Unplanned pregnancies may affect the perinatal mental health of women. We demonstrated the importance of family or husbands' support for women with perinatal depression. In addition, our research showed that pregnancy at an early age is a risk factor for postnatal depression. Therefore, these women should be closely monitored not only during their pregnancy but also during the first postpartum year.

A Longitudinal Multilevel Analysis of the Effects of Contraceptive Failures on Unintended Pregnancies among Women in Urban Nigeria

Unintended pregnancy is a global public health concern. However, the effect of contraceptive failure on unintended pregnancy remains unclear in Nigeria. We undertook a longitudinal analysis to examine the effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. We used panel data from the Nigerian Urban Reproductive Health Initiative. The Measurement, Learning and Evaluation program conducted the surveys among a cohort of women aged 15-49 who were first interviewed at baseline in 2010/2011 and followed up at endline in 2014/2015. Analytic sample was 4140 women aged 15-49 who ever used contraceptives. We fitted three-level multilevel binary logistic regression models estimated with GLLAMM. The study established evidence that there is a significant effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. The positive effect of between-person contraceptive failure indicates that respondents who experienced more contraceptive failure than the average in the sample had 5.26 times higher odds of unintended pregnancy (OR = 5.26; p-value < 0.001). Results also established a significant effect of within-person contraceptive failures among the respondents. Findings suggest there is evidence of a significant longitudinal effect of contraceptive failure on unintended pregnancy in urban Nigeria. Efforts to reduce unintended pregnancy must include interventions to address the problem of contraceptive failure among urban women in Nigeria.

Emergency Contraception Knowledge, Attitudes, and Barriers Among Men: A Cross-Sectional Study

Background Emergency contraception (EC) plays a pivotal role in the prevention of unintended pregnancies following unprotected sexual intercourse. Men's awareness regarding emergency contraception is pivotal for informed decision-making and for enhancing reproductive health in this context. This study investigated Syrian men's awareness and perspectives on emergency contraception to inform diverse reproductive health initiatives. Methods We conducted a cross-sectional study in Syria, from June 2022 and April 2023. Our study included male participants aged 18 years or older who held Syrian nationality and volunteered to participate. The data collection involved administering a questionnaire comprising three sections (knowledge, attitude, and barrier assessment), encompassing a total of 30 questions. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY). Results Most participants were aged 18-25 (65.7%) and single (75.4%) and held a university degree (79.3%). The knowledge of emergency contraception was low (36.1%), with the Internet and social media (77.5%) being the primary sources of information. While 89% held positive attitudes toward emergency contraception, only 37.3% supported nonprescription availability. Age, income, and desire for children were associated with knowledge, attitudes, and the use of emergency contraception. Men aged 26-35 exhibited the highest positive attitude (8.11±1.83). Those desiring no children showed higher attitude scores (7.42±2.04). Income was positively associated with knowledge (adjusted odds ratio {AOR}=1.75 and confidence interval {CI}=1.02-2.99) and emergency contraception use (AOR=2.87 and CI=1.27-6.48). Conclusion This study underscores the knowledge gap regarding emergency contraception in Syrian men. Despite positive attitudes, awareness remains limited, particularly among those of childbearing age. Targeted education and improved accessibility to emergency contraception can enhance its use among men, particularly in those with low socioeconomic status and younger age groups.

Availability of self-care products for sexual and reproductive health provided by community pharmacists in Rwanda: A cross-sectional study

Access to and use of sexual and reproductive health (SRH) services remain a global public health concern, particularly in developing countries. This study aimed to understand the attitudes and perceptions of pharmacists in Rwandan community pharmacies and to assess the availability of sexual and reproductive health products in these pharmacies.In a cross-sectional study conducted in Rwanda from 1 September 2023 to 30 November 2023, registered and licensed pharmacists from 864 community pharmacies were surveyed, employing a quantitative research approach. Systematic sampling was used to collect the data. A chi-square test was conducted for relationships between variables.SRH products for self-care were widely available in Rwandan community pharmacies, ranging from 82.3% to 97.3%, except for ovulation tests (28.4%). Chi-square tests indicated that married pharmacists were more likely to provide educational guidance on SRH products (χ2 =  8.81, P-value = 0.012). Community pharmacists had positive attitudes and self-reported confidence in dispensing and providing education to pharmacy-based SRH users.The Rwandan community pharmacies had extensive availability of SRH products for self-care use. Pharmacists in these pharmacies had positive attitudes and self-reported confidence in dispensing and guiding the community on SRH products. Continuous professional training is recommended to enhance the quality and standards of SRH.

Explainable machine learning for modeling predictors of unintended pregnancy among married/in-union women in sub-Saharan Africa, a multi-country analysis of MICS 6 survey

Introduction

Unintended pregnancy is defined as a pregnancy that is either mistimed (wanted at a later time) or unwanted (not wanted at all). It has been a concerning issue for reproductive health and public health, with significant negative effects on the mother, child, and the public at large. It is a worldwide public health issue that can have a major impact on the health of pregnant women and newborns.

Methods

The study was conducted using secondary data from IPUMS Multiple Indicator Cluster Surveys round 6. The analysis was based on a data merged from six sub-Saharan Africa countries such as Gambia, Ghana, Lesotho, Malawi, Nigeria, and Sierra Leone. A total weighted sample of 28,027married/in-union reproductive-age women was included in the study. Seven machine learning algorithms were trained and their performance compared in predicting unintended pregnancy. Finally, Shapley Additive exPlanations model explanation technique was used to identify the predictors of unintended pregnancy.

Results

XGBoost was the top-performing model, achieved the highest area under receiver operating characteristic curve (0.62) and accuracy (65.92%), surpassing all other models. SHAP global feature importance identified top predictors of unintended pregnancy, with women from Malawi, Ghana, and Lesotho, women having primary education and secondary education, with parity of more than three, have higher likelihood of unintended pregnancy. In the other hand, women from Nigeria and Sierra Leone, whose husband/partner has more wives or partners (polygamy relation), and women who owns mobile phone had lower risk of unintended pregnancy.

Conclusion

These findings highlight the importance of considering contextual factors, such as country-specific sociocultural norms and individual characteristics, in understanding and addressing unintended pregnancies. By strategically addressing the identified predictors, policymakers, and healthcare providers can develop impactful programs that address the root causes of unintended pregnancies, ultimately contributing to improved reproductive health outcomes worldwide.

Relationship between health insurance enrolment and unintended pregnancy in Ghana

CONTEXT

The effect of health insurance coverage on sexual and reproductive health, especially unintended pregnancy, has scantly been researched. Using the 2014 Ghana Demographic and Health Survey, the study examined the links between women's health insurance enrolment on unintended pregnancy in Ghana.

METHOD

The sample consisted of 9,396 women aged 15-49 years, but the analysis was limited to the 4,544 women who were pregnant in the two years preceding the survey. The effects of health insurance enrolment on unintended pregnancy was examined with the propensity score matching. The health insurance enrolment was the treatment variable and unintended pregnancy as the outcome variable.

RESULTS

This study showed that 66.0% of all women surveyed had health insurance coverage and 31.8% of all women of childbearing age who were currently or had previously been pregnant reported having at least one unintended pregnancy. Thirty percent of insured women had an unintended pregnancy, compared to 37% of uninsured women. The results showed that education, household wealth index, religion, and type of marital union were significant predictor of health insurance coverage among Ghanaian women. The PSM split the women based on their health insurance status. After matching, the difference between the insured and uninsured women reduces significantly. Results demonstrated that, the probability of unintended pregnancy was 0.312 among insured women and 0.351 among those not insured in Ghana. This implies that having health insurance coverage will help in reducing the likelihood of women experiencing unintended pregnancy.

CONCLUSIONS

Results highlight the importance of the target of universal health coverage under the sustainable development goal 3 and demonstrate that expanding existing health insurance schemes within Ghana could contribute to reducing the number unintended pregnancies experienced each year.

Digital support for first time self-injectable contraceptive users in Nairobi, Kenya: A design evaluation

BACKGROUND

Women in Kenya have an unmet need for contraception, and self-injectable contraceptives offer a new, self-managed fertility control option. Self-injection reduces the need to travel to a facility for ongoing care, but the initial, in-person, consultation may be a barrier. Training in self-injection administration could be delivered via WhatsApp on a mobile phone.

METHODS

This study aimed to observe and document the design process of a WhatsApp delivered self-injectable contraceptive service. This design evaluation employs a mixed methods approach using; observation of design meetings, analysis of design documents (process maps, prototypes) and interviews with the design team. Participants who tested the remote training element of the final service design were interviewed about their experiences.

RESULTS

Four tasks, delivered by the digital service, were explored in further detail: provide information on self-injectables; ensure the technical and privacy requirements of the video call are met; obtain information from the user to check eligibility; and observe the users first self-injection. The challenges, assumptions, iterations, and learning associated with these key tasks were documented and 3 case studies emerged. These case studies explore how the digital service altered the timing and medium of a clinical interaction, the construction of the user's physical space when interacting with the service and the challenge of performing legitimacy via WhatsApp.

CONCLUSION

By examining self-care facilitated by digital technologies, there are opportunities to learn about self-care, digital care and face-to-face care. Through examining the design process, we discovered ways in which digital services can change the rhythm of health care interactions, namely by stretching the time, space and medium of clinical interaction. When interactions are altered in this way, clinical legitimacy must be negotiated in new ways.

Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.

Role of community-level emergency contraceptive pills awareness and possibilities of long-acting reversible or permanent methods in reducing unwanted births in Bangladesh: evidence from a nationwide cross-sectional survey

OBJECTIVE

This study aims to investigate the role of community-level emergency contraceptive pill (ECP) awareness in reducing unwanted births (UWBs) in Bangladesh and explore the regional variation in women's appropriateness to adopt long-acting reversible contraceptives or permanent methods (LARCPMs) based on their child desire.

DESIGN, SETTINGS AND PARTICIPANTS

We used data from the cross-sectional Bangladesh Demographic and Health Survey 2017-2018. We analysed the planning status of the last live birth 3 years preceding the survey of 20,127 ever-married women of reproductive age.

METHODS

Considering women were nested within clusters, a mixed-effect multiple logistic regression was implemented to investigate the association between community-level ECP awareness and UWB by controlling for the effects of contextual, individual, and household characteristics.

RESULTS

Only 3.7% of women belonged to communities with high ECP awareness. At the national level, 2% of women had UWB. About 2.1% of women who resided in communities of low ECP awareness had UWB, while UWB was only 0.5% among women residing in high ECP awareness communities. The odds of UWB was 71% lower among women who resided in high ECP awareness communities than among those who resided in communities with low ECP awareness. However, community-level ECP awareness could not avert mistimed birth. Dhaka, Chattogram and Rangpur held the highest share of UWB. Fertility persisted for 89% of the women who wanted no more children. Among women who wanted no more children, 15% were not using any method, 13% used traditional family planning methods and only 13% adopted LARCPM. These women mostly resided in Dhaka, followed by Chattogram and Rajshahi.

CONCLUSION

This study highlights the significant positive role of ECP awareness in reducing UWB in Bangladesh. Findings may inform policies aimed at increasing LARCPM adoption, particularly among women residing in Dhaka and Chattogram who want no more children.

Unintended Pregnancy and Associated Factors among Pregnant Women Attending Antenatal Care Unit in Public Health Facilities of Dire Dawa City, Eastern Ethiopia, 2021

BACKGROUND

Unintended pregnancy refers to a pregnancy that is either mistimed or unwanted. Unintended pregnancy has been a troubling public health and reproductive health issue, which imposes appreciable adverse consequences on the mother, child, and the public in general. Globally 121 million unplanned pregnancies occurred from 2015 to 2019. A significant proportion (61%) of these pregnancies ended in abortions each year. In Ethiopia, the challenges of unintended pregnancy and its related complications still exist because of the high rate of unmet need for contraceptives. In addition, no research has been conducted on unintended pregnancy among pregnant women in Dire Dawa city administration.

OBJECTIVE

To determine the prevalence of unintended pregnancy and associated factors among pregnant women attending antenatal care public health facilities in Dire Dawa in 2021.

METHODS

A facility-based cross-sectional study was conducted. After being chosen randomly, 382 pregnant women were interviewed at 9 urban public health facilities. A pretested questionnaire was used to collect data, entered into Epi Info 7, and exported into SPSS version 25 for analysis. The variables, which were significant at P ≤ 0.25 in bivariate analysis, were included in multivariable analysis. Statistical significance was declared at a P value <0.05 and a 95% CI.

RESULTS

In this study, the prevalence of unintended pregnancy was 23.8% at 95% CI (19.8-28.3). The following factors were associated with unintended pregnancy: single women (AOR = 10.93, 95% CI 3.65-32.74), low family income (2000 ETB) (AOR = 4.01, 95% CI 1.73-9.28), parity 3 (AOR = 10.3, 95% CI 4.07-25.84), no history of family planning use (AOR = 5.91, 95% CI 2.46-14.21), and husband decision-making role on reproductive health (AOR = 2.956, 95% CI 1.048-8.340). Conclusion and Recommendations. The prevalence of unintended pregnancy was relatively high in this study. Efforts should be made to scale up women's decision-making power on family planning services and give support to empower women economically. There is the need to promote family planning services to minimize unintended pregnancy and to decrease parity and family size.

Program impact and potential pitfalls of multi-purpose technologies (MPTs) for HIV prevention and contraception

The overlapping epidemics of HIV and unplanned pregnancy disproportionately affect adolescent girls and young women (AGYW) in sub-Saharan Africa. Prevailing dynamics driving benefits of any prevention method at the population level depend on: 1) population size, risk profile, and prevalence of method use, 2) method efficacy, and 3) method use-effectiveness. Adding a multi-purpose technology (MPT) to prevent HIV and pregnancy to this three-part equation results in scenarios that may enhance HIV population impact, even with methods that exhibit less than "perfect" method efficacy, by extending protection among existing users and attracting new users, resulting in greater population coverage. However, the interplay of epidemic drivers is complex and the greatest population benefit of such a MPT would be realized among those most at risk for HIV and pregnancy, and could be harmful if successful contraceptive users switch to a method with lower use-effectiveness. While MPTs are highly desired, and may offer considerable individual, population, and system-level public health benefits, there is no "magic bullet", nor single prevention method-MPT or otherwise-that will end the HIV epidemic nor fully resolve unmet need for family planning. All methods have inherent tradeoffs and women have varied reproductive and HIV prevention needs across their life course. Key programmatic features to maximize the potential of MPTs include offering them among a range of safe and effective methods with comprehensive information about their features allowing women to make a fully-informed method choice. Programmatic follow-up should support consistent and correct use to maximize use-effectiveness, and then monitor for potential untoward effects.

Exploring user and stakeholder perspectives from South Africa and Uganda to refine microarray patch development for HIV PrEP delivery and as a multipurpose prevention technology

BACKGROUND

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, but alternative delivery options are needed to reach more users. Microarray patches (MAPs), a novel drug-delivery system containing micron-scale projections or "microneedles" that deliver drugs via skin, are being developed to deliver long-acting HIV PrEP and as a multipurpose prevention technology to protect from HIV and unintended pregnancy. We explored whether MAP technology could meet user and health system needs in two African countries.

METHODS

Researchers in South Africa and Uganda conducted 27 focus group discussions, 76 mock-use exercises, and 31 key informant interviews to explore perceptions about MAPs and specific features such as MAP size, duration of protection, delivery indicator, and health system fit. Participants included young women and men from key populations and vulnerable groups at high risk of HIV and/or unintended pregnancy, including adolescent girls and young women; female sex workers and men who have sex with these women; and men who have sex with men. In Uganda, researchers also recruited young women and men from universities and the community as vulnerable groups. Key stakeholders included health care providers, sexual and reproductive health experts, policymakers, and youth activists. Qualitative data were transcribed, translated, coded, and analyzed to explore perspectives and preferences about MAPs. Survey responses after mock-use in Uganda were tabulated to assess satisfaction with MAP features and highlight areas for additional refinement.

RESULTS

All groups expressed interest in MAP technology, reporting perceived advantages over other methods. Most participants preferred the smallest MAP size for ease of use and discreetness. Some would accept a larger MAP if it provided longer protection. Most preferred a protection duration of 1 to 3 months or longer; others preferred 1-week protection. Upper arm and thigh were the most preferred application sites. Up to 30 minutes of wear time was considered acceptable; some wanted longer to ensure the drug was fully delivered. Self-administration was valued by all groups; most preferred initial training by a provider.

CONCLUSIONS

Potential users and stakeholders showed strong interest in/acceptance of MAP technology, and their feedback identified key improvements for MAP design. If a MAP containing a high-potency antiretroviral or a MAP containing both an antiretroviral and hormonal contraceptive is developed, these products could improve acceptability/uptake of protection options in sub-Saharan Africa.

Exploring health insurance and knowledge of the ovulatory cycle: evidence from Demographic and Health Surveys of 29 countries in Sub-Saharan Africa

BACKGROUND

Unplanned pregnancy continues to be a major public health concern in Sub-Saharan Africa (SSA). Understanding the ovulatory cycle can help women avoid unplanned pregnancy. Though a wide range of factors for ovulatory cycle knowledge in SSA countries has not been well assessed, the influence of health insurance on ovulatory cycle knowledge is largely unknown. As a result, we set out to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age. This study aims to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age in sub-Saharan Africa (SSA).

METHODS

Demographic and Health Surveys (DHSs) data from 29 SSA countries were analyzed. The association between health insurance and ovulatory cycle knowledge was investigated using bivariate and multivariate multilevel logistic regression models among 372,692 women of reproductive age (15-49). The findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of 0.05 was considered statistically significant.

RESULTS

The pooled result shows that the prevalence of knowledge of ovulatory cycle in the studied 29 SSA countries was 25.5% (95% CI; 24.4%-26.6%). Findings suggest higher odds of ovulatory cycle knowledge among women covered by health insurance (AOR = 1.27, 95% CI; 1.02-1.57), with higher education (higher-AOR = 2.83, 95% CI; 1.95-4.09), from the richest wealth quintile (richest-AOR = 1.39, 95% CI; 1.04-1.87), and from female headed households (AOR = 1.16, 95% CI; 1.01-1.33) compared to women who had no formal education, were from the poorest wealth quintile and belonged to male headed households, respectively. We found lower odds of ovulatory cycle knowledge among women who had 2-4 parity history (AOR = 0.80, 95% CI; 0.65-0.99) compared to those with history of one parity.

CONCLUSIONS

The findings indicate that the knowledge of the ovulatory cycle is lacking in SSA. Improving health insurance enrollment should be considered to increase ovulatory cycle knowledge as an approach to reduce the region's unplanned pregnancy rate. Strategies for improving opportunities that contribute to women's empowerment and autonomy as well as sexual and reproductive health approaches targeting women who are in poorest quintiles, not formally educated, belonging to male headed households, and having high parity should be considered.

Male characteristics and contraception in four districts of the central region, Ghana

BACKGROUND

A lack of male involvement in contraception can negatively affect its practice. To promote male participation in family planning, there is a dire need to understand male attributes that play a role in contraception. This study focuses on the male characteristics that influence the practice of traditional and modern methods of contraception.

METHODS

This study is a secondary analysis of quantitative data obtained from the baseline assessment of the Ghana Community-Based Action Teams Study that aimed to prevent violence against women in the Central Region of Ghana in 2016. The analysis included 1742 partnered males aged 18-60 years. Chi-square test, t-test and logistic regression analyses were used to assess the association between male characteristics and the practice of contraception (significance level = 0.05).

RESULTS

The prevalence of contraception was 24.4% (95% CI = 20.8-28.5). Significant male characteristics that were positively associated with the practice of contraception in adjusted models were: post-primary education (AOR = 1.96, 95% CI = 1.27-3.04), perpetration of Intimate Partner Violence (AOR = 1.83, 95% CI = 1.49-2.26), and the number of main sexual partners (AOR = 1.78, 95% CI = 1.15-2.75). However, wanting the first child (AOR = 0.71, 95% CI = 0.54-0.94) and male controlling behaviour (AOR = 0.7, 95% CI = 0.49-0.99) statistically significantly associated with reduced odds of practicing contraception.

CONCLUSION

Male partner characteristics influence the practice of contraception. Family planning sensitization and education programs should target males who are less likely to practice contraception.

Post-War Assessment of the Prevalence and Determinants of Unplanned Pregnancy Among Pregnant Women Attending Public Hospitals in Conflict-Zones of South Wollo, Northeast Ethiopia, 2022, Multi-Center Study

Background

Worldwide, although unplanned pregnancy seems decreasing, 38% of pregnancies are unintended. In sub-Saharan Africa, unintended pregnancy accounts for more than a quarter of the 40 million pregnancies that occur annually.

Objective

The study aimed to assess the prevalence and determinants of unplanned pregnancy among pregnant women attending public hospitals in conflict-zones of South Wollo zone, Northeast Ethiopia, 2022.

Methods

A multi-center facility-based cross-sectional study was conducted from December 20, 2021 to February 30, 2022 among the hospitals of South Wollo zone that that were destructed by the armed conflict.

Results

The prevalence of unplanned pregnancy in our study was 44.72% (CI=39.40-48.08%).

Conclusion

In this study nearly half of the pregnancies were unplanned, which is shocking to the health care system in the 21st century.

Factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District, Ghana: a qualitative study

BACKGROUND

Fertility declines with age, but it remains important to protect women from unplanned pregnancies throughout their reproductive lives. The objective of this study was to describe factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District of Ghana.

METHODS

In-depth interviews were conducted remotely for 22 women, 15 male partners of the women interviewed and seven family planning (FP) providers. In all, a total of 44 participants took part in the study. Seven refusals were recorded, four females and three males. Four focus group discussions were organized for 21 participants who took part in the in-depth interviews. Data collected were transcribed and coded after exporting to Nvivo12 qualitative analysis software. Thematic analysis was undertaken using an abductive approach.

RESULTS

Factors that influenced the use of modern contraceptives included: achieved desired family size, providing for the family, counselling by health professionals, influence of the male partner, and health reasons. Barriers cited included: religious or socio-cultural reasons, experience or fear of side effects, rumors or misconceptions, declining fertility, and the belief that contraceptive use is a matter for women. Within the study group, roughly half of women used modern contraceptives, while the majority of male partners were non-users.

CONCLUSION

Contraception among women aged 35 to 49 years and their male partners is influenced by several factors such as achieved desired family size, influence of the male partner, rumors or misconceptions, and declining fertility. Strengthening male involvement in family planning activities and health educational activities could alleviate fear and reduce misconceptions about using modern contraceptives.

Reasons and prevention strategies of unintended pregnancy in Addis Ababa, Ethiopia: a phenomenological qualitative study

OBJECTIVES

To explore the reasons for unintended pregnancy and effective prevention measures from the perspectives of women and healthcare providers in Addis Ababa, Ethiopia.

DESIGN

Phenomenological qualitative study.

SETTING AND PARTICIPANTS

This study was conducted at three public health facilities found in Addis Ababa, Ethiopia. Women with unintended pregnancies and healthcare providers currently working in maternal health services were purposively recruited for in-depth interviews. Twenty in-depth interviews were conducted until data saturation was achieved. Data were analysed using thematic analysis.

RESULTS

Seven themes emerged from the transcribed interview data. These include: Personal characteristics (negligence; lower pregnancy expectation), family influence (fear of family), sociocultural and economic influence (stigma and discrimination), healthcare provider influence (disrespectful and abusive approach; disregard for women's contraceptive choice), preconception thoughts and behaviours (unprotected early sexual practice; myths and misunderstanding), lack of access to quality family planning services (lack of trained contraceptive counsellor, inappropriate contraceptive use), and preventive strategies for unintended pregnancy (comprehensive sexual education; sexual and reproductive health and rights service integration) CONCLUSIONS: This study identified multilevel reasons for unintended pregnancy from the perspective of the participants. Participants shared their views on preventive measures for unintended pregnancy, including comprehensive sexual education, service integration and male-inclusive contraceptive counselling. This study highlights the need to improve sexual and reproductive health services by shedding light on the viewpoints and experiences of women and healthcare providers.

Unintended pregnancy and its associated factors among women with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

BACKGROUND

Unintended pregnancy is one of the most common reproductive health problems. The problem makes women with disabilities doubly burdened by their disabilities. The previous evidences are inconsistent and do not address all women with disabilities. The study aimed to assess the prevalence of unintended pregnancy and its associated risk factors among women with disabilities in Dale and Wonsho districts and Yirgalem city administration central Sidama National Regional State, Ethiopia.

METHODS

A community-based cross-sectional study design was conducted among 355 randomly selected women with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviews using a structured questionnaire. A multilevel logistic regression analysis model was employed to identify factors associated with an unintended pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations.

RESULTS

In this study, the prevalence of unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). After adjusting for potential confounding variables, middle economic status (AOR = 2.07; 95% CI: 1.02, 4.20), giving birth (AOR = 2.20; 95% CI: 1.21, 3.99), extremity paralysis types of disability (AOR = 0.26; 95% CI: 0.12, 0.57), living in urban residences (AOR = 0.22; 95% CI: 0.12, 0.40) and alcohol using (AOR = 0.28; 95% CI: 0.11, 0.74) were risk factors with unintended pregnancy.

CONCLUSIONS

Unintended pregnancy among women with disabilities is remarkably high in central Sidama National Regional State, Ethiopia. Economic status, giving birth, types of disability, residence, and alcohol use were factors associated with an unintended pregnancy. As a result, economic empowerment, strengthening education and information about unintended pregnancy and its prevention strategies in rural settings are vital.

Magnitude of unintended pregnancy and its determinants among childbearing age women in low and middle-income countries: evidence from 61 low and middle income countries

Background

Unintended pregnancy is one of the most serious health issues in low and Middle-Income Countries (LMICs), posing significant health, economic, and psychosocial costs to individuals and communities. However, there is limited evidence on the prevalence of unintended pregnancies and their determinants in LMICs. Hence, this study aimed to assess the prevalence of unintended pregnancy and its associated factors among childbearing-age women in LMICs.

Method

Data for the study were drawn from a recent 61 Demographic and Health Surveys (DHS) conducted in LMICs. A total sample of 187,347 mothers who gave birth in the five years preceding the survey was included. STATA version 16 was used to clean and analyze the data. Multilevel multivariable logistic regression was employed to identify individual and community-level factors of unintended pregnancy in LMICs. In the multivariable analysis, an adjusted odds ratio with a 95% confidence level was reported to indicate statistical association.

Results

The pooled magnitude of unintended pregnancy in LMICs was 26.46%% (95% CI: 25.30%, 27.62%), ranging from 19.25%% in Egypt to 61.71% in Bolivia. Working status (AOR =  1.03; 95% CI: 1.01, 1.06), having a husband with no education (AOR = 1.07; 95% CI: 1.00, 1.15), and primary education (AOR =  1.05; 95% CI: 1.01, 1.11), women from male-headed households (AOR = 1.04; 95% CI: 1.00, 1.08), media exposure (AOR = 1.05; 95% CI: 1.02, 1.08), unmet need for contraception (AOR = 1.05; 95% CI: 1.02, 1.08), distance from a health facility (AOR = 1.03; 95% CI: 1.00, 1.06) were significantly associated with unintended pregnancy.

Conclusion

Unintended pregnancy rates remain high in LMICs. Women whose husband has no education and primary education, women with media exposure, working status, women who live in a household headed by male, women with unmet need for contraception, and women with a big problem of distance to health facilities were variables that were significant predictors of unintended pregnancy. When attempting to minimize unintended pregnancy in LMICs, these factors need to be considered. Furthermore, most of these attempts should be driven by government entities in low and middle-income countries.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017-2018 data

OBJECTIVES

This study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged 15-49 years.

DESIGN

Cross-sectional study.

SETTING

We used data from Bangladesh Demographic Health Survey (BDHS) 2017-2018.

PARTICIPANTS

A total of 9669 Bangladeshi reproductive-aged women who gave information on contraception use were the study participants. A multilevel multinomial logistic regression model was employed where the SARC method was considered as the base category and the cluster was considered as level-2 factor.

RESULTS

Among the contraceptive users in Bangladeshi women, about 83.48% used the SARC method, while 11.34%, and 5.18% used permanent and LARC methods, respectively. Compared with SARC, women with no formal education and only primary education who were non-Muslims, and had parity of ≥3 had a higher likelihood of using both permanent and LARC methods. Women from the age group of 25-34 years (adjusted relative risk ratio (aRRR): 7.03, 95% CI: 4.17 to 11.85) and 35-49 years (aRRR: 12.53, 95% CI: 7.27 to 21.58) who were employed (aRRR: 1.19, 95% CI: 1.00 to 1.40), had media access (aRRR: 1.24, 95% CI: 1.03 to 1.49), gave birth in last 5 years (aRRR: 1.40, 95% CI: 1.11 to 1.76), whose contraception decision solely made by their husband (aRRR: 7.03, 95% CI: 5.15 to 9.60) and having high decision-making power (aRRR: 2.12, 95% CI: 1.62 to 2.77) were more likely to use permanent contraceptive methods. We observed that women from households with richer (aRRR: 0.65, 95% CI: 0.45 to 0.93) and richest (aRRR: 0.38, 95% CI: 0.23 to 0.63) wealth quintiles were less likely to use LARC methods.

CONCLUSIONS

This study identified that women with no/less education, non-Muslims, and having parity of ≥3 were more likely to use both permanent and LARC methods than SARC methods. Targeted interventions could be developed and implemented to promote personalised contraceptive use.

The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study

BACKGROUND AND AIM

By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests.

RESULTS

Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05).

CONCLUSION

Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.

Changes in Socioeconomic Inequalities in Unintended Pregnancies Among Currently Married Women in India

Background

Despite the consistent prevalence of unintended pregnancies in India and its adverse impact on maternal and neonatal mortality, the literature discussing socioeconomic inequality remains scarce. This study aims to assess the change in wealth-related inequalities in unintended pregnancy in India from 2005-2006 to 2019-20 and to quantify the contribution of various factors towards inequality.

Methods

The present study analyzed cross-sectional data from the third and fifth rounds of the National Family Health Survey (NFHS). The information on fertility preferences and pregnancy intention of most recent live birth during the five years preceding the survey was collected from eligible women. The concentration index and Wagstaff decomposition were used to analyze wealth-related inequality and the contributing factors.

Results

Our results show that the prevalence of unintended pregnancy has declined in 2019-20 to 8% from 22% in 2005-2006. With the increase in education and wealth status, unintended pregnancy decreases significantly. The results of the concentration index depict that unintended pregnancy is more concentrated among the poor than the rich in India, and the individual's wealth status has the highest contribution to unintended pregnancy inequality. Other factors like mothers' BMI, place of residence and education also contribute majorly to the inequality.

Conclusions

The study results are critical and increase the need for strategies and policies. Disadvantaged women need education and family planning information, plus access to reproductive health resources. Governments should improve accessibility and quality of care in family planning methods to prevent unsafe abortions, unwanted births, and miscarriages. Further research is needed to investigate the impact of social and economic status on unintended pregnancies.

Knowledge and utilization of sexual and reproductive health services among young males in a slum area in Nigeria: A cross-sectional study

Background

Globally, young people are faced with sexual and reproductive health challenges such as unintended pregnancies, sexually transmitted infections and unsafe abortions which result from limited knowledge of sexual and reproductive health and poor utilization of the available services. The purpose of this study was to assess the sexual and reproductive health knowledge, pattern of service utilization, and the associated factors among young males in slum communities of Mushin Local Government Area (L.G.A), Lagos State, Nigeria.

Methods

The study was conducted among young males, 15-24 years in Mushin Local Government Area, Lagos State, Nigeria. Data was collected using a pre-tested structured questionnaire that consisted of three domains with 57 questions, and was interviewer-administered. Multi-stage sampling technique was used to select 422 participants. Descriptive statistics, bivariate analysis, and binary logistic regression were carried out using SPSS version 20.

Results

The mean age of the respondents was 21.01 years ± 2.00, and 73.06% of the respondents had good knowledge of sexual and reproductive health. 52.85% of the respondents had poor knowledge regarding the likely occurrence of pregnancy at mid-menstrual cycle. Nearly two-third (64%) of the respondents have ever visited a health facility for sexual and reproductive health service. Ethnicity(AOR = 2.73), access to the internet(AOR = 1.77) and having ever had sex(AOR = 1.96) were significantly associated with the utilization of the services.

Conclusion

Good knowledge of sexual and reproductive health was observed among the respondents, although misconceptions still exist. Service utilization, however, remains low due to some individual and socio-cultural factors. It is therefore important to increase awareness of Sexual and Reproductive Health, and make the services available and affordable to young people for increased uptake.

Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa

Introduction

Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence.

Methods

The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence.

Results

In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use.

Discussion

AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.

Investigating the relationship between growing season quality and childbearing goals

Agricultural production and household food security are hypothesized to play a critical role connecting climate change to downstream effects on women's health, especially in communities dependent on rainfed agriculture. Seasonal variability in agriculture strains food and income resources and makes it a challenging time for households to manage a pregnancy or afford a new child. Yet, there are few direct assessments of the role locally varying agricultural quality plays on women's health, especially reproductive health. In this paper we build on and integrate ideas from past studies focused on climate change and growing season quality in low-income countries with those on reproductive health to examine how variation in local seasonal agricultural quality relates to childbearing goals and family planning use in three countries in sub-Saharan Africa: Burkina Faso, Kenya, and Uganda. We use rich, spatially referenced data from the Performance Monitoring for Action (PMA) individual surveys with detailed information on childbearing preferences and family planning decisions. Building on recent advances in remote monitoring of seasonal agriculture, we construct multiple vegetation measures capturing different dimensions of growing season conditions across varying time frames. Results for the Kenya sample indicate that if the recent growing season is better a woman is more likely to want a child in the future. In Uganda, when the growing season conditions are better, women prefer to shorten the time until their next birth and are also more likely to discontinue using family planning. Additional analyses reveal the importance of education and birth spacing in moderating these findings. Overall, our findings suggest that, in some settings, women strategically respond to growing season conditions by adjusting fertility aspirations or family planning use. This study also highlights the importance of operationalizing agriculture in nuanced ways that align with women's lives to better understand how women are impacted by and respond to seasonal climate conditions.

The burden of unintended pregnancies among Indian adolescent girls in Bihar and Uttar Pradesh: findings from the UDAYA survey (2015-16 & 2018-19)

BACKGROUND

Unintended pregnancy severely affects the health and welfare of women and children, specifically if women are young and vulnerable. This study aims to determine the prevalence of unintended pregnancy and its determinants among adolescent girls and young adult females in Bihar and Uttar Pradesh. We believe the present study is unique as it examines the association between unintended pregnancy and sociodemographic factors among young female population in two states of India from 2015-19.

METHODS

The data for the present study is derived from the two-wave longitudinal survey "Understanding the lives of adolescents and young adults" (UDAYA) conducted in 2015-16 (Wave 1) and 2018-19 (Wave 2). Univariate, bivariate analysis along with logistic regression models were employed.

RESULTS

The results revealed that 40.1 per cent of all currently pregnant adolescents and young adult females reported their pregnancy as unintended (mistimed and unwanted) in Uttar Pradesh at Wave 1 of the survey, which decreased to 34.2 per cent at Wave 2. On the contrary, almost 99 per cent of all currently pregnant adolescents in Bihar reported their pregnancy as unintended at Wave 1, which decreased to 44.8 per cent at Wave 2. The sociodemographic factors like age, caste, religion, education, wealth, media and internet use, knowledge and effective contraception highly impacted unintended pregnancy in Bihar and Uttar Pradesh. The longitudinal results of the study revealed that place of residence, internet use, number of wanted children, heard about contraception and SATHIYA, use of contraception, side effects of contraception, and the confidence in getting contraceptives from ASHA/ANM did not appear significant predictors at Wave 1. However, they emerge significant over time (Wave 2).

CONCLUSIONS

Despite many recently launched policies for adolescents and the youth population, this study comprehended that the level of unintended pregnancies in Bihar and Uttar Pradesh stands worrisome. Therefore, adolescents and young females need more comprehensive family planning services to improve their awareness and knowledge about contraceptive methods and use.