FACTORS INFLUENCING MISTIMED AND UNWANTED PREGNANCIES AMONG NEPALI WOMEN

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.

Pregnancy intentions and its associated factors among married women in resunga, Gulmi, Nepal

Pregnancy intention refers to a women's thinking at the time she became aware that she was pregnant. It can be categorized as intended and unintended. Identifying pregnancy intentions during prenatal periods help to employ careful monitoring of pregnancy that is at high risk for mother and children's health outcomes. Unintended pregnancy is a contributing factor for maternal and infant mortality, which is still high in Nepal. Reproductive and family planning program should incorporate pregnancy intention domains in health education and counseling with priority to design program to address and reduce unintended pregnancy. This brief research examines the pregnancy intentions and its associated factors among married women so that it could identify the intentions of pregnancy and factors influencing unintended pregnancy and could be useful to improve and maintain the health and well-being of women, family, community, and nation.

Sexual violence as a predictor of unintended pregnancy among married women of India: evidence from the fourth round of the National Family Health Survey (2015-16)

BACKGROUND

Sexual Intimate Partner Violence (IPV) is a public health problem globally, with about one in three women experiencing sexual IPV ever in their lifetime. Unintended pregnancy is one of the consequences of sexual IPV and has its repercussions that can span generations. The present study was conducted to estimate the prevalence of sexual intimate partner violence (IPV) and assess the association between sexual IPV and unintended childbirth in India among married women aged 15-49 years.

METHODS

The National Family Health Survey-India (NFHS-4) fourth-round dataset was used for the present study. Pregnancies intention was the primary outcome variable, and the main predictor variable was self-reported sexual IPV in the past 12 months. Women's current age, age at marriage, education and occupation, place of residence, wealth quintile, parity, religion, caste, region, mass media exposure, and husband's education were other control variables. Weighted analysis depicted the prevalence of unintended pregnancies and their association with different socio-demographic variables. Binary logistic regression was done in two steps respecting a hierarchical approach for potential confounders.

RESULTS

Approximately 6.4% of study participants had ever experienced sexual IPV in India. Prevalence of sexual IPV was significantly higher when the age of marriage was < 19 years, among uneducated, in the lowest wealth index quintile, belonging to scheduled caste, having multiparity, and not having mass media exposure. About 12.1% of pregnancies were considered unintended by the respondents, and 22.9% of women who ever had a history of sexual IPV considered the last pregnancy to be unintentional. Women who experienced sexual IPV were in younger age groups, having parity ≥1, and bigger families had significantly higher odds of having an unintended pregnancy compared to their reference groups.

CONCLUSIONS

We observed that sexual IPV has a significant role in unintended pregnancies. Effective counseling means should be rolled out for victims of sexual IPV as it is a taboo subject. The significant factors that can predict unintended pregnancies highlighted in our study should be acknowledged while counseling.

Changes of health related quality of life during pregnancy based on pregnancy context: a prospective study

Background

The significance of planned pregnancy is an accepted principle for improving the health of pregnant women; and quality of life, as one of the important indicators of women’s health, is reduced in high-risk pregnancies. The aim of this research was to investigate the changes in the health related quality of life (HRQL) in low risk pregnancies in different groups based on pregnancy context.

Methods

The present study was a prospective study conducted on 250 pregnant women divided into three groups of women with planned pregnancy, unplanned/wanted pregnancy and unwanted pregnancy. Then, using WHOQOL-26 questionnaire, the quality of life of these women was measured in physical, psychological, social and environmental dimensions at the beginning of pregnancy as well as at the end of the first, second and third trimesters.

Results

Based on the results, the mean score of environmental-HRQL in women with unwanted pregnancy was significantly lower than the other two groups. All dimensions on HRQL were influenced by time and group. However, changes in the physical, psychological and social dimensions of HRQL varied within the groups. Physical- HRQL changes were different within the groups. The intergroup effect on environmental dimension of quality of life changes was significant.

Conclusions

It was observed in this study that HRQL in the women with unwanted pregnancy was lower than the women with planned pregnancy and those with unplanned /wanted pregnancy. Moreover, increase in gestational age would lower quality of life, but this decline had a similar pattern in different groups.

Turkish adaptation of Desire to Avoid Pregnancy Scale: A validity and reliability study

AIM

The purpose of the study was to adapt the Desire to Avoid Pregnancy Scale into Turkish and to study its validity and reliability.

METHODS

The methodological study design was used. The study sample consisted of 510 nonpregnant women in a university hospital of a province in the east of Turkey between the dates of August 2019-February 2020. Personal information form and Turkish form of the scale were administered to women. The contraceptive intention scale was used as a parallel form.

RESULTS

In the study, it was determined that the scale consisted of 14 items as a result of exploratory factor analysis. As a result of the item analysis, it was determined that the scale item total correlations were between r = 0.71 and 0.92. The Cronbach alpha coefficient of the scale was 0.97. The item-total correlation of the scale and parallel form reliability showed a high level of agreement.

CONCLUSION

It was determined that the Desire to Avoid Pregnancy Scale is a valid and reliable measurement tool for determining the wishes of Turkish women regarding pregnancy.

Attitudes Toward Pregnancy Among Women Enrolled in Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in Moshi, Tanzania

For pregnant women living with HIV (WLWH), feelings about pregnancy may influence their emotional well-being and health seeking behaviors. This study examined attitudes toward pregnancy and associated factors among women enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Moshi, Tanzania. 200 pregnant WLWH were enrolled during their second or third trimester of pregnancy and completed a structured survey. Univariable and multivariable regression models examined factors associated with attitudes toward pregnancy, including demographics, interpersonal factors, and emotional well-being. Attitudes toward the current pregnancy were generally positive, with 87% of participants reporting feeling happy about being pregnant. In the final multivariable model, having higher levels of partner support, being newly diagnosed with HIV, and having fewer children were significantly associated with more positive attitudes toward their pregnancy. Findings point to a need for tailored psychosocial support services in PMTCT, as well as comprehensive reproductive health care for WLWH.

Effect of sexual violence on planned, mistimed and unwanted pregnancies among women of reproductive age in sub-Saharan Africa: A multi-country analysis of Demographic and Health Surveys

Introduction

Sexual violence plays a key role in women's pregnancy intention. We investigated the influence of sexual violence on planned, mistimed, and unwanted pregnancies in sub-Saharan Africa (SSA).

Materials and methods

Data from the Demographic and Health Survey (DHS) of 22 countries in SSA were used in this study. Both descriptive and inferential analyses were conducted. We carried out a multinomial logistic regression analysis to examine the effect of sexual violence on planned, mistimed, and unwanted pregnancies. STATA version 14.2 was used to carry out all analyses. Statistical significance was declared at p<0.05.

Results

At the descriptive level, we found that 74.1% of women of reproductive age in SSA had planned pregnancies, with the remaining 25.9% having either mistimed (20.4%) or unwanted (5.5%) pregnancies. Women in Nigeria had the lowest proportion of mistimed pregnancies (7.5%) whereas those in Burundi had the greatest percentage of unwanted pregnancies (12.4%). Women who had history of sexual violence had increased risk of mistimed [ARRR = 1.5, CI = 1.3–1.7] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.0], compared to those with no history of sexual violence. Women aged 40–44 [ARRR = 3.3, CI = 1.4–7.6] and 45–49 [ARRR = 4.4, CI = 1.7–11.2] had higher risk of unwanted pregnancies, compared to women aged 15–19. Women who were cohabiting had higher risk of mistimed [ARRR = 1.3, CI = 1.1–1.4] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.1], compared to married women.

Conclusion

Sexual violence plays a key role in mistimed and unwanted pregnancies. It is, therefore, prudent to develop various assessment techniques to detect sexual violence in unions and refer victims to appropriate services to diminish the risk of mistimed and unwanted pregnancies. Our findings provide a basis for developing and implementing policies and interventions aimed at reducing mistimed and unwanted pregnancies.

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Sexual violence is a global concern.

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Sexual violence plays a key role in women's pregnancy intentions.

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74% of pregnancies in SSA are planned.

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25.9% are either mistimed (20.4%) or unwanted (5.6%).

Correlates of mistimed and unwanted pregnancy among women in the Democratic Republic of Congo

Unwanted and mistimed pregnancies impose threats on the health and well-being of the mother and child and limit the acquisition of optimal sexual and reproductive health services, especially in resource-constrained settings like the Democratic Republic of Congo (DRC). This study aimed to determine the prevalence and correlates of mistimed and unwanted pregnancies among women in the DRC. Data were drawn from the 2013-14 DRC Demographic Health Survey (EDS-RDC II). Bivariate and multivariate logistic regression analysis was performed to identify correlates of mistimed and unwanted pregnancies. Sequential logistic regression modelling including distal (place of residence), intermediate (socio-demographic and socioeconomic factors) and proximal (reproductive health and family planning) factors was performed using multivariate analysis. More than a quarter (28%) of pregnancies were reported as unintended (23% mistimed and 5% unwanted). Women who wanted no more children (aOR 1.21; CI: 1.01, 1.44) had less than 24 months of birth spacing (aOR 2.14; CI: 1.80, 2.54) and those who intended to use a family planning method (aOR 1.24; CI: 1.01, 1.52) reported more often that their last pregnancy was mistimed. Women with five or more children (aOR 2.13; CI: 1.30, 3.49), those wanting no more children (aOR 13.07; CI: 9.59, 17.81) and those with more than 48 months of birth spacing (aOR 2.31; CI: 1.26, 4.23) were more likely to report their last pregnancy as unwanted. The high rate of unintended pregnancies in the DRC shows the urgency to act on the fertility behaviour of women. The associated intermediate factors for mistimed and unwanted pregnancy indicate the need to accelerate family planning programmes, particularly for women of high parity and those who want no more children. Likewise, health promotion measures at the grassroots level to ensure women's empowerment and increase women's autonomy in health care are necessary to address the social factors associated with mistimed pregnancy.

Sexual violence as a predictor of unintended pregnancy among married young women: evidence from the 2016 Nepal demographic and health survey

BACKGROUND

Sexual violence in marital relationship is higher among women married at young age. Although sexual violence has been found to increase risk for unintended pregnancy, there is a limited published data from Nepal linking sexual violence with unintended pregnancy. The current study aimed to investigate association of partner sexual violence with unintended pregnancy among young married women who experienced child birth in last 5 years.

METHODS

Using data from Nepal Demographic and Health Survey, we studied the prevalence of sexual violence and unintended pregnancy, and their association among 560 married women (weighted sample) of 15-24 years who gave childbirth in last 5 years of the survey. We used multivariate logistic regression to analyse the association of sexual violence and other factors with unintended pregnancy. Analysis was conducted considering inverse probability weighting, clustering, and stratification to provide unbiased estimates of the population parameters.

RESULTS

Nearly a quarter of women (22.7%) reported to have experienced unintended pregnancy in the last 5 years of the survey and almost one in 10 women (9%) reported to have ever experienced sexual violence from their husbands. Women who ever experienced sexual violence from their husbands were at 2.3 times higher odds to report an unintended pregnancy (aOR = 2.3; 95% CI = 1.1-4.8) compared to women who did not experience sexual violence from their husbands independent of important socio-demographic variables and ever use of contraception.

CONCLUSION

The strong association of sexual violence within marital relationship with unintended pregnancy among young women in Nepal necessitates the provision of comprehensive sexual and reproductive health services. Women need routine assessment, and referral to appropriate services for sexual violence to reduce unintended pregnancy and its consequences.

Correlates of institutional deliveries among teenage and non-teenage mothers in Nepal

Introduction

Globally, maternal age is identified as an important predictor of institutional service utilization during delivery. This study aims to assess the correlates of institutional delivery among teenage and non-teenage mothers in Nepal by using the data from Nepal Demographic and Health Survey 2011.

Methods

The study population consisted of 5391 women of reproductive age (15–49 years) who had given birth to a child within five years before the survey. Out of them, 381 (7.07%) were teenage mothers. The association between the background characteristics and institutional delivery was assessed separately for the teenage and non-teenage mothers using chi-square test and multiple logistic regression analysis.

Results

After adjusting for background characteristics, teenage mothers were found more likely to deliver at a health facility [AOR: 2.25; 95% CI: 1.10 4.59] in comparison to the non-teenage mothers. Place of residence, occupation, socioeconomic status, and frequency of ANC visits were associated with institutional delivery in both the teenage and non-teenage mothers. However, educational status, parity, birth preparedness and women autonomy had statistically significant association with institutional delivery among the non-teenage mothers only. None of the background characteristics were significantly associated with institutional delivery in teenage mothers only.

Conclusions

This study identified a significant difference in institutional delivery service utilization among the teenage and non-teenage mothers. While the association of most of the background characteristics with institutional delivery was uniform for both teenage and non-teenage mothers, the association with educational status, parity, birth preparedness and women autonomy was significant only for non-teenage mothers. Considering this difference in the interaction of women’s background characteristics with institutional delivery between teenage and non-teenage mothers might help in identifying the pain points and devise targeted interventions to encourage institutional delivery in teenage mothers or non-teenage mothers or both.