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Prevalence and Associated Factors of Unintended Pregnancy in Welkaite Woreda, Tigray and North Ethiopia Cross Sectional Study by 2012

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Abstract

Background: Of an estimated 210 million pregnancies that occur in the world each year, 38% are unplanned, out of which 22% end in abortion. In Ethiopia, the estimates of unintended pregnancy indicate that it is one of the major reproductive health problems with all its adverse outcomes.

Objective: The objective of this study was to assess the prevalence of unintended pregnancy and its associated factors among pregnant women in Welkaite district, Tigray region, northwest Ethiopia.

Methods: Acommunity based cross sectional study was conducted from 24/09/2012 to 18/10/2012 among pregnant women. The study includes 626 pregnant women found in Welkaite district selected from the study population using cluster sampling technique. A structured questionnaire was used for data collection. Data were analyzed using SPSS. Adjusted Odds Ratio was used to assess the strength of association and declare significance of the associations.

Results: Unintended pregnancy was reported by 26% (166/626) of the study subjects. Out of which, 75.9% were mistimed and 24.1% were unwanted pregnancy. Unintended pregnancy was associated with ante natal visit (AOR=3.434;95%CI:2.136,5.520), awareness of contraceptive (AOR=2.830;95% CI: 1.527,5.244)., husband communication about pregnancy (AOR=2. 245; 95% CI: 1.430,3.524) , awareness of the concept of unintended pregnancy is preventable (AOR=2. 563 ; 95% CI: 1.580,4.158).

Conclusions: In this study prevalence was high, and,women’s decision to follow antenatal care, and antenatal care visit, ever heard contraceptive communication with husband were strong predictors of unintended pregnancy.

Recommendation: Women’s need to be, strength, communication with husband about pregnancy, antenatal care follow up, and women’s information, education; communication programs and improvements in counseling about contraceptive is recommended to decrease unintended pregnancy

Keywords

Unintended pregnancy; Unwanted pregnancy; Contraceptive; Antenatal care

Introduction

Statement of the problem

Unintended pregnancy has typically been defined as a pregnancy that is either mistimed or unwanted at conception. Mistimed is generally defined as a pregnancy that is desired later in life but not at conception” and unwanted is defined as not wanted then or at any time in the future [1]. Unintended pregnancy is a potential hazard for every sexually active woman. It is a worldwide problem that affects women, their families, society and nation. A complex set of social and psychological factor puts women at risk for unintended pregnancy [2]. Each year, 210 million pregnancies occur throughout the world, 80 million of the women have unintended pregnancies, 45 million of which are terminated. Thirteen percent Of these 45 million abortions, 19 million are unsafe, 40% of them are done on women aged under 25, and about 68 000 women die every year from complications of unsafe abortion [3-5].

Unintended pregnancy, in recent times, emerged as a crucial public health issue in developing world because it has extensive adverse health, social and economic effects, not only upsetting for the affected mothers and children. Mothers who have mistimed pregnancy are less likely to initiate and utilize prenatal and antenatal care, or seek it later than mothers whose pregnancies are intended [3,6]. Unwanted pregnancy poses a major and continuing social and health challenge in Africa, accounting for more than a quarter of the 40million pregnancies that occur annually in the region. It is a key risk factor for adverse pregnancy and maternal outcomes, including mortality and morbidity associated with unsafe and induced abortion [7].

One of the negative consequences of unintended pregnancy in developing countries is abortion that can result serious long-term negative health effects including infertility maternal death, and other complications. Women living in every country irrespective of development status have been facing the problem of unintended pregnancy [8,9]. Unintended pregnancy is the most common cause of maternal mortality in developing countries. In Africa, the very high rate of unintended pregnancy in 1995 which was 92 per 1000 women declined only slightly by 2008, to 86 per 1,000 noted that unwanted, [10].

In Ethiopia, the few surveys conducted on issues related to unintended pregnancy suggested thatit is among the main causes of maternal mortality. Even if fertility declined steadily from 6.8 live births per women in 1981 to 4.8 in 2011 and there is an increase in contraceptive prevalence, many women in Ethiopia are experiencing unintended pregnancy [10]. Ethiopian Demographic Health Survey2011 by fertility planning status, in the five years preceding the survey reported that 28% women in reproductive age including current pregnancy were unintended [11]. Although there are a number of contributing factors for the occurrence of unintended pregnancy, failure of the health care system to meet the demands for reproductive health services particularly that limit family size is recognized as the major one woman who were unmarried, lower economic status, at an early or Late age of reproductive life, not using contraceptives consistently and attending formal education are factors associated with unintended pregnancy [2].

The Ethiopian Demographic Health Survey 2011 states that women in the vulnerable group (illiterate, living in the rural area, working on the agricultural sector, husband’s disapproval), who have a less autonomy in the family, who are not exposed to mass media lead to low knowledge of family planning and low utilization of the health services which in turn lead to higher unintended pregnancy [12].

Objectives

General objective

• The main aim of this study is to assess the prevalence of unintended pregnancy and its associated factors among pregnant women in Welkaite district Northwest Ethiopia 2012.

Specific objectives

• To determine the prevalence of unintended pregnancy in the study area.

• To identify associated factors of unintended pregnancy.

Methods

Study design

The study utilized a community based cross sectional quantitative study using a structured questioner with face to face interview.

Study period and area

The study was conducted in Welkaite district from August 24/09/2012 to 18/10/2012. Welkaite is found in Northwest of Tigray regional state and is located 275 km North West of Gondar. According to the 2007 Ethiopian census report, Welkaite has a total population of, 158097 and around half of (75721) of them were females. Administratively the district is divided into 25 administrative villages.

Sample size determination

The actual sample size was calculated using single population proportion formula.

Where:P= the prevalence of unintended pregnancy 28% (EDHS 2011) [2].

d =the marginal error 5%.

Z α/2= critical value at 95% confidence interval (1.96).

The calculated sample size=310

Non response rate 5%=15,

Design effect=2

The final sample will be =650

Sampling procedure

During the study period a total of 1662 pregnant women were found in the district, which were taken from the bed net distribution .The district has 25 administrative villages, and then twelve administrative villages were selected by simple random sampling using lottery method. From the selected village by cluster sampling method the pregnant women’s were selected.

Results

A. Socio-demographic and household characteristics

Of the total calculated 650 sample size the response rate was 626(96.3%) respondents. Majority, (84.8%) pregnant women were in the age group greater than or equal to 20 years and the rest 95(15.2%), of them were less than 20 years.

B. Reproductive and contraceptive history

Four hundred sixty (74%) of the respondents were intended their current pregnancy while one hundred sixty six (26%) hasn’t intentionally intended their pregnancy. Of these unintended pregnancies (76%) were mistimed pregnancy and (24%) were unwanted pregnancy (Figure 1).

Five hundred forty five (87.1%) respondents ever heard about contraceptive. Two hundred twenty four (35.8%) of the respondents responded modern contraceptive can prevent unintended pregnancy.

Four hundred thirty seven (69.8%) of the respondent were ever used any type of contraceptive before becoming pregnant. The majority, two hundred fifty nine (82.2%) of them were used to inject tables, followed by a pill (8.9%), implants (8.6%), condom (0.3%). Only (17.7%) of the respondents have ever heard about emergency contraceptive.

C. Women’s autonomy and access to health service

Majority, (55.3%) of the respondents decided to take contraceptive by their husband and (64.1%) of the respondents were decided themselves to conceive a pregnancy, of these (57%) they decided themselves since they were housed hold leader. Most of,55.3% of the respondents have been heard unintended pregnancy is preventable before it occurs. Of these majority, three hundred four (87.9%) of respondents obtained the information from health professionals and 68.8% % of the respondents took the distance from home to health facility less than two hours.

D. Factors associated with unintended pregnancy (Table 1)

Discussion

In Ethiopia In 2008, 42% of all pregnancies were unintended [9]. In this study unintended pregnancy was 26% among the study participants, this is lower than this study this is because of an access health facility and contraceptive distribution but in line with a study done in the eastern part of Ethiopia keresa district 27.9% and EDHS 2011 reported that 28% of unintended pregnancy [2,11]. And comparable with a similar study conducted Harare town, Hosanna, in which the prevalence of unintended pregnancy was 33.3%, 34% respectively [12-16]. On the other hand, the result is in contrast to the currently increasing awareness of modern contraceptive methods, availability of services and increased contraceptive prevalence rate may decrease from the other results [17-23].

Antenatal visit was significantly associated with unintended pregnancy, this revealed that, those who did not follow ANC (antenatal care) have 3.434 more likely to have an unintended pregnancy than followers (AOR=3. 434;95% CI: 2.136,5.520).A study done in Egypt, Women with unintended pregnancies are less likely to use any antenatal follow up than women with intended pregnancies [24-28], Specifically, research shows that women who have unintended pregnancy are more likely to delay the initiation of prenatal care relative to women with intended pregnancies. This is because unhappy about the pregnancy, they did not want to follow ANC or they start later to follow ANC.

Awareness of contraceptive was significantly associated an unintended pregnancy, those who did never heard about contraceptive 2.830more likely to have an unintended pregnancy than ever heard (AOR=2. 830; 95% CI: 1.527, 5.244) this indicated that having information and education on contraceptive increase knowledge as a result of this ever heard contraceptive have less likely to have an unintended pregnancy, study done in the Nepal higher level of knowledge of family planning methods has lower the percentage of women reporting the current pregnancy as unintended (34%) [3,29- 32].

In this study, the most known types of contraceptives were injectable and pill (87.1%) respondents either heard or know about contraceptive, the rest (12.9%) did not have information about contraceptive, which means that they did not know about contraceptive, this indicates that they are at risk for unintended pregnancy. This in line with EDHS2011, More than nine women in every ten have heard about the pill and injectable, since, those are the most accessible, affordable at the community level [11] and also, those who never heard unintended pregnancy is not preventable have 2.245 more likely to have unintended pregnancy than those who ever heard unintended is preventable (AOR=2.245; CI: 1.430, 4.524). This indicate that, some information and knowledge have an effect on unintended pregnancy.

Furthermore, husband communication is associated with unintended pregnancy those who did not communicate have 2.563 more likely to have unintended pregnancy than those who communicate (AOR=2.563; 95%CI: 1.580, 4.158). In the Previous studies documented that women’s perception that their husbands oppose FP is one of the dominant factors for discouraging contraceptive practice in a wide variety of Settings this study is similar , a study conducted in Damot Gale Wereda, Southern Ethiopia significant predictors women’s autonomy and spousal communication for unintended pregnancy were significant variable [10].

On the basis of the key findings discussed above, the first and foremost call of this study is the prevention of the occurrence of unintended pregnancies by all bodies at both regional and local levels. As part of long term strategy, programs need to be, improving inter- spousal communication and community level orientation, disseminating family planning and related information on modern contraceptive are key factors to reduce unintended pregnancy.

Conclusions and Recommendations

• In the study area prevalence of unintended pregnancy was high which is one of the major reproductive health problems with all its adverse health outcomes; this may tend to unsafe abortion and maternal health problems in Welkaite District.

• Awareness of contraceptive, ANC visit, and communication with husband about pregnancy,awareness of the concept of unintended pregnancy is preventable were strong predictors of unintended pregnancy.

Recommendations

• It is recommended that policy makers, health professionals and authorities should pay more attention towards the prevention of unintended pregnancy in Welkaite District, North Ethiopia.

• Health professionals should encourage communications with husband, in the house hold and outside of the house hold in relation to their health status.

• Health care providers should provide information, education; communication programs and improvements in counseling are needed to have knowledge on unintended pregnancy and contraceptive methods.

• Regional health bureau, district health office, health care facilities should due attention/ mobilize for Antenatal follow up and accesses for maternal health service.

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Tables and Figures at a glance

Table 1

Figures at a glance

Figure 1