Abstract
BackgroundUnintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART).MethodData are from the Rakai Community Cohort Study (RCCS) – a cohort of communities with 10,000–12,000 adults, ages 15–49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years.ResultsThe prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65–3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002].DiscussionHIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.
Highlights
Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies
After controlling for other predictors, human immunodeficiency virus (HIV) status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy
Unintended pregnancy decreased in the sample over time which may be due to an increase in anti-retro viral therapy (ART) availability and rising levels of education
Summary
Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. Unintended pregnancy is a persistent and global issue with considerable consequences for the health and well-being of mothers, babies, and families [1]. Unintended pregnancies included mistimed births (wanted if occurred later), unwanted births (not wanted or later), and induced. Antecedent factors including demographic (e.g. age, parity), relationship (e.g. marital status, partner preferences) and social factors (e.g. poverty and family support) are associated with unintended pregnancy. There are many potential consequences of unintended pregnancy such as delay in initiation of prenatal care and infant health care, increased risk of child mortality, and increased risk of maternal depression and anxiety [5]. Due to the illegality of abortion in Uganda, unintended pregnancy may lead to illegal and unsafe abortion which may result in infection and maternal morbidity and mortality [6]
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