Abstract
Globally, unintended pregnancy represents an important public health challenge with significant social, economic and clinical repercussions which are worse in low-income and middle-income countries. Appropriate use of modern contraceptives averts significant proportions of unintended pregnancies and pregnancy complications. The objective of this study was to determine the prevalence and determinants of unintended pregnancy and explore modern contraceptive use among pregnant women
 
 A cross-sectional study was conducted among pregnant women receiving antenatal care at Korle-Bu Teaching hospital in Ghana using a face-to-face structured interview. Descriptive analysis was performed and multivariable logistic regression was used to assess the determinants of unintended pregnancy.
 
 Among the included 450 pregnant women receiving antenatal care, 155 (34.4%) had unintended pregnancy out of which 33 (21.3%) were using contraceptives prior to conception. In all, 14.2% (64/450) were using modern contraceptives. There was a significant difference between women and their partners regarding the perception of their index pregnancy as unintended (34.4% versus 31.6%, p-value <0.001). Significant determinants of unintended pregnancy include younger maternal age [aOR:5.706, 95%CI (1.860, 19.732)], unmarried status [aOR:5.238, 95%CI (2.882, 9.735)], previous childbirth [(aOR:2.376, 95%CI (1.460, 4.758], number of pregnancies ≥6 [aOR:2.640, 95%CI (1.210, 5.854)], number pregnancies ≤2 [aOR:0.417, 95%CI (0.252, 0.682)], previous caesarean birth [aOR:2.034, 95%CI (1.154, 3.306)] and contraceptive use prior to index pregnancy [aOR:2.305 95%CI (1.283-4.162)]. 
 
 The prevalence of unintended pregnancy remains markedly high while prior contraceptive use was relatively low among women receiving antenatal care. Evidence-based interventions including specialized client education are vital in improving optimal use of contraceptive services. We recommend further research including community-based qualitative studies to better understand the factors associated with contraceptive uptake and outcomes of unintended pregnancy.
Highlights
Pregnancy that occurs sooner than expected and or when the woman has no desire to have more children at the time of conception are collectively referred to as unintended pregnancy (Santelli et al, 2003)
Inclusion criteria consisted of pregnant women attending antenatal clinic and who provided informed consent to be included in the study
The prevalence of unintended pregnancy determined in this study is consistent with 33% reported for the African continent (Sedgh et al, 2014) but moderately lower than the prevalence 40% and 43.8% reported by Nyarko in Ghana (Nyarko, 2019) and Lawani et al in Nigeria (Lawani et al, 2018) respectively
Summary
Pregnancy that occurs sooner than expected (mistimed) and or when the woman has no desire to have more children at the time of conception (unwanted) are collectively referred to as unintended pregnancy (Santelli et al, 2003). Varying across countries, unintended pregnancy remains a subject of global concern because it is a major public health challenge with significant social, economic and clinical consequences. Global data analysis between 2010 and 2014 shows that 44% of pregnancies were unintended worldwide with greater proportion resulting in abortion (Bearak, Popinchalk, Alkema, & Sedgh, 2018). The burden of unintended pregnancy remains unacceptably high considering the potential adverse effects and the associated economic ramifications gjhs.ccsenet.org. 30% were nulliparous with 70% having a history of one or more childbirths (Table 1). Women of gravidity 1-2 and 6 or more represented 47.1% and 8% respectively with 78 (17.3%) having a history of previous induced termination of pregnancy. Majority of the participants (71.4%) had pregnancy interval of at least two years whereas 28.6% had pregnancy interval of less than two years
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