Risk factors and knowledge associated with high unintended pregnancy rates and low family planning use among pregnant women in Papua New Guinea

Elizabeth Peach,William Pomat,Michelle J L Scoullar,Arthur Elijah,Andrew Vallely,Freya J I Fowkes,Pele Melepia,Lisa M Vallely,Elissa Kennedy,Primrose Homiehombo,Brendan S Crabb,Stanley Luchters,Christopher Morgan,James G Beeson,Peter M Siba,Alexandra J Umbers,Leanne J Robinson,Lucy Au,Angela Kelly-Hanku

doi:10.1038/s41598-020-79103-6

Abstract

Unintended pregnancy is a major driver of poor maternal and child health in resource-limited settings. Data on pregnancy intention and use of family planning (FP) is scarce in Papua New Guinea (PNG), but are needed to inform public health strategies to improve FP accessibility and uptake. Data from a facility-based cross-sectional sample of 699 pregnant women assessed prevalence and predictors of unintended pregnancy and modern FP use among pregnant women in East New Britain Province, PNG. More than half (55%) the women reported their pregnancy as unintended. Few (18%) reported ever having used a modern FP method, and knowledge of different methods was low. Being single, separated or divorced (AOR 9.66; 95% CI 3.27–28.54), educated to a tertiary or vocational level (AOR 1.78 CI 1.15–2.73), and gravidity > 1 (AOR 1.43 for each additional pregnancy CI 1.29–1.59) were associated with unintended pregnancy; being accompanied by a male partner to ANC was associated with a reduced unintended pregnancy (0.46 CI 0.30–0.73). Factors associated with modern FP use included male partner involvement (AOR 2.26 CI 1.39–3.67) and gravidity > 1 (AOR 1.54 for each additional pregnancy CI 1.36–1.74). FP use also varied by the facility women attended. Findings highlight an urgent need for targeted interventions to improve FP knowledge, uptake and access, and male partner involvement, to reduce unintended pregnancies and their complications.

Highlights

Unintended pregnancies expose women to obstetric risks arising from undesired fertility, unsafe abortions, inadequate birth spacing, and pregnancies in high risk groups[1,2,3,4,5]
Papua New Guinea (PNG)’s Demographic and Health Survey (DHS) found that over 80% of women and men aged 15–49 years could recall a modern method of Family planning (FP), but only 37% reported ever having used a modern method of F P21
This is the first report to describe pregnancy intention and FP knowledge and use in PNG including pregnant women in urban and smaller rural health facilities in PNG, and identifying factors associated with unintended pregnancy and FP use

Summary

Introduction

Unintended pregnancies expose women to obstetric risks arising from undesired fertility, unsafe abortions, inadequate birth spacing, and pregnancies in high risk groups[1,2,3,4,5]. If all women who wanted to avoid pregnancy were able to access effective FP, an estimated 54 million unintended pregnancies, 21 million unplanned births, 16 million unsafe abortions, 1.1 million infant deaths and 118,000 maternal deaths would have been prevented[3]. This represents a 30% reduction in maternal deaths globally[6]. There are significant geographic, social and cultural barriers and health system constraints to delivering modern FP and maternal and child health (MCH) services in P NG16–20, and data on unintended pregnancy and FP use among women of childbearing age to inform evidence-based public health strategies and interventions is limited. This study aimed to generate findings to inform public health strategies to facilitate improved access to and uptake of a range of FP options and reduce unintended pregnancies

Objectives

Methods

Results

Conclusion