Socio-demographic predictors of unintended pregnancy and late antenatal booking in Honiara, Solomon Islands.

Abstract

The Solomon Islands is a Pacific nation with a maternal mortality of 114 per 100000 births. Around 57% of pregnancies are unintended and only 15% of women attend their first antenatal visit in the first 12weeks as recommended by the World Health Organization. We sought to examine the socio-demographic predictors of unintended pregnancy and late antenatal booking (>18weeks) among women attending antenatal care in Honiara. From January 2014 to May 2015 we undertook a cross-sectional survey using a structured questionnaire on women presenting to the National Referral Hospital and community clinics in Honiara for antenatal care. Of 1441 women, 41.0% of pregnancies were intended, 55.7% were ambivalent and 3.3% were fully unintended. Unintended pregnancy was significantly associated with being unemployed (adjusted odds ratio (aOR) 1.45, P=0.024), being a teenager at first intercourse (aOR 1.53; P=0.004), shared family planning decision making (aOR 0.54; P=0.006) living with a husband (aOR 0.31 P<0.001) and a short interpregnancy interval (OR 4.48, P≤0.001). Late booking occurred in 1168 (84.7%) women and independent predictors of this included ambivalent or unintended pregnancy (aOR 1.74, P=0.005) and multiparity (aOR 2.05, P=0.001). Unintended pregnancy and late antenatal booking remain a challenge to improving maternal health in the Solomon Islands. Investments in family planning could target reproductive health education and post-partum family planning. Improving the quality of antenatal care as well as addressing social determinants of health, including gender equity, education and employment of women, is required if maternal mortality is to be reduced.