Abstract
BACKGROUND: In spite of the last decade increase in availability of contraception, around half of the annual 21 million pregnancies notified in low- and middle-income countries in individuals aged 15-19 years are unintended. We sought to explore the contribution of the underuse of modern of contraception methods (MMC) to the annual incidence of unintended pregnancies among adolescent women. METHODS: We used Demographic and Health Survey (DHS) data from 12 low- and middle-income countries. The pooled analysis exploring the risk of unintended pregnancy included 1,717 adolescent women with a current unintended pregnancy and 29,304 currently not pregnant 15- to 19-year-old sexually active women who did not desire pregnancy. For each country and the pooled analysis, the odds ratio of unintended pregnancy was calculated in relation to the type of contraception (MMC, Traditional Methods, and No Contraception). Expected unintended pregnancies and population attributable fraction (PAF) of unintended pregnancies attributable to not using MMC were calculated for each country. FINDINGS: The use of traditional methods was associated with a 3·4 (95% CI 2·0-4·9) time increased odds of having an undesired pregnancy compared with the use of MMC of contraception while not using any method of contraception was associated with a 4.9 (95% CI 2·9-6·8) times increased odds. The population attributable fraction (PAF) of not using MMC accounted for 86·6% of the estimated unintended pregnancies (9,464,654 in total in the 12 countries) in the pooled analysis. PAF ranged from 62·7% (974,760) for Bangladesh to 95·1% (540,176) for Niger and the estimated number of unintended pregnancies because of the use of traditional methods or non-use of contraception ranged from 18,638 in Namibia to 4,234,916 in India. INTERPRETATION: Eight million out of 9·5 million unintended pregnancies occurring annually in twelve countries could have been prevented with the optimal use of MMC of contraception. MMC need to be further supported in order to further prevent unintended pregnancies globally. FUNDING STATEMENT: None. DECLARATION OF INTERESTS: The authors declare no competing interests. ETHICS APPROVAL STATEMENT: This analysis did not require additional ethical approval. The analysis relied upon publicly available dataset with no identifying data to guarantee participant anonymity. Ethics approval for the survey was obtained by the institutional review board of ORC Macro (Calverton, MD, USA) and country health authorities.
Highlights
Correspondence to: Background In spite of the last decade increase in availability of contraception, around half of the annual 21 million pregnancies notified in low- and middle-income countries in individuals aged 15-19 years are unintended
The use of traditional methods was associated with a 3.4 (95% confidence interval (CI) = 2.1-4.7) time increased odds of having an undesired pregnancy compared with the use of modern methods of contraception (MMC) of contraception while not using any method of contraception was associated with a 4.6 times increased odds
The population attributable fraction (PAF) of not using MMC accounted for 86.8% of the estimated unintended pregnancies (9 464 654 in total in the 12 countries) in the pooled analysis
Summary
We used Demographic and Health Survey (DHS) data from 12 low- and middle-income countries. DHS use standardized measurement tools and techniques to ensure comparability across diverse sites and time-periods, and consist of different questionnaires, including a household and a women’s modules [14]. The latter is administered to women of reproductive age (ie, 15–49 years) and includes a contraceptive history calendar for the five years prior to the survey [15]. The answer “no” to the DHS question “Are you currently doing something or using any method to delay or avoid getting pregnant?” and the answers “no more children” and “no children within the two years” to the question “Would you like to have (a/another) child?” were used to construct the variable ‘not desiring pregnancy and not desiring contraception’ for the currently non-pregnant girls
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