Abstract
BackgroundThis study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications.MethodsCross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh (N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications.ResultsAround one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57–2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01–2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47–3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage (p < 0.001).ConclusionUnintended pregnancy is associated with increased risk for maternal health complications, but provision of ANC clinical visits and CHW home visits in pregnancy may be able to reduce potential effects of unintended pregnancy on maternal health.
Highlights
This study aims to explore the potential association between unintended pregnancy and maternal health complications
Minimum 4 antenatal care (ANC) at index pregnancy was reported by 12.4%, and no Accredited social health activist (ASHA) home visit in that pregnancy was reported by 39.7%; 30.7% reported that their index child was delivered at home
Consistent with prior research [5, 12, 16], we found that women with unintended pregnancies were less likely to receive adequate ANC, and, as seen in prior research [39, 40], we found that nonreceipt of adequate ANC or home visits by an ASHA during pregnancy were associated with increased risk for complications
Summary
This study aims to explore the potential association between unintended pregnancy and maternal health complications. We test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications. Studies from India indicate that unintended pregnancy is associated with lower maternal health care utilization and poorer infant health outcomes [5, 6]. This study assesses unintended pregnancy and its association with maternal health complications among women in Uttar Pradesh, India. Heightened maternal risk in Uttar Pradesh can be attributed, at least in part, to poorer maternal health care utilization, including antenatal care (ANC) [9]. Studies from India and elsewhere indicate that women with an unintended pregnancy are less likely to recieve ANC [6, 10,11,12,13,14,15,16]. Given the heightened risk for unintended pregnancy and related complications among socially vulnerable women [18, 19], ASHA contacts during pregnancy may be important, but these have received little focus in the research literature
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