Unintended Pregnancy Research Articles

Advancing Health Solutions: Practical Considerations for Multipurpose Prevention Technologies in Sub-Saharan Africa’s Fight Against HIV, Sexually Transmitted Infections, and Unintended Pregnancies

Sub-Saharan African (SSA) women experience a high prevalence of HIV, sexually transmitted infections (STIs), and unintended pregnancies, necessitating effective, integrated prevention strategies. Multipurpose prevention technologies (MPTs) offer a promising approach to address these overlapping health concerns by providing single products that simultaneously prevent HIV, other STIs, and/or unintended pregnancies. Given the persistent sexual and reproductive health (SRH) challenges faced by women in SSA, in this opinion piece, we explore practical considerations for MPT adoption and scale-up within the region. With this opinion article, we discuss the data on MPT development and identify key factors for successful MPT implementation in SSA. We examine the current MPT pipeline, product features, regulatory challenges, and structural, individual, and community barriers that impact MPT acceptance and usage among SSA women. Successful MPT uptake hinges on designing discreet, user-controlled products and engaging end-users, healthcare providers, and communities in product development and promotion. Structural factors such as robust supply chains, regulatory clarity, and financial support are also essential. Addressing socio-cultural norms, especially partner consent, and strengthening demand creation through community-driven, culturally sensitive strategies are critical for scaling MPTs. In conclusion, MPTs represent a transformative opportunity to reduce the burden of HIV, STIs, and unintended pregnancies in SSA. Strategic, culturally attuned approaches are essential to ensure the acceptability and accessibility of MPTs. Expedited pathways for regulatory approval, collaborative partnerships, and community-centered demand creation will be vital to realize the full potential of MPTs in advancing women’s SRH in SSA.

Sex differences in alcohol and other substance use in sexual contexts among adolescents: an observational study

Background There is a co-occurrence of adolescents’ substance use and sexual practices, with an important impact on their health and health behaviours; however, limited research is conducted with adolescents. The aim of this study was to estimate the prevalence of substance use (alcohol and/or other substances) in sexual contexts and to identify its associated factors among adolescents, comparing boys and girls. Methods Cross-sectional study with data from 6352 adolescents aged 14­­­–18 years from the DESKcohort project. Prevalence of alcohol and/or other substance use in sexual contexts (OSUSC) stratified by sex were calculated, according to axes of inequality, psychosocial factors, and sexual health and health variables. Poisson regression models with robust variance were calculated to analyse potential associations with independent variables. Results Girls (51.4% of the sample) reported a higher prevalence of alcohol use in sexual contexts than boys (43.9% vs 33.9%, P < 0.001), whereas OSUSC was reported by 12–14% of adolescents. Alcohol and/or OSUSC were associated to several risk practices, such as having multiple sexual partners and inconsistent condom use, for both sexes. Also, sexual minority orientation students, natives, and students with disadvantaged socioeconomic positions (SEPs) presented higher prevalences of substance use in sexual contexts. Conclusions These findings suggest that substance use in sexual contexts reflects a broader pattern of co-occurring risky behaviours rather than intentional sexualised substance use. Some vulnerable groups include girls, adolescents with a minority sexual orientation, and students with disadvantaged SEPs. These findings underscore the need for holistic interventions targeting adolescents’ health, addressing substance use and sexual risk behaviours simultaneously to reduce potential consequences such as unplanned pregnancies and sexually transmitted infections.

Effects of maternal healthcare service utilization on modern postpartum family planning access in Bangladesh: insights from a National representative survey.

Access to modern family planning is critical for improving maternal and child health outcomes, yet it remains severely lacking in low- and middle-income countries, including Bangladesh. Maternal healthcare utilization during and after pregnancy is vital for promoting postpartum family planning. This study examined the effects of maternal healthcare service utilization on postpartum family planning uptake in Bangladesh. Reproductive calendar data from 4,081 women with recent live births were extracted from the cross-sectional 2017/18 Bangladesh Demographic and Health Survey and analyzed. The outcome variable was uptake of modern postpartum family planning methods and the exposure variables were different types of maternal healthcare services. Kaplan-Meier methods were used to calculate cumulative probabilities of modern postpartum family planning method uptake within 12 months post-delivery, and modified Poisson regression models were used to estimate the effects of utilizing maternal healthcare services on modern postpartum family planning method uptake. Modern family planning methods in the 12 month postpartum period were used by 72% of women, with over 60% starting after day 40. Less than 4% used long-acting family planning methods, while almost 40% relied on the oral contraceptive pill. Utilizing maternal healthcare services was associated with up to a 7% higher uptake of modern postpartum family planning methods compared to non-users. Three-quarters of Bangladeshi women use modern family planning within the 12 months postpartum, but often rely on less effective methods. Additionally, 25% of these women resort to traditional or no use of contraceptive methods, increasing the risks of unintended pregnancy, short birth intervals, and adverse maternal and infant health outcomes. Maternal healthcare services, including private facilities, should prioritize modern postpartum family planning provision, along with education and counseling on the benefits of long-acting contraception.

Make It or Break It? Pregnancy Scares and Romantic Relationship Dissolution.

Young adult romantic relationships have undergone significant changes in recent decades, resulting in such distinct demographic trends as rising rates of relationship dissolution. Union dissolution during young adulthood can influence future relationship stability, financial well-being, and health. Reproductive experiences are an important factor that can shape relationship stability. Much of past research, however, has focused on the impact of childbearing on relationship stability while less attention has been paid to other reproductive experiences that could also shape relationship stability, such as pregnancy scares. A pregnancy scare is when a woman suspects she has an undesired pregnancy but later discovers she is not pregnant. This experience might increase or decrease relationship stability. Drawing on data collected from young women in the Relationship Dynamics and Social Life study, this analysis examines the association between pregnancy scares and union dissolution. Results suggest that pregnancy scares are negatively associated with union dissolution, and this relationship persists over time; however, this association varies by relationship type, with serious dating relationships experiencing the most protective benefits.

Long-acting family planning uptake and associated factors among women in the reproductive age group in East Africa: multilevel analysis

IntroductionThe campaign to encourage sexually active women to utilize family planning is one of the primary initiatives being undertaken globally to reduce unintended pregnancies and fertility rates. Evidence suggests that family planning measures can lower this maternal mortality ratio by nearly 25%. According to our literature search, there is no known study that has reported on the study area to assess utilization and factors associated with the use of long-acting contraceptive methods (LACMs) among women of reproductive age. Therefore, this study aimed to assess long-acting contraceptive method uptake and its associated factors among women of reproductive age in East Africa.MethodsA weighted total of 50,525 women of reproductive age were included in this study. A community-based cross-sectional study was conducted on the most recent Demographic and Health Surveys in 12 East African countries. The pooled prevalence of long-acting contraceptive uptake with a 95% confidence interval (CI) was reported and presented in a forest plot for East African countries using STATA version 14.1. Intraclass correlation coefficient, likelihood ratio (LR) test, median odds ratio, and deviance (−2 log-likelihood) values were used for model comparison and fitness. Adjusted odds ratios (AOR) with a 95% CI and p-value ≤0.05 in the multilevel logistic model were used to declare significant factors associated with long-acting contraceptive uptake.ResultsThe overall prevalence of long-acting contraceptive methods in East African countries was 19.41% (95% CI 19.07%–19.76%). In the multilevel logistic regression analysis, women in the age group of 35–49 years (AOR 1.09, 95% CI 1.06–1.17), women who were married (AOR 1.31, 95% CI 1.10–1.56), and women who were exposed to media (AOR 1.06, 95% CI 1.00–1.13) were significantly associated with LACM uptake. Moreover, living in urban areas (AOR 1.23, 95% CI 1.14–1.32) and living in the highest household wealth index (AOR 1.09, 95% CI 1.01–1.17) were also significantly associated with long-acting contraceptive uptake.ConclusionThe overall utilization of acting contraceptive methods was low. Therefore, future interventions should be planned to target women in younger age groups, with lower socioeconomic backgrounds, and those living in rural areas to improve LACM uptake.

Exploring knowledge, attitudes, practices, and determinants regarding emergency contraception use among female university students in Goma, Democratic Republic of the Congo: a cross-sectional study

IntroductionEmergency contraception is an essential method for preventing unintended pregnancies, especially after unprotected sexual intercourse. However, knowledge, attitudes, and practices related to emergency contraception among university students remain underexplored, particularly in low-resource settings such as Goma, Democratic Republic of the Congo. The objective of this study is to assess the knowledge, attitudes, practices, and determinants influencing the use of emergency contraception among female students in Goma.MethodsA cross-sectional survey was conducted with 677 female students from two universities in Goma who were selected via a cluster sampling method. Data were collected via a preestablished questionnaire, and participants were interviewed after providing consent. The data were analysed via STATA 16, with chi-square tests to compare variables, considering a significance threshold of 5%.ResultsA total of 625 (92.32%) students reported being aware of emergency contraception, and 80.32% demonstrated good knowledge of it. In terms of attitudes, 533 (85.28%) students had positive attitudes towards emergency contraception. Among the 625 students who were familiar with emergency contraception, 416 had engaged in sexual intercourse, with 294 (70.67%) having utilized emergency contraception. Factors significantly linked to emergency contraception use included being single (adjusted OR = 1.9 [95% CI: 1.1–3.2]), possessing good knowledge (adjusted OR = 3.0 [95% CI: 1.6–5.8]), and having a positive attitude (adjusted OR = 2.4 [95% CI: 1.1–4.9]).ConclusionAlthough the students demonstrated good awareness of emergency contraception and its utilization, the high frequency of emergency contraception use underscores the importance of promoting knowledge about conventional contraceptive methods. It is crucial to enhance educational campaigns within universities to mitigate the elevated risk of unsafe abortions.

Karakteristik Layanan Pencegahan Prevalensi Stunting di Bolaang Mongondow Timur

The stunting rate in East Bolaang Mongondow has increased quite significantly, reaching 346 cases or above 30%, second in North Sulawesi, so specific and sensitive interventions are needed from cross-sectoral Regional Work Units and problems found in the field. The phenomenon of stunting in school-age teenagers who marry too early, premarital sex for teenagers and unwanted pregnancies, then the lack of marriage guidance services for prospective brides and grooms by educating prospective brides and grooms to have an understanding and readiness to enter the world of marriage. as well as guidance services for family resilience to worship (sakinah). Additional food for toddlers is not optimal, the implementation of collaboration with the Village Government throughout Boltim in providing additional food (PMT) of animal protein given for three months is considered not optimal. The purpose of this study was to analyze the characteristics of stunting prevention services in East Bolaang Mongondow Regency. The expected results are that the prevalence of stunting in East Bolaang Mongondow Regency can reduce stunting cases.

The changing landscape of emergency contraception.

NPs play a pivotal role in preventing unintended pregnancies in the US. This article provides a comprehensive update on emergency contraception (EC) trends, emphasizing the persistent challenge of reducing unintended pregnancies-a key health priority in the Healthy People 2030 initiative. Despite a declining trend in unintended pregnancy rates from 2010 to 2019, national goals have not been met, and healthcare disparities persist. NPs should be aware of EC methods and prescribing implications. In addition, NPs should be aware of ongoing research focusing on EC options such as levonorgestrel intrauterine devices and the promising addition of cyclooxygenase-2 inhibitors to oral EC options.

Knowledge of Ghana’s liberal abortion law and use of modern contraceptives among women of reproductive age

BackgroundModern contraceptives have been widely promoted as an effective tool for birth control. They are highly effective for preventing unintended pregnancies thereby reducing the risk of abortions, maternal morbidities, and mortalities. Abortion or planned abstinence from sexual intercourse may be perceived as alternatives to the use of modern contraceptives. The aim of this study was to assess whether knowledge of the legal status of abortion, and knowledge of the monthly fertile period, were associated with the use of modern contraceptives among women of reproductive age in Ghana.MethodsWe used nationally representative secondary data from the 2017 Ghana Maternal Health Survey. A weighted sample of 23,466 non-pregnant women aged 15–49 years were included in the study. Pearson chi-square and multivariable logistic regression analysis were conducted to assess the association between the independent and the outcomes variables. Sampling weight, cluster, and strata were applied at all levels of the analysis.ResultsMore than half (55.4%) lived in urban area, 80.1% were 20 years or older, 52.2% were multiparous women, 61.9% had secondary or higher education, and 34.5% were in the lower two wealth quintiles. We found no statistically significant association between knowledge of the legal status of abortion and use of modern contraceptives, or between knowledge of the monthly fertile period and use of modern contraceptives. Women with history of an induced abortion were 1.57 times as likely to use modern contraceptives compared to those with no history [adjusted odds ratio (aOR) 1.57, 95% CI 1.41–1.75]. Each additional increase in knowledge of a different modern contraceptive method was associated with 1.25 times increase in modern contraceptive use (aOR 1.25, 95% CI 1.22–1.29).ConclusionsIntensifying education on modern contraceptive methods and use, especially at abortion facilities, may help improve the uptake of modern contraceptives among women in Ghana.

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.

Factors Associated With Low Childbirth Self-Efficacy for Vaginal Birth in High-Risk Pregnant Women.

Low childbirth self-efficacy is a significant indicator of vaginal birth and is closely related to adverse perinatal outcomes. This study aimed to evaluate factors associated with low childbirth self-efficacy for vaginal birth in high-risk pregnant women. This descriptive study was conducted between July and December 2022 in Van, Turkey, with a total of 200 participants. Data collection instruments included a Socio-demographic Questionnaire and the Self-Efficacy Regarding Vaginal Birth (SEVB) scale. Independent t-test, chi-square test and multivariable binary logistic regression were employed for data analysis. The mean age of the participants was 27.74 ± 5.12 years, and the mean gestational age was 33.22 ± 4.28 weeks. Unplanned pregnancy status (p = 0.002), a history of caesarean section (p = 0.013), multiparity (p = 0.001), age (p < 0.01) and gestational age (p = 0.001) were associated with low childbirth self-efficacy for vaginal birth. In multivariate analysis, only age (B: 1111; 95% CI: 1038-1189; p = 0.002) and gestational age (B: 1120; 95% CI: 1034-1214; p = 0.004; and p = 0.005) were independently associated with low childbirth self-efficacy. Low childbirth self-efficacy for vaginal birth was associated with higher maternal age and gestational ages. Identifying high-risk pregnant women with low childbirth self-efficacy will improve the care process for women and their newborns.

A good start for all children: integrating early-life course medical and social care through Solid Start, the Netherlands’ nationwide action programme

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Factors Influencing Modern Family Planning Utilization and Barriers in Women of Reproductive Age in the Iringa Region, Tanzania: A Mixed-Methods Study.

Preventing unwanted pregnancies, achieving optimal child spacing, and improving quality of life are benefits of modern family planning (FP). This study aimed to assess modern FP use, identify the factors influencing its use and determine the barriers to FP use among women of reproductive age. A mixed-methods approach was conducted in the Iringa Region between March and July 2022. Conveniently, 368 women of reproductive age were included in the quantitative study, and 48 were purposively selected for the qualitative study based on reported barriers to using modern FP. Interviewer-administered questionnaires and interview guides were used for data collection. The factors of modern FP use were determined using multivariable logistic regression analysis. The p < 0.05 was considered to be significant. For qualitative data, all interviews were recorded and transcribed. Data were analyzed manually through thematic analysis. The prevalence of modern FP use was 181 (49%). Being married (adjusted odds ratio [AOR] = 5.44, 95% confidence interval [CI] = 1.77-16.73, p = .003), parity of 6 and more (AOR = 2.43, 95% CI = 1.99-5.95, p = .052), availability of modern FP methods (AOR = 1.71, 95% CI = 1.03-2.85, p = .038), and women with primary education level (AOR = 2.99, 95% CI = 1.03-3.25, p = .001), women with secondary and higher education (AOR = 3.53, 95% CI = 1.41-4.38, p = .001), were predictors for modern FP utilization. Four main themes merged (1) individual barriers, (2) hospital barriers, (3) cultural barriers, and (4) knowledge of modern FP methods. The use of modern FP increases with women's education. There is a need for the government to invest in women's education and raise awareness and knowledge of the benefits of modern FP methods.

Association of contraception use and pregnancy intention with perinatal depression risk among Omani mothers—a longitudinal cohort study

BackgroundUnplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers.MethodsA prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables.ResultsThe study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p &amp;lt; 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p &amp;lt; 0.001), and those who were primiparous (p &amp;lt; 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p &amp;lt; 0.001, 95% CI 0.401–0.603) according to the Edinburgh Postpartum Depression Scale.ConclusionsThe findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.

Abortion and unintended pregnancy in Pakistan: new evidence for 2023 and trends over the past decade

BackgroundDespite induced abortion being highly legally restricted in Pakistan, studies in 2002 and 2012 showed that many women rely on abortion when faced with an unintended pregnancy. Following the 2012...

Characteristics and determinants of quality non-directive pregnancy options counselling: a scoping review.

Non-directive pregnancy options counselling (POC) is a core component of comprehensive reproductive health care for pregnant people wanting support in making a pregnancy outcome decision. Approximately one quarter of people with unintended pregnancies and people seeking abortion care seek POC. This study synthesises global evidence on access to and characteristics of quality non-directive POC. We searched five health databases in line with PRISMA guidelines. Primary research articles (published in English, 2011-2023) were included if they addressed provision, experiences, or characteristics of non-directive POC. Data were synthesised and organised thematically. Twelve of the 4021 unique citations identified were included in the review. Four themes were generated: (1) characteristics of quality non-directive POC; (2) provider-level determinants of care quality and provision; (3) patient level factors impacting the desire for and receipt of care; and (4) organisational setting and legal determinants of provision and quality of care. Abortion-related values and policies at the provider, organisational and legislative levels were the most common and salient determinants of POC access and quality. Quality POC includes non-directive, empathetic, compassionate discussions about all pregnancy options that convey non-judgement and respect. However, we identified provider, organisational setting, and legal level determinants that disproportionately impact access to POC for marginalised pregnant people. Research regarding POC access and quality outside of the USA is needed. Upskilling primary care and other health professionals in POC and embedding referral pathways to non-directive POC and abortion care will support Australia to achieve its commitment to universal access to reproductive health care by 2030.

Incidence of unintended pregnancies and pregnancy experience among adolescents living with perinatally-acquired HIV in West Africa: a mixed-method study.

Sexual and reproductive health issues in adolescents living with HIV (ALHIV) have been left behind in HIV care programs. ALHIV are at risk of unintended pregnancy which jeopardizes their socio-economic future, health outcomes and exposes their newborn to HIV transmission. A better understanding of these events is needed. We studied the 18-month pregnancy incidence, and explored experiences of pregnancy among female ALHIV enrolled in the OPTIMISE-AO cohort, nested in the prospective paediatric IeDEA cohort in Côte d'Ivoire and Burkina Faso. We conducted a mixed-method study nested in the OPTIMISE-AO-ANRS-12390 project, a stepped-wedge interventional trial launched in 2021 to support HIV-disclosure and antiretroviral treatment (ART) adherence in assenting ALHIV aged 10-17years in Abidjan, Cote d'Ivoire and Ouagadougou, Burkina Faso. We estimated the 18-month incidence rate of pregnancy per 100 woman-years (WY) among those older than 14years at inclusion. In Abidjan, semi-structured interviews were also conducted with eight adolescents who became pregnant since their inclusion to report their pregnancy experience. After 18months of follow-up, 12 pregnancies occurred among the 111 ALHIV followed up over 153 WY, yielding an overall pregnancy incidence of 7.8/100 WY (95% confidence interval [95%CI]: 4.4-13.7). Stratified by age at enrolment, it was 2.2 (95%CI: 0.3-15.5), 7.6 (95%CI: 2.8-20.3), 13.1 (95%CI:5.4-31.4), 11.5 (95%CI: 2.8-45.8) per 100 WY in those aged 14, 15, 16, and 17years, respectively. After birth, all the newborns (12/12) had received prevention of HIV mother-to-child transmission ART, and were HIV-negative at the 6-week early infant HIV diagnosis. The eight ALHIV interviewed shared that the discovery of their pregnancy, all unintended, was a shock, and led to negative consequences, such as rejection from their family, and stigmatisation. Most attempted to terminate their pregnancy unsuccessfully. They reported major financial challenges associated with their pregnancy that forced them to find a job rather than going back to school after delivery. In West Africa, the incidence of unintended pregnancy was high among female ALHIV and resulted in negative socioeconomic outcomes. HIV care programs should include interventions that improve awareness and access to sexual and reproductive healthcare, including contraception, to meet the needs of ALHIV in West Africa. Registered with the Pan African Clinical Trials Registry on 13 February 2024 (reference no. PACTR202402863175053).

Exploring knowledge, attitudes, and the use of modern contraceptive methods among women of reproductive age in Abuja, Nigeria

Contraceptive use in Sub-Saharan Africa, including Nigeria, is critically important for reducing unintended pregnancies, unsafe abortions, and maternal mortality. This study investigates the knowledge, attitudes, and practices regarding modern contraceptive methods among women of reproductive age (15–49 years) in Gwarinpa, Abuja, Nigeria. Using a descriptive cross-sectional design, data were collected from 206 women through a semi-structured electronic questionnaire. The study found that 71% of participants used modern contraceptive methods, with oral contraceptives being the most popular. A majority (85%) had favourable attitudes towards contraceptive use, and 88.3% were aware of the benefits of modern contraceptives. However, cultural and religious opposition (42%) posed significant barriers. Despite concerns about side effects, the study revealed that access to contraception was generally not a major issue. Health facilities played a major role in providing information, though other sources, such as the Internet and social networks, were also influential. The study suggests that targeted interventions are needed to overcome cultural barriers and improve contraceptive uptake, particularly in rural and underserved areas, contributing to better maternal health outcomes in Nigeria.

Case report: Holistic approach to pregnant adolescents

Introduction: Teenage pregnancy is a global health problem with significant impacts on physical, mental, social, and economic health. In Indonesia, the prevalence of teenage pregnancy reaches 10%, with East Java recording a higher rate (12%). Factors such as lack of sexual education, limited access to contraceptives, social stigma, and low family support exacerbate this condition. Case Report: A 14-year-old adolescent girl in Surabaya experienced an unplanned pregnancy and faced limited family support and economic problems. During pregnancy, she experienced eating disorders, anxiety, and limited access to health services. A holistic approach was taken by a midwife, nutritionist, and psychologist, including family counseling, nutrition education, and planning for delivery by caesarean section to prevent complications. Discussion: Teenage pregnancy involves biological, psychosocial, and economic factors. Family and health professional support is essential to reduce the risk of complications such as anemia, preterm labor, and mental health disorders. 5 A holistic approach includes nutrition education, psychological counseling, and family and community support to improve the quality of life of mothers and babies. Continuity of Care (COC) ensures continuity of care from pregnancy, labor, to postpartum. Conclusion: A holistic approach and COC are effective in addressing the challenges of teenage pregnancy with a focus on the following aspects keywords.

P-1405. Drivers of Unplanned Pregnancy among Women with HIV in the Northern and Southern United States

Abstract Background National estimates from 1986-2015 show that the proportion of unplanned pregnancies among women with HIV (WWH) is high at 78% and that Black/African American women are disproportionately impacted. We aimed to evaluate the prevalence of unplanned pregnancy using a contemporary cohort of pregnant and postpartum WWH (2019-2024), and identify the individual, interpersonal, community and societal factors associated with pregnancy planning.Table 1.Sociodemographic, sociocultural, and psychosocial variables in a cohort of pregnant and postpartum women (2019-2024)Footnote: social support (Likert scale 1=never 5=always), HIV provider trust (Likert scale 1=strongly disagree 5=strongly agree), self-efficacy (additive scale 0=cannot do at all 10=completely certain can do), HIV related stigma (additive 0=never experienced 9=heavily experienced) Methods We performed a secondary data analysis of cross-sectional surveys from an on-going randomized controlled trial testing a peer-led behavioral intervention to improve postpartum retention in HIV care. WWH were recruited from six sites in the northeast and southern US. We used unadjusted and adjusted logistic regression to estimate the association between study outcome, pregnancy planning (“Were you planning to get pregnant?” Yes/No) and individual/interpersonal (self-efficacy, social support, HIV provider trust, HIV related stigma) and community/societal (race, ethnicity, marital status, income, employment) factors.Table 2.Factors associated with pregnancy planning among women with HIV Results To date, a total of 137 women (83% Black, 7% White, 10% Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander categorized as other race; 14% Hispanic ethnicity) enrolled in the trial and were included in this analysis. The proportion of unplanned pregnancy was high at 73%. Among WWH with unplanned pregnancy, 90% were Black, 4% were White, 6% were women of other race (p=0.002). While Black women had significantly reduced odds of pregnancy planning (OR 0.18, 95% CI 0.046-0.68), married women (OR=3.33, 95% CI 1.26-8.85), women with higher income (OR=1.27, 95% CI 1.03-1.57) and those with employment (OR 2.33, 95% CI 1.08-5.03) had higher odds of pregnancy planning. In the fully adjusted model, Black race (aOR 0.11 95% CI 0.02 -0.48) was the only factor negatively associated with pregnancy planning. Conclusion Unplanned pregnancy among women with HIV and its disproportionate burden on Black women continues to be an area we have yet to make significant progress. Interventions addressing social determinants of unplanned pregnancy and racial disparities are needed to improve reproductive health care for WWH. Disclosures William R. Short, MD, Gilead: Grant/Research Support|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria