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Timely ANC is necessary to identify and mitigate risk factors in pregnancy but many mothers in Namibia do not receive such care. Reducing unwanted pregnancies through family planning may limit ANC delays. After unwanted pregnancies occur, women may benefit from further education and resources that empower them to pursue ANC promptly.

Aim To examine how pregnancy intention may be related to insecticide-treated bed net (ITN) use among pregnant women in Rwanda. Subject and methods This cross-sectional study applied random effects models to a nationally representative sample of pregnant women (n=837) from the 2010 Rwanda demographic and health survey (RDHS) who reported owning an ITN for their personal ownership and use at the time of the survey. Results The odds of reported ITN use the night before the survey are lower for women who reported a wanted but mistimed pregnancy-odds ratio (OR)=0.45, 95 % confidence interval (CI) =0.18-0.77, p-value (p)<0.01)-and yet lower for women who reported an unwanted pregnancy (OR= 0.19, 95 % CI=0.06-0.42, p<0.05) relative to women who categorized their pregnancy as wanted. However, adjusting for marital status in a multivariate model, the relationship between wanted but mistimed pregnancy and ITN use the night before the survey loses statistical significance, suggesting that marriage may confer spousal support and agency to women to use ITNs. In this model and another model with obstetric, personal, household, socioeconomic, and geographic variables, the negative association between unwanted pregnancy and ITN use the night before the survey remains robust (OR= 0.42, p<0.01). Conclusion Unwanted pregnancy is associated with reduced odds of ITN use demonstrating that ITN use is not uniform across all pregnant women in Rwanda despite near universal access to ITNs. Prevention of unwanted pregnancies may enhance ITN use. Moreover, women with unwanted pregnancies may benefit from further education and motivation to use ITNs.