Comparing the Demographic and Health Survey’s timing-based measure of unintended pregnancy to the London Measure of Unplanned Pregnancy in Bangladesh

Abstract

Background: Demographic and Health Survey's timing-based measure is commonly used in Low and Middle Income Countries to estimate unintended pregnancy despite its limitations, including ambivalent responses and failure to consider the partner's intention, while LMUP, which can address these limitations, is not widely used in LMICs and is yet to be administered in Bangladesh. This study compared unintended pregnancy rates measured by the DHS timing-based measure and LMUP, as well as explored the extent of discordance between the measures and their determinants. Methods: A cross-sectional survey was conducted in four districts of Bangladesh using two-stage stratified random sampling. Data was collected from 1,200 postnatal women. The study focused on discordance in reporting pregnancy intention between DHS timing-based measure and LMUP. Multivariate logistic regression models were used to identify predictors of discordant responses in reporting pregnancy intention. Results: The prevalence of unintended pregnancy was found to be 24.3% through the DHS timing-based measure and 31.0% through the LMUP. Discordance in responses to pregnancy intention in the two measures was around 28%. Key predictors of discordance included older age, female last child, more than two children, poorer wealth quintile, and rural residence. Conclusions: Prevalence of unintended pregnancy in Bangladesh and other LMICs, measured by DHS timing-based measure, may grossly underestimated. This suggests that the negative effects of unintended pregnancy are even more significant than currently believed, further highlighting the need to strengthen the family planning program in Bangladesh.