Determinants of unintended pregnancies in rural Ghana

Abstract

BackgroundUnintended pregnancies may carry serious consequences for women and their families, including the possibility of unsafe abortion, delayed prenatal care, poor maternal mental health and poor child health outcomes. Although between 1993 and 2008, unintended births decreased from 42% to 37% in Ghana, the rate of decline is low, whilst levels are still very high. This raises the need to understand factors associated with unintended pregnancies, especially among women in rural settings where the rates and risks are highest to help improve maternal health.MethodWe collected data from 1,914 pregnant women attending antenatal clinic between January 2012 and April 2012 in four health facilities in the Mfantseman Municipal of the Central Region of Ghana. We used bivariate and multivariate logistic regression analyses to explore how socio-demographic characteristics, past reproductive health experiences, partner characteristics and relations, awareness and past experience with contraceptives, influenced the status of women’s current pregnancy (whether intended or unintended).ResultsThe mean age of the 1,914 respondents in this study was 25.6 ± 6.5 years. Seventy percent (70%) said the pregnancies they were carrying were unintended. The odds of carrying unintended pregnancy among women with five or more children were higher than those with one to two children [AOR 6.06, 95% CI (3.24-11.38) versus AOR 1.48, 95% CI (1.14-1.93)]. Women with other marital arrangements showed significantly higher odds of carrying unintended pregnancy compared to those married by ordinance (Muslim or Christian wedding). Women not living with their partners exhibited increased odds of having unintended pregnancies compared to women who lived with their partners (AOR 1.72, 95% CI: 1.28 - 2.30). Awareness of traditional methods of family planning (withdrawal and rhythm) was associated with lower odds of having unintended pregnancy compared to non-awareness (AOR 0.66, 95% CI (0.49-0.89).ConclusionsIn this study, important risk factors associated with unintended pregnancies were: parity, living arrangements with partner, marriage by ordinance and awareness of traditional, non-pharmacological contraceptive methods. Family planning interventions targeting different groups of women, especially during the postpartum period, would be essential to reduce rates of unintended pregnancies and promote positive health outcomes.

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

“…Women who had a parity of greater than two were more likely to have an unintended pregnancy. This finding is comparable to studies conducted in other developing countries [20, 34, 35, 38, 45]. Similar to parity, short birth intervals of less than 12 months were also found to be significantly associated with unintended pregnancies in our study as has been noted elsewhere [20, 46, 47].…”

“…These previous studies used a dichotomous scale whereas we employed the six item LMUP [17–30, 32]. The prevalence of unintended pregnancies in our study is higher than the studies from Iran (33.7%) [21], Kenya (24%) [33], Ethiopia (27.9%) [34] and Sudan (30.2%) [35] but lower than in Nepal (41%) [36], Papua New Guinea (49.4%) [20], Tanzania (45.9%) [37] and Ghana (70%) [38]. The most relevant comparable data are those from Iran and Papua New Guniea [20, 21] who also used the LMUP, although in Papua New Guinea a five item partial LMUP was used as item 6 was dropped to be locally appropriate.…”

Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

“…Thirdly, some studies may have missed important determinants meaning that they have not been able to fully describe the relationships between determinants of pregnancy intention or deal with residual confounding. For example, two studies did not collect data on parity [19, 25] and two others did not consider SES [23, 24]. Two studies also compared ever-experience of an unintended pregnancy with current socio-demographic factors, which may further obscure the relationships [19, 21].…”

Context-specific Factors and Contraceptive Use: A Mixed Method Study among Women, Men and Health Providers in a Rural Ghanaian District

“…These views are expressed strongly by other researchers as well. Specifically, male spouses may not necessarily be against birth spacing or limitation, which refutes the notion or perception about male roles in family fertility regulation 41,49 . According to women in our study, strategies for scaling up contraceptive uptake with men inclusion must identify existing strengths for male support under the specific context to ensure that they are willing to continue to use contraceptive services.…”

“…Opportunities that assist women to adopt the current use regimes by improving their knowledge on failed method options will improve the consistency and correctness for contraceptive use. It is also proven that effective counseling could assist women to make postpartum contraceptive choices later in life 49 . Clinic counseling services must incorporate willing men who support contraceptive use as role models for community reproductive health services that target improving male support for women use for contraception.…”