Investigating the association between pregnancy intention and insecticide-treated bed net (ITN) use: a cross-sectional study of pregnant women in Rwanda

Abstract

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.

Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

“…Compared to women who did not want their pregnancies at all, women who wanted their pregnancies were more probable to use ITN. Women who become pregnant at the desirable time (planned) initiate have early and consistent ANC visits, adhere to health precautions and are health conscious [ 67 ]. Conversely, women whose pregnancies occurred later or earlier than planned (unintended) undergo heightened stress levels, which attenuates their prospects of undertaking healthy measures such as sleeping under ITNs [ 66 ].…”

“…Women who were not subscribed to health insurance were less probable to use ITN relative to those who had subscribed. To subscribe to health insurance is an indication of one’s consciousness and readiness to enjoy good health [ 67 ]. By inference, women who are subscribed to health insurance are sensitive to health issues and more conscious about the demerits of not using ITN compared with those who are not subscribed [ 68 ].…”

Rural–urban variation in insecticide-treated net utilization among pregnant women: evidence from 2018 Nigeria Demographic and Health Survey

“…It is however, noteworthy, that several other factors may contribute to less ITN use other than psychosocial distress and stress levels. In Rwanda, Thogarapalli et al [55] similarly observed that women with unintended pregnancies had reduced chances of utilizing ITNs. Women with unintended pregnancies in Nigeria may require further encouragement and education about ITN use.…”