Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study

Abstract

Background Unmet need for contraception refers to the proportion of women who want to postpone or stop childbearing but are not using a contraceptive method. Addressing unmet need is especially important for women with medical conditions such as cardiovascular disease (CVD). Preventing unintended pregnancy is crucial to improve pregnancy outcomes and minimize complications of CVD during pregnancy. However, unmet need for contraceptives continues to undermine the potential benefits of contraceptive use. This research aimed to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was conducted from February 1 to May 31/2020. A total of 284 reproductive age women with cardiovascular disease having follow-up at the cardiac clinic of SPHMMC were enrolled consecutively until the desired sample size was reached. Data was collected through an exit interview using a structured and pretested questionnaire. Descriptive, bivariate, and multivariable methods were used to analyze the level of unmet need and its associated factors. Results The overall unmet need for contraception was 36.0% (95% CI: 30.4–41.5). The majority of the respondents lack counseling on contraception use. The most common reasons for non-use of a contraceptive method were fear of drug side effects and drug interaction. Unmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8–24.7) and those who lack partner support on contraception use (AOR = 6.2, CI: 1.91–19.8). Unmet need was also found to be more likely among women who have never used contraception before (AOR = 3.2, CI 1.12–8.92). Conclusion Unmet need for contraception was high in this high-risk population group. The cardiac follow-up clinic should implement client-centered counseling by a multidisciplinary team to address the needs of women and prevent consequences of unintended pregnancy. Furthermore, there is a need to initiate interventions that encourage communication between couples and increase male partner involvement through a renewed focus on couples counseling.

The Prevalence of Unintended Pregnancy and Its Association with Unmet Need of Contraception among Reproductive Age Women: An Analysis of the 2016 Uganda Demographic Health Survey (UDHS)

“…The term "unmet need for contraceptive" refers to women who want to delay their next pregnancy for at least a few years or stop having children but are not using a contraceptive method [12].…”

“…Several research agrees that unwanted pregnancy usually comes from unmet contraception needs, however this is not always accurate because some unintended pregnancies happen to women who are using family planning [7]. The term "unmet need for contraceptive" refers to women who want to delay their next pregnancy for at least a few years or stop having children but are not using a contraceptive method [12]. Thus, resulting in a woman being exposed to the risk of pregnancy at an unplanned time.…”

Exploring the association between unintended pregnancies and unmet contraceptive needs among Ugandan women of reproductive age: an analysis of the 2016 Uganda demographic and health survey

“…However, there were significant regional and subregional variations in the trends and levels of unintended pregnancy. The highest rates of unintended pregnancy were found in Africa (101 per 1,000 women), followed by Latin America and the Caribbean (76 per 1,000 women), Asia (59 per 1,000 women), Europe (44 per 1,000 women), and North America (42 per 1,000 women) [ 3 , 5 ]. Within Africa, eastern Africa had the highest rate of unintended pregnancy (116 per 1,000 women), followed by central Africa (107 per 1,000 women), western Africa (94 per 1,000 women), southern Africa (77 per 1,000 women), and northern Africa (61 per 1,000 women) [ 3 ].…”

Abortion care in women with underlying medical conditions: The role of multidisciplinary team approach in increasing safety of abortion procedures

“…The study was conducted at St. Paul's Hospital Millennium Medical College (SPHMMC) (one of the leading tertiary hospitals in Ethiopia). A total of 284 subjects were included, and 65% had underlying cardiac problems (congenital heart disease, rheumatic valve disease, coronary heart disease, and cardiomyopathy) [14]. In short, this region of Africa has a high unmet need for contraception among patients with medical conditions, which translates in to a higher risk of unintended pregnancy that could result in abortion, with a higher probability of second‐trimester abortion.…”