Geographic Access to Working Family Planning Centers and Unintended Pregnancies among Married Women: A Community Based Nested Case Control Study

Background: Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas. Objective: The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women. Methods: We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and follows all pregnant women in the catchment area of Thatta district. Women were enrolled during the first trimester;those that reported their pregnancy to be unintended were selected as cases (n = 200), and those whose pregnancies were intended served as controls (n = 600). We defined geographic access as including both the distance of a family planning center from the woman’s home, and availability of personal transportation. Logistic regression was used for analysis. Results: In the multivariate model, neither distance [OR = 1.0;95% CI (0.95 - 1.05)] nor availability of transportation [OR = 1.14;95% CI (0.78 - 1.67)] were significantly associated with unintended pregnancy. In fact, women with unintended pregnancies were more likely to be aware of family planning [OR = 2.21;95% CI (1.23 - 3.97)] and more likely to have been using a contraceptive method before conceiving their index pregnancy [OR = 3.59;95% CI (1.83 - 7.06)]. Other factors related to unintended pregnancy were older maternal age [OR = 1.13;95% CI (1.08 - 1.17)], having already had at least one son [OR = 3.13;95% CI (1.93 - 5.07)];spousal opposition to contraceptive use, [OR = 3.24;95% CI (1.89 - 5.56)] and low spousal education level [OR = 1.85;95% CI (1.08 - 3.18)] as compared to women with intended pregnancy. Conclusion: Lack of geographic access to FP centers is not a risk factor for unintended pregnancy in women from the Thatta district. However, in this population, unintended pregnancies are more common among older women, women having at least one son, and those who have a spouse who does not approve of contraceptive use, and is less educated. Of note, women who reported unintended pregnancy did have knowledge about FP and were more often using contraceptives before they conceived.

Unintended Pregnancy Determinants among Antenatal Clinic Attendees: A University of Port Harcourt Teaching Hospital Experience

An unintended pregnancy is a pregnancy that is either mistimed or unplanned. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinics at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria. It was a descriptive, cross-sectional study of 215 women attending the antenatal clinic of UPTH from July to August 2022. Information on socio-demographic characteristics, reproductive history, desirability of the current pregnancy at the time of conception, knowledge and use of contraceptive methods were collected using a pretested questionnaire and analyzed using SPSS version 26.0. Chi-square test was used for test of associations with the level of significance set at P < 0.05. The prevalence rate of unintended pregnancy from the study was 16.28% (≈16%). The contraceptive awareness was very high (209, 97.21%), however, 101 (46.98%) participants had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unintended pregnancy (P = 0.042), level of education and unwanted pregnancy (P = 0.033) as well as parity and unintended pregnancy (P = 0.019). The prevalence of unintended pregnancy among women attending antenatal clinics was high, possibly due to low contraceptive usage. More efforts should be geared towards ensuring access to comprehensive contraceptive care and contraceptive methods, this will enhance uptake and reduce the rate of unintended pregnancy.

Correlates of Mistimed Pregnancy and Unmet Need for Family Planning among Women of Reproductive Age in Sandema, Ghana

Background: Globally, an estimated 80 million unintended pregnancies comprising both mistimed and unwanted pregnancies are recorded yearly. Yet only half of the women at risk of mistimed pregnancy use contraceptives. In developing countries, over 100 million females have unmet need, and national surveys in Ghana indicate 23% unmet need rate. Methods: Using a cross-sectional community-based approach, a sample size of 300 women of reproductive age were selected using multi-step cluster sampling techniques. The study was quantitative, using structured interviewer-administered questionnaires. Results: Two-third (66%) of the women in reproductive age still had unmet need, 71% were currently pregnant, and more than a third (36%) confirmed ever having a mistimed pregnancy. Fifty-three percent (53%) of the women confirmed never communicating with their partners on family planning issues, a little below half (45%) took their own health care decisions. Seventy nine percent (79%) ever received family planning services from a health professional. Factors related to unmet needs included mistimed pregnancy, level of education, preferred birth/pregnancy interval, communication between partners and the autonomy to spend self-earnings. Conclusion: Considering that high rates of unmet need results in mistimed pregnancy, improved policies around the influence of unmet need on mistimed pregnancies are needed.

Prevalence and Socio-Demographic Determinants of Unintended Pregnancy among Women Attending Antenatal Clinic in Thyolo District, Malawi

Background: Unintended pregnancies remain a public health problem. Unintended pregnancies continue to be a leading predisposing factor to the high total fertility rate, high maternal and child health morbidity and mortality. Unintended pregnancies lead to unsafe abortion and poor health-seeking behavior, especially among young and poor women. Knowledge of associated factors can help to design and implement appropriate interventions. Objectives: This study aimed to determine the prevalence and socio-demographic factors associated with unintended pregnancy among women attending antenatal clinic (ANC) at Thyolo District Hospital in Malawi. Methodology: It was a quantitative cross-sectional study. Data was collected through face-to-face interviews with 396 women using a questionnaire. Systematic random sampling was used to recruit study participants. STATA version 13 package was used for univariate descriptive statistics, and logistic regression for bivariate and multivariate data analysis. Results: Slightly over half (54%) of women attending the antenatal clinic at Thyolo District Hospital had an unintended pregnancy. Unintended pregnancy was more likely to be reported among women of less than 20 years, education below secondary school level, marriage before 20 years, and polygamous relationships. In addition, families relying on farming alone other than employment or business were more likely to have an unintended pregnancy. Primgravidity and having no living child were also significantly associated with unintended pregnancy. Conclusion: Prevalence of unintended pregnancy is a health burden in Thyolo. Strategies to keep the girl child in school and delay marriage could address this challenge. Increasing access to effective contraceptive methods for the youth could mitigate the problem.

Determinants of emergency contraceptive pill use in Bangladesh: An analysis of national survey data

Objective:To examine the determinants of emergency contraceptive pill use in Bangladesh.Methods:Data for this cross-sectional study came from 2017-2018 Bangladesh Demographic and Health Survey.Characteristics of 906 reproductive age women who were potential candidates for using emergency contraceptive pill were analysed in this study.Data were analysed using univariate and multivariate analyses.Stepwise binary logistic regression was employed as multivariate analysis.Results:Only 10.9%candidates were found to ever use emergency contraceptive pill.The odds of using emergency contraceptive pill for women visited by family planning field worker was significantly higher than that for those who were not visited by family planning field worker[odds ratio(OR)1.94;95%confidence interval(CI)1.19–3.17;P=0.008],while the odds of using emergency contraceptive pill for women with high socioeconomic status was higher than that for those with low socioeconomic status(OR 3.10;95%CI 1.61–5.97;P=0.001).Additionally,having some media access was linked to an increase in the odds of using emergency contraceptive pill(OR 3.01;95%CI 1.33–6.83;P=0.008).Women empowerment related factors did not show any significant effect on emergency contraceptive pill use.Conclusions:The findings indicate that family planning programme has a great opportunity of playing an important role in increasing emergency contraceptive pill use in Bangladesh by increasing the knowledge and awareness of women about emergency contraceptive pill.

Urgent need to change clinical practices about postpartum contraception

In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.

Sexuality and Emergency Contraceptive Practice among Female Undergraduates in Lagos, Nigeria

Background: Young people, especially those in tertiary institutions are vulnerable to unplanned and unprotected sexual intercourse which predisposes them to unintended pregnancies and subsequently unsafe abortions. One of the key interventions for reduction of unwanted pregnancies and unsafe abortions is effective use of emergency contraceptives. Objectives: To assess the sexuality, perception, attitude towards and determinants of usage of emergency contraception among female undergraduates in Lagos, Nigeria. Methods: Cross-sectional survey conducted in June 2016 among 805 female students of the Lagos State University. Data were collected through structured self-administered questionnaire by obtaining information on demography, sexual and contraceptive history, perception, attitude towards and use of emergency contraceptives. Data obtained were analyzed using SPSS version 16. Chi-square and logistic regression models were applied to variables to test for significance that predicts the use of emergency contraceptives. Results: Of the 725 (90%) completed questionnaires, 334 (46%) of the respondents were sexually active with 115 (34%) having previous history of pregnancy. Eighty-two percent of those pregnancies were unintended. Eighty-eight percent of those with unintended pregnancy had them terminated by induced abortions, 54% of which was carried out by untrained persons. Only 29% of those who had unprotected sexual intercourse used emergency contraceptives. Lack of knowledge and promotion of sexual promiscuity were identified as the main reasons for not using emergency contraceptives. Previous use of contraceptives, married status, increasing age and year of study were positive predictors for the use of emergency contraceptives while poor knowledge was a significant predictor of non-use. Conclusion: There was poor knowledge and low utilization of emergency contraceptives among respondents. Information on contraceptives should be introduced in secondary schools and in general studies courses in tertiary institutions while parents and caregivers should discuss issues relating to sex and contraceptives with adolescents.

Heightened risk of unintended pregnancy among sex workers and sex worker organizations’response during the stringent COVID-19 containment measures in East and Southern Africa

The UNFPA 2022 State of the World Population(SWOP)report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy,but did not adequately address the grave situation of female sex work­ers(FSWs),who experience the worst sexual and reproductive health outcomes,especially during humanitarian crises.This study assesses the risks of unintend­ed pregnancy among FSWs and sex worker organizations?response during the stringent COVID-19 containment measures in East and Southern Africa(ESA).A mixed-methods approach consisting of a desk review,key informant interviews and an online survey was used for data collection.Key informants and survey re­spondents included representatives of sex worker-led organisations and networks,organisations providing services to sex workers,development partners,advocacy organisations and donors,with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic.In total,21 key informants were interviewed and 69 respondents participated in the online survey,with representation from 14 out of 23 countries in the ESA region.The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers’access to contraception and risk of unintended pregnancy.Look­ing to the uncertain future of humanitarian crises,the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions,such as sex workers.

Analysis of unintended pregnancy and influencing factors among married women in China

Unintended pregnancy often ends with induced abortion,an outcome that affects a woman’s physical and mental health and consumes social resources.A national fertility survey conducted by the former National Health and Family Planning Com-mission in 2017,gathered data on pregnancies among married women aged 15-49 to analyze the changing circumstances of such pregnancies and the factors that influ-ence their occurrence.The analysis found that the incidence of unintended pregnan-cies among married women in China was 42.4‰in 2017,and that such pregnancies accounted for 22.9%of all pregnancies in China for the years 2010-2017.Of all abortions,91.9%were used to terminate unintended pregnancies,and of unintended pregnancies,67.1%ended with induced abortions.The incidence of unintended pregnancy and that of induced abortion to terminate the unintended pregnancy were higher among women living in an urban rather than a rural area,having previously given birth to a boy,having a large number of children,being at the older end of their childbearing years,or having a shorter interpregnancy interval.Only 37.3%of women chose long-term contraceptive methods after an induced abortion caused by an unintended pregnancy;their sense of self-protection was not strong.It is neces-sary to strengthen education and advocacy,enhance women’s awareness of the pro-tection contraceptives offer,and improve the quality of and access to contraceptive services to reduce the incidence of unintended pregnancy,and reduce the incidence of induced abortion to terminate unintended pregnancy.

Chinese Expert Consensus on Clinical Application of Female Contraceptive Methods

Unintended pregnancy is a global issue, with approximately 85,000,000 women around the world having unintended pregnancy annually. The contents of clinical application of women’s contraceptive methods are very wide, involving multiple areas. This consensus deeply discusses the specific contraceptive needs at different statuses, combined with gynecological diseases, postabortion contraception, and postpartum family planning, ensuring the correct use of contraceptive methods under the corresponding status. The top priority of the consensus is the specific contraception consensus section for women combined with gynecological diseases because medical treatment effect as well as side effects should be weighed carefully. The consensus is to make high-efficiency and individual contraceptive strategy for different groups based on multidisciplinary(gynecology, obstetrics, and family planning) and multidimensional aspects, which can provide uniform guidance for medical and health organizations under the condition as relevant global guidance or consensus is still lacking.