Prevalence and Determinants of Unintended Pregnancy among Women Receiving Antenatal Care Services: A Facility-Based Cross-Sectional Study in Ghana

Abstract

Globally, unintended pregnancy represents an important public health challenge with significant social, economic and clinical repercussions which are worse in low-income and middle-income countries. Appropriate use of modern contraceptives averts significant proportions of unintended pregnancies and pregnancy complications. The objective of this study was to determine the prevalence and determinants of unintended pregnancy and explore modern contraceptive use among pregnant women A cross-sectional study was conducted among pregnant women receiving antenatal care at Korle-Bu Teaching hospital in Ghana using a face-to-face structured interview. Descriptive analysis was performed and multivariable logistic regression was used to assess the determinants of unintended pregnancy. Among the included 450 pregnant women receiving antenatal care, 155 (34.4%) had unintended pregnancy out of which 33 (21.3%) were using contraceptives prior to conception. In all, 14.2% (64/450) were using modern contraceptives. There was a significant difference between women and their partners regarding the perception of their index pregnancy as unintended (34.4% versus 31.6%, p-value <0.001). Significant determinants of unintended pregnancy include younger maternal age [aOR:5.706, 95%CI (1.860, 19.732)], unmarried status [aOR:5.238, 95%CI (2.882, 9.735)], previous childbirth [(aOR:2.376, 95%CI (1.460, 4.758], number of pregnancies ≥6 [aOR:2.640, 95%CI (1.210, 5.854)], number pregnancies ≤2 [aOR:0.417, 95%CI (0.252, 0.682)], previous caesarean birth [aOR:2.034, 95%CI (1.154, 3.306)] and contraceptive use prior to index pregnancy [aOR:2.305 95%CI (1.283-4.162)]. The prevalence of unintended pregnancy remains markedly high while prior contraceptive use was relatively low among women receiving antenatal care. Evidence-based interventions including specialized client education are vital in improving optimal use of contraceptive services. We recommend further research including community-based qualitative studies to better understand the factors associated with contraceptive uptake and outcomes of unintended pregnancy.