Unintended Pregnancy and Associated Factors among Pregnant Women in Rural Ethiopia

Background: Unintended pregnancy is a worldwide problem that affects the health of women, families and relatives. This study was aimed to identify the major factors associated with unintended pregnancy among women in rural Ethiopia. Methods: We used 2016 Ethiopian Demographic and Health Survey (EDHS) data on 853 rural pregnant women aged 15–49. Analyses of the data were done using SPSS 25 version 25. Chisquare test was used to filter candidate independent variables to be included in a multivariable logistic regression. And the multivariable logistic regression model was employed to estimate the relative association of factors associated with unintended pregnancy. The significance of the factors was considered based on p-value of less than 0.05. Results: The prevalence of unintended pregnancy in study area was 20.9% (95% CI: 18.2, 23.8). The unintended pregnancy was associated with region Afar (AOR: 0.308, 95% CI: 0.101, 0.943) and Somalia (AOR: 0.064, 95% CI: 0.012, 0.331), women aged 35 or older (AOR: 2.016, 95% CI: 1.014, 4.009), women who had primary education (AOR: 0.284, 95% CI: 0.190, 0.425) and secondary/higher education (AOR: 0.201, 95% CI: 0.123, 0.329), Women who knew about contraceptives (AOR: 0.481, 95% CI: 0.379, 0.610), and parity 1 or 2 (AOR: 0.782, 95% CI: 0.750, 0.815). Conclusion: About one-fifth of the pregnancies were unintended. Region, age, educational level, knowledge about contraceptive and parity were significantly associated factors of unintended pregnancy. Providing health education to women needs to be encouraged to minimize the magnitude of unintended pregnancy. Original Research Article Wolde and Mekebo; JPRI, 33(60B): 2432-2440, 2021; Article no.JPRI.82224 2433


INTRODUCTION
Unintended pregnancy is defined as pregnancy that is either mistimed (pregnancy that occurred earlier than the desired time) or unwanted totally (pregnancy that occurred when no more children were desired) [1]. Sexual activity without using contraception through choice or coercion is the predominant cause of unplanned pregnancy [2].
Unintended pregnancy is a worldwide problem that affects the health of women, families and society [3]. About 26.5 million unplanned pregnancies occurred annually due to the incorrect use or failure of contraceptives globally [4]. In developing countries, unintended pregnancy accounted for 65% of all pregnancies and 59% of these pregnancies end with abortion [5].
Unintended pregnancy results in maternal mortality and morbidity because of the complications of unplanned births, unsafe abortion which has a negative impact on health, economical and psychosocial costs to individual and society as well as significant emotional distress to women, families, and society [6]. The impact of unintended pregnancy is higher during the adolescent period resulting in dropping out of school, unstable and lack of proper management of family relationships [7]. In developing countries around 22000 women lost their lives because of the complication of abortion annually [8].
According to 2016 Ethiopian Demographic and Health Survey (EDHS) report, in Ethiopia, 25% of all births in the past five years and current pregnancies were unintended [9]. In Ethiopia, 24.7% and 42% of unintended pregnancy were caused by contraceptive failure and not using contraceptive methods respectively [10].
Unintended pregnancy is affected by various factors such as educational status, knowledge on contraceptives, use of contraceptive methods, marital status, residence, religion, number of living children, age, parity, working status, economic status, family size, number of births in past 5 years .
Nowadays, one of the intervention areas for minimizing maternal mortality is preventing unintended pregnancy [32]. Identifying factors associated with unintended pregnancy is essential to inform the policy makers for the provision of safe and reliable service to reproductive-aged women. Hence, this study was aimed to identify factors associated with unintended pregnancy among pregnant women in rural Ethiopia based on 2016 Ethiopian Demographic and Health Survey data.

Data source and Population
This study used the 2016 Ethiopian demographic and health survey (EDHS) data, which was collected from January 18 to June 25, 2016. The 2016 EDHS was designed to provide estimates for the health and demographic variables of interest at national and regional level. In this study, 853 pregnant women were selected from the total of 15683 reproductive aged women interviewed in the 2016 EDHS.

Dependent variable
Dependent variable is unintended pregnancy. The pregnancy is intended if it is planned at the time of survey and unintended if it is not planned at the time of survey or it is not planned at all.

Independent variables
Region, age, religion, marital status, educational status, household wealth index, family size, knowledge of contraceptive, sex of household head, parity, number of births in past five years, and ever terminated pregnancy.

Statistical Data Analysis
The data were analysed using statistical packages SPSS version 25. Frequencies and percentages were used to summarize the background characteristics of the women. And the Pearson's chi-square test of association was used to filter the significant independent variables that are associated to the dependent variable unintended pregnancy. A multivariable logistic regression model was used to fit the predictor variables associated with the unintended pregnancy. The model goodness of fit was checked using the Hosmer and Lemeshow test.

Prevalence of Unintended Pregnancy
The overall prevalence of unintended pregnancy among pregnant women in rural Ethiopia was 20.9 % (95% CI: 18.2, 23.8).

Background Characteristics of Pregnant Women
Of all 853 women included in the study, 138(16.2%) of them were living in Oromia region. Nearly half (48.3%) of women were in the age range of 25-34 years. More than three fifth (65.4%) of the women did not attend the formal education. Majority (97.2%) of them were in married/ living together at a time of survey. Majority (63.9%) of the women were from the households with the poor wealth index. Nearly three fifth (58.4%) of the women were Muslim religion followers. 254(29.8%) women had five or more ever born children. Majority (620(72.7%)) of women had 3 to 4 births in the last five years. More than three fourth (719(84.3%)) women were from household headed by males. More than half (490(57.4%)) of women were from family of size 5 or less. Only 86(10.1%) women ever had a terminated pregnancy. Majority (713(83.6%)) of women know about the contraceptive (Table 1).

Unintended Pregnancy by Characteristics of Women
Among 178 women who had unintended pregnancy, 48 (34.8%) of them were living in Oromia region at the time of survey. 43(32.3%) of the unintended pregnancy occurred among women who were in the age groups of 25 and above. 59(23.7%) of unintended pregnancy occurred among women who attended primary education. 45(26.5%) unintended pregnancy occurred among women with rich wealth index. 69(27.2%) unintended pregnancy occurred among women who had ever born 5 or more children. 150(24.2%) unintended pregnancy occurred among women who had 1 or 2 births in last five years. 88(24.2%) unintended pregnancy occurred among women from families of size more than 5. 62(44.3%) unintended pregnancy occurred among women who did not know contraceptive methods. No difference has been observed in unintended pregnancy between women who had ever terminated pregnancy (20.9%) and women had no ever terminated pregnancy (20.9%) ( Table 2).

Factor Associated with Unintended Pregnancy
The multivariable logistic regression analysis showed that region, age, education, parity and knowledge about contraceptive were significantly associated factors with unintended pregnancy.

CONCLUSION
The study was aimed to identify factors that are associated with unintended pregnancy among pregnant women in Ethiopia based on EDHS 2016 data. Region, age, educational level, knowledge about contraceptive and parity were significant factors associated with unintended pregnancy among pregnant women in Ethiopia.
Providing health education to women is important to prevent unintended pregnancy.

FUNDING
This study was not funded.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.