Association between pregnancy intention and late initiation of antenatal care among pregnant women in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Antenatal care is one of the continua of reproductive health care, and inadequate antenatal care utilization results in an adverse feto-maternal outcome. Pregnancy intention is an essential factor that plays a paramount role on timing of antenatal care service. The finding of a few studies conducted on the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia presented inconclusive. Therefore, the objective of this systematic review and meta-analysis was to determine the pooled estimate of the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia. Methods: Both published and unpublished studies were accessed through electronic search from databases such as MEDLINE, Scopes, PubMed, CINAHL, PopLine, MedNar, Cochrane library, the JBI Library, the Web of Science, and Google Scholar. All observational studies that were conducted on the association between pregnancy intention and late initiation of ANC among pregnant women in Ethiopia were included. STATA 14.1 version was used for data analysis. A random effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). The Cochrane Q test statistic and I 2 tests were used to assess heterogeneity. Presence of publication bias was checked by funnel plots and Egger's statistical tests. Results: A total of 670 published and unpublished studies were identified from several databases and fourteen studies fulfilled inclusion criteria and included in the meta-analysis. The overall pooled estimate indicates the odds of late initiation of antenatal care were 2.16 times higher among pregnant women who had unintended pregnancy as compared to pregnant women who had intended pregnancy (OR 2.16, 95% CI 1.62, 2.88). Conclusion: The systematic review and meta-analysis found a statistically significant effect of pregnancy intention on late initiation of antenatal care among pregnant women in Ethiopia. Increased effort should be made to improve women's behavior towards contraceptive use through health education and counseling, especially those with unintended pregnancies. Furthermore, health education, counseling, and communication campaigns related to the timing of ANC and frequency should be promoted nationally.

Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

“…In agreement with existing literature [ 7 , 9 , 11 , 19 , 39 – 42 , 45 , 57 , 65 ], this study indicated that women with unwanted pregnancy (pregnancy wanted later and no more) were less likely to start the first ANC visit within recommend time compared to women who wanted their pregnancy then. The possible reason might be women having wanted pregnancy has a chance of detecting the pregnancy earlier or women may give more cautious and excited to know their pregnancy status than those who had unwanted pregnancy.…”

The magnitude and determinants of delayed initiation of antenatal care among pregnant women in Gambia; evidence from Gambia demographic and health survey data

“…According to earlier research, women who initiate ANC later tend to be younger, more gravid or parous, single, of lower socioeconomic status, less educated, and have less access to healthcare services [ 24 , 26 , 34 – 36 ]. Women who experience unplanned pregnancies, find out they are pregnant later than average, and have had healthy pregnancies in the past are also more likely to start ANC later in their pregnancy [ 20 , 30 , 37 – 39 ]. Additionally, if women have had bad experiences in the past or have a negative perception of the quality of the services, they will not attend ANC [ 30 , 40 , 41 ].…”

Association between pregnancy intention and smoking or alcohol consumption in the preconception and pregnancy periods: A systematic review and meta‐analysis

“…During the pregnancy period, the findings indicated that women with unplanned pregnancy were more likely to consume cigarettes and alcohol. This was particularly because that unplanned pregnancy was associated with delayed pregnancy recognition, late initiation of antenatal care (Tolossa et al., 2020) and poor knowledge regarding these unhealthy behaviours (Mullan et al., 2016). Thus, health education related to regular antenatal care and adverse outcomes of smoking or alcohol consumption during pregnancy should be promoted especially for those women with unplanned pregnancy.…”

“…Pregnancy intention is an imperative concept implicated in preconception health (Johnson et al., 2006) and provides opportunity to explore motivation for early intervention. However, few women discussed their pregnancy intentions with healthcare providers (Tolossa et al., 2020). Some women were even not aware of pregnancy when they conceived.…”

“…Prior systematic review and meta‐analysis had investigated the association between pregnancy intention and diet, physical activity (Nkrumah et al., 2020), perinatal depression (Abajobir et al., 2016) and late initiation of antenatal care (Tolossa et al., 2020). One recent systematic mapping review investigated pregnancy intention and health‐related lifestyles or psychological variables and recommended to comprehensively synthesize literatures of smoking and alcohol consumption among unplanned pregnancy (Hill, Kothe, et al., 2019).…”