Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub‐Saharan Africa: a multicountry analysis of Demographic and Health Survey data

Amo-Adjei, Joshua; Tuoyire, Derek Anamaale

doi:10.1111/tmi.12788

Cited by 22 publications

(20 citation statements)

References 56 publications

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“…Previous studies have reported pregnancy and parity to be a significant barrier for ANC services utilization [4,45], and we also observed a similar relationship in the current analysis. Women's feelings about unplanned pregnancy might influence their health care seeking behavior which in turn can increase risks of pregnancy complications or mortality [46].…”

Section: Pregnancy Statussupporting

confidence: 90%

“…Employment status was a protective factor from inadequate ANC visits which is consistent with previous findings [21]. Women who are employed might be more informed and have financial autonomy to access health care compared to unemployed women as many other studies have reported [4,21,42].…”

Section: Demographic and Socio-economic Status Factorssupporting

confidence: 89%

“…The primary outcome of the study was inadequate ANC visits which is defined as "no" if the woman had at least four ANC visits and had first ANC visit within 3 months and "yes" if the number of visits were less than four or/ and the first ANC visit was delayed (> 3 months) [4]. The exposure of interest was perceived barriers to accessing health care.…”

Section: Study Variables Outcome and Exposurementioning

confidence: 99%

“…Sub-Saharan Africa (SSA) is by far among the regions with the highest ratios of maternal mortality with 351 per 100 000 live births and high neonatal mortality rates with 20 per 1000 live births [2]. Several studies have shown that 15% of maternal and newborn deaths in SSA are attributed to pregnancy complications that are a result of inadequate pregnancy follow-up [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

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Background: Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda. Methods: This study is cross-sectional using secondary data from the 2014-15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15-49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.Results: Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results. Conclusion: The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

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Section: Pregnancy Statussupporting

confidence: 90%

Section: Demographic and Socio-economic Status Factorssupporting

confidence: 89%

Section: Study Variables Outcome and Exposurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…These might prevent the uptake of healthcare services for these women. These factors were highlighted in a number of studies conducted in different settings in which it was found that the occurrence of unintended pregnancy was associated with lower use of maternal healthcare services (Abosse et al 2010;Amo-Adjei and Tuoyire 2016;Guliani et al 2013;Ochako and Gichuhi 2016). However, this association is equivocal (Dahiru and Oche 2015;Wado et al 2014;Zegeye et al 2014), with our understanding of the relationship between unintended pregnancy and maternal healthcare services utilization limited, and, at best, fragmented.…”

Section: Introductionmentioning

confidence: 99%

Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis

Khan

Harris

Shifti

et al. 2019

Int J Public Health

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Objectives To examine the association between unintended pregnancy and maternal healthcare services utilization in lowand lower-middle-income countries. Methods A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics. Results A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25-39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted). Conclusions Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services. Keywords Unintended pregnancy Á Maternal healthcare services use Á Low-and lower-middle-income countries Á Systematic review and meta-analysis Electronic supplementary material The online version of this article (

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Does unwanted pregnancy lead to adverse health and healthcare utilization for mother and child? Evidence from low- and middle-income countries

Hajizadeh

Nghiem

2020

Int J Public Health

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Objectives Unwanted pregnancy is an important public health concern in low-and middle-income countries (LMICs). Using a pooled dataset from 48 Demographic Health Surveys conducted in Africa, Asia, Latin America and Europe (n = 494,778), we examined the effect of unwanted pregnancy on maternal and child healthcare utilization and child health outcomes in LMICs. Methods We used logistic regression models to estimate the effect of unwanted pregnancy on antenatal care use, supervised delivery, childhood vaccination and three indicators of child health, viz. stunting (height-forage), underweight (weight-forage) and wasting (weight-for-height). Results We found that mothers of children whose pregnancies had been unwanted had a lower probability of attending four or more antenatal care visits by 3.6% (95% confidence interval = 1.9-5.4%) compared to those whose pregnancy was wanted. We did not find significant impacts of unwanted pregnancy on supervised delivery, childhood vaccination uptake or child health indicators. Conclusions Birth characteristics, household-level determinants and country-level characteristics seem to be more closely related to maternal and child healthcare utilization as well as child health outcomes than whether the pregnancy was wanted or unwanted in LMICs. Keywords Unwanted pregnancy Á Maternal and child healthcare Á Child health Á Low-and middle-income countries This article is part of the special issue ''Sexual and reproductive health of young people-Focus Africa''. The Rudolf Geigy Foundation (Basel, Switzerland) funded the open access publication of this article.

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Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub‐Saharan Africa: a multicountry analysis of Demographic and Health Survey data

Abstract: Unintended pregnancies are critical risks to achieving improved maternal health in respect of early and optimal ANC coverage for women in Africa. Programmes targeted at advancing coverage of ANC in Africa need to deploy contextually appropriate mechanisms to prevent unintended pregnancies.

Cited by 22 publications

References 56 publications

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis

Does unwanted pregnancy lead to adverse health and healthcare utilization for mother and child? Evidence from low- and middle-income countries

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