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

Khan, Nuruzzaman; Harris, Melissa L.; Shifti, Desalegn Markos; Laar, Alexander Suuk; Loxton, Deborah

doi:10.1007/s00038-019-01238-9

Cited by 50 publications

(99 citation statements)

References 52 publications

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“…The factors associated with lower likelihoods of ANC uptake following an unintended pregnancy are complex, making designing interventions challenging. A variety of factors related to the pregnancy, the woman and her partner, and psychological responses following pregnancy could be linked with lower likelihoods of ANC uptake [ 46 ]. For instance, a mistimed or an unwanted pregnancy are most often identified later than a wanted pregnancy [ 47 ], and delay in deciding whether to terminate the pregnancy [ 48 ] could result in less time to receive ANC.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, women who have an unintended pregnancy may have psychological problems (e.g. depression, anxiety) that arise from less favourable behaviours, either from their partners, their family members, or both [ 46 ]. These are most often in addition to women’s concern about adverse life events (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Together, this contributes to lower uptake of ANC following an unintended pregnancy. The underlying causes are women’s lower autonomy, and their partners/family members unfavourable behaviours as well as unwillingness or inability to expense travel money [ 46 , 51 ]. These limitations are further amplified for women residing in rural areas and communities with higher illiteracy and poverty, where previous studies have found a higher occurrence of unintended pregnancy [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

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Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data

et al. 2020

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Background Around 48% of all pregnancies in low- and middle-income countries are unintended. Unintended pregnancy may contribute to lower use of antenatal care (ANC); however, current research in the area is largely inconclusive due to the methodological approaches applied. Methods Responses from 4493 women extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) were used to assess the association between unintended pregnancy and subsequent uptake of at least one and at least four skilled ANC visits. For this, Bayesian multilevel logistic regression models with informative priors (representing a range of values within which the researcher is certain the true effect of the parameters included lies) were used, adjusting for other factors that affect ANC uptake. Informative priors were selected from the BDHS data collected in 2004, 2007, and 2011. Results Around 64% of women in Bangladesh who had at least one pregnancy within 3 years prior to the survey (that ended in a live birth) received ANC at least once, and of these around 32% used ANC at least four times. Mistimed (aOR, 0.73, 95% Cred I, 0.66–0.81) and unwanted (aOR, 0.69, 95% Cred I, 0.64–0.75) pregnancy were associated with reduced odds of attending the recommended minimum of four skilled ANC visits compared with wanted pregnancy. These likelihoods were even lower for at least one skilled ANC visit among women with a mistimed (aOR, 0.59, 95% Cred I, 0.53–0.65) or an unwanted pregnancy (aOR, 0.67, 95% Cred I, 0.61–0.74) than women with a wanted pregnancy. Conclusions In Bangladesh, more than one-quarter of women who report an unintended pregnancy at conception and do not terminate the pregnancy are at high risk of not using ANC. It is important for policies to include women with unintended pregnancy in mainstream healthcare services. This will increase the use of ANC and reduce associated adverse consequences.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data

et al. 2020

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“…Other drivers of maternal services identi ed were never having been cautioned or charged due to sex working, knowing the number of ANC visits, disagreeing with the statement that FSWs could be denied maternal services due to job status, openly discussing sex work with service providers, and living with adults at home. Previous literature shows that women in the general population who plan for pregnancies are more likely to use subsequent maternal services [14,15,43,44]. This study adds to this body of knowledge by focusing on a marginalized key population in Uganda.…”

Section: Discussionmentioning

confidence: 92%

“…Despite the available interventions, women in general population still face a number of challenges in utilizing the maternal services. According to 2016 UDHS, 41% of women in Uganda had unplanned pregnancies [5].The literature shows that women with unplanned pregnancies are more likely to experience delayed and inadequate ANC attendances [14], deliver outside health facilities and not to likely to attend PNC [15]. Pre-conception care including pregnancy planning has the potential to maximize maternal and child health outcomes but has not been embraced globally [16].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility-based survey

Bukenya

Barrett

Kaharuza

et al. 2019

Preprint

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Introduction Female sex workers (FSWs) are marginalized due to social rejection and stigma, especially in countries where the practice is illegal. Many FSWs are mothers but little is known about their utilization of maternal services. This study investigated the determinants of utilization of maternal services by FSWs in Uganda. Methods FSWs were recruited from the “Most at-Risk Initiative” clinics in Uganda. We analyzed data for 318 FSWs who had given birth within two years of the study to estimate the proportion of FSWs who used all the components of maternal services (antenatal, facility-based delivery and postnatal). The outcome variable (utilization of maternal services) was categorized as “recommended package” if the women received all the three services, “moderate” if they received any two and “limited/none” if they received only one or none of the services. Multinomial logistic regression analysis was used to quantify the impact of pregnancy planning and other factors on the utilization of maternal services. Results Overall, 25.2% (80) utilized all the three services in the recommended package of maternal services, 47.5% (151) had moderate utilization, while 27.3% (87) utilized limited or no services. Factors that influenced utilization of the recommended package compared to “limited/none” use were having a planned pregnancy (adjusted RRR (aRR) = 3.87; 95% CI = 1.40-10.67), knowing four as the minimum number of ANC visits (aRR = 2.43; 95% CI = 1.22-4.87), never having been criminalized for sex work (aRR = 2.48; 95% CI = 1.30-4.74) and not believing that health providers deny services to FSWs believing (aRR = 2.63; 95% CI = 1.37-5.07). Conclusion These findings confirm the relevance of pregnancy planning in the utilization of maternal services among FSWs. However, maternal health service utilization was generally low and interventions to reduce barriers including inadequate knowledge of ANC visits, internal stigma and criminalization of sex work are required. These are necessary steps in the move towards universal health coverage.

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Place of birth for unintended pregnancies in six former Soviet Union countries

Bellizzi¹,

Pichierri

Napodano

et al. 2021

Health Planning & Management

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Objective: This paper aims at exploring the association between unintended pregnancies and place of birth in six Former Soviet Union (FSU) countries. Material and methods: A secondary analysis of the latest cross-sectional Demographic and Health Surveys of six FSU countries from 2005 through 2012 was conducted. Prevalence of institutional births and unintended pregnancies was estimated by country and for the pooled population. Odds ratio (OR) and 95% confidence interval (CI) were calculated to measure the country and pooled association between pregnancy intention and institutional birth. Results: Institutional births occurred in 90.4% of the overall study population and ranged from 78.2% in Tajikistan to 99.7% in Ukraine Demographic and HealthSurvey. Around one out of 10 pregnancies resulted unintended. In the pooled analysis, unintended pregnancies were significantly associated with giving births outside health facility (aOR1.2; 95% CI 1.0-1.6). Conclusion:Based on the study findings we suggest that increase awareness of benefit of skilled delivery care is needed among women with poor access to family planning.

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

Cited by 50 publications

References 52 publications

Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data

Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data

Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility-based survey

Place of birth for unintended pregnancies in six former Soviet Union countries

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