The effects of pregnancy intention on the use of antenatal care services: systematic review and meta-analysis

Abstract

BackgroundThere has been considerable debate in the reproductive health literature as to whether unintended pregnancy influences use of maternal health services, particularly antenatal care. Despite the wealth of studies examining the association between pregnancy intention and antenatal care, findings remain mixed and inconclusive. The objective of this study is to systematically review and meta-analyse studies on the association between pregnancy intention and antenatal care.MethodsWe reviewed studies reporting on pregnancy intention and antenatal care from PubMed, Popline, CINHAL and Jstor search engines by developing search strategies. Study quality was assessed for biases in selection, definition of exposure and outcome variables, confounder adjustment, and type of analyses. Adjusted odds ratios, standard errors and sample size were extracted from the included studies and meta-analyzed using STATA version 11. Heterogeneity among studies was assessed using Q test statistic. Effect-size was measured by Odds ratio. Pooled odds ratio for the effects of unintended pregnancy on the use of antenatal care services were calculated using the random effects model.ResultsOur results indicate increased odds of delayed antenatal care use among women with unintended pregnancies (OR 1.42 with 95% CI, 1.27, 1.59) as compared to women with intended pregnancies. Sub-group analysis for developed (1.50 with 95% CI, 1.34, 1.68) and developing (1. 36 with 95% CI, 1.13, 1.65) countries showed significant associations. Moreover, there is an increased odds of inadequate antenatal care use among women with unintended pregnancies as compared to women with intended pregnancies (OR 1.64, 95% CI: 1.47, 1.82). Subgroup analysis for developed (OR, 1.86; 95% CI: 1.62, 2.14) and developing (OR, 1.54; 95% CI: 1.33, 1.77) countries also showed a statistically significant association. However, there were heterogeneities in the studies included in this analysis.ConclusionUnintended pregnancy is associated with late initiation and inadequate use of antenatal care services. Hence, women who report an unintended pregnancy should be targeted for antenatal care counseling and services to prevent adverse maternal and perinatal outcomes. Moreover, providing information on the importance of planning and healthy timing of pregnancies, and the means to do so, to all women of reproductive ages is essential.

The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia

“…Facility based study in Addis Ababa has shown that women with planned pregnancies were more likely to book ANC early [22] as compared to those with unplanned pregnancies. Other studies also show that unintended pregnancies are associated with delayed initiation of antenatal care [15,16]. An urban based study in the Democratic Republic of Congo shows that women who had unplanned pregnancies were less likely to attend ANC services compared to those who had planned their pregnancies by themselves or jointly with their partners [42].…”

What socioeconomic factors are associated with different levels of antenatal care visits in Bangladesh? A behavioral model

“…A variable for whether or not the pregnancy was intended was also included to capture the need for ANC. Previously, researchers have shown that willingness to visit healthcare professionals are higher for desired pregnancies (Dibaba, Fantahun, & Hindin, 2013).…”

Violência física pelo parceiro íntimo e uso inadequado do pré-natal entre mulheres do Nordeste do Brasil

“…This association was evidenced by similar studies conducted in Brazil In the study conducted in three maternity hospitals in Rio de Janeiro, in 2000, the probability of women undergoing inappropriate prenatal care was twice as high for victims of PVIP during pregnancy than among women who did not report violence 9 . Women in situations of intimate partner violence tend to start prenatal care later and present lower adhesion to the program due to problems resulting from violence, such as depression during pregnancy, low self-esteem, and greater difficulty in caring for their health 32 ; that also happens because they have less partner support, including for prenatal care 33 , as evidenced in this study, or because it is an unintended pregnancy 8 . Nevertheless, it is possible that the embarrassment of exposing physical marks of violence can contribute to lower adhesion to prenatal care appointments 33 .…”

“…569/GM, Minister's Office, from December 1 st 2000) established the Program for Humanization of Prenatal Care and Childbirth (PHPN) to reduce maternal and child morbidity and mortality by improving access to as well as coverage and quality of care in prenatal, childbirth, and puerperium periods 6 . Some factors are described as associated with no prenatal care, which include belonging to social segments with lower income, having less formal education, belonging to the black race, being over 35 years old, being multiparous, having depressive symptoms during pregnancy, making abusive use of alcohol and/or illicit drugs, having unstable marital status, unintended pregnancy history, partner's dissatisfaction with pregnancy, and partner's violence [7][8][9][10][11][12][13][14] . RESUMO: Objetivo: Analisar a associação entre violência física pelo parceiro íntimo e uso inadequado da atenção pré-natal.…”