The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019

To describe the prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa. A cross-sectional survey was conducted between October and mid-November 2019 among pregnant women aged 15–49 years in 1589 selected public antenatal care facilities. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy. Survey logistic regression examined factors associated with unintended pregnancy. Among 34,946 participants, 51.6% had an unintended pregnancy. On multivariable analysis, the odds of unintended pregnancy was higher among women who knew their HIV-positive status before pregnancy but initiated treatment after the first antenatal visit (adjusted odds ratio [aOR], 1.5 [95% confidence interval (CI):1.2–1.8]), women who initiated treatment before pregnancy (aOR, 1.3 [95% CI:1.2–1.3]), and women with a new HIV diagnosis during pregnancy (aOR, 1.2 [95% CI:1.1–1.3]) compared to HIV-negative women. Women who were single, in a non-cohabiting or a cohabiting relationship, and young women (15–24 years) had significantly higher risk of unintended pregnancy compared to married women and women aged 30–49 years, respectively. A comprehensive approach, including regular assessment of HIV clients’ pregnancy intention, and adolescent and youth-friendly reproductive health services could help prevent unintended pregnancy.

Faktor-Faktor yang Memengaruhi Kehamilan Tidak Diinginkan di Indonesia

Unintended pregnancy can cause pregnancy termination, which leads to safety risks. This study analyzed factors affecting unintended pregnancy in Indonesia. The analysis units were women aged 15-49 who gave birth in the past five years. The sample size was 36,472 women. The research variable was unintended pregnancy, residence, age, education, husbands/partners, employment, wealth, parity, pregnancy termination, decision-maker in woman's access to health care, access to family planning information on radio, television, and newspapers/magazines. The final stage analysis used binary logistic regression. Women in urban were 1.834 times more likely to experience an unintended pregnancy than women in rural. The 20-24 age group was 0.202 times more likely to experience an unintended pregnancy than the 15-19 age group. Women with secondary education were 1.447 times more likely to experience an unintended pregnancy than no education women. The poorer were 1.190 times more likely to experience an unintended pregnancy than the poorest. Multiparity was a strong determinant of unintended pregnancy. History of pregnancy, a decision by husbands, and access to family planning information on radio and television in the last few months were risk factors for unintended pregnancies. The study concluded that eight variables affected unintended pregnancies. Keywords: unintended pregnancy, women of childbearing age, contraceptive use, family planning, maternal health. Abstrak Kehamilan yang tidak diinginkan dapat menyebabkan terminasi kehamilan, yang berujung pada risiko. Studi menganalisis faktor yang mempengaruhi kehamilan tidak diinginkan di Indonesia. Unit analisis wanita usia 15-49 tahun yang melahirkan dalam lima tahun terakhir. Besar sampel 36.472 responden. Variabel penelitian adalah kehamilan tidak diinginkan, tempat tinggal, usia, pendidikan, pasangan, pekerjaan, kekayaan, paritas, terminasi kehamilan, pengambil keputusan akses perempuan terhadap pelayanan kesehatan, akses informasi KB di radio, televisi, dan surat kabar/majalah. Analisis tahap akhir menggunakan regresi logistik biner. Hasil penelitian menunjukkan bahwa perempuan di perkotaan 1,834 kali lebih mungkin mengalami kehamilan yang tidak diinginkan dibandingkan perempuan di perdesaan. Usia 20-24 tahun 0,202 kali lebih mungkin mengalami kehamilan yang tidak diinginkan dibandingkan kelompok 15-19 tahun. Wanita dengan pendidikan menengah 1,447 kali lebih mungkin mengalami kehamilan yang tidak diinginkan daripada yang tidak berpendidikan. Kelompok yang lebih miskin 1,190 kali lebih mungkin mengalami kehamilan yang tidak diinginkan daripada yang paling miskin. Multiparitas adalah determinan kuat dari kehamilan yang tidak diinginkan. Riwayat kehamilan, keputusan suami, dan akses informasi KB di radio/televisi merupakan faktor risiko terjadinya kehamilan yang tidak diinginkan. Studi menyimpulkan delapan variabel yang mempengaruhi kehamilan yang tidak diinginkan. Kata kunci: kehamilan tidak diinginkan, wanita usia subur, penggunaan kontrasepsi, keluarga berencana, kesehatan ibu

Stress and coping among unmarried pregnant university students in South Africa

Background The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy. Methods Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents’ reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy. Conclusion The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children.

Influencing factors of unmet needs for child spacing among selected countries experiencing high maternal-mortality in sub-Saharan Africa

Background: Maternal complication and death has been implicated in unintended pregnancy. The indicator for measuring the risk of unintended pregnancy is unmet need for family planning (FP). It is necessary to explore the current situation of unmet need for child spacing (UNCS) as well as its influencing factors among countries that are experiencing high maternal mortality ratio. We aimed to unveil the prevalence of UNCS and its associated factors in Nigeria, Liberia and Sierra Leone.Methods: We analysed the data from DHS phase VII survey, a cross- sectional study conducted from year 2017 to 2018 across several countries. Total records of 25,539, 5,553, and 10,050 were extracted for Nigeria, Liberia and Sierra Leone respectively. Explored variables were UNCS, demographic characteristics and husband’s partners profile. Data was analysed using SPSS version 25. Descriptive statistics, test of association (chi-square) and binary logistic regression were used during the data analysis (α0.05).Results: UNCS was high in Nigeria (15.9%), Liberia (22.5%) and Sierra Leone (21.9%). In Nigeria, Liberia and Sierra Leone, 40%, 37% and 49.1% were uneducated respectively. The proportion of married women were 89% in Nigeria, 32% in Liberia and 70.2% in Sierra Leone. Also, female headship of household (OR: 1.29, 95%CI: 1.09-1.54) was associated with UNCS relative to male headship of household.Conclusions: UNCS was high in the three countries. Factors like educational status of women, age, as well as women as head of the households should be given much attention in the efforts to reduce UNCS as identified in this study.

Child marriage and adverse reproductive outcomes among young Afghan women: implication for policy and practice in Afghanistan

Background: Child marriage is defined as marriage before the age of 18 years and it has been linked to several adverse health and social outcomes. This study aimed to explore the prevalence and determinants of child marriage and its association with adverse reproductive outcomes among a nationally representative sample of young Afghan women. Methods: This was a secondary analysis of the 2015 Afghanistan Demographic and Health Survey (DHS) data. Based on the UN recommendation on child marriage study, only women aged 20-24 years old were included. Descriptive statistics and binary logistic regression were employed to determine the distribution of respondents' characteristics and prevalence and determinants of child marriage. Multivariate logistic models examined the association between child marriage and adverse reproductive outcomes accounting for the sociodemographic factors. Results: An estimated 52% of the Afghan women aged 20-24 married at ages less than 18 years. Poor illiterate women were more likely to marry at early ages (<18). There was a significant negative relationship between child marriage and history of rapid repeat childbirth, delivery by skilled personnel, and institutional delivery. In both adjusted and unadjusted models, women married at age ≤14 were more likely to experience terminated or unintended pregnancy (AOR = 1.89, 95% CI: 1.31-2.75 and AOR = 2.20. 95% CI: 1.24-3.91, respectively), inadequate ANC (AOR = 1.71, 95% CI: 1.01-2.90), unmet need for family planning (AOR = 1.44, 95% CI: 1.05-1.98), fistula (AOR = 2.36, 95% CI: 1.22-4.57); While, for those married at age 15-17 years, only terminated or unintended pregnancy remained significant. Conclusion: The younger age of marriage was associated with a higher prevalence of adverse reproductive outcomes among Afghan women. Moreover, poverty and illiteracy proved to be important predictors of child marriage in Afghan women. Strict international law enforcement and advocacy are a need in the current situation of Afghanistan to increase young women's education, promote their civil rights, and improve their autonomy and role in decision-making concerning their health.

Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States payer perspective

Background: In the United States of America (USA), nearly 10 million women use oral contraceptives (OCs). Concomitant administration of certain medications can result in contraceptive failure, and consequently unintended pregnancies due to drug–drug interactions (DDIs). The objective of this analysis was to estimate the economic impact of unintended pregnancies due to DDIs among women of reproductive age using an OC alone or in combination with an enzyme inducer co-medication in the USA from a payer perspective. Methods: A Markov model using a cohort of 1,000 reproductive-age women was developed to estimate costs due to contraceptive failure for OC alone versus OC with concomitant enzyme inducer drugs. All women were assumed to begin an initial state, continuing until experiencing an unintended pregnancy. Unintended pregnancies could result in birth, induced abortion, spontaneous abortion, or ectopic pregnancy. The cohort was analyzed over a time horizon of 1 year with a cycle length of 1 month. Estimates of costs and probabilities of unintended pregnancy outcomes were obtained from the literature. Probabilities from the Markov cohort trace was used to estimate number of pregnancy outcomes. Results: On average, enzyme inducers resulted in 20 additional unintended pregnancies with additional unadjusted and adjusted costs median (range) of USD136,304 (USD57,436–USD320,093) and USD65,146 (USD28,491–USD162,635), respectively. The major component of the direct cost is attributed to the cost of births. Considering the full range of events, DDIs with enzyme inducers could result in 16–25 additional unintended pregnancies and total unadjusted and adjusted costs ranging between USD46,041 to USD399,121 and USD22,839 to USD202,788 respectively. Conclusion: The direct costs associated with unintended pregnancies due to DDIs may be substantial and are potentially avoidable. Greater awareness of DDI risk with oral contraceptives among payers, physicians, pharmacists and patients may reduce unintended pregnancies in at-risk populations.