Relationship Between Unintended Pregnancy and Antenatal Care Use During Pregnancy Pregnancy During Use Care Antenatal and Pregnancy Unintended Between Relationship Al

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, 4 , Terefe Markos , Terefe ended pregnancy.  ntended pregnancy 3 Care Use DuringCare Use , Dejene Ermias lation with poor utilization of ma- poor utilization lation with 3 ncy to counterparts. as compared ciation between unintended pregnan- ated with use of antenatal care. Wom- re likely have late ANC initiation to nt mothers were included using single nt mothers re selected by simple random sampling sampling selected by random re simple n with unintended pregnancy were less tionship between uni women reported unint women te logistic regression was employed to stered questionnaire was used to collect to delay initiation of antenatal care. Lon- ed with unhealthyed with behaviors during preg- ay A, Yohannes Y, Ermias D, Markos T, et D, Markos Y, Ermias A, Yohannes ay ing pregnancy among pregnant women in ing pregnancy pregnant women among egnancy in developing countries including association between unintended pregnancy nded pregnancy on the outcomes of interest. of interest. nded pregnancythe outcomes on Women across the world experience unintended Women

wanted (That is, they occurred when no children, of time at the were desired) children more no or conception (1). sta- their development irrespective of pregnancies million 213 Globally,approximately tus. in 2014,

Hadiya, Unintended pregnancy. pregnancy. Unintended Hadiya,

, Yonas Yohannes Yohannes , Yonas  2 nancy and Antenatal and Antenatal nancy ncy were 69% less likelyreceive ANC (AOR=0.31, ncy69% less to were Un-

l Sciences, School of Public Health, Harar, Ethiopia l Sciences, School of Public ity of Illinois at Chicago, Chicago, Illinois, USA ity of Illinois at Chicago, Abame DE, Abera M, Tesf M, DE, Abera Abame , Amanuel Tesfay Tesfay Amanuel , 2 Unintended pregnancy has re direct J ReprodInfertil. 2019;20(1):42-51 This study an asso finding showed Antenatal care, Ethiopia, Antenatal unintended. Community based cross sectional study in Hadiya design was employed Community

Faculty of Public Health, Jimma, Ethiopia Faculty of Public Health,

Health Sciences, Wolaeta, Ethiopia Health Sciences, Wolaeta, More than one third (36.2%) of More than one third (36.2%)

lth Office, Hadiya Zone, Ethiopia lth Office, Hadiya Zone, pregnant

al. Relationship Between Unintended Pregnancy and Antenatal Care Use During Pregnancy Pregnancy During Use Care Antenatal and Pregnancy Unintended Between Relationship al. in Hadiya Zone, Southern2019;20(1):42-51. Ethiopia.Infertil. J Reprod Keywords: To cite this article: nancy. Few studies have examined the nancy.Few studies have examined health behaviors during pr and maternal ternal health care services and also associat services health care ternal Ethiopia. The purpose of the study of the association was to determine unintended pregnancy with use of antenatal care dur Abstract Background: Hadiya zone, southern Ethiopia. Methods: pregna zone, southern Ethiopia in 2017. 748 technique. A structured interviewer admini population proportion. Studypopulation participants we data. Descriptive, bivariate and multivaria of uninte identify effect the independent The level of significance was if p-value was confirmed less than 0.05. Results: (AOR=4.40, 95% CI; 1.70–11.40) during pregna (AOR=4.40, 95% Conclusion: likely to use antenatal likelycare and more rela on studies are recommended gitudinal 95% CI; 0.21–0.46) and were four times mo times 95% CI; 0.21–0.46) and were four cy and ANC use during pregnancy. Wome Unintended pregnancy was significantly associ en with unintended pregna and ANC use. , Muluembet Abera

1 Introduction

become

5 world

Nov. 24, 2018 Sept. 1, 2018 the

regnancy is a happy event for the woman, regnancyis a happyevent for the woman, when it is and community family, husband, of wanted or intended. women But millions

Pregnancy in Hadiya Zone, Southern Ethiopia Ethiopia Zone, Southern Hadiya in Pregnancy intended pregnancy is when it is either mistimed is, theythan desired) or un- (That occurred earlier Gelila Goba around

2- Jimma University, Institute of Health, 2- Jimma University, Hea 3- East Badawacho, District College of 4- Wolaeta Sodo University, and Gynecology, Univers 5- Department of Obstetrics

1- Haramaya University, College of Health and Medica 1- Haramaya University, Desta Erkalo Abame Desta Erkalo Relationship Between Unintended Preg Unintended Between Relationship Dejene Ermias, University, Wachemo Sciences, Health of College Hossana, Ethiopia E-mail: [email protected], [email protected] Received: Accepted: * Corresponding Authors: * Corresponding Authors: Wachemo Tesfay, Amanuel of College University, Hossana, Sciences, Health Ethiopia

Original Article Article Original Downloaded from http://www.jri.ir

43 JRI

A community based A community egnancy and antenatal Methods . In the zone, the contraceptive 2 Km Besides, women with unintended pregnancies with unintended pregnancies women Besides, on the There are few literatures that focus asso- Study setting and design: The sample size for The sample prevalence of unintended technique was Multi-stage stratified sampling cross sectional study design was conducted in March 13, 2017 to April Hadiya13, zone from divided into 10 rural Hadiya zone was 2017. Woreda and with towns two administrative total rural and which 303 of them 329 kebeles from of were urban. 26 of them Hadiya zone hosts a total of 1,573,841 populations with a total area of 3542.66 nancy utilization of relation with poor has direct during health care services pregnancymaternal like delayed at or low attendance initiation of, (12-15). Even though antenatal care visits the in developed countries, were conducted studies developing country studies from findings limited pregnancythat unintended suggested has association with unhealthy behaviors during maternal pregnancy such as use drugs, of illicit smoking, (11). and drinking alcohol to pregnancyless attention have related complica- And theytions. social support and lower have low as use of sup- behaviors such for self-care scores vaccination or multivitamin), (Folic acid plements Consequently, nutrition (16). problems these and such as unfavor- complications obstetric increase morbidity and able pregnancymaternal outcome, birth, low birth weight, neo- premature mortality, natal death, and infant abuse (11). ciation of unintended pr care utilization in developing countries, particu- to exam- studylarlyin Ethiopia. Thus, this aimed whether unintended pregnancyine influences antenatal care utilization during pregnancy. prevalence rate was 49% and ANC coverage was rate was 49% and ANC coverage was prevalence studyThe from was conducted (18). 83% about March 13 to April 13, 2017. pregnancyusing single was determined popula- The following assump- tion proportion formula. level and 5% confidence tions were used at a 95% a of error, and p is the proportion from margin study (12). in southwestern Ethiopia (p=35%) rate and de- non-response the 10% Considering size sign effect of 2, the final sample was 770. as rural districts Hadiyawas stratified used. zone town administra- One town administrations. and selected tion and 3 districts were randomly from and 2 town 10 districts, administration re- among Abame DE. et al. Abame DE. et world

the

around

J Reprod 2019Infertil, Vol1, Jan-MarNo 20, Thus, unintended preg- nded pregnancy is 36% unintended pregnancy in delivery

and

pregnancy

Pregnancies that are unintended result in un- Pregnancies Pregnancy is a crucial time to promote healthy to promote time Pregnancyis a crucial Unintended pregnancy results in unsafe abortion About 830 women die from preventable preventable causes die from About 830 women healthybehaviors or continue unhealthy behaviors during pregnancy (11). behaviors and parenting skills. World Health Or- behaviors that adequate an- ganization (WHO) recommends pregnancytenatal care for a normal that has no four Antenatal should comprise complications (ANC) visits, with the first occurring within care care provides an (10). Antenatal first trimester the interventions for providing opportunityto deliver nutrition maternal health education, improving and encouraging skilled attendance at birth. Early widelyin ANC is a accepted and rec- enrollment to im- women behavior for pregnant ommended prove pregnancy and is late enrollment outcome at viewed as a behavior in- women that places creased risk of poor pregnancy outcome. that is one of the direct mortal- causes of maternal ity morbidity and to induced (7). It leads abortions for wom- that can have deleterious consequences en living in countries where are abortions general- Preventing unintended pregnancies lyunsafe (8). planning could avert effective family through deaths (9). of maternal about 30% every deaths (99%) oc- day. all maternal Almost Ethiopia, the cur in developing countries (4). In mortality ratio was 412 maternal per 100,000 live Health according to Ethiopian Demographic births target under Sus- One (5). Survey(EDHS 2016) Goal (SDG) 3 is to reduce Development tainable less than 70 mortality ratio to global maternal the per 100 000 births (6). Therefore, reducing mater- closelyto prevention of mortality is related nal unintended pregnancy (1). related the same year (2). Of the same these, 50 percent ended in and 38 ended in miscarriage, abortion, 13 percent in an unplanned birth (2). percent resulted The less developed is not different from situation problem suffer from women in Ethiopia; countries of unintended pregnancy. According to Guttma- Ethiopia, in 2014, about Institute’s report in cher pregnancies occurred annually,of out 4.93 million (38%) were unintended preg- which 1.9 million nancy (3). higher in developing countries than developing countries higher in developed total of 53.8 million a In Africa, from countries. were pregnancies, 35% pregnancies occurred pregnancies annually, out which, of 40% Uninte were unintended. Downloaded from http://www.jri.ir

. 4 i.e The data on each planning, 2) number of planning, 2) number The main explanatory variable was The main pregnancy of used Wealth index was socio- as a measure was in decision making participation Women’s processing and analysis: Data coded questionnaire were entered into Epidata 3.1. Then, the entire data were exported to version version 21 statistical packages for analysis.SPSS Descriptive analysis was done fre- to compute quencies, percentage and cross tabulations. Biva- to select variables riate analysis was performed and above, were considered as participated in above, were considered and household decision otherwise not participated in decision and coded 1 and 0, respective- household ly. intention, which was measured by asking a which was measured intention, wom- about her an’s desire pregnancyshe time at the questions and the pregnant. The answers became you pregnant, time became as follows; at the were then, did you pregnant youto become did want youto wait until later, or didn’t want to have want any children at all? (more) were; The answers 1) 2) wanted then intended, happen wanted to later Un- all unwanted. want at not 3) did mistimed, pregnancies were then wanted and mistimed as unintended pregnancies. grouped together status of It was mothers. calculated economic of ownership the following household from re- television, electricity, radio, including bi- sources cycle,motorcycle, car, typefloor, type of of wall toilet facilities, type of roof material, material, such as cattle, animals land, and of domestic farm Five principal components goats, and mule. sheep, were with eigenvalues greater than one summed Principal to obtain wealth index values after Com- ponent Analysis (PCA) was run (18,19). The re- into three catego- then divided index was sulting and wealthy.ries representing poor, middle of eight index composed by composite measured asked "who in her were women The questions. usuallyfamily final say has the on the following decisions" of 1) use family yourself,children, 3, obtaining health care for 4) visits to or family relatives and 5) large household index of composite Then a (20, 21). purchases household decision making in autonomy women's was coded indicator obtained. Each autonomy was a binary1) where 0 represents a as variable (0, and category 1 rep- low level of decision making of decision making a relativelyhigh level resents by alone (Decisions were made either or woman the these values, husband jointly).Based on with overall score was found to be 8. Therefore, those who scored half of the total score, women

which

questionnaire

for completeness, for completeness, accura- who were qualified with qualified who were J Reprod Infertil, Vol 20, No1, Jan-Mar 2019 administered

ANC use refers to use of antena- Unintended PregnancyEthiopiaANC in and interviewer

The data were collected using a pre-tested The data were collected using a pre-tested struc- Measurements: JRI Diploma in nursing and BSc. in public health, BSc. in public in nursing and Diploma were recruited. The data collectors and the super- were trained for two days on questionnaire, visors of interview- details to the interviewees, approach ing techniques, respect privacyand maintaining and confidentiality of the respondents. The collected data was checked was developed from EDHS 2016 and other similar and other similar EDHS 2016 developed from was literatures. The questionnaire had sociodemo- access to reproduc- graphic and socio-economic tive health services, decision women’s making like ANC use and health behaviors maternal and factors influencing utilization of ANC service. It English to local language was translated from (Hadiyisa)and back to English. Face validation of data collectors Ten was determined. questionnaire and three supervisors, cy,clarity and consistencyby the principal inves- tigator.

tured spectively. Gibe, Misha namely Three districts selected by randomly Badewacho were Mirab and In and logistic reasons. for cost lotterythe method way,same thirteen kebeles Gibe, 5 (5 from from Badewacho) were Mirab select- Misha and 3 from administra- Hossana town from Three kebeles ed. in the studytions were included the to represent sixteen kebeles A total of communities. urban urban districts were selected and both rural from by lotteryThe list method. of pregnant mothers obtained bywas select- conducting census in each on ed kebele. Based population size, a sampling which enlists all frame eligible pregnant mothers se- were randomly was prepared and 770 women lected to be included in the study and interviewed by using health extension workers. their home in unit in Ethi- administrative is the smallest Kebele opia. tal care during this pregnancy. Women were ask- tal care during this pregnancy. Women whether theyed had used ANC during current pregnancy. by The variable was measured binary variable "yes"who use and "no" for not for those was collected on Moreover, information using. of initiation of ANC visits to determine time started earlywhether women within the first tri- and the second trimester or initiated late in mester adequate WHO recommends third trimester. the including care for without complications a woman ANC visits, with the first visit occurring in four or before 12 weeks of gestation first trimester the but not later than 16 weeks (10). 44

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8.3 8.3 4.5 2.8 1.5 1.6 1.2 5.6 2.0 4.9 45 33.4 33.4 33.3 24.3 24.3 67.4 89.6 98.8 68.0 32.0 54.1 24.2 21.7 79.4 13.0 83.7 11.4 33.3 JRI Percent (%) Percent (%)

In this study,

9 97 42 15 85 37 62 34 21 11 12 162 594 626 249 250 249 182 504 670 739 509 239 405 181 of pregnant women interviewed interviewed women of pregnant Frequency (n) self-employee, self-employee, student, daily laborers ich 230 (30.7%) ich 230 (30.7%) expe-

in Hadiya zone south Ethiopia, 2017 2017 zone south Ethiopia, in Hadiya

** * Sociodemographic characteristics characteristics Sociodemographic Prevalence of unintended pregnancy: Secondary and above (9-12) + Protestant Orthodox Muslim Catholic Housewife Government employee Others Low Middle Upper 15-24 25-34 35+ Hadiya Kambata Gurage Amhara Others Married Single/Divorced/Widowed Rural Urban No formal education level Primary (1-8) rienced mistimed pregnancy had and 41 (5.5%) mistimed rienced unwanted pregnancy. from the total pregnant women interviewed, the total pregnant women from CI; 32.9-39.63) experienced unin- (95% 36.2% tended pregnancywh from (21.4%) were gravida five and above. The median were gravida five and above. The (21.4%) median in age of their first women pregnancy was 21 study, In this 474 (63.4%) of 3. yearswith IQR were participating in all household deci- women were not participating sion and the rest (36.6%) in all household decision. Religion Occupation Wealth index Variables Maternal age Ethnicity status Marital Residence Educational status

Note * Silte, Oromo, Woleta, Halaba **

Abame DE. et al. Abame DE. et Table 1.

From From

: Out of 770 eli-

: J Reprod 2019Infertil, Vol1, Jan-MarNo 20,

nded secondarynded and above Ethical approval was Ethical approval ob- : Results

Five hundred four (67.4%) of the respondents Five hundred four (67.4%) Reproductive health related characteristics Sociodemographic characteristics Sociodemographic Access to health information or health services

Ethical consideration (Table 1). were in the age group of 25-34 years. of In terms 405 (54.1 educational status had %) no of women, lev- were primary education, 181 (24.2%) formal el, and 162 (21.7%) atte gible pregnant women, 748 women were inter- 748 women women, pregnant gible a response rate of The viewed making 97%. re- A ma- (SD±4.4). 27.34 age was mean spondents (739, jorityof studywere married participants in religion. (594, 79.4%) and protestants 98.8%) Hadiya were from Majorityof the respondents ethnic group (670, 89.6%) and 509 (68.0%) were rural residents. tained from ethical review committee of Jimma of Jimma ethical review tained from committee University, Support letter was Institute of Health. of population and fami- department obtained from ly health. The was necessaryobtained permission Hadiya and zone selected from health department, administrative Woreda health offices and kebele offices. All the study participants were informed about the purpose of the study, their right to re- fuse and assured confidentiality and informed verbal consent was obtained prior to the interview.

for multivariate analysis. p- variables with multivariate Hence, for analysis in the bivariate <0.25 value were taken as analysis. But, statisti- for multivariate candidates tested at the level of 5% at cal significance was level. Finally, the multivariate lo- multivariate to gistic regression analysisidenti- was performed of pregnancyfyindependent effect the intention other interest after controlling of the outcomes on possible confounding variables. Adjusted odds were ratios with 95% CI reported. From a total of 748 respondents, 483 (64.6%) of 748 respondents, 483 (64.6%) a total had From as TV, radio and the such media to mass exposure media. rest (265, 35.4%) had no exposure to mass health facility,nearest to distance to Concerning of respondents took thirty304 (40.6%) to sixty took 295 (39.4%) of respondents less minutes, than thirtyand 149 of minutes, (20.1%) respondents took greater than one hour to walk on foot. the total pregnant women interviewed, 151 total pregnant women the (Gravida one), 437 were primigravida (20.2%) and were gravida one to four (58.4%) 160 Downloaded from http://www.jri.ir

17 17

1 1 1 1 1 1 1 1 1 1 AOR 0.63(0.40–1.0) 0.63(0.40–1.0) 1.18(0.79–1.76) 1.18(0.79–1.76) 1.21(0.79–1.84) 0.98(0.58–1.66) 0.86(0.55–1.35) 1.17(0.46–2.99) 1.01(0.66–1.55) 1.01(0.66–1.55) 0.74 (0.43–1.26) 0.74 (0.43–1.26) 1.38 (0.84–2.28) 1.38 (0.84–2.28) 1.21 (0.55–2.65) 0.99 (0.51–1.90) 0.90 (0.42–1.94) 1.62 (1.11–2.38)* 1.62 (1.11–2.38)* 2.33 (1.01–5.35) * * 2.33 (1.01–5.35) * 0.57 (0.36–0.89) 0.40 (0.22–0.74)** 0.40 (0.22–0.74)** 0.31 (0.21–0.46)** 0.31 (0.21–0.46)** 95% C.I for EXP(B) for EXP(B) C.I 95%

n in Hadiya zone, southern Ethiopia, 20 Ethiopia, zone, southern n in Hadiya

1 1 1 1 1 1 1 1 1 1 OR 0.89 (0.60-1.33) 0.89 (0.60-1.33) 2.90 (2.08–4.05) 2.90 (2.08–4.05) 1.98 (1.42–2.76) 0.85 (0.59–1.23) 0.57 (0.37–0.87) 0.49 (0.30–0.81) 0.23 (0.13–0.41) 0.49 (0.35–0.70) 0.53 (0.23–1.17) 0.47 (0.25–0.86) 0.47 (0.25–0.86) 0.98 (0.67–1.44) 2.47 (1.53–4.01) 0.85 (0.42–1.73) 0.55 (0.36–0.83) 0.56 (0.37–0.85) 0.20 (0.14–0.28) 4.56 (2.06–10.08) 4.56 (2.06–10.08) 95% C.I for EXP(B) for EXP(B) C.I 95%

antenatal care visit, 144 (26.3%), 249 (45.5%) and 249 (45.5%) (26.3%), care visit, 144 antenatal had first, 128 (23.4%) second pregnant women third visits during the recent pregnancy,and re- with intended spectively.preg- of 84.6% women nancy with and unintended of 52.8% women pregnancy used ANC. Out care of antenatal at- and took tendants, 503 (92.0%) 464 (84.6%) the tetanus toxoid (TT) dose recommended minimum respectively. and iron folate supplementation,

7(8.3) 7(8.3) 90(19) 128(33) 95(21.9) 95(21.9) 69(23.4) 80(26.6) 52(34.9) 22(14.6) 67(41.9) 63(19.5) 10(31.3) 12(32.4) 12(32.4) 49(19.7) 77(30.8) 75(30.1) 73(15.3) 44 (24.2) 44 (24.2) 25 (40.3) 55 (30.4) 24 (14.8) 111(44.5) 111(44.5) 106(35.8) 112(25.6) 122(30.1) 122(30.1) 182(29.1) 128(47.2) 132 (26.2) 132 (26.2)

ANC not used (%)ANC not used

fourth

the

gnancy and antenatal care among pregnant wome pregnant among care antenatal and gnancy

Besides 264(67) 384(81) 97(65.1) 97(65.1) 93(58.1) 22(68.7)

37 (59.7) 37 (59.7) 78 (91.7) 25 (67.6) 226(76.6) 226(76.6) 224(73.4) 129(85.4) 325(74.4) 261(80.5) 200(80.3) 200(80.3) 173(69.2) 174(69.9) 404(84.7) 143(52.8) 163(54.5) 377(64.2) 170(78.1) 138(75.8) 138(75.8) 372(73.8) 283(69.9) 126(69.6) 138(85.2) 444(70.9) ANC used (%)ANC used

Among the study partici- Among

J Reprod Infertil, Vol 20, No1, Jan-Mar 2019 professionals.

skilled min

Unintended PregnancyEthiopiaANC in and from

min Multivariate association of unintended pre of unintended association Multivariate Unintendedpregnancy and maternal antenatal care JRI use during pregnancy: pants, 73.1% (95% CI; 70.1–76.2) received at 73.1% (95% CI; 70.1–76.2) received at pants, one ANC visit during their pregnancyleast while the rest did not. Of ANC, those who received 343 health center and the rest (62.7%) received from hospital and health were from and 15.5%) (21.8% respectively.post, (n=26) had Only4.8% about ANC 4 or more received the WHO recommended visits

46 9–12 9–12 1–4 5–8 Gravida 1 Gravida 1 Gravida 2–4 Gravida 5+ 30-60 hour one than Greater Have exposure Have exposure 30 Less than Yes exposure Have no Unintended Unintended No Middle Upper Intended Other Lower Housewife Housewife Government employee No education No education Primary (1-8) Secondary above and (9-12)+ 25–34 35+ 15–24

**P<0.01 *P<0.05

Family size size Family

Gravidity health facility Distance from media Exposure to mass decision in Participated Pregnancy intention Wealth index Occupation

Educational status Age Variable Table 2. Downloaded from http://www.jri.ir

* ** ** preg-

JRI 1 1 1 1 1 1 1 1

AOR

1.64(0.86–3.10) 1.21(0.58–2.52) 1.29(0.67–2.46) 1.02(0.55–1.90) 0.72(0.40–1.28) 1.75(0.39–7.75) 1.31 (0.76–2.26) 2.43 (1.17–5.02) 3.62 (1.18–11.07) 0.48 (0.28–0.80) 0.48 (0.28–0.80) 4.40(1.70–11.40) 95% C.I for EXP(B) C.I 95%

controlling other possi-

1 1 1 1 1 1 1 1 COR 3.64 (1.83–7.27) 0.36 (0.22–0.59) 1.34 (0.67–2.67) 2.90 (2.08–4.05) 1.71 (1.02–2.87) 2.02 (1.24–3.29) 0.44 (0.26–0.76) 3.28(0.94–11.41) 2.05 (1.239–3.40) 6.29 (2.49–15.89) 6.45 (2.18–19.07) 95% C.I for EXP(B) C.I 95%

The result showed that women with The result showed unintended that women Variables other than pregnancy intention were health information, participation in household de- participation information, health health facilitycision, distance from and gravidity were entered in to logistic regres- the multivariate using backward LR method. sion model pregnancy were 69% less likely receive antena- to a tal care health professional from (AOR=0.31, with to women CI; 0.21–0.46) as compared 95% intended pregnancy after ble variables in the model. significantly associated with antenatal care use occupation, wealth index, theyand were maternal participation in household decision and gravidity. gov- higher for were two times of ANC use Odds with house- when compared employers ernment CI; 1.01–5.35). Women (AOR=2.33, 95% wives 43% less like- wealth tertile were the middle from to women as compared lyto receive antenatal care

ciation of unintended pregnancy and late initiation of ANC among ANC among of initiation late and pregnancy of unintended ciation

Abame DE. et al. Abame DE. et one, southern Ethiopia, 2017 2017 Ethiopia, one, southern 5(3.5) 3(8.1) 4(4.3) 10(5.9) 30(9.4) 12(9.5) 31(22.5) 35(12.4) 70(18.6) 17(10.4) 29(22.5) 50(19.2) 75(18.6) 46(12.4) 50(22.1) 63(16.4) 47(14.5) 30(10.5) 33(23.9) ANC earlyinitiation (%)

nant women in Hadiya z J Reprod 2019Infertil, Vol1, Jan-MarNo 20, 34(91.9) 89(95.7) 160(94.1) 248(87.6) 307(81.4) 291(90.6) 146(89.6) 100(77.5) 211(80.8) 329(81.4) 107(77.5) 326(87.6) 176(77.9) 114(90.5) 321(83.6) 278(85.5) 256(89.5) 138(96.5) 105(76.1) ANC late ANC late above education (138, initiation (%) intention, exposure to east once as compared east once as compared to Factors that were associat-

Multiple logistic regression model with backward to show asso to show backward with model regression logistic Multiple

Multivariate associations of unintended pregnancy When the use of antenatal care with different When

and antenatal care use: and antenatal 85%), women who intended pregnancy (84.6%), women 85%), all household decisions participating in women with gravida one (85%), and women (81%), living nearer to women health facility (86.4%) used antenatal care at l their counterparts. maternal and socio-demographic characteristics is and socio-demographic maternal proportion of pregnant the higher concerned, with age group 15-24 yearswomen (138, 75%), with secondarywomen and ed with antenatal care use on bivariate analysiscare use with antenatal ed at the level of P value less using enter method logistic than 0.25 were fit regres- in multivariate Accordingly,sion model. variables such as age, educational status, occupation, place of residence, wealth index, pregnancy

No education Intended exposure Have no Have exposure =< 1 No Gravida 1 1-4 25–34 15–24 >1 Primary (1-8) Yes Gravida 2–4 5-12 Unintended 35+ Gravida 5+ Secondary and above Secondary (9-12)+ Table 3.

Family size Family Gravidity Participated in decision in Participated Distance from health facility Distance from Exposure to mass media Exposure to mass Pregnancy intention Educational status Variable Age

** p<0.01 * p<0.05,

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childbearing (35) and mothers with intended with intended mothers egnancy. And also, late loped countries showed nded pregnancydo not use This finding was consistent with the study was consistent finding This con- received at least this study,women In 73.1% of Additionally, about one in twenty (5%) women This study revealed that unintended pregnancy ducted in different parts ducted in Ethiopia (13, of 22-24) of and reports developing countries (2). The magnitude was higher than the study conducted in And General Hospital, Ethiopia (25). the Gelemso slightlyvalue was finding con- lower than studies countries (2). This difference ducted in developed fact that the latter studycould be due to the was birth through interviews after child conducted pregnancy recent but this studymost consid- from during ers the pregnancy.time And also the dif- attributed to socio-demographic ferences can be characteristics, and availability of health service. one antenatal care visit during this pregnancy. of This value was higher than the findings the Wollega Zone, Ethiopia and East EDHS (5) 2016 analysis (26), and also higher than multilevel of than the val- lower it was (27). However, Zambia ue in the study conducted in Hosanna town, Ethi- opia (28). The difference could be due to EDHS areas while this studyincluding the remote area have increased access to the service. And might be relat- difference might socio-demographic also the study and ed to Zambia in Hosanna town considered only urban individuals. of 4 or WHO recommendation received the had ANC skilled professionals from visits more which East Wollega (5) and lower than 2016 EDHS was users of ANC, 85.4% of Zone (26). Even among visit late after the started the first ANC women of gestational age at The median four months. first the first antenatal care visit was This six months. finding was consistent with the studies done in Arba Minch Town and Arba Minch District, Ethi- town, Ethiopia (30). opia (29) and Ambo was significantly associated with ANC. Thus, the odds of receiving antenatal care were lower for pregnancy with unintended as compared women with intended pr to women initiation of ANC was with higher for mothers unintended pregnancy than pregnancy. different studies conducted Similarly, in developing and deve with uninte that women (13, 15, 31-34). inadequate care or receive ANC who were less This could be due to those women prepared financially and emotionally for the de- pregnancyof and mands likelyalso, most due to the delay in recognizing pregnancy.

were

house-

pregnancy

1.70–11.40) more 1.70–11.40) more

participated CI;

who 95%

unintended

J Reprod Infertil, Vol 20, No1, Jan-Mar 2019 Discussion with

Women

(AOR=4.40, Women

Unintended PregnancyEthiopiaANC in and times

0.36–0.89).

The result showed that pregnancyresult showed that is intention The Time of ANC initiation and unintended pregnancy:

Variables other than pregnancy intention were The study found significant association between JRI four

significantly associated with delayed (late) ANC initiation. Even among the users of ANC, 85.4% (95% CI; (95% 85.4% the users of ANC, among Even first antenatal their started of women 82.3–88.3) as a result four months latelythe first visit after in the 3rd and 8.2% in the 2nd trimester (77.2% at the first gestational age The median trimester). Earlyantenatal care visit was six months. ANC pregnancies initiation was the highest for intended but lowest for unintended pregnancies. from the lowest wealth tertile (AOR=0.57, 95% tertile (AOR=0.57, lowest wealth the from CI; hold decision making were 62% more likely to more were 62% making decision hold receive ANC than their counterparts (AOR= 1.62, belonging to gravida CI; 1.11–2.38). 95% Women 60% less likely were five and more to receive with those belong- compared ANC services when CI; 0.22– (AOR=0.40, 95% to gravida one ing 0.74) (Table 2). significantly associated with late initiation of an- initiation significantlyassociated with late distance media, tenatal care; exposure to mass health facility, of and gravidityfrom or number total pregnancy were the typical ones. Odds of (AOR=2.43, two times were ANC initiation late who likely women for more CI; 1.17–5.02) 95% to as compared had no media exposure to mass who travel had exposure. Women who women than one hour to the nearest health facilityless were 52% less likely to late ANC initiation than than one hour. Women who travel more those (AOR= 3.62 times were or more gravida five with likely to experi- CI; 1.18–11.07) more 95% 3.62, to gravi- when compared late ANC initiation ence (Table 3). da one women pregnancyof antenatal care unintended and use in Hadiya zone, southern pregnant women among of unintended pregnancyEthiopia. The magnitude the studynoticeablyin area was of high in light reproductive the goals of ensuring the women the among and rights which was 36.2% health and study5.5% population, for 30.7% mistimed for unwanted pregnancy. likely to have delayed initiation of ANC when pregnancy with intended compared after controlling all the other variables. 48

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49 JRI

l Statistical Agency of on of effective contra-

during pregnancy in the References Conflict of Interest

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Ministry Zo- of Health, Regional Health Bureau, change communicationTherefore, behavioral Longitudinal study including husband’s infor-

All authors declared that they All have no competing so, women so, women pregnancywith unintended less were de- have to likely more and ANC, use likely to layed ANC. of initiation and Woreda Health Office nal Health Department unintended of prevention the should strengthen utilizati through pregnancy of the magnitude will help to reduce ception that these unhealthy Also, majority prenatal behaviors. who attend of the visits ANC initiated the mothers time recommended Health by World later than the Organization. and commu- (BCC) is recommended at individual during attaining healthybehaviors nity level in Health professionals, particularly pregnancy. areHealth Extension Workers (HEWs), placed to counsel especially who happen to women those the order to minimize conceive unintentionally in not using behavior like unhealthyrisk of having ANC or receiving inadequate care and delaying ANC initiation. will be suggested on pregnancy intention mation behavior and maternal study area. 5. 1. 2. 3. 4. interests. Abame DE. et al. Abame DE. et near-

was

J Reprod 2019Infertil, Vol1, Jan-MarNo 20,

pregnancy

This study has its own

onfident about pregnancy Conclusion unintended

magnitude

Limitation of study: this

Furthermore, in this study, factors inde- other Furthermore, gravidity, media, exposure to mass Women’s This study found significant association in unin- limitations. There is social desirabilitylimitations. bias since relationships of the out- is self-report. Temporal it predictor variables cannot variable and the come be established due to cross sectional nature of the study. ly comparable with developed countries. And al- ly comparable pendentlywith associated ANC use included ma- and gravidity. occupation, wealth, Govern- ternal likely to receive ANC more employers were ment This finding with housewives. compared when was supported by other done in studies North West Ethiopia (36) and Kenya (32). The possible are who em- be that women justification could and understand- access a better have ployedmight who participat- Women ing of the ANC services. likely more were making ed in household decision who did not to receive ANC than partici- women with the pate which was studysimilar done in be due to southwestern Ethiopia (12). This might the fact that when resources are controlled by to use the freedom have the they might women, who be- service whenever they need it. Women were less likely five or more to gravida to long was in line This gravida one. ANC than receive study in the first with in rural Nepal that mothers visit than second or pregnancyhad higher ANC of pregnancies (37). The reason number higher being c be due to could health facilityand distance from were significant- Women ANC initiation. lyassociated with late were more media mass to had no exposure who likely to have late ANC initiation than their coun- with the study in which was in agreement terparts town, Ethiopia (30) and Nigeria (38). Late Ambo in gravida initiation of ANC 5+ more was 3 times to gravida as compared This one women. women was supported by the study conducted in Wollaita Soddo town, Ethiopia and that, it indicated preg- who have no history of paritynant women were likelymore than to initiate ANC visit timely with one and above (39). women from previous experience which may reduce ma- previous experience which may from ternal health seeking behavior. tended pregnancy and maternal behavior during during behavior maternal tended pregnancy and area. More than one-third the study in pregnancy pregnancy the area. in had unintended of women The Downloaded from http://www.jri.ir

preg-

among

pregnancy

unintended pregnancy pregnancy and unintended unintended

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