Prevalence of Unplanned Pregnancy and Factor Among Pregnant Women, Ethiopia 2018 GC

Unplanned pregnancy is a public health concern in both developing and developed world. It is predispose women to maternal deaths and illness mainly through unsafe abortion and poor maternity care, and also it causes adverse social and health outcome for mother, children and family as whole. Unplanned pregnancy can have serious health, economic, psychological and social consequence for women, their children and families. The objectives of this study are to assess the prevalence and associated factors of unplanned pregnancy among pregnant mothers in Arerti town. Community based cross sectional study was done from March 18 – March 22, 2018 GC. Out of 334 pregnant women in Arerti town, data were collected from 327(97.9%) pregnant women. The prevalence of unplanned pregnancy was 97(29.9%). Use of family planning methods [AOR= 3.845(2.023-7.307)] and educational status of pregnant women [AOR=12.472(1.571-99.011)] were factors significantly associated with unplanned pregnancy. According to this study over one third of pregnant women had unplanned pregnancy. We Recommend that there is an apparent need to provide information and counseling about each contraceptive methods by health extension and other health service worker in order to make informed choice and correct method use and strengthening family planning methods among client in need of service and encourage women’s education.


Introduction
Background Unplanned pregnancy is a public health problem in both developing and developed world, because of it cause adverse social and health outcome for mother, children and family as whole [1]. Unplanned pregnancy can have serious health, economic, psychological and social consequence for women, their children and families. In order to achieve reducing child mortality and improving maternal health; the incidence of unplanned pregnancy and its consequences must be dramatically reduced [2].
Unplanned pregnancy can lead to unwanted birth or abortion which could be unsafe; it might affect the mothers, child and the society at large and different circumstance. For instance they may be un safe abortion, delayed or no prenatal care, poor maternal health reduce mother child relationship quality, physical abuse and violence against women, poor developmental out comes for children, increase risk of low birth weight as well as increased morbidity and mortality [3].
Globally in 2012 out of 213 million pregnancy, 85 million were unplanned, in which 50% ended with abortion, 13 miscarriage and 38% unplanned birth [4]. In 2008 out of 210 million pregnancy, 80 million were un intended, in which 21.6 million were completed by un safe abortion causing the death of 47000 women, this indicate that the incidence of 1 in 10 million pregnancy end in unsafe abortion. Generally the number of abortion increase from 19.7 million in 2003 to 21.6 million in 2008 which occurs almost in developing country [5].
The rate of unintended pregnancy decline from 69 per 1000 women,  in 1995 to 55 in 2008, 20% drop that is reflective of the worldwide trend towards increase the use of contraception. But it is still public health problem affecting significant number women and child life [6].
Most of (95%) unsafe abortion occurs in developing countries. Millions more suffer long term injuries from life threatening complication. In many poor countries treatment of this complication consume up to half of hospital budget for obstetrics and gynecology [7]. For instance, according to the study by WHO in 2008, in Africa about 5.5 million unsafe abortion were performed each year and 3600 of them died. In the same year, in Ethiopia the study made by Guttmacher institute, showed that 101 unwanted pregnancies occurred per 1000 women aged 15-44, and 42% of all pregnancies were unintended; 382,500 induced abortions performed in which the annual rate was 23 abortion per 1000 women. Regarding the capital city Addis Ababa, the situation was more severe than the national level which was 49 per 1000 on average. Those women had a chance to develop complication, like acute trauma, organ failure, infection and future reproductive problems due to unsafe abortion [8].
Unmarried women and teenagers face up, since it is ignominy on the societies they become obligated to perform clandestine unsafe abortion which causes, physical abuse, thrown out of home, exposed to prostitution, infected with HIV or unplanned child bearing, morbidity and mortality [9].

Study Area
The study was conducted on pregnant women in Arerti town, Minjar shenkora woreda, north shewa, Amhara region, Ethiopia. Minjar is located in north shewa zone, is one of the 105 woredas (a district managed by a local government) in the Amhara rigion of Ethiopia. It is located about 133km from Addis Abeba, the capital city of Ethiopia.
Minjar shenkora woreda has an estimated population of 161,352 according to 2010 EC. census and an area of 229,463 square kilometer with 90% living in rural settings [31]. Arerti, the main city of minjar shenkora woreda had one kebele but recently it divided in to two kebeles. Among the total population in both kebeles 496 are pregnant women. In Arerti town there is one hospital and one health center which makes the health coverage 100% and 70% respectively according to Federal Ministry of Health hospital or health center to number of population proportion.

Study Period
The study was conducted from February 15-April 15, 2018 GC.

Study Design
Community based cross sectional study was conducted to assess the prevalence of unplanned pregnancy and associated factor among pregnant women in Areri town.

Source Population
All Pregnant women who were lives Arerti town.

Study Population
All Pregnant women in selected ketenas were included.

Inclusion Criteria's
-All currently pregnant women who live in Arerti town were included.

Exclusion Criteria's
-Pregnant mothers who are critically ill.

Sample Size Determination
The study sample size was determined by statistical calculation. The estimation of population proportion, p, where p is the proportion of prevalence of unplanned pregnancy and its associated factors for pregnant women, p=0.34 [32], as this value gives sample size sufficiently large to guarantee an accurate prediction, at 95% confidence interval and 5% marginal error. The following formula will be used.

Operational Definitions
i. Unintended pregnancy: is a pregnancy, which is either unwanted or mistimed. ii. Unwanted pregnancy: a pregnancy that has occurred to the women who were not wishing to become pregnancy neither at the time of conception nor in the future. iii. Mistimed pregnancy: a pregnancy, which has occurred without the wish of the women at the specific time of occurrence of the pregnancy, but she has a desire to be pregnant and have a child or children sometime in the future. iv. Intended pregnancy: is pregnancy that occurred to women who wanted a baby at the time she became pregnant or sooner or were in different about conserving. v. Unmet need for family planning: the percentage of married women or in union who wants to space their next birth at least two years or stop child bearing entirely but are not using contraception. vi. Unplanned pregnancy: is pregnancy which was not planned, but after conception it may be wanted or unwanted.

Information About Family Planning Services and Service Utilization
Among 327 pregnant women almost all have information about family planning services which accounts 323(98.8%) but the rest 4(1.2%) have no information about family planning services. Those pregnant women who had information about family planning services, majority of them got information from health professional which accounts 144(44%) followed by from neighborhood, mass media, school and reading from books which accounts 122(37.3%), 34(10.4%), 25(7.6%) and 2(0.6%) respectively. Regarding to who make decision on family planning majority of them decided by their husbands which accounts 280(85.6%) and 15(4.6%) of them decided by their Owen, the other family member were decided 32(9.8%).
Among 323(98.8%) of pregnant women 280(85.6%) utilize family planning services. The type of family planning methods that have been practiced by the pregnant women were pill, depoprovera, IUCD, and implants. From 280(85.6%) pregnant women 80(28.6%) were use pill and the rest 200(71.4%) were not use pill as a contraceptive methods, and from 280(85.6%) pregnant women 217(77.5%) were use depoprovera and the other 63(22.5%) were not use depoprovera and from 280(85.6%) pregnant women 6(2.1%) were use IUCD and majority of them which was 274(97.9%) were not use IUCD and from 280(85.6%) pregnant women 75(26.8%) were use implants and the other 205(73.2%) were not use implants as a contraceptive methods.
Among 323(98.8%) pregnant women 47(14.4%) not utilized family planning services at all. Majority of them 16(34.0%) of the pregnant women the reason not used family planning were fear of side effects followed by fear of religion, lack of knowledge both need of child birth and fear of husband, and lack of family planning services each accounts 13(27.7%), 10(21.3%), 3(6.4%) and 2(4.3%) respectively.

Prevalence of Unplanned Pregnancy
According to this study the prevalence of unplanned pregnancy was 97(29.7%), of them 36(37.1%) the reason for unplanned were forgot time of contraceptive use followed by lack of family planning services, failure of family planning methods, husband preference and rape which accounts 23(23.7%), 20(20.6%), 12(12.4%) and 6(6.2%) respectively. Among 206(63.0%) pregnant women 141(68.4%) had not history of unplanned pregnancy but the rest 65(31.6%) had history of unplanned pregnancy, from those 60(92.3%) had one unplanned pregnancy, the other 4(6.2%) and 1(1.5%) had two and three unplanned pregnancy respectively. The reason for previously unplanned were forgot time of contraceptive use which accounts 43.1%, followed by lack of family planning services and failure of contraceptive methods, 38.5% and 3.7% respectively. The reason for unplanned pregnancy were due to forgot time of contraceptive which was 28(43.1%), lack of family planning service and failure of contraceptives 25(38.5%) and 12(185%) respectively. From 65(31.6%) pregnant women 40(61.6%) previously had unplanned due to contraceptive methods failure. From the contraceptive methods depoprovera 19(47.5%) was the predominant, followed by pill, implants and IUCD, 17(42.5%), 3(75%) and 1(2.5%) respectively.

Bivariate and Multivariate Analysis Result of Dependent Variable (Unplanned Pregnancy) with Independent Variables
Bivariate and multivariate logistic regression analyses were done to analyze factors associated with unplanned pregnancy. On the bivariate logistic regression analysis: residence, religion, educational status, occupation, income, information about family planning, source of information about family planning, decision maker about family planning, family planning practice, reason not to use family planning and pregnancy before pregnancy were associated with unplanned pregnancy at P<0.2. In the multivariate model of logistic regression, variables which had significant level of p<0.2 were entered in to the model. The Adjusted OR (AOR) findings showed the significant of the multivariable with the dependent variable.
From those variables unplanned pregnancy were significantly associated with educational status and use of family planning methods of the pregnant women.
Regarding to educational status of pregnant women unplanned pregnancy had significantly associated with illiterate pregnant women compared to higher educated pregnant.
Concerning to use of family planning methods pregnant women who used family planning methods were significantly associated with unplanned pregnancy as compared to pregnant women who didn't use family planning methods.
Regarding to educational status of pregnant women illiterate pregnant women 12 times more likely associated with unplanned pregnancy compared to higher educated pregnant women [AOR=12.472 (1.571-99.011)]. pregnant women who educated from grade 9 up to grade 12 were more likely significantly associated with unplanned pregnancy compared to higher educated pregnant women [AOR=11.030 (1.090-111.6)]. Pregnant women who educated from grade 1 up to grade 4 were more likely associated with unplanned pregnancy compared to higher educated pregnant women [AOR=5.838 (0.740-46.074)]. Pregnant women who educated from grade 5 up to grade 8 were more likely significantly associated with unplanned pregnancy compared to higher educated pregnant women [AOR=5.038 (0.616-41.20]. Concerning to use of family planning methods pregnant women who had not use contraceptive methods more significantly associated with unplanned pregnancy compared to pregnant women who had use contraceptive methods [AOR=2.686 (1.204-5.996)]. But residence, religion, information about family planning and decision maker on family planning, were not associated with unplanned pregnancy with p value <0.05.

Discussion
This study was designed to assess the prevalence of unplanned pregnancy and its associated factors, among pregnant women who live in Arerti town.
Unplanned pregnancy is a public health problem that predispose women to maternal death and illness mainly through unsafe abortions and poor maternity care.
In this study unplanned pregnancy was 29.9% among the study participants. This findings is in agreements with the findings from other studies in Ethiopia [36] and Kenya [18] but it is lower than the other studies that were conducted in Jimma 35% [37] and Hosana 34% [19], this might be due to the increased availability and accessibility of maternal health services, including access to modern family planning with time. More over this finding were much lower than the findings of studies conducted in Tanzania 45.9% [38] and Nepal 41.1% [35]. This might be due to the socio-cultural and health coverage difference among the countries.
In contrast this study also slightly higher in proportion to the study conducted in Kersa eastern Ethiopia in 2010 (27.9%) [39] and facility based study done in Bahir Dar 26% [34]. This may be due to a difference in socio-demographic characteristics and it was done one facility.
In the multivariate analysis, educational status and use of contraceptives methods of pregnant women were found to have statistically significant on unplanned pregnancy.
Regarding to educational status of pregnant women, several studies showed that as the educational level increases unplanned pregnancy decreases and reduces the chance of discontinuity of contraceptives [35].
This study showed that educational status of the pregnant women was found to be significantly associated with unplanned pregnancy. The risk of experiencing unplanned pregnancy was higher in women who are unable to read and write [AOR=12.472(1.571-99.011) compared to higher educated women. Even little advance in education improves women's decision making power and leading to advance of unplanned pregnancy, hence education has a pervasive impact on a women pregnancy intension since it empowers to manage their family size and intensively develop selffeelings and their planning experience's reduce the chance of un intended pregnancy with the same study conducted in hawassa, southern Ethiopia showed the same result.
Regarding to their use of contraceptives methods pregnant women who used contraceptives more likely associated with unplanned pregnancy compared to pregnant women who didn't use contraceptive methods [AOR=12.472(1.571-99.011)]. This findings is also consistent with findings in Ethiopia [40] and other countries [35]. Similar to the study done by Guttmacher institute in 2010 which is the proportion of women using modern contraceptives in the developing world as a whole greatly increased and reduced the experiences of unplanned pregnancy.
The present finding is in line with the study done in West Wollega (OR 3.76; 95% CI; 2.37, 5.96) [35]. Our result supports the hypothesis that if a women higher use of contraceptives methods she is more likely to be aware of the benefits of those method which in turn will motivate her to use the methods and less likely to have unplanned pregnancy. The similar result was found in Ecuador as well [41]. Studies conducted in developing countries indicate that women's age, level of education, number of children, social and economic deprivation are the major determinant of unplanned pregnancy [42]. While our study shows that unplanned pregnancy have strong association with educational status and use of family planning methods.
Limitation of the study a) The respondents were not volunteer to answer their approximate monthly income these may affect our result. b) Lack of personal computer. c) Lack of internet access for sending and receiving comments to our advisor.

Conclusion
The present study revealed that 29.9% pregnant women in arerti town had unplanned pregnancy. This indicates unplanned pregnancy is one of the major reproductive health problem in the study area.
The result of this study showed that some factors were interwoven to affect the occurrence of the event including educational status and use of family planning methods which showed significant associated with unplanned pregnancy.

Recommendation
Based on the finding of this study, the following recommendation are given.
Address the issue of unplanned pregnancy by designing strategies in policy documents, strategic plan including health sector development.
Provide information and counselling about each contraceptive methods in order to make informed choice and correct use and strengthening family planning method among client in need of service.

Declaration
Ethical Considerations Ethical clearance and permission was obtained from Debre Berhan University, institute of medicine and health science ethical review committee. The nature of the study participants to obtain there oral informed consent prior to the study and data was kept confidential. Oral informed consent was obtained from each respondent before interview. The information was not be used for other researchers and never be exposed to third person without their consent.