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      Prevalence and determinants of unintended childbirth in Ethiopia

      research-article
      , ,
      BMC Pregnancy and Childbirth
      BioMed Central
      Women, Unintended pregnancy, Determinants

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          Abstract

          Background

          Ethiopia’s population policy specifically aims to reduce TFR from 7.7 to 4.0 and to increase contraceptive use from 4.0% to 44.0% between 1990 and 2015. In 2011, the use of contraceptive methods increased seven-fold from 4.0% to 27%; and the TFR declined by 38% to 4.8. The use of modern contraceptives is, however, much higher in the capital Addis Ababa (56%) and other urban areas but very low in rural areas (23%) far below the national average (27%). In 2011, one in four Ethiopian women had an unmet need for contraception. The main aim of this study was to assess the pattern and examine the socioeconomic and demographic correlates of unintended childbirth among women 15-49 years in Ethiopia.

          Methods

          Data from the 2011 nationally representative Ethiopia Demographic and Health Survey are used. It covered 16,515 women of which 7,759 had at least one birth and thus included for this study. Multivariate logistic regression is used to see the net effects of each explanatory variable over the outcome variable.

          Results

          The study found that nearly one in three (32%) births was unintended; and about two-thirds of these were mistimed. The regression model shows that the burden of unintended births in Ethiopia falls more heavily on young, unmarried, higher wealth, high parity, and ethnic majority women and those with less than secondary education and with large household size. These variables showed statistical significance with the outcome variable.

          Conclusion

          The study found a relatively high prevalence of unintended childbirth in Ethiopia and this implies high levels of unmet need for child spacing and limiting. There is much need for better targeted family planning programs and strategies to strengthen and improve access to contraceptive services, to raise educational levels, and related information and communication particularly for those affected groups including young, unmarried, multipara, and those with less than secondary level of education. Further quantitative and qualitative research on the consequences of unintended pregnancy and childbirth related to prenatal and perinatal outcomes are vital to document process of change in the problem overtime.

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          Most cited references33

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          Low use of contraception among poor women in Africa: an equity issue.

          To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.
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            Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya

            Background The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15–19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008–09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi. Methods This study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15–49 years in Nairobi. The data was analyzed using simple percentages and logistic regression. Results The study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15–19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in non-slum settlements were significantly more likely to experience unintended pregnancy than their counterparts in slum settlements. The determinants of unintended pregnancy differed between women in each type of settlement. Among slum women, age, parity and marital status each had significant net effect on unintended pregnancy. But for non-slum women, it was marital status and ethnicity that had significant net effects. Conclusion The study found a high prevalence of unintended pregnancy among the study population and indicated that young and unmarried women, irrespective of their educational attainment and household wealth status, have a higher likelihood of experiencing unintended pregnancy. Except for the results on educational attainments and household wealth, these results compared well with the results reported in the literature. The results indicate the need for effective programs and strategies to increase access to contraceptive services and related education, information and communication among the study population, particularly among the young and unmarried women. Increased access to family planning services is key to reducing unintended pregnancy among the study population. This calls for concerted efforts by all the stakeholders to improve access to family planning services among the study population. Increased access should be accompanied with improvement in the quality of care and availability of information about effective utilization of family planning methods.
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              Married women's decision making power on modern contraceptive use in urban and rural southern Ethiopia

              Background Women in developing countries are either under collective decision making with their partners or completely rely on the male partner's decision on issues that affect their reproductive live. Identifying the major barriers of married women's decision making power on contraceptive use has significant relevance for planning contextually appropriate family planning interventions. The objective of this study was to determine current modern contraceptive practices and decision making power among married women in Tercha Town and surrounding rural areas of Dawro zone, Southern Ethiopia. Methods Community based comparative cross-sectional design with both quantitative and Qualitative study has been employed in March and April 2010. The respondents were 699 married women of child bearing age from urban and rural parts of Dawro zone. After conducting census, we took the sample using simple random sampling technique. Results Current modern contraceptive use among married women in the urban was 293 (87.5%) and 243 (72.8%) in rural. Married women who reside in urban area were more likely to decide on the use of modern contraceptive method than rural women. Having better knowledge about modern contraceptive methods, gender equitable attitude, better involvement in decisions related to children, socio-cultural and family relations were statistically significant factors for decision making power of women on the use of modern contraceptive methods in the urban setting. Better knowledge, fear of partner's opposition or negligence, involvement in decisions about child and economic affairs were statistically significant factors for better decision making power of women on the use of modern contraceptive methods in the rural part. Conclusions High level of current modern contraceptive practice with reduced urban-rural difference was found as compared to regional and national figures. Urban women had better power to make decisions on modern contraceptive than rural women. Modern family planning interventions in the area should be promoted by considering empowering of women on modern contraceptive use decision making.
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                Author and article information

                Contributors
                ytebekaw@gmail.com
                bzuhanaemro@gmail.com
                profcharlesteller@gmail.com
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                18 September 2014
                18 September 2014
                2014
                : 14
                : 1
                : 326
                Affiliations
                [ ]World Health Organization, Juba, Republic of South Sudan
                [ ]BZY Research Consult, Addis Ababa, Ethiopia
                [ ]Department of Global Health, Milken Institute of Public Health, George Washington University, Washington, DC, USA
                Article
                1202
                10.1186/1471-2393-14-326
                4190466
                25233950
                d92861b5-20cf-4d96-8ca7-83ceefc590af
                © Tebekaw et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 March 2014
                : 16 September 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Obstetrics & Gynecology
                women,unintended pregnancy,determinants
                Obstetrics & Gynecology
                women, unintended pregnancy, determinants

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