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Background: The benefits of maternal health care to maternal and neonatal health outcomes have been well documented. Antenatal care attendance, institutional delivery and skilled attendance at delivery all help to improve maternal and neonatal health. However, use of maternal health services is still very low in developing countries with high maternal mortality including Ethiopia. This study examines the association of unintended Pregnancy with the use of maternal health services in Southwestern Ethiopia. Methods. Data for this study come from a survey conducted among 1370 women with a recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern Ethiopia. An interviewer administered questionnaire was used to gather data on maternal health care, pregnancy intention and other explanatory variables. Data were analyzed using STATA 11, and both bivariate and multivariate analyses were done. Multivariate logistic regression was used to assess the association of pregnancy intention with the use of antenatal and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported. Results: More than one third (35%) of women reported that their most recent pregnancy was unintended. With regards to maternal health care, only 42% of women made at least one antenatal care visit during pregnancy, while 17% had four or more visits. Institutional delivery was only 12%. Unintended pregnancy was significantly (OR: 0.75, 95% CI, 0.58-0.97) associated with use of antenatal care services and receiving adequate antenatal care (OR: 0.67, 95% CI, 0.46-0.96), even after adjusting for other socio-demographic factors. However, for delivery care, the association with pregnancy intention was attenuated after adjustment. Other factors associated with antenatal care and delivery care include women’s education, urban residence, wealth and distance from health facility. Conclusions: Women with unintended pregnancies were less likely to access or receive adequate antenatal care. Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women’s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care. © 2013 Wado et al.; licensee BioMed Central Ltd.
This is a cross-sectional study conducted in Gilgel Gibe Health and Demographic Surveillance System (HDSS) in Jimma zone, Southwestern Ethiopia, which is located at 260 kilometers to the southwest of Addis Ababa. The study population was women, of age 15–49 years, with a live birth in the two years before the survey (March 2012). The HDSS at the Gilgel Gibe site in southwestern Ethiopia is used to collect vital events data by Jimma University. Accordingly, data on all births occurring in the site is collected through an update of multiple times in a year. Participants were then drawn from eleven sub-districts (kebelesa) in HDSS using a simple random sampling procedure. In this HDSS area consisting of over 55,000 people, there were 3293 women with a live birth in the 2 years before the survey date, of which 1456 were randomly selected for the present study. A sample size of 1456 was calculated for the study using two population proportion formula, assumptions of the prevalence of ANC use (50%) and difference of 8% between women with intended and unintended pregnancies, and power of 80%. Data were collected by ten trained female data collectors who had a diploma level training and experience in data collection. They were closely supervised by supervisors who had better experience in data collection. The data collectors had five days of training on how to administer the questionnaire including practice interviewing, role playing and addressing ethical issues. After the training, a pilot study was done and information from the pilot study was used to finalize the questionnaire. A structured questionnaire originally developed in English and translated to local language (Oromo) was used to collect data. Data on maternal health care, pregnancy intention and other explanatory variables were gathered using interviewer administered structured questionnaire. Ethical approval was obtained from the College of Health Sciences, Addis Ababa University. Moreover, participants were asked for informed consent, and participation in the study was fully voluntary. Consent form was translated to local language (Oromo) and was read to every participant before starting the interview. In this study, maternal health care refers to the use of antenatal care during pregnancy and delivery at a health facility. Women were asked whether they have used any antenatal care during their most recent pregnancy and whether they delivered at a health facility. The two variables were measured on a binary scale as ‘yes’ for those who used the services, and ‘no’ for those who did not use the services. For antenatal care, we examined two measures of women’s use of antenatal care. The first is receiving any antenatal care, named hereafter as ‘antenatal care use’. The second is making adequate number of antenatal care visits – defined based on recommendations from a World Health Organization (WHO) which stated that a woman without complications should have at least four antenatal care visits, the first of which should take place during the first trimester. The key independent variables were measured in the following ways. Pregnancy intention was measured using the standard DHS approach, which asks women to recall their feelings at the time they became pregnant; “At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?”. The responses are: (1) wanted then “intended”, (2) wanted to happen later “mistimed”; (3) did not want at all “unwanted”. Mistimed and unwanted pregnancies were then grouped together as “unintended pregnancies”. Other explanatory variables included age (coded as 15–24, 25–34 and 35–49), women’s education (coded as no education, primary and secondary and above), place of residence, wealth index, distance from health facility, presence of pregnancy related morbidity, parity, ever use of modern family planning and time of pregnancy recognition. The wealth index was computed from ownership of the following household assets: radio, television, electricity, refrigerator, toilet, farm land, and quantity of animals such as cattle, sheep, and goats. Principal Component Analysis (PCA) was run, and four principal components with eigenvalues greater than one were summed to obtain wealth index values [39]. The resulting index was then divided into three categories representing poor, middle and wealthy. Distance from health facility was asked in walking hours or minutes; ‘How long it takes to walk on foot from their home to the nearest health facility providing maternal health services?’. Moreover, women were asked whether they have experienced any illness during pregnancy. Time of pregnancy recognition refers to the approximate gestational age at which the women found out that she was pregnant. Similarly, women’s participation in decision making was measured by asking the following questions; “who makes decisions in your household about: (1) obtaining health care for yourself; (2) large household purchases; (3) household purchases for daily needs; and (4) visits to family or relatives?”. The responses were: (1) respondent alone, (2) respondent and husband/partner, (3) husband/partner alone, (4) someone else. Women are considered to participate in a decision if they usually make that decision alone or jointly with their husbands. Then a composite index was constructed by grouping women into two categories: women who have any say (alone or jointly) in all four household decisions, indicating a higher level of empowerment, and women who do not have any say in one or more decisions. Data were analyzed using STATA software version 11. First, a descriptive analysis of the characteristics of study population was made. Bivariate analysis was done to compare use of maternal health care among different groups using chi-square test. Multivariate logistic regression was done to identify factors that are independently and significantly associated with use of antenatal care and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported. Multicollinearity of variables was checked using variance inflation factor.
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