Menu
Menu
Menu
Menu
Unintended pregnancy is a major driver of poor maternal and child health in resource-limited settings. Data on pregnancy intention and use of family planning (FP) is scarce in Papua New Guinea (PNG), but are needed to inform public health strategies to improve FP accessibility and uptake. Data from a facility-based cross-sectional sample of 699 pregnant women assessed prevalence and predictors of unintended pregnancy and modern FP use among pregnant women in East New Britain Province, PNG. More than half (55%) the women reported their pregnancy as unintended. Few (18%) reported ever having used a modern FP method, and knowledge of different methods was low. Being single, separated or divorced (AOR 9.66; 95% CI 3.27–28.54), educated to a tertiary or vocational level (AOR 1.78 CI 1.15–2.73), and gravidity > 1 (AOR 1.43 for each additional pregnancy CI 1.29–1.59) were associated with unintended pregnancy; being accompanied by a male partner to ANC was associated with a reduced unintended pregnancy (0.46 CI 0.30–0.73). Factors associated with modern FP use included male partner involvement (AOR 2.26 CI 1.39–3.67) and gravidity > 1 (AOR 1.54 for each additional pregnancy CI 1.36–1.74). FP use also varied by the facility women attended. Findings highlight an urgent need for targeted interventions to improve FP knowledge, uptake and access, and male partner involvement, to reduce unintended pregnancies and their complications.
This study included analysis of cross-sectional baseline data from a larger prospective observational cohort study of pregnancy and childbirth undertaken in ENB Province, by a multi-partner research program led by the Burnet Institute with the PNG Institute of Medical Research, the ENB Provincial Health Office (now Provincial Health Authority) and the Kirby Institute of the University of New South Wales, Sydney. Input from relevant national and local stakeholders, including policy-makers, medical specialists, and healthcare workers at all levels, was sought during 2013 and 2014 to inform the design of the study. This paper reports on interview data relevant to FP collected at the enrolment contact point at the first ANC visit. ENB Province is located in the Islands Region of PNG. According to the 2011 census, ENB had a population of 328,369 and a population growth rate of 3.6% between 2000 and 201123. The province is predominantly rural, reflecting PNG’s national profile wherein 87% of the PNG population reside in rural areas24, with two small urban centres (populations estimated at close to 32,000 (Kokopo) and 5000 (Rabaul)23). Pregnant women of any gravidity attending their first ANC visit were recruited from five healthcare facilities located in three of the four districts in ENB (Gazelle, Kokopo and Rabaul) where 78% of the provincial population resides23. They comprise a mix of two government and three church-run facilities and are the busiest providers of reproductive health services in these adjoining districts, accounting for over 75% of antenatal services, based on information provided by the Provincial Health Office in 2014. Nonga General Hospital is the government referral hospital for the province, and is located near Rabaul township. The government-run Kerevat Rural Hospital is the most remotely located of the participating facilities and is administered by the Gazelle District Health Administration. Saint Mary’s Hospital Vunapope, and Napapar and Paparatava Health Centres are administered by Catholic Health Services, PNG, under the Gazelle District Health Administration. Vunapope is located in the town of Kokopo, the capital and largest urban centre in ENB, whereas Napapar and Paparatava are smaller, rural facilities. Women were enrolled between March 2015 and June 2017. A target sample size of 700 was set by the larger cohort study’s parameters needed to assess predictors of low birth weight. Recruitment aimed for a representative sample of pregnant women attending ANC who were selected randomly (by rolling dice) with spacing to ensure both early and late attendees were invited. Women had to meet the following eligibility criteria; (1) age of 16 years or older; (2) attending ANC for the first time for the current pregnancy; (3) residing within the catchment area of the healthcare facility; (4) intending to live in ENB for the subsequent 12 months; (5) agree to participate in the study. Written informed consent was obtained from all study participants. A questionnaire with a mix of closed and open-ended questions was drafted in English and translated into Tok Pisin language, the most widely spoken national language of PNG. It was administered using electronic handheld devices by research officers of PNG nationality, trained in clinical interview techniques, using a private location at each facility to ensure confidentiality. Outcome measures of pregnancy intention and FP use were adapted from standard FP items in the DHS women’s questionnaire25, and modified to the PNG context after pre-testing (including revision to include contraceptive methods currently available). Women could report their current pregnancy as either (1) mistimed (i.e., wanting to be pregnant later, but not at this time), (2) unwanted (i.e., not wanting to be pregnant at all) or (3) wanted; a pregnancy was considered unintended if it was mistimed or unwanted26. Women were asked if they had ever used FP, and if so, without prompting, were asked to recall all methods (modern and/or traditional) that they had ever used. Modern and traditional methods of FP were defined using World Health Organization classifications27 with modern methods comprising: oral contraceptive pills, implants, injectables (Depo Provera), female sterilisation, male sterilisation, intra-uterine devices, diaphragm, emergency contraception, male and female condoms. Exposure measures comprised of questions relating to socio-demographic characteristics, male partner involvement in ANC, pregnancy history, and knowledge of FP methods. Male partner involvement was assessed by asking women whether their husband/male partner was in attendance at ANC that day, and if not, whether he would have liked to attend. Questions relating to pregnancy history (pregnancy number and number of years since the previous pregnancy) included all previous pregnancies regardless of outcome. Similar to questions on FP use, without prompting, women were asked to recall all methods of FP of which they were aware. Open-ended questions asked women to give opinions on barriers to accessing FP services if they reported that access to FP was sometimes a problem, or if they were unsure if access was difficult. They were also asked to provide reasons for non-use of FP if they reported never having used any method of FP. Research officers selected from a list of standardised response options those that best matched the woman’s answer/s, with multiple response options allowed. If a participant’s response differed from the standardised list this was captured as a free-text entry. Bivariate and multivariable logistic regression explored correlates of unintended pregnancy and lifetime use of a modern method/s of FP. Variables of interest were chosen for multivariable analyses a priori and included healthcare facility of recruitment and variables cited in the literature to be associated with these outcomes of interest (marital status, indicators of socio-economic status and gravidity21,22,28) and variables hypothesised to have an association (male involvement in ANC and reporting difficulty accessing FP). Due to collinearity between participant educational level, male partner educational level, participant employment status, male partner employment status and monthly household expenditure, only participant educational level was included in the final multivariable model. Similarly, due to collinearity between age and gravidity, only gravidity was included in the final models. All analyses were performed using STATA version 13.0 (StataCorp, TX, USA). Approval for the study protocol was granted in PNG by the Papua New Institute of Medical Research’s Institutional Review Board (14.11), the National Department of Health Medical Research Advisory Committee (14.27), and in Australia by the Alfred Hospital Human Research Ethics Committee (348/18). Approval to conduct the study was obtained from the Provincial Executive Committee of the East New Britain Provincial Government, and the individual health centres involved. Key considerations were to ensure written informed consent using local language forms and detailed explanations, minimisation of discomfort during data collection, and assurance of confidentiality through use of non-identifiable study identifiers; there was separate, limited, controlled access to any identifying information required for follow-up. Independent contact points for complaints or adverse event reporting were publicised and maintained by the Burnet Institute and PNG Institute of Medical Research. All study participants provided written informed consent. All study procedures were performed in accordance with relevant guidelines and regulations.
N/A
