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Correlates of mistimed and unwanted pregnancy among women in the Democratic Republic of Congo

Published online by Cambridge University Press:  14 August 2019

Tara Ballav Adhikari Open the ORCID record for Tara Ballav Adhikari [Opens in a new window] ,
Pawan Acharya ,
Anupa Rijal ,
Mala Ali Mapatano  and
Arja R Aro
Tara Ballav Adhikari*
Affiliation:
Nepal Health Frontiers, Maharajgunj, Kathmandu, Nepal Department of Public Health, Aarhus University, Aarhus, Denmark
Pawan Acharya
Affiliation:
Nepal Health Frontiers, Maharajgunj, Kathmandu, Nepal
Anupa Rijal
Affiliation:
Nepal Health Frontiers, Maharajgunj, Kathmandu, Nepal Department of Regional Health Research, University of Southern Denmark, Denmark
Mala Ali Mapatano
Affiliation:
School of Public Health, University of Kinshasa, Democratic Republic of Congo
Arja R Aro
Affiliation:
Faculty of Health Sciences, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
*
*Corresponding author. Email: [email protected]
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Abstract

Unwanted and mistimed pregnancies impose threats on the health and well-being of the mother and child and limit the acquisition of optimal sexual and reproductive health services, especially in resource-constrained settings like the Democratic Republic of Congo (DRC). This study aimed to determine the prevalence and correlates of mistimed and unwanted pregnancies among women in the DRC. Data were drawn from the 2013–14 DRC Demographic Health Survey (EDS-RDC II). Bivariate and multivariate logistic regression analysis was performed to identify correlates of mistimed and unwanted pregnancies. Sequential logistic regression modelling including distal (place of residence), intermediate (socio-demographic and socioeconomic factors) and proximal (reproductive health and family planning) factors was performed using multivariate analysis. More than a quarter (28%) of pregnancies were reported as unintended (23% mistimed and 5% unwanted). Women who wanted no more children (aOR 1.21; CI: 1.01, 1.44) had less than 24 months of birth spacing (aOR 2.14; CI: 1.80, 2.54) and those who intended to use a family planning method (aOR 1.24; CI: 1.01, 1.52) reported more often that their last pregnancy was mistimed. Women with five or more children (aOR 2.13; CI: 1.30, 3.49), those wanting no more children (aOR 13.07; CI: 9.59, 17.81) and those with more than 48 months of birth spacing (aOR 2.31; CI: 1.26, 4.23) were more likely to report their last pregnancy as unwanted. The high rate of unintended pregnancies in the DRC shows the urgency to act on the fertility behaviour of women. The associated intermediate factors for mistimed and unwanted pregnancy indicate the need to accelerate family planning programmes, particularly for women of high parity and those who want no more children. Likewise, health promotion measures at the grassroots level to ensure women’s empowerment and increase women’s autonomy in health care are necessary to address the social factors associated with mistimed pregnancy.

Keywords

Unintended pregnancyReproductive healthDRC
Type
Research Article
Information
Journal of Biosocial Science , Volume 52 , Issue 3 , May 2020 , pp. 382 - 399
Copyright
© Cambridge University Press 2019

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References

Abada, T and Tenkorang, EY (2012) Women’s autonomy and unintended pregnancies in the Philippines. Journal of Biosocial Science 44(6), 703–718.CrossRefGoogle ScholarPubMed
Acharya, DR, Bhattarai, R, Poobalan, A, Teijlingen, VE and Chapman, G (2014) Factors associated with teenage pregnancy in South Asia. Health Science Journal 4(1), 3–14.Google Scholar
Acharya, P, Gautam, R and Aro, AR (2016) Factors influencing mistimed and unwanted pregnancies among Nepali women. Journal of Biosocial Science 48(2), 249–266.CrossRefGoogle ScholarPubMed
Acharya, P and Khanal, V (2015) The effect of mother’s educational status on early initiation of breastfeeding: further analysis of three consecutive Nepal Demographic and Health Surveys. BMC Public Health 15(1), 1069.CrossRefGoogle ScholarPubMed
Ali, A, Ali, SA, Aziz, AS and Khuwaja, NS (2016) Determinants of unintended pregnancy among women of reproductive age in developing countries: a narrative review. Journal of Midwifery and Reproductive Health 4(1), 513–521.Google Scholar
Arousell, J and Carlbom, A (2016) Culture and religious beliefs in relation to reproductive health. Best Practice & Research Clinical Obstetrics & Gynaecology 32, 77–87.CrossRefGoogle ScholarPubMed
Banwell, S (2014) Rape and sexual violence in the Democratic Republic of Congo: a case study of gender-based violence. Journal of Gender Studies 23(1), 45–58.CrossRefGoogle Scholar
Black, BO, Bouanchaud, PA, Bignall, JK, Simpson, E and Gupta, MJTO (2014) Reproductive health during conflict. The Obstetrician & Gynaecologist 16(3), 153–160.CrossRefGoogle Scholar
Bongaarts, J (2016) WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division trends in maternal mortality: 1990 to 2015 Geneva: World Health Organization, 2015. Population and Development Review 42(4), 726–726.CrossRefGoogle Scholar
Boonstra, D (2015) Advancing sexuality education in developing countries: evidence and implications. Guttmacher Policy Review 14(3), 17–23.Google Scholar
Bradley, SE, Croft, T and Rutstein, SO (2011) The impact of contraceptive failure on unintended births and induced abortions: estimates and strategies for reduction. DHS Analytical Studies 22, ICF Macro, Claverton, MD, USA.Google Scholar
Brown, SS and Eisenberg, L (1995) The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. National Academies Press, Washington, DC.Google Scholar
Calvert, C, Baisley, K, Doyle, AM, Maganja, K, Changalucha, J, Watson-Jones, Det al. (2013) Risk factors for unplanned pregnancy among young women in Tanzania. Journal of Family Planning and Reproductive Health Care 39(4), e2.CrossRefGoogle ScholarPubMed
D’Angelo, DV, Gilbert, BC, Rochat, RW, Santelli, JS and Herold, JM (2004) Differences between mistimed and unwanted pregnancies among women who have live births. Perspectives on Sexual and Reproductive Health 36(5), 192–197.CrossRefGoogle ScholarPubMed
Dahab, M, Charalambous, S, Karstaedt, AS, Fielding, KL, Hamilton, R, La Grange, Let al. (2010) Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study. BMC Public Health 10(1), 430.CrossRefGoogle ScholarPubMed
Dahlgren, G and Whitehead, M (1991) Policies and strategies to promote social equity in health. Background document to WHO – Strategy paper for Europe. Working paper, Stockholm Institute for Future Studies. URL: https://core.ac.uk/download/pdf/6472456.pdf (accessed 25 July 2019)Google Scholar
Dhakal, S, Song, JS, Shin, DE, Lee, TH, So, AY and Nam, EW (2016) Unintended pregnancy and its correlates among currently pregnant women in the Kwango District, Democratic Republic of the Congo. Reproductive Health 13(1), 74.CrossRefGoogle ScholarPubMed
Dutta, M, Shekhar, C and Prashad, L (2015) Level, trend and correlates of mistimed and unwanted pregnancies among currently pregnant ever married women in India. PloS One 10(12), e0144400.CrossRefGoogle ScholarPubMed
Exavery, A, Kanté, AM, Njozi, M, Tani, K, Doctor, HV, Hingora, A and Phillips, JF (2014) Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reproductive Health 11(1), 63.CrossRefGoogle ScholarPubMed
Exavery, A, Mrema, S, Shamte, A, Bietsch, K, Mosha, D, Mbaruku, G and Masanja, H (2012) Levels and correlates of non-adherence to WHO recommended inter-birth intervals in Rufiji, Tanzania. BMC Pregnancy and Childbirth 12(1), 152.CrossRefGoogle ScholarPubMed
Gipson, JD, Koenig, MA and Hindin, MJ (2008) The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Studies in Family Planning 39(1), 18–38.CrossRefGoogle ScholarPubMed
Guengant, JP and May, JF (2013) African demography. Global Journal of Emerging Market Economies 5(3), 215–267.CrossRefGoogle Scholar
Habte, D, Teklu, S, Melese, T and Magafu, MG (2013) Correlates of unintended pregnancy in Ethiopia: results from a national survey. PloS One 8(12), e82987.CrossRefGoogle ScholarPubMed
Hall, JA, Barrett, G, Phiri, T, Copas, A and Stephenson, J (2016) Prevalence and determinants of unintended pregnancy in Mchinji District, Malawi: using a conceptual hierarchy to inform analysis. PloS One 11(10), e0165621.CrossRefGoogle ScholarPubMed
Hall, JA, Stephenson, J, and Barrett, G (2019) On the stability of reported pregnancy intentions from pregnancy to 1 year postnatally: impact of choice of measure, timing of assessment, women’s characteristics and outcome of pregnancy. Maternal and Child Health Journal 23(9), 1177–1186.CrossRefGoogle ScholarPubMed
Ikamari, L, Izugbara, C and Ochako, R (2013) Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya. BMC Pregnancy and Childbirth 13(1), 69.CrossRefGoogle ScholarPubMed
Johnson-Mallard, V, Kostas-Polston, EA, Woods, NF, Simmonds, KE, Alexander, IM and Taylor, D (2017) Unintended pregnancy: a framework for prevention and options for midlife women in the US. Women’s Midlife Health 3(1), 8.CrossRefGoogle ScholarPubMed
Kassa, N, Berhane, Y and Worku, A (2012) Predictors of unintended pregnancy in Kersa, Eastern Ethiopia, 2010. Reproductive Health 9(1), 1.CrossRefGoogle Scholar
Klima, CS (1998) Unintended pregnancy: consequences and solutions for a worldwide problem. Journal of Midwifery & Women’s Health 43(6), 483–491.Google ScholarPubMed
Koren, A and Mawn, B (2010) The context of unintended pregnancy among married women in the USA. Journal of Family Planning and Reproductive Health Care 36(3), 150–158.CrossRefGoogle ScholarPubMed
Kott, A (2011) Rates of unintended pregnancy remain high in developing regions. International Perspectives on Sexual and Reproductive Health 37(1), 46.Google Scholar
Kramer, MR, Hogue, CJR and Gaydos, LM (2007) Noncontracepting behavior in women at risk for unintended pregnancy: what’s religion got to do with it? Annals of Epidemiology 17(5), 327–334.CrossRefGoogle Scholar
Lusey, H, San Sebastian, M, Christianson, M, Dahlgren, L and Edin, KE (2014) Conflicting discourses of church youths on masculinity and sexuality in the context of HIV in Kinshasa, Democratic Republic of Congo. Sahara Journal 11, 84–93.CrossRefGoogle Scholar
Ministère De La Santé Publique (MSP) and ICF International (2014) Democratic Republic of Congo Demographic and Health Survey 2013–14: Key Findings. MPSMRM, MSP and ICF International, Rockville, MD, USA.Google Scholar
Moreau, C, Hall, K, Trussell, J and Barber, J (2013) Effect of prospectively measured pregnancy intentions on the consistency of contraceptive use among young women in Michigan. Human Reproduction 28(3), 642–650.CrossRefGoogle ScholarPubMed
Mukaba, T, Binanga, A, Fohl, S and Bertrand, JT (2015) Family planning policy environment in the Democratic Republic of the Congo: levers of positive change and prospects for sustainability. Global Health: Science and Practice 3(2), 163–173.Google ScholarPubMed
Ndziessi, GBM and Kaboru, BB (2016) Unintended pregnancies and associated factors among contraceptive users: a study from referral hospitals in Brazzaville, Republic of Congo. SM Journal of Community Medicine 2(1), 7.Google Scholar
O’Brien, GD (2010) The Church and Abortion: A Catholic Dissent. Rowman & Littlefield Publishers, MD, USA.Google Scholar
Okonofua, FE, Odimegwu, C, Ajabor, H, Daru, PH and Johnson, A (1999) Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria. Studies in Family Planning 30(1), 67–77.CrossRefGoogle ScholarPubMed
Pallitto, CC, Campbell, JC and O’Campo, P (2005) Is intimate partner violence associated with unintended pregnancy? A review of the literature. Trauma, Violence, & Abuse 6(3), 217–235.CrossRefGoogle ScholarPubMed
Pitblado, J (2009) Survey data analysis in Stata. Paper presented at the Canadian Stata Users Group Meeting. URL: https://econpapers.repec.org/paper/boccsug09/07.htm (accessed 11 July 2018)Google Scholar
Plummer, ML, Wamoyi, J, Sshigongo, Z, Mshana, G, Obasi, AI, Ross, DA and Wight, D (2010) “Seek any means, and keep it your secret”: young women’s attempts to control their reproduction through contraceptive and fertility practices in rural Tanzania. Tanzania Journal of Health Research 12(3), 1–17.Google Scholar
Ramarao, S, Townsend, J and Askew, I (2006) Correlates of inter-birth intervals: implications of optimal birth spacing strategies in Mozambique. Frontiers in Reproductive Health, Population Council, Washington, DC.Google Scholar
Rice, WS, Turan, B, Stringer, KL, Helova, A, White, K, Cockrill, K and Turan, JM (2017) Norms and stigma regarding pregnancy decisions during an unintended pregnancy: development and predictors of scales among young women in the US South. PloS One 12(3), e0174210.CrossRefGoogle Scholar
Romaniuk, A (2011) Persistence of high fertility in tropical Africa: the case of the Democratic Republic of the Congo. Population and Development Review 37(1), 1–28.CrossRefGoogle ScholarPubMed
Rosenzweig, MR and Wolpin, KI (1993) Maternal expectations and ex post rationalizations: the usefulness of survey information on the wantedness of children. Journal of Human Resources 28(2) 205–229.CrossRefGoogle Scholar
Santelli, J, Rochat, R, Hatfield‐Timajchy, K, Gilbert, BC, Curtis, K, Cabral, Ret al. (2003) The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health 35(2), 94–101.CrossRefGoogle ScholarPubMed
Santelli, JS, Lindberg, LD, Orr, MG, Finer, LB and Speizer, I (2009) Toward a multidimensional measure of pregnancy intentions: evidence from the United States. Studies in Family Planning 40(2), 87–100.CrossRefGoogle Scholar
Sedgh, G, Bankole, A, Oye-Adeniran, B, Adewole, IF, Singh, S and Hussain, R (2006) Unwanted pregnancy and associated factors among Nigerian women. International Family Planning Perspectives 32(4)175–184.CrossRefGoogle ScholarPubMed
Sedgh, G, Singh, S and Hussain, R (2014) Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in Family Planning 45(3), 301–314.CrossRefGoogle ScholarPubMed
Singh, A, Singh, A and Mahapatra, B (2013) The consequences of unintended pregnancy for maternal and child health in rural India: evidence from prospective data. Maternal and Child Health Journal 17(3), 493–500.CrossRefGoogle ScholarPubMed
Singh, S, Bankole, A and Woog, V (2005) Evaluating the need for sex education in developing countries: sexual behaviour, knowledge of preventing sexually transmitted infections/HIV and unplanned pregnancy. Sex Education 5(4), 307–331.CrossRefGoogle Scholar
Sonfield, A, Kost, K, Gold, RB and Finer, LB (2011) The public costs of births resulting from unintended pregnancies: national and state‐level estimates. Perspectives on Sexual and Reproductive Health 43(2), 94–102.CrossRefGoogle ScholarPubMed
Tiruneh, FN, Chuang, K-Y, Ntenda, PA and Chuang, Y-C (2017) Unwanted pregnancy, pregnancy loss, and other risk factors for intimate partner violence in the Democratic Republic of the Congo. Women & Health 58(9), 983–1000.CrossRefGoogle ScholarPubMed
Trussell, J, Henry, N, Hassan, F, Prezioso, A, Law, A and Filonenko, A (2013) Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception. Contraception 87(2), 154–161.CrossRefGoogle ScholarPubMed
Uganda Bureau of Statistics and ICF International (2012) Uganda Demographic and Health Survey 2011. UOBS, Kampala, Uganda, and ICF International Inc., Claverton, MD, USA.Google Scholar
Van De Walle, EJD (1992) Fertility transition, conscious choice, and numeracy. Demography 29(4), 487–502.CrossRefGoogle ScholarPubMed
Yazdkhasti, M, Pourreza, A, Pirak, A and Abdi, F (2015) Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iranian Journal of Public Health 44(1), 12.Google ScholarPubMed