Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan.
BACKGROUND
Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP).


METHODS
We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP.


RESULTS
Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age < 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = < 12 months (AOR 1.7 1.4-2.2), having a parity of >2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach's alpha of 0.85.


CONCLUSIONS
This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan.
['Habib|Muhammad Atif|MA|', 'Raynes-Greenow|Camille|C|', 'Nausheen|Sidrah|S|', 'Soofi|Sajid Bashir|SB|', 'Sajid|Muhammad|M|', 'Bhutta|Zulfiqar A|ZA|', 'Black|Kirsten I|KI|']
D000328:Adult D003267:Contraception D003268:Contraception Behavior D003430:Cross-Sectional Studies D005193:Family Planning Services D005260:Female D006801:Humans D010154:Pakistan D011247:Pregnancy D049168:Pregnancy, Unplanned D011275:Pregnancy, Unwanted D011295:Prenatal Care D015995:Prevalence D012307:Risk Factors D011795:Surveys and Questionnaires D062606:Tertiary Care Centers D055815:Young Adult
Unintended pregnancies Pakistan London measure of unplanned pregnancies Contraceptive methods Family planning