Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?

Abstract

Objectives: The study aimed to estimate the proportion of unplanned pregnancies among mothers delivering at the referral Harare Hospital and to describe their levels of contraceptive use and awareness in relation to the planning of pregnancy.

Design: Systematic sample of mothers who had just delivered identified through maternity delivery, records. The study was analysed as a case-referent study where cases where mothers who had unintended pregnancies and those with intended or planned pregnancies served as referents.

Setting: Postnatal wards of Harare Maternity Hospital.

Subjects: 923 mothers following delivery.

Main outcome measures: Socio-demographic characteristics, pregnancy planning, contraceptive history and contraceptive knowledge.

Results: Of the 923 deliveries studied, 377 (41%) were unintended (cases), of which 9% were unwanted. Mothers aged 19 years or below (Odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.6 to 3.7) and those aged 35 years or above (OR = 3.2, 95% CI = 1.8 to 5.5) were significantly more likely to report the index pregnancy as having been unintended. Nulliparous (OR = 2.4) and parity five or more (OR = 8.2) mothers were at significantly increased risk of unintended pregnancy. Mothers presenting with unintended pregnancies were also significantly more likely to be single (OR = 7.8), divorced/separated or widowed (OR = 6.0). Contraceptive ever use was 53% and 58% in cases and referents, respectively. The combined oral contraceptive pill was the most commonly known and used method of contraception. Contraceptive failure was reported by 23% of mothers with unplanned pregnancies. Previous use of the progesterone only pill (OR = 2.2), the condom (OR = 2.3) or the IUCD (OR = 6.3) were significantly associated with the likelihood of reporting with unplanned pregnancy. Mothers in both groups were concerned about contraceptive method failure, irregular menstruation and perceived subsequent infertility with contraception. Failure to discuss family planning with the male partner (OR = 2.3) or partner refusing use of contraception (OR = 2.8) constituted risk factors for unplanned pregnancy.

Conclusion: Results point to the need for wider contraceptive counselling and provisions which encourage and involve the male partner. Programmes for reproductive health services and education should target women in identified high risk circumstances.