The prevalence, associated factors and coping strategies of women with unintended pregnancies attending antenatal care in Mulago Hospital
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Unintended pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. Unintended pregnancy can result in induced and spontaneous abortion or unintended birth. It is also associated with adverse prenatal behavior, bad perinatal outcomes, postpartum depression and poor child psychosocial development. The rate of unintended pregnancy in Africa was 86 per 1000 women in 2008 while in Uganda unintended births were 46% in 2006. Two thirds of these pregnancies occur as result of non-use of contraceptives while a seventh results from use of traditional methods with high pregnancy failure rates. With a high unmet need for contraception in Uganda of 41%, many women will continue to experience unintended pregnancy and its related complications. The overall life event of pregnancy is a major stressor that mediates other stressors like illness, violence and others in the environmental system that women cope with. The magnitude, associated factors and coping strategies of unintended pregnancy has not been documented in Mulago Hospital and there are no programs designed to address these women. Objectives: To determine the prevalence, associated factors and coping strategies of women with unintended pregnancy attending antenatal care in Mulago Hospital. Methods: A cross sectional study on women attending antenatal care in both New and old Mulago Hospital antenatal clinics was carried out from 1st February to 16th March 2012. A pre-tested interviewer administered questionnaire was used to interview a total of 883 antenatal mothers to obtain quantitative data and thirteen in depth interviews were done to identify coping strategies. Data was coded, cleaned, double entered into Epi-data version 3.1, and then exported xii to STATA version 10.0 for analysis. Univariate analysis was used to describe the demographic characteristics of study participants. Independent variables with P-Value of ≤0.05 were taken for bivariate analysis and those with p-value of ≤0.02 at bivariate level were taken for multivariate logistic regression to control for confounders. In depth interviews were tape recorded, transcribed, abstracted and themes of coping strategies identified. Results: The prevalence of unintended pregnancy among women attending antenatal care was found to be 29.9%. Unmarried women OR 4.26(95% CI 2.41-7.55), age at first marriage less than 20years OR 1.43(95%CI 1.01-2.02), unemployed women OR 1.4 (95% CI 1.04– 2.00), absence of outreach by family planning workers in last 12 months OR 1.57(95% CI 1.09-2.25) and use of contraception for less than a month OR 2.54 (95% CI 1.38–4.68) were associated with unintended pregnancy. Most women with unintended pregnancy use emotion focused coping strategies with a few using problem focused coping strategies. Conclusion and recommendations: These finding show that the prevalence of unintended pregnancy is high, with unmarried status, age at first marriage below 20 years, unemployed, absence of family planning outreaches and beginning of contraception being significant associated factors. Most of the women used emotion focused coping strategies which could predispose depression. Health programs should aim at identifying women with unintended pregnancy that may require supportive counseling. And delay of age at first marriage to above 20 years would reduce unintended pregnancy.