Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis
To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries.
A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics.
A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25–39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted).
Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.
KeywordsUnintended pregnancy Maternal healthcare services use Low- and lower-middle-income countries Systematic review and meta-analysis
We acknowledge the support of the Priority Research Centre for Generational Health and Aging, a member of the Hunter Medical Research Institute, Australia, where this research was conducted.
MNK., MLH., and DL developed the study concept. MNK, DMS, and AL reviewed the articles independently, extracted data, and assessed study quality. MNK conducted the formal analysis and drafted the manuscript. MLH and DL critically reviewed the manuscript. All authors approved the final version of this manuscript.
The first author is supported by a PhD research scholarship from the University of Newcastle, Australia. Dr Melissa L. Harris is supported by an Australian Research Council Discovery Early Career Research Award.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Availability of data and material
Associated data of this study are available upon submitting a reasonable request to the corresponding author.
- Abosse Z, Woldie M, Ololo S (2010) Factors influencing antenatal care service utilization in hadiya zone. Ethiop J Health Sci 20:75–82Google Scholar
- Chompikul J, Isaranurug S (2008) Factors related to the utilization of antenatal care services among pregnant women at health centers in Aceh Besar district, Nanggroe Aceh Darussalam province, Indonesia. J Publ Health Dev 6:99–108Google Scholar
- Feyisso M, Girma A, Yimam H, Hailu S (2017) Magnitude of unintended pregnancy and its determinants among pregnant women visiting Dilla University Referral Hospital, South Ethiopia. J Women’s Health Care 6:2167-0420Google Scholar
- Green S, Higgins J (2005) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration and John Wiley & Sons Ltd, ChichesterGoogle Scholar
- Herrera CA et al (2017) Governance arrangements for health systems in low-income countries: an overview of systematic reviews. The Cochrane Library, LondonGoogle Scholar
- Hunt P, Bueno de Mesquita J (2007) Reducing maternal mortality: the contribution of the right to the highest attainable standard of health. The University of Essex, United KingdomGoogle Scholar
- Kuzara J, Woodriff Sprinkel A, Mekuria FT, Rubardt M, Maguiraga F, Sissoko K, Hastings P (2018) Addressing social and gender norms to improve uptake of maternal health services in Mali: a descriptive study of CARE’s Project Hope for Mothers and Newborns (PEMN). Culture Health Sex 20:1–14CrossRefGoogle Scholar
- Nair M, Ariana P, Webster P (2012) What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India. Rural Remote Health 12:2311Google Scholar
- Pantoja T et al (2017) Implementation strategies for health systems in low-income countries: an overview of systematic reviews. The Cochrane Library, LondonGoogle Scholar
- Regassa N (2011) Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. Afr Health Sci 11(3):390–397Google Scholar
- UN (2015) Transforming our world: the 2030 agenda for sustainable development. United Nations, New YorkGoogle Scholar
- UN (2018) Millennium Development Goals (MDGs) The United Nation, USA Retrieved 10 June 2017 from http://www.whoint/news-room/fact-sheets/detail/millennium-development-goals-(mdgs)
- WHO (2015) State of inequality: reproductive, maternal, newborn and child health. The World Health Organization, GenevaGoogle Scholar
- WHO (2016) New guidelines on antenatal care for a positive pregnancy experience. The world health Organization, Geneva, Swezarland Accessed from https://www.whoint/reproductivehealth/news/antenatal-care/en/. 1 Jan 2019
- WHO (2018a) Maternal Mortality. The world health Organization, Geneva, Swezarland Accessed from http://www.whoint/news-room/fact-sheets/detail/maternal-mortalityon. 10 Oct 2018
- WHO (2018b) New borns: Reducing mortality. The world health Organization, Geneva, Swezarland Accessed from http://www.whoint/news-room/fact-sheets/detail/newborns-reducing-mortality. 20 Oct 2018
- World Bank (2017) World Bank Country and Lending Groups: Country Classification. URL: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed 8 Oct 2018
- Zegeye K, Gebeyehu A, Melese T (2014) The role of geographical access in the Utilization of institutional delivery service in rural Jimma Horro District, Southwest Ethiopia. Primary Health Care 4(2167–1079):1000150Google Scholar