Advertisement

International Journal of Public Health

, Volume 64, Issue 5, pp 743–754 | Cite as

Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis

  • Md Nuruzzaman KhanEmail author
  • Melissa L. Harris
  • Desalegn Markos Shifti
  • Alexander Suuk Laar
  • Deborah Loxton
Review

Abstract

Objectives

To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries.

Methods

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.

Results

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).

Conclusions

Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.

Keywords

Unintended pregnancy Maternal healthcare services use Low- and lower-middle-income countries Systematic review and meta-analysis 

Notes

Acknowledgements

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.

Authors’ Contribution

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.

Funding

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.

Supplementary material

38_2019_1238_MOESM1_ESM.docx (176 kb)
Supplementary material 1 (DOCX 153 kb)

References

  1. Abosse Z, Woldie M, Ololo S (2010) Factors influencing antenatal care service utilization in hadiya zone. Ethiop J Health Sci 20:75–82Google Scholar
  2. Achyut P, Mishra A, Montana L, Sengupta R, Calhoun LM, Nanda P (2015) Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India. J Fam Plann Reprod Health Care 42:107–115CrossRefGoogle Scholar
  3. Ali SA, Tikmani SS, Qidwai W (2016) Prevalence and determinants of unintended pregnancy: systematic review. Middle East J Fam Med 14:37CrossRefGoogle Scholar
  4. Amo-Adjei J, Tuoyire DA (2016) Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub-Saharan Africa: a multicountry analysis of demographic and health survey data. Tropical Med Int Health 21:1552–1561CrossRefGoogle Scholar
  5. Barrett G, Wellings K (2002) What is a ‘planned’pregnancy? Empirical data from a British study. Soc Sci Med 55:545–557CrossRefGoogle Scholar
  6. Bassani DG, Surkan PJ, Olinto MTA (2009) Inadequate use of prenatal services among Brazilian women: the role of maternal characteristics. Int Perspect Sex Reprod Health 35:15–20CrossRefGoogle Scholar
  7. Bearak J, Popinchalk A, Alkema L, Sedgh G (2018) Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health 6:e380–e389CrossRefGoogle Scholar
  8. Bitew T, Hanlon C, Kebede E, Honikman S, Onah MN, Fekadu A (2017) Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia. BMC Pregnancy Childbirth 17:206CrossRefGoogle Scholar
  9. Chao F, You D, Pedersen J, Hug L, Alkema L (2018) National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment. The Lancet Global Health 6:e535–e547CrossRefGoogle Scholar
  10. 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
  11. Cripe SM, Sanchez SE, Perales MT, Lam N, Garcia P, Williams MA (2008) Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru. Int J Gynecol Obstet 100:104–108CrossRefGoogle Scholar
  12. Dahiru T, Oche OM (2015) Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria. Pan Afr Med J 21:321CrossRefGoogle Scholar
  13. Dansereau E et al (2016) Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries. BMC Pregnancy Childbirth 16:234CrossRefGoogle Scholar
  14. Dibaba Y, Fantahun M, Hindin MJ (2013) The effects of pregnancy intention on the use of antenatal care services: systematic review and meta-analysis. Reprod Health 10:50CrossRefGoogle Scholar
  15. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463CrossRefGoogle Scholar
  16. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRefGoogle Scholar
  17. 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
  18. Fullman N et al (2018) Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. The Lancet 391:2236–2271CrossRefGoogle Scholar
  19. Green S, Higgins J (2005) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration and John Wiley & Sons Ltd, ChichesterGoogle Scholar
  20. Guliani H, Sepehri A, Serieux J (2013) Determinants of prenatal care use: evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America. Health Policy Plan 29:589–602CrossRefGoogle Scholar
  21. Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan_Koru JA, Stevenson R, Brandes N, Baqui AH (2014) Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS ONE 9:e101893CrossRefGoogle Scholar
  22. Herrera CA et al (2017) Governance arrangements for health systems in low-income countries: an overview of systematic reviews. The Cochrane Library, LondonGoogle Scholar
  23. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557CrossRefGoogle Scholar
  24. 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
  25. Islam M (2007) The safe motherhood initiative and beyond. Bull World Health Organ 85(10):735CrossRefGoogle Scholar
  26. Kanté AM, Chung CE, Larsen AM, Exavery A, Tani K, Phillips JF (2015) Factors associated with compliance with the recommended frequency of postnatal care services in three rural districts of Tanzania. BMC Pregnancy Childbirth 15:341CrossRefGoogle Scholar
  27. Kaufmann RB, Morris L, Spitz AM (1997) Comaparison of two question sequences for assessing pregnancy intentions. Am J Epidemiol 145:810–816CrossRefGoogle Scholar
  28. Kuuire VZ et al (2017) Timing and utilisation of antenatal care service in Nigeria and Malawi. Global Public Health 12:711–727CrossRefGoogle Scholar
  29. 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
  30. Mahler H (1987) The safe motherhood initiative: a call to action. Lancet (London, England) 1:668CrossRefGoogle Scholar
  31. Modesti PA et al (2016) Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS ONE 11:e0147601CrossRefGoogle Scholar
  32. Mohan D, Gupta S, LeFevre A, Bazant E, Killewo J, Baqui AH (2015) Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey. BMC Pregnancy Childbirth 15:282CrossRefGoogle Scholar
  33. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefGoogle Scholar
  34. 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
  35. Ochako R, Gichuhi W (2016) Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya. Reprod Health 13:51CrossRefGoogle Scholar
  36. Pallitto CC, Campbell JC, O’Campo P (2005) Is intimate partner violence associated with unintended pregnancy? A review of the literature. Trauma, Violence Abuse 6:217–235CrossRefGoogle Scholar
  37. Pantoja T et al (2017) Implementation strategies for health systems in low-income countries: an overview of systematic reviews. The Cochrane Library, LondonGoogle Scholar
  38. Paredes I, Hidalgo L, Chedraui P, Palma J, Eugenio J (2005) Factors associated with inadequate prenatal care in Ecuadorian women. Int J Gynecol Obstet 88:168–172CrossRefGoogle Scholar
  39. Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH (2008) Poverty and access to health care in developing countries. Ann N Y Acad Sci 1136:161–171CrossRefGoogle Scholar
  40. Rahman MM, Rahman MM, Tareque MI, Ferdos J, Jesmin SS (2016) Maternal pregnancy intention and professional antenatal care utilization in Bangladesh: a nationwide population-based survey. PLoS ONE 11:e0157760CrossRefGoogle Scholar
  41. Regassa N (2011) Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. Afr Health Sci 11(3):390–397Google Scholar
  42. Sedgh G, Hussain R (2014) Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Stud Fam Plann 45:151–169CrossRefGoogle Scholar
  43. Sedgh G, Bankole A, Oye-Adeniran B, Adewole IF, Singh S, Hussain R (2006) Unwanted pregnancy and associated factors among Nigerian women. Int Fam Plan Perspect 32(4):175–184CrossRefGoogle Scholar
  44. Singh A, Singh A, Mahapatra B (2013) The consequences of unintended pregnancy for maternal and child health in rural India: evidence from prospective data. Matern Child Health J 17:493–500CrossRefGoogle Scholar
  45. Tafere TE, Afework MF, Yalew AW (2018) Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: a prospective follow up study. PLoS ONE 13:e0192428CrossRefGoogle Scholar
  46. Tebekaw Y, James Mashalla Y, Thupayagale-Tshweneagae G (2015) Factors influencing Women’s preferences for places to give birth in Addis Ababa, Ethiopia. Obstet Gynecol Int 2015:439748CrossRefGoogle Scholar
  47. Tegegne TK, Chojenta C, Loxton D, Smith R, Kibret KT (2018) The impact of geographic access on institutional delivery care use in low and middle-income countries: systematic review and meta-analysis. PLoS ONE 13:e0203130CrossRefGoogle Scholar
  48. Tesfaye G, Loxton D, Chojenta C, Semahegn A, Smith R (2017) Delayed initiation of antenatal care and associated factors in Ethiopia: a systematic review and meta-analysis. Reprod Health 14(1):150CrossRefGoogle Scholar
  49. Thompson SG, Higgins JP (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573CrossRefGoogle Scholar
  50. Titaley CR, Dibley MJ, Roberts CL (2009) Factors associated with non-utilization of postnatal care services in Indonesia. J Epidemiol Community Health 63:827–831CrossRefGoogle Scholar
  51. UN (2015) Transforming our world: the 2030 agenda for sustainable development. United Nations, New YorkGoogle Scholar
  52. 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)
  53. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296CrossRefGoogle Scholar
  54. Wado YD, Afework MF, Hindin MJ (2014) Effects of maternal pregnancy intention, depressive symptoms and social support on risk of low birth weight: a prospective study from southwestern Ethiopia. PLoS ONE 9:e96304CrossRefGoogle Scholar
  55. WHO (2015) State of inequality: reproductive, maternal, newborn and child health. The World Health Organization, GenevaGoogle Scholar
  56. 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
  57. 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
  58. 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
  59. 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
  60. 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

Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  1. 1.Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and MedicineHunter Medical Research Institute, University of NewcastleNew Lambton HeightsAustralia
  2. 2.Department of Population SciencesJatiya Kabi Kazi Nazrul Islam UniversityMymensinghBangladesh

Personalised recommendations