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



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.


Unintended 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.

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.


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)


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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

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