Determinants of Unintended Pregnancy among Women Attending Antenatal Clinic at Kenyatta National Hospital

Abstract

Estimates regarding pregnancy intentions provide insights into the reproductive health status of people. Unintended pregnancy contributes significantly to adverse outcomes like unsafe abortions, maternal fatalities, malnutrition, mental health issues due to stress, and transmission of HIV. In Kenya, prevalence of unintended pregnancies has risen from 34% in 2014 to 41.9% in 2020, with an accompanying increase in abortion rates from 24% to 34% between 2015 and 2019. The study aimed to identify the determinants of unintended pregnancies among pregnant women receiving care at the antenatal clinic in Kenyatta National Hospital, Nairobi, Kenya. This study took place at the antenatal clinic, KNH and it adopted a cross sectional study design that had a sample size of 227 study participants. All the study participants were sampled from women who were currently pregnant and attending the antenatal clinic in addition met the inclusion and exclusion criteria. The data was collected using a structured questionnaire. A pregnancy was said to be unintended if it was mistimed or unwanted. A structured questionnaire was used to collect data and analyzed using the Statistical Package for Social Sciences (SPSS) version 21. Bivariate analysis examined associations using odds ratios and statistical significance interpreted at 5%. Multivariate logistic regression analysis determined independent predictors of unintended pregnancy. Statistical significance of p < 0.05 or p=0.05. The proportion of unintended pregnancy among the study participants was at 29.9%. Age under 25 years [aOR 8.1 (95% CI 1.4-48.6)], prior use of contraceptive methods [aOR 7.9 (95% CI 2.5-25.0), p<0.001], and the woman being the only one who decides when to become pregnant [aOR 3.8 (95% CI 1.3-11.2), p=0.014] were the main independent predictors of unintended pregnancy. Unintended pregnancies were also substantially correlated with infrequent use of family planning services and unfavourable opinions of facility-based reproductive health education, highlighting the influence of service delivery on pregnancy outcomes. The study emphasizes the critical need to improve young women's access to comprehensive, youth-friendly sexual and reproductive health education and family planning services. To address these challenges, the Ministry of Health, in collaboration with healthcare providers, should develop and implement sustainable strategies. These should include integrated service delivery models that combine family planning with other reproductive health services such as HIV/AIDS prevention, STI screening, and maternal and child healthcare.