- Title
- Effects of unintended pregnancy on maternal healthcare services use in Bangladesh
- Creator
- Khan, Md Nuruzzaman
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Around 112 million unintended pregnancies occur each year in low- and middle income countries, representing around 39% of the total pregnancies and 92% of total unintended pregnancies (250 million) that occur worldwide. In Bangladesh, around 48% of total pregnancies are unintended at conception, and a significant percentage of these occur among women with previous experience of unintended pregnancy. Around 51% of these end with induced abortion (which is mostly unsafe), and the remaining 49% end with live births, which contributes around 26% of the total live births in Bangladesh. Pregnancy complications,birth injury, and maternal and neonatal mortality are higher among women experiencing unintended pregnancies and are even higher among women with previous experience of unintended pregnancy. Increased attention to the impact of unintended pregnancy is therefore needed to improve maternal and child health, which are vital targets in the Sustainable Development Goals to be achieved by 2030. Maternal healthcare services use, including antenatal healthcare, delivery healthcare, and postnatal healthcare, could reduce the occurrence of unintended pregnancy and its associated complications and deaths. Post-partum contraception use could prevent the occurrence of repeated unintended pregnancy. However, disagreement about the association of unintended pregnancy with maternal healthcare services and post-partum contraception use is common in low- and middle-income countries, and there is sparse research on this topic for Bangladesh. Objectives: The broad aim of this thesis was to investigate the association between unintended pregnancy and maternal healthcare services use. The specific aims were: i) appraise current evidence of the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use in low- and lower-middle-income countries; ii) determine the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use, as well as the continuity of using these services in Bangladesh; and iii) determine the association between unintended pregnancy and post-partum contraception use in Bangladesh. Design: This thesis comprises a systematic review and cross-sectional analyses of the nationally-representative 2014 Bangladesh Demographic and Health Survey. Participants: Participants in all cross-sectional studies were 4,493 women who reported a live birth within three years prior to the date of the survey and responded to the questions related to maternal healthcare services use. Methods: The multiple objectives of this thesis were addressed through a range of methodological approaches, reported across six papers. In the first paper, a systematic review and meta-analysis were used to collect and appraise existing evidence of the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use in low- and lower-middle-income countries. Multilevel modelling was used in the remaining five papers to determine the association of unintended pregnancy with antenatal, delivery, and postnatal healthcare services use, continuity of using antenatal, delivery, postnatal healthcare services, and post-partum contraception uptake. Results: The systematic review identified 38 studies in low- and lower-middle-income countries related to unintended pregnancy and antenatal, delivery, and postnatal healthcare services use. Their pooled odds showed 25-39% lower use of antenatal, delivery, and postnatal healthcare services following an unwanted pregnancy compared to a wanted pregnancy. Follow-up quantitative papers provided insight into this association for Bangladesh, with this study reporting that around 26% of total pregnancies (of which 15% were mistimed and 11% were unwanted) that ended with a live birth were unintended at conception. At least one antenatal healthcare consultation was reported among 64% of Bangladeshi women, 34% of whom reported at least four antenatal healthcare consultations. Only 41% of women reported having a skilled birth attendant present at their last birth, and 38% reported delivery in a healthcare facility. Around one quarter (27%) of women reported postnatal healthcare service use. Only 12% of all women reported using antenatal, delivery, and postnatal healthcare services. Unintended pregnancy was found to be associated with a decreased likelihood of using each of these services. A 27% (95% Credible Interval, 0.66-0.81) and 31% (95% Credible Interval, 0.64-0.75) lower likelihood of at least four antenatal healthcare consultations were found among women who had a mistimed or unwanted pregnancy, respectively, compared to a wanted pregnancy. This association was stronger for unwanted pregnancy than wanted pregnancy for the presence of a skilled birth attendant during delivery (OR, 0.70, 95% Confidence Interval [95% CI], 0.52-0.93), delivering in a healthcare facility with skilled providers (OR, 0.65, 95% CI, 0.48-0.89), and postnatal healthcare services use (OR, 0.58, 95% CI: 0.34-0.98). Further, the odds of using at least two of the recommended antenatal, delivery,and postnatal healthcare services, as well as using all of these services, were 39% (95% CI, 0.47-0.78) and 62% (95% CI, 0.23-0.64) lower for an unwanted pregnancy than a wanted pregnancy, respectively. Mistimed pregnancy (rather than a wanted pregnancy) was not associated with either delivery healthcare services use or postnatal healthcare services use, although mistimed pregnancy was found to be negatively associated with continuity of using recommended antenatal, delivery, and postnatal healthcare services (OR, 0.69, 95% CI, 0.47-0.78). In addition, relative to a wanted pregnancy, 62% (95% CI, 1.28-2.05) higher odds of modern contraception use was found among women with a mistimed pregnancy, whereas no association was found between unwanted pregnancy and post-partum uptake of modern contraception. Conclusion: This study confirms that more than one-quarter of women who reported unintended pregnancy at conception in Bangladesh (and who did not terminate their pregnancies) are at high risk of not using maternal healthcare services. This indicates that the current provision of health coverage does not necessarily translate into actual uptake, challenging Bangladesh's ability to achieve its Sustainable Development Goals targets for reducing preventable maternal and under-five mortality. Earlier detection of women's pregnancy intention and initiatives to include women in the mainstream of maternal healthcare services are important to ensure maternal healthcare services are available to and accessible by women having an unintended pregnancy in Bangladesh.
- Subject
- unintended pregnancy; maternal healthcare services use; low- and lower-middle income countries; Bangladesh
- Identifier
- http://hdl.handle.net/1959.13/1423635
- Identifier
- uon:37957
- Rights
- Copyright 2021 Md Nuruzzaman Khan
- Language
- eng
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