Pregnancy Intentions and Maternal Health Behaviours: Observational Study in 18 African Countries.

Area of Science:

• Reproductive Health
• Maternal Health
• Public Health in Sub-Saharan Africa

Background:

• Pregnancy intentions significantly influence maternal health behaviors and outcomes.
• Understanding the link between intended vs. unintended pregnancies and health practices is vital for targeted interventions.

Purpose of the Study:

• To explore the relationship between pregnancy intentions (intended vs. unintended) and key maternal health behaviors in sub-Saharan Africa.
• To analyze how unintended pregnancies affect utilization of antenatal care, malaria prevention, tetanus toxoid vaccination, and breastfeeding practices.

Main Methods:

• Secondary data analysis of recent (2018-2023) cross-sectional demographic and health surveys from 18 sub-Saharan African countries.
• Logistic regressions and meta-analysis were used to examine associations in a sample of 39,936 women aged 15-49 with a child under one year old.
• Maternal health behaviors included early antenatal care (ANC) visits, 4+ ANC contacts, intermittent preventive treatment of malaria in pregnancy (IPTp3+), mosquito net use, tetanus toxoid receipt, and immediate breastfeeding.

Main Results:

• Approximately 25% of women reported unintended index pregnancies, with significant country-level variation (13%-49%).
• Unintended pregnancies were associated with significantly reduced odds of early ANC, 4+ ANC contacts, IPTp3+, tetanus toxoid receipt, and immediate breastfeeding.
• Adjusted odds ratios (aORs) ranged from 0.68 for early ANC to 0.87 for IPTp3+, indicating lower uptake of these essential maternal health services.

Conclusions:

• Findings highlight the critical role of reproductive health agency and pregnancy preparedness in optimizing maternal health behaviors.
• Integration of reproductive health services, malaria prevention programs, and behavior change interventions is recommended to improve maternal and newborn outcomes.
• Addressing unintended pregnancies through enhanced reproductive health services can lead to better utilization of essential maternal health services.