Prevalence of Unintended Pregnancy and Associated Factors Among Women Enrolled in the Support-Moms Study in Southwestern Uganda: A Cross-Sectional Analysis of Baseline Data

Abstract

Unintended pregnancies and unmet need for contraception continue to be a public health concern in Sub-Saharan African countries. This potentially contributes to the high maternal mortality rate in these countries. This study highlights the burden and the context-specific factors associated with unintended pregnancy in Southwestern Uganda. This was a secondary analysis of baseline data from pregnant women enrolled in the Support-Moms trial, which was a community-based randomized controlled trial. The Support-Moms trial recruited 824 pregnant women who had not started antenatal care visits, and these were randomly assigned (1:1) into two groups: the control group, which received standard of care, and the intervention group that received health information messages in the form of Short Messaging Service (SMS) or audio from the Support-Moms app. Participants were recruited from Mbarara City, Mbarara District, and Mitooma District. Enrolled women completed an interviewer-administered questionnaire to collect data on sociodemographic characteristics, reproductive history, prior birth and pregnancy outcomes, household food security, and pregnancy intention. Women who had unwanted or mistimed pregnancies were collectively regarded as having an unintended pregnancy. Data analysis was done using Stata version 19 (StataCorp LLC, College Station, TX), and a modified Poisson regression analysis was employed to document the factors associated with unintended pregnancy. Statistical significance was set at a p-value < 0.05. To assess the prevalence of unintended pregnancy and the associated factors, a total of 818 women were included in the final analysis. The median age was 27 years. Overall, 296 (36.2%) women reported an unintended pregnancy. In multivariable analysis, moderate (adjusted prevalence ratio (aPR) = 1.55; 95% CI: 1.02-2.36) and severe food insecurity (aPR = 1.96; 95% CI: 1.25-3.06), grand multigravidity (aPR = 1.64; 95% CI: 1.11-2.41), and lack of awareness of the partner's desired number of children (aPR = 1.22; 95% CI: 1.01-1.47) were independently associated with unintended pregnancy. Over one-third of pregnant women in the Support-Moms trial, Southwestern Uganda, had unintended pregnancy, largely driven by food insecurity, grand multigravidity, and inadequate partner communication. Context-specific interventions are critical to mitigating this high burden.