Introduction

According to the world health organization, unintended pregnancy is defined as a pregnancy which is not wanted and/or not planed at the time of conception[1]. Similarly, Federation of international gynecologists and obstetricians defines unintended pregnancy is a pregnancy that is mistimed or unwanted at the time of conception[2]. This unintended pregnancy happens due to different reasons like; not using family planning, failure of contraceptive methods, lack of contraceptive methods, incidental sexual intercourse, including rape, and lack of awareness regarding family planning [3].

Unintended pregnancy has a bad consequence on the mother and newborn health. Studies indicate that women who have unintended pregnancy are more likely exposed to eclampsia, preeclampsia, postpartum hemorrhage, physical abnormality and maternal death than mothers who have intended pregnancy [4]. The most common consequence of unintended pregnancy is unsafe abortion [5]. Studies done in different parts of Ethiopia reveal that the prevalence of abortion is high. According to a study done in Harrar, the prevalence of abortion was 14.4% [6]. A national study done in Ethiopia indicates that the number of induced abortion was 620,300 in 2014 [7]. Moreover; a study done in Dessie reveals that 45% of induced abortions were unsafe abortion [8]. Despite the burden of abortion is high in Ethiopia, unmet need in the country is still a major reproductive health problem. According to Ethiopian demographic health survey 2016, unmet need in Ethiopia is as high as 22% [9].

Globally, there are 216 million maternal deaths per 100,000 live births every year [10]. Moreover; in Ethiopia, the maternal mortality rate is 412 per 100, 000 live births [9]. In Ethiopia, unsafe abortion is the second common cause of maternal mortality, which accounts for 19.7% maternal mortality [11].

Articles indicate that unintended pregnancy is one of the most critical problems in the public health system that imposes substantial financial and social costs on society. Unintended pregnancy leads to the reduction of quality of life and workforce efficiency, which indicates that unintended pregnancy affects fertility indicators [4, 5].

Even if these problems are known, the prevalence of unintended pregnancy is still high worldwide. According to WHO, every year there are around 210 million pregnancies worldwide, out of these pregnancies, 44% of pregnancies are unintended and around 59% pregnancies ended by abortion. Furthermore; most of these unintended pregnancies(65 pregnancies per 1000 women) happen in developing countries like Ethiopia [10, 12]. Different studies done in Ethiopia indicate that the prevalence of unintended pregnancy is 37.8%, 36.9%, 33.3%, 36.5% and 32.9% in Adis Ababa [13], Dilla [14], Harrar [6], Wellega [15], Debre Markos [16] respectively. However, in the best of investigators knowledge, there is no a study done in Gondar state (South and North Gondar Zone) regarding unintended pregnancy.

Unintended pregnancy is high among single women, women who have multiple sexual partners, women who have lower/no educational level, women who have low income, unemployed women, women who didn’t use family planning, multiparous mothers, young women, women who traveled long time to reach health facility, women who have more children, multigravida women, women who are not visited by health professionals, women who discussed with their husband and women who desire fewer children [17–27].

By considering these high prevalence of maternal mortality, unintended pregnancy, unmet need, abortion and high consequence of unintended pregnancy; this study was aimed to assess the prevalence and determinants of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. The findings of this study will be helpful for policymakers in order to properly allocate resources and intervene maternal and child health problems.

Methods

Result

Socio-demographic characteristics

A total of 398 pregnant mothers participated in the study making the response rate 100%. Almost all (99.4%) of participants were Amhara in ethnicity and most of the participants (79.1%) were Orthodox Christian in religion. Nearly one-fifth participants (21.1%) were found in the age group between 15 and 24. Most of the mothers (85.9%) had at least one type of means of communication. More than half (57.8%) of women lived in rural part and around one-third of participants had a monthly household income of 50 US dollars or less. Around one-fourth (26.1%) of respondents had no formal education and three-fourth participants (74.9%) were married (Table 1).

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Table 1. Socio-demographic characteristic of pregnant women in Addis Zemen primary hospital, Northwestern Ethiopia, 2018 (n = 398).

https://doi.org/10.1371/journal.pone.0210206.t001

Reproductive history

Among a total of 398 mothers, 104 (26.1%) of respondents’ current pregnancy was unintended (CI;22.1, 30.4). Among those whose current pregnancy was unintended, 87 (83.7%) women’s pregnancy was mistimed whereas the rest (16.3%) women’s pregnancy was unwanted. Almost all participants (99.2%) knew the source of contraceptive methods. More than three-fourths of participants (77.2%) have freely discussed with their husbands/spouses regarding contraceptive and pregnancy. Around two-thirds of participants (67.1%) have ever used family planning (Table 2).

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Table 2. Reproductive characteristics of women in Addis Zemen primary hospital, North-western Ethiopia, 2018 (n = 398).

https://doi.org/10.1371/journal.pone.0210206.t002

Associated factors

In order to check the association between dependent and independent variables, first 13 variables were entered intothe binary logistic regression. Then eleven variables (women’s age, educational status, monthly income, occupation, marital status, gravidity, parity, religion, residence, ever used family planning and family size) were found to be a p-value of <0.25and these variables were entered into multivariable logistic regression. Finally, in multivariable logistic regression, only five variables (women’s educational status, residence, religion, gravidity, and parity) were statically significant with unintended pregnancy (P-value <0.05). Women who were multiparous were 2.6 times more likely had an unintended pregnancy when compared to nulliparous women (AOR; 2.8: CI; 2.6, 9.7). Mothers who were from rural were 2.6 times more likely had an unintended pregnancy than mothers who were from urban (AOR; 2.6: CI; 1.5, 4.6). Participants who attended secondary education were approximately 42% less likely had anunintended pregnancy when compared to participants who had no formal education (AOR; 0.58: CI; 0.42, 0.78) (Table 3).

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Table 3. Determinant factors of unintended pregnancy in Addis Zemen primary hospital, Northwestern Ethiopia, 2018(n = 398).

https://doi.org/10.1371/journal.pone.0210206.t003

Discussion

This study revealed that the prevalence of unintended pregnancy was 26.1% (CI;22.1, 30.4). The finding of this study is comparable to a study done in Kersa(27.9%) [22] and Gelemseo General Hospital (27.1%) [21]. This figure is also comparable to a study done in northeast Ethiopia (23.5%) [25]. However; the result of this study is lower than studies done Congo (40%) [17] and Malawi (43%) [18]. This difference may be due to the sample size difference which means the current study was carried out on small sample sizes whereas the previous Congo study was conducted on large sample size. Another explanation may be due to time variation; the use of family planning is increasing time to time and this may decrease the prevalence of unintended pregnancy. The finding of this study is also lower than studies done in Addis Ababa (37.8%) [13], Dilla (36.9%) [14],Wellega (36.5%) [15], Harar (33.3%) [6],and Debre Markos (32.9%) [16]. This difference may be due to different reasons like study design difference, time variation, socio-cultural difference, demographic differences between the current study and the previous studies. For instance, a study done in Wellega is a community-based study design which assessed all pregnant women including who had no antenatal visit. Different findings indicate that women who have intended pregnancy more utilize antenatal care than women who have unintended pregnancy [29, 30]. So the difference between the current study and previous Wellega study may be study design difference. In addition to this, the difference may be due to cultural and religious difference.

Based on multivariate logistic regression analysis family size, gravidity, parity, and educational status were found to be the determinant factors of unintended pregnancy. Multiparous women were more risky to experience an unintended pregnancy. Women who were multiparous were 2.8 times more likely to had an unintended pregnancy when compared to nulliparous women(AOR; 7.1: CI; 2.6, 9.7). The finding is in line with studies done in northeast Ethiopia [25], Kersa[22], Wellega [15]and Gelmsogeneral hospital [21] which show that women who delivered three or four children more likely experienced an unintended pregnancy. This result is also similar to a study done in Malawi as it indicated nulliparous women less likely had an unintended pregnancy. This association may be due to the fact that multiparous women may deliver every type of pregnancy intention (unintended or intended) and this may increase women’s parity.

Gravidity was another predictor variable of an unintended pregnancy. When gravidity increased, the probability of exposure to unintended pregnancy was increased. Mothers who have been pregnant for 3–4 times were 3.6 times more likely experienced an unintended pregnancy when compared to mothers who have been pregnant for 2 or less times(AOR; 3.6: CI; 2.1, 7.3). Similarly, participants who have been pregnant for 5 and more times were 4.7 times more likely reported their pregnancy was unintended than who have been pregnant for 2 or less times (AOR; 4.7: CI; 2.3, 6.8). This is in agreement with studies done in Debre Markos[16], northeast[25], and Hosana[23] as the findings indicate risk of unintended pregnancy is higher in women who have been pregnant many times. This finding is also in the agreement with a study done in Harrar [6] which shows women who have been pregnant for 2 or less times were less likely reported having an unintended pregnancy than women who have been pregnant for 5 or more times. Since gravidity is the number of pregnancy women’s gravidity may increase regardless of pregnancy intention.

This study also revealed that participants who attended secondary education were less likely at risk of having an unintended pregnancy. Respondents who attended secondary school were 42% less likely experienced an unintended pregnancy than respondents who had no formal education (AOR; 0.58: CI; 0.42, 0.78). The finding of this study is in line with studies done in Dila (14), Damote Dale (26) and north-Shewa (20). This result is also supported by two national studies done in Ethiopia (24 & 27). The association of this finding may be due to the fact that educated women may read information regarding complication of unintended pregnancy including prevention of unintended pregnancy. So, more educated women may easily get family planning methods.

In this study another most important variable which significantly associated with unintended pregnancy was religion. Muslim mothers were nearly 20% less likely to report having an unintended pregnancy as compared orthodox mothers (AOR; .79: CI; 0.60, 0.90). This finding is similar toanational study done in Ethiopia that shows Muslim mothers less likely faced an unintended pregnancy than Orthodox mothers (24). This is also in agreement with a study done in Wolaita sodo as the study reveals orthodox mothers more likely experienced an unintended pregnancy than Muslim mothers (19). This association may be due the fact that Muslim mothers take every child as a gift of the Lord and even in their religion contraceptive method is not recommnded. So, Muslim mothers don’t think that there is unintended pregnancy.

This study also found that mother’s residence as a predictor variable of unintended pregnancy. Mothers who were from rural were 2.6 times more likely had an unintended pregnancy than mothers who were from urban (AOR; 2.6: CI; 1.5, 4.6). This finding is supported by a study done in Kersa which shows that women who were from rural were 2.1 times more likely faced unintended pregnancy (22). The association of residence may be due to the fact that women who are from rural can’t easily access information regarding an unintended pregnancy and contraceptive methods. So, women who are from rural may not get easily family planning methods.

We have used a high proportion of unintended pregnancy that gives the maximum sample size and it has to be taken as a strength of the study. The other strength of the study was the probability sampling method was considered. Since this study was hospital-based, it might not be a true representative of the population. Social desirability bias mighccurred since the data were collected via face to face interview. Another limitation of this study was participants’ feelings were not studied.

Conclusion

This finding concluded that the prevalence of unintended pregnancy is relatively low in the study area. Educational status, parity, gravity, residence, and religion were the most important predictor variables of unintended pregnancy. Reducing the prevalence of unintended pregnancy especially in the rural area is recommended. A qualitative study is highly recommended to assess mothers’ feeling regarding unintended pregnancy.

Supporting information

Acknowledgments

Firstly, we would like to thanks Debre Tabor University for the approval of the Ethical Clearance, and for its financial support for the study. Our sincere appreciations also go to data collectors and supervisors for their time and honestly collect the required data. Finally, we would like to express our heartfelt thanks to the participants for their willingness to participate in the study, without whom this research would be impossible.