Unintended pregnancies are a critical public health concern, particularly in regions like Bihar, India, where empowerment disparities persist (18). In the our research paper, we thoroughly explore and interpret the diverse findings uncovered during our study on unintended pregnancies among pregnant females in Bihar. The determinants identified, spanning sociodemographic factors, obstetric parameters, contraceptive use, and knowledge about contraceptive practices, provide a comprehensive understanding of the complex landscape surrounding unintended pregnancies in this region (22). The discovery that younger partners play a significant role in the likelihood of unintended pregnancies adds a nuanced layer to existing knowledge. While some results align with established literature, such as the influence of socioeconomic status and media use on pregnancy planning, others, like the unexpected prevalence of unintended pregnancies among literate females, offer novel insights (23). Our study, conducted at the Gynecology and Obstetrics Outpatient Department of AIIMS Patna, offers a nuanced comparison with the aforementioned study on mistimed and unwanted pregnancies in India, as well as relevant literature on unintended pregnancies (24). There is a shared recognition of unwanted pregnancies as significant public health concerns, linked to adverse health outcomes for women and children. The call for measures and program strategies to minimize such pregnancies is echoed in both research efforts, emphasizing the importance of proper interventions. Adolescent health and wellbeing are integral aspects of the Sustainable Development Goals (SDGs), aiming for comprehensive and sustainable development by 2030. India, aligning with these goals, introduced the Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016–2030) in 2015. This study specifically addresses the issue of unintended pregnancies among adult females in Bihar, one of the less empowered states in India (18).
In terms of prevalence, our study provides a more localized perspective by focusing on participants attending a clinical setting in Patna. Approximately one-third of the patients in our study experienced unplanned pregnancies, aligning with the broader trend observed in the national study (24). A study, which utilizes data from NFHS-4 and NFHS-5, found the prevalence of unintended pregnancy among adolescents and young women in India was reported to be at least 7% which is much lower when we compare to our study where about one third, 33.1% of the pregnancies are unintented (25). The trend analysis reveals a slight increase (7.29–7.52%) in unintended pregnancies from NFHS-4 to NFHS-5, indicating a persistent challenge despite government initiatives such as the Rashtriya Kishor Swasthya Karyakram (RKSK). The lack of a significant decline in unintended was attributed to factors like poor RKSK implementation, pandemic-induced challenges, and worsening mental health conditions among adolescents(26).
Age-related factors emerge as pivotal determinants among studies, underlining the vulnerability of unwanted pregnancies among womens. This finding resonates with evidence from Ethiopia, Tanzania, and Kenya, providing a cross-cultural validation of age's impact on pregnancy intentions (22, 27–29). While studies address unintended pregnancies among women aged 15–24 in India, they reveal nuanced differences. In our study,females less than 20 years exhibited a higher likelihood of unintended pregnancies, aligning with previous research emphasizing the vulnerability of younger women to such outcomes (30). Surprisingly, our findings challenge the conventional wisdom regarding the association between religion and unintended pregnancies. While in our study non hindu women are generally less likely to experience unintended childbearing, our study indicates that women from hindu religions were more prone to unintended pregnancies, with non hindu women showing a decreased likelihood (26,31). Both studies converge on the lack of a statistically significant association between the wealth index and unintended pregnancies, contributing valuable insights into the complex interplay of socioeconomic factors in shaping pregnancy intentions among adolescents and young women in India (26). We found that education plays a significant role in unintended pregnancy, partner having higher degree like diploma or a professional has lesser chances of having unintended pregnancy compare to illiterate which is comparable to a study conducted in Iran (5). These variations underscore the importance of context-specific considerations in understanding and addressing unintended pregnancies in diverse populations. Additionally, our study delves into marital factors, revealing that women married between 20 to 29 years exhibited higher odds of planned pregnancies, offering nuanced insights into the timing of marriage and its association with pregnancy planning, The finding of significant association between younger maternal age and unintended pregnancy were consistent with other local and international studies from Kenya, Pakistan, Brazil, Papua New Guinea, Tanzania, Canada and Ghana (32–35) .
The consistent finding across studies regarding the role of education as a predictor of unintended pregnancies highlights its significant impact on reproductive health outcomes. Higher-education, as indicated in our study supported by the national context exhibited lower odds of experiencing unwanted pregnancies. This alignment underscores the crucial link between educational attainment, heightened awareness of family planning methods, and the correct utilization of contraception. Conversely, the observation in our study that illiterate women were more likely to have unintended pregnancies resonates with evidence from other studies (36–38). This consistency reinforces the notion that literacy equips women with a better understanding of their rights and responsibilities, granting them greater freedom, control, and active participation in decisions related to contraception use and family planning. The collective evidence emphasizes the pivotal role of education in shaping reproductive choices and underscores the importance of targeted educational interventions to empower women in making informed decisions about their reproductive health(39–41)
In our study, we found that the Number of Living Children played a crucial role, participants identified as multigravida were significantly associated with unplanned pregnancies, reflectinga significant relationship. This suggests that both nulliparous status and being a first-time mother initially correlated with lower odds of unintended pregnancies. However, in contrast to our findings, other studies have also reported a consistent link between higher parity and increased frequency of unintended pregnancies (34, 38, 42). This observed significant association between previous childbirth and unintended pregnancies can be attributed, in part, to the likelihood that women with multiple births may have already achieved their desired family size, reducing the expectation of future childbearing. Additionally, the preference for a specific gender, such as desiring a male child, could lead to multiple childbirths beyond the initially intended family size (42).
The association between parity and unintended pregnancies observed in our study aligns with findings from other developing countries(30, 38, 42–44). Specifically, women with a parity of greater than two were more likely to experience unintended pregnancies. This corresponds to our study's results, where the number of live children demonstrated a significant impact on the odds of unintended pregnancies. Participants with more than one live child had substantially higher odds, indicating a robust association. Notably, the prevalence of planned pregnancies was higher among those with no children compared to those with more than one living child. This consistency across studies underscores the influence of parity on shaping pregnancy intentions and highlights the need for targeted interventions not only making a range of contraceptive options accessible but also emphasizing educational initiatives to empower women with knowledge and autonomy in reproductive decision-making. Targeted interventions can contribute significantly to reducing unintended pregnancies and promoting the overall reproductive health and well-being of women. In a study in ghana, it was identified that only 28% of the couples use contraception among those 78.7% of women experiencing unintended pregnancies had never used contraceptives before their current pregnancies, highlighting a gap in the effectiveness of contraceptive methods (45). Conversely, our study revealed that, 28.7% of participants, were using contraceptives, out of which 61.9% of these participants had never used contraception before. The observed low prevalence of contraceptive use in our study could be attributed to various factors, such as couple doesn’t know how to use, partnet did’t want to use any contraception, a thought of occasional sex could’t lead to pregnancy, not ready for pills or methods, newly married couples actively seeking conception, and concerns about potential side effects associated with contraceptive methods (45).
The influence of women's autonomy and exposure to mass media on reducing the likelihood of unwanted pregnancies is echoed in both studies, emphasizing the role of decision-making power and information dissemination in family planning. Our study reinforces this by associating autonomy with the LUMP scale, providing additional evidence supporting the need to empower women in decision-making regarding pregnancy (30, 34).
Contraceptive use and its complex relationship with unintended pregnancies form a significant point of comparison. While studies acknowledge the importance of contraception in reducing unintended pregnancies, our clinical study provides insights into the real-world scenario of contraceptive use, discontinuation, and method failure among patients attending AIIMS Patna. This practical perspective adds depth to the broader understanding derived from the national study and related literature [20, 29, 33, 34].
Moreover, our study contributes to the discourse by examining obstetric parameters such as folic acid consumption during pregnancy, number of living children, and the age at first sexual behavior, offering unique insights into the intersection of reproductive health behaviors and pregnancy planning. The findings related to these parameters enrich the discussion on unintended pregnancies, providing a more comprehensive understanding of the factors influencing pregnancy intentions.