Unintended pregnancy is defined as pregnancy among women who were not planning to have any more children including pregnancies that occurred earlier than desired.1 Unintended pregnancy is a mistimed, unplanned or unwanted pregnancy at the time conception.2 Unintended pregnancy can occur when conceptions happen yet no child or children are desired (unwanted) or when it was not expected.2
Globally, nearly 10,000 women become pregnant every day without planning,3 with a global estimate of 44% of all pregnancies unplanned4. The rate of unintended pregnancies have generally decreased globally although rates in low and middle income countries remain disproportionately high.5 This general decline has been attributed to long-term global decreases in desired family size and changes in the age at which people want to start families4.
In Africa 8 in 100 and in Sub Sahara Africa, 91 per 1000 women aged 15–49 years experience unplanned pregnancies, with east Africa taking the lead and approximately14 million unintended pregnancies are recorded annually in sub-Saharan Africa.5 Several African countries continue to record high levels of unintended pregnancies. The prevalence of unintended pregnancy in Ethiopia in a study conducted among students found the prevalence of unintended pregnancy to be at 10.00%.6 Furthermore, in Ethiopia, a study that examined the correlates of unintended pregnancies found out a significant proportion of the pregnancies unintended with significant variations among the different regions.7 Women already burdened with higher fertility were suffering from effects unintended pregnancy.6, 7
In Uganda, the burden of unintended pregnancy remains high with regional and socio-economic variations within the country.8 In 2008, an estimated 1.2 million unintended pregnancies occurred in Uganda, representing more than half of the country’s 2.2 million pregnancies.9 According to the results of an analysis of the 2016 Uganda Demographic and Health Survey, nearly 40% of the pregnancies among married women in Uganda are unintended10 and this may be as high as 52%.11
The proportion of births that are unplanned is higher among rural, poor and less educated women than among their urban, wealthier and better educated counterparts.12 Women in the Eastern and North regions had the highest proportions of unplanned births (50–54%), while the proportions among women living in Karamoja, Kampala and the Central 1 and Southwest regions were lower (12–37%) than the national average.13 Ugandan women on average give birth to nearly two children more than they want and the fertility rate of the country remains high due to low uptake of family planning interventions.13 Currently, the fertility rate of Uganda is at 4.6 births per woman albeit a 2.4% decrease from 2020.14 This difference between Ugandan women's total fertility rate and their wanted fertility rate is one of the highest levels of excess fertility in sub-Saharan Africa.15
Previous studies done in African countries on unintended pregnancy reveal that different factors contribute the prevalence unintended pregnancy. For instance, the study conducted in Egypt found that women having a young husband, women working for cash, and a woman’s perception of her ideal family were associated with unintended pregnancies.16
Similarly, another study conducted revealed that having multiple sexual partners, non-use of condom and non-consensual sex and sexual intercourse before high school potentiated unintended pregnancy.17 The drivers of unintended pregnancies in sub-Saharan Africa are complex and operate at individual, household, community and policy levels. Understanding them is important to develop policies and effective interventions to reduce unintended pregnancies and unsafe abortion in the region.1
Unintended pregnancy has several adverse outcomes and of these, unsafe abortion is a major and critical potential outcome which may lead to infection, hemorrhage, reproductive organ perforation, infertility and even death.5,18 A recent study indicated that the risk of unintended pregnancy in SSA continues to be high and unsafe, and this predisposes mental health and psychological problems including depression and stress.19 Unplanned pregnancy and short inter-pregnancy spacing are leading causes of maternal and child death in sub Saharan Africa.20 Reducing unintended pregnancy rate likely requires addressing fundamental socioeconomic inequalities, as well as increasing contraceptive use and the uptake of highly effective methods of family planning.5