TITLE:
Geographic Access to Working Family Planning Centers and Unintended Pregnancies among Married Women: A Community Based Nested Case Control Study
AUTHORS:
Sumera Aziz Ali, Sarah Saleem, Neelofar Sami, Mir Shabbar, Muhammad Ahmed, Shafquat Rozi, Robert L. Goldenberg, Margo S. Harrison, Omrana Pasha
KEYWORDS:
Unintended Pregnancy, Geographic Access, Family Planning
JOURNAL NAME:
Open Journal of Epidemiology,
Vol.6 No.1,
February
29,
2016
ABSTRACT: Background: Unintended pregnancies pose
substantial risk to mothers and children. In Pakistan, unintended pregnancies
account for 46% of all pregnancies. Lack of geographic access to open and
well-supplied family planning (FP) centers may be related to the occurrence of
such pregnancies, particularly in rural areas. Objective: The objective of this
analysis is to determine if geographic access to family planning centers in the
Thatta district of Pakistan is related to unintended pregnancy rates among
married women. Methods: We conducted a community-based, nested case-control
study of 800 pregnant women identified from the database of an active
surveillance system, which registers and follows all pregnant women in the
catchment area of Thatta district. Women were enrolled during the first
trimester; those that reported their pregnancy to be unintended were selected
as cases (n = 200), and those whose pregnancies were intended served as
controls (n = 600). We defined geographic access as including both the distance
of a family planning center from the woman’s home, and availability of personal
transportation. Logistic regression was used for analysis. Results: In the
multivariate model, neither distance [OR = 1.0; 95% CI (0.95 - 1.05)] nor
availability of transportation [OR = 1.14; 95% CI (0.78 - 1.67)] were
significantly associated with unintended pregnancy. In fact, women with
unintended pregnancies were more likely to be aware of family planning [OR =
2.21; 95% CI (1.23 - 3.97)] and more likely to have been using a contraceptive
method before conceiving their index pregnancy [OR = 3.59; 95% CI (1.83 -
7.06)]. Other factors related to unintended pregnancy were older maternal age
[OR = 1.13; 95% CI (1.08 - 1.17)], having already had at least one son [OR =
3.13; 95% CI (1.93 - 5.07)]; spousal opposition to contraceptive use, [OR =
3.24; 95% CI (1.89 - 5.56)] and low spousal education level [OR = 1.85; 95% CI
(1.08 - 3.18)] as compared to women with intended pregnancy. Conclusion: Lack
of geographic access to FP centers is not a risk factor for unintended
pregnancy in women from the Thatta district. However, in this population,
unintended pregnancies are more common among older women, women having at least
one son, and those who have a spouse who does not approve of contraceptive use,
and is less educated. Of note, women who reported unintended pregnancy did have
knowledge about FP and were more often using contraceptives before they
conceived.