Unplanned pregnancies: prevalence, outcome, and contraceptive use, in an urban area in Dar es Salaam.

Abstract

Objectives: To determine the prevalence of unplanned pregnancies at the last conception III the past five years, outcome, and contraceptive use prior to that conception among women of reproductive age group in an ur,?an area of Dar es Salaam. \ Design: A Community based cross sectional study, in Kinondoni District urban areas by house to house visits survey for 30 days from 21 st August to 19th September 2000. Setting: Multistage sampling method was adopted to select Kinondoni district out of the three districts of Dar es Salaam Region using a table of random numbers. Then 4 administrative wards(kata) from a total of 11 wards(kata) of Kinondoni urban were selected from which 2 streets(mitaa) from each ward were also selected using the same sampling procedure of random numbers. Subjects: 900 women in their reproductive years between the age of 15-49 years inclusive who have had at least one conception in the past five years preceding the survey were recruited for an interview. Of these, 893 women were interviewed; using a structured closed questionnaire for their last conception in the past five years regrding whether it was planned or unplanned, its outcome, and contraceptive use prior to the conception .

- -- ----------~ - - ~ -- IX The remaining seven women were excluded from the data analysis because they refused to give consent for an interview. Results: Of the women interviewed, the last conception in 227(25%) was unplanned. 162(71%) of these were unplanned but accepted and 65(29%) were unplanned and unwanted. Teenagers who were 15 to 19 years old had the highest proportion (44%) of unplanned pregnancies. Contraceptive use prior to conception of the undesired pregnancies were generally low among the respondents, l36(60%) of those who had unplanned pregnancies never used any method to prevent the conception. The use was even lower among teenagers who were aged 15 to 19 years, the proportion of use being only 8.5% and this difference was found to be statistically significant, P=O.OOOOOl. The main reason for not using any method to prevent the undesired conception was lack of knowledge on methods of contraception. 48.83% of teenagers knew nothing about contraceptive methods. The main reason for not usmg any method of contraception to prevent the undesired pregnancies by the older age groups was fear of side effects of contraceptives. 52(6%) or the pregnancies outcome in the entire study population were abortion, of which 31(60%) were from planned conception and 21(40%) were from unplanned

x conceptions. There was significantly higher rate of abortions in the unplanned group than in the planned group. This was found to be statistically significant, P=O.006. Conclusions: Unplanned pregnancies are a significant Public health problem in Dar es Salaam urban. It is even more prominent among teenagers than in the older women. Unplanned pregnancies were also associated with higher rate of abortions than the planned conceptions possibly because of induced abortions. And contraceptive use were generally low among women with unplanned pregnancies, but more so among teenagers than the older women. In order to reduce the problem of unplanned pregnancies, there is a need to change the current clinic based family planning services to the establishment of vigorous outreach programme to reach all eligible couples and individuals who are sexually active and this to involve also teenagers in and out of school. The knowledge on modem methods of contraception should be offered to every eligible sexually active individual.