Targeting women at risk of unintended pregnancy in Ghana: Should geography matter?
ABSTRACT Unintended childbearing in Ghana is estimated to be about 0.7 births per woman, thus contributing to the high total fertility rate of more than 4 births. About one-third of women of reproductive age have an unmet need for family planning and there are strong geographic differences between and within ecological zones. Spatial analysis of risk of unintended pregnancies planning can reveal differences in the provision and usage of contraceptive commodities, thereby providing information of areas where programmes should be strengthened. This study uses data from the 1998 and 2003 Ghana Demographic and Health Surveys to examine geographical variation in the risk of unintended pregnancies among women in the three ecological zones of Ghana (Savannah, Forest, and Coastal). The data was analysed using multilevel logistic regression. Approximately 55% of Ghanaian women (married or in union) are at risk of unintended pregnancies and there are differences between urban and rural women, with rural women more likely to have their demand for contraception unmet. After adjusting for the socio-economic and demographic factors, the results show little differences between ecological zones in the levels of women exposed to the risk of unintended pregnancy, but they demonstrate significant within community effects, which influence the risk of unintended pregnancies for women within the community. Communities, therefore, can be used as units for targeting services aimed at increasing coverage of contraceptive commodities.
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ABSTRACT: Unintended pregnancies may carry serious consequences for women and their families, including the possibility of unsafe abortion, delayed prenatal care, poor maternal mental health and poor child health outcomes. Although between 1993 and 2008, unintended births decreased from 42% to 37% in Ghana, the rate of decline is low, whilst levels are still very high. This raises the need to understand factors associated with unintended pregnancies, especially among women in rural settings where the rates and risks are highest to help improve maternal health.BMC Pregnancy and Childbirth 08/2014; 14(1):261. · 2.15 Impact Factor
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ABSTRACT: There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.BMC Psychiatry 05/2014; 14(1):156. · 2.24 Impact Factor
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ABSTRACT: Despite an increased use of contraceptive methods by women, unintended pregnancies represent one of the most evident violations of women's sexual and reproductive rights around the world. This study aims to measure the association between individual and community exposure to different forms of violence against women (physical/sexual violence by the partner, sexual abuse by any person, or controlling behavior by the partner) and unintended pregnancies. Data from the 2006/2007 Nicaraguan Demographic and Health Survey were used. For the current study, 5347 women who reported a live birth in the five years prior to the survey and who were married or cohabitating at the time of the data collection were selected. Women's exposure to controlling behaviors by their partners was measured using six questions from the WHO Multi-Country Study on Women's Health and Domestic Violence against Women.Area-level variables were constructed by aggregating the individual level exposures to violence into an exposure measurement of the municipality as a whole (n = 142); which is the basic political division in Nicaragua. Multilevel logistic regression was used to analyze the data. In total, 37.1% of the pregnancies were reported as unintended. After adjusting for all variables included in the model, individual exposure to controlling behavior by a partner (AOR = 1.28, 95% CrI = 1.13-1.44), ever exposure to sexual abuse (AOR = 1.31, 95% CrI = 1.03-1.62), and ever exposure to physical/sexual intimate partner violence (AOR = 1.44, 95% CrI = 1.24-1.66) were significantly associated with unintended pregnancies. Women who lived in municipalities in the highest tertile of controlling behavior by a partner had 1.25 times higher odds of reporting an unintended pregnancy than women living in municipalities in the lowest tertile (AOR = 1.25, 95% CrI = 1.03-1.48). Nicaraguan women often experience unintended pregnancies, and the occurrence of unintended pregnancies is significantly associated with exposure to different forms of violence against women at both the individual and the municipality level. National policies aiming to facilitate women's ability to exercise their reproductive rights must include actions aimed at reducing women's exposures to violence against women.BMC Women's Health 02/2014; 14(1):26. · 1.66 Impact Factor