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R E S E A R C H A R T I C L E Open Access
Determinants of unintended pregnancies in
rural Ghana
Sebastian Eliason
1*
, Frank Baiden
2
, Barbara A Yankey
3
and Kofi Awusabo–Asare
4
Abstract
Background: 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.
Method: We collected data from 1,914 pregnant women attending antenatal clinic between January 2012 and
April 2012 in four health facilities in the Mfantseman Municipal of the Central Region of Ghana. We used bivariate
and multivariate logistic regression analyses to explore how socio-demographic characteristics, past reproductive
health experiences, partner characteristics and relations, awareness and past experience with contraceptives,
influenced the status of women’s current pregnancy (whether intended or unintended).
Results: The mean age of the 1,914 respondents in this study was 25.6 ± 6.5 years. Seventy percent (70%) said the
pregnancies they were carrying were unintended. The odds of carrying unintended pregnancy among women with
five or more children were higher than those with one to two children [AOR 6.06, 95% CI (3.24-11.38) versus AOR
1.48, 95% CI (1.14-1.93)]. Women with other marital arrangements showed significantly higher odds of carrying
unintended pregnancy compared to those married by ordinance (Muslim or Christian wedding). Women not living
with their partners exhibited increased odds of having unintended pregnancies compared to women who lived
with their partners (AOR 1.72, 95% CI: 1.28 - 2.30). Awareness of traditional methods of family planning (withdrawal
and rhythm) was associated with lower odds of having unintended pregnancy compared to non-awareness
(AOR 0.66, 95% CI (0.49-0.89).
Conclusions: In this study, important risk factors associated with unintended pregnancies were: parity, living
arrangements with partner, marriage by ordinance and awareness of traditional, non-pharmacological contraceptive
methods. Family planning interventions targeting different groups of women, especially during the postpartum
period, would be essential to reduce rates of unintended pregnancies and promote positive health outcomes.
Keywords: Unintended pregnancy, Family planning, Parity, Contraceptive methods
* Correspondence: sakeliason@yahoo.co.uk
1
Department of Community Medicine, University of Cape Coast, Cape Coast,
Ghana
Full list of author information is available at the end of the article
© 2014 Eliason et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Eliason et al. BMC Pregnancy and Childbirth 2014, 14:261
http://www.biomedcentral.com/1471-2393/14/261
Background
Unintended pregnancies refer to pregnancies that are
not wanted or those that are mistimed at the time of
conception [1]. Out of the 208 million pregnancies
estimated worldwide, in 2008, 41% were unintended
[2]. Rates of unintended pregnancies though declining
world-wide are still high. Rates of unintended pregnan-
cies declined by 20% from 71 to 57 per 1000 from 1995
to 2008 among women aged 15 to 44 years in Low- and
Middle-Income Countries (LMICs) [3]. In 2008, 75 mil-
lion women in LMICs reported that their pregnancies
were unintended [4] with 23% of these pregnancies oc-
curring in Sub-Saharan Africa [5]. Guttmacher Institute
and the United Nations Population Fund (UNFPA) esti-
mated the level of unintended pregnancies in 2008 at 49
per 1000 pregnancies in Asia, 72 per 1000 in Latin
America and the Caribbean and for women aged 15 –
44 years in Africa, 86 per 1000; that of Africa was rated
as the highest [6] and stated that in Ghana, 37 percent
of all births are unintended [7].
Unintended pregnancies may carry serious conse-
quences for women and their families, including possible
unsafe abortion, delayed prenatal care, poor maternal
mental health, reduced mother/child relationship quality,
poor developmental outcomes for children, physical abuse
and violence against women, increased risk of low birth
weight of babies as well as increased maternal morbidity
and mortality [2,8,9]. Available data suggests that induced
abortion and related complications are the most common
outcomes of unintended pregnancies [10]. It is estimated
that in Ghana, induced abortions account for about 12%
of maternal deaths, third after hemorrhage (22%) and un-
classified causes (14%) [10]; furthermore, the proportion
of unintended births also showed a decreasing trend:
From 1993 to 2008, unintended births decreased from
42% to 37% [11]. In-spite of this decrease, the rate con-
tinues to be high and is estimated to be about 0.7 per
woman [12,13].
The high rate of unintended pregnancies in Sub-
Saharan Africa, including Ghana, attests to poor access to
reproductive health care especially family planning, inad-
equate reproductive health rights and low empowerment
of women. Partly due to these prevailing situation, Ghana
and most Sub-Saharan African countries are not likely to
attain Millennium Development Goals (MDGs) 3, 4 and 5.
Targeted interventions, especially during the postpartum
period when an unintended pregnancy can be of great risk
to mother and baby [14] would be essential, if the rates of
unintended pregnancies are to be reduced, to promote
positive health outcomes. To achieve this objective, factors
that are associated with unintended pregnancies need to
be investigated and understood. Studies conducted in the
United States, Asia, Middle East and Latin America have
revealed several demographic and socio-economic factors
as predictors of unintended pregnancies; among them are
contraceptive failure, lack of access to contraception,
religious beliefs and poor knowledge on contraception,
fertility and pregnancy, a history of previous unintended
pregnancy, insufficient reproductive health education, de-
sire for at least two children, parity of five, lack of com-
munication or support within the relationship, husband’s
reluctance to limit family size, and sexual violence [15-18].
In Ghana, where the situation is critical, very few stu-
dies have been undertaken on unintended pregnancies.
For instance, one study [12] only detailed analysis of the
predictors of unintended pregnancies. Some are listed as
age, marital status, abode, educational status, profession,
gravidity and parity, poverty or inadequate resources for
raising a child, stigma against unmarried mothers, a
cultural preference for sons, completion of family size,
disagreement between spouses about family size, poor
access to family planning services, and poor understan-
ding of risks associated with unintended pregnancy
[3,12]. The objective of this study is to contribute to the
search for predictors of unintended pregnancies in Ghana
through a survey among pregnant women attending an-
tenatal clinics in rural and semi-urban health facilities in
the Mfantseman Municipal of the Central Region.
Methods
This study was part of a bigger study on the factors in-
fluencing the intention of women in rural Ghana to adopt
post-partum family planning (PPFP). The method has
been described in an earlier publication [19]. The study
was conducted at four health facilities in the Mfantseman
Municipal of the Central Region. The area was selected in
the Central Region because of consistent reports of ad-
verse maternal health/family planning (FP) outcomes: It
reported the highest level of teenage pregnancy (13.6% of
all pregnancies in 2010), high incidence of induced abor-
tions and low level of unmet need [11,20].
For this study, all pregnant Ghanaian women living in the
municipal and attending antenatal clinic at the Saltpond
Government Hospital, Mankessim Health Centre (located
in semi-urban settings - i.e.-demographically urban with
population of about 42,000, economically agro-based with
values, attitudes, tastes and behaviours characteristic of
both urban and rural settings) and the Biriwa and Anomabo
Health Centers (both rural) between January 2012 and
April 2012 were targeted for interview within the
premises of the health facilities, using a five-page
questionnaire. Questions related to socio-demographic
background, socio-demographic characteristics of male
partners, issues pertaining to the nature of relationships
between the respondents and the male partners, re-
spondents’reproductive history including status of
current pregnancy (whether wanted, unwanted or mis-
timed), awareness and ever use of various Family
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Planning (FP) methods and the intention to use FP after
delivery.
A total of 1900 pregnant women were targeted to be
interviewed on the assumption that 50% of them will
have the intention to adopt PPFP. With 80% power, it
was possible to estimate the proportion of women wil-
ling to adopt PPFP within a margin of error of 3%. The
municipal recorded about 4000 deliveries in 2009.
Cleaned data were exported into STATA/IC (version
11.2) for analyses. Descriptive and bivariate logistic re-
gression analyses were conducted under the various sub-
themes of the questionnaire. Two models were used in
the bivariate logistic regression analyses. In Model I, tests
of association were conducted between eighteen (18) inde-
pendent variables and the outcome variable (unintended
pregnancy). Fifteen (15) of the independent variables were
found to be significantly associated (P < 0.05) with the out-
come variable; however, since P < 0.05 is not appropriately
robust to determine which associations were real and
which were by chance, given so many tests, a second
model (Model II) was introduced.
In Model II, the significance level threshold was set
higher to 0.003 by conducting a Bonferroni correction.
Factors found to be significantly associated with the main
outcome of interest, were included in a multivariate lo-
gistic regression model (Model III), to identify significant
independent predictors of unintended pregnancy. Tests of
covariance were conducted among all the significant va-
riables and those found to show covariance were dropped
from model III.
The outcome variable (unintended pregnancy) was de-
fined as any pregnancy that was not wanted at all at the
time it occurred or in the future, or mistimed i.e. wanted
at a later time but not at the time it occurred. An
intended pregnancy was defined as any pregnancy that
was wanted at the time it occurred or wanted at an ear-
lier time but occurred later.
Ethical approval was obtained from the Ethics Review
Committee of the Ghana Health Service (GHS). Insti-
tutional approval was also obtained from the Municipal
Health Directorate (MHD) and the heads of the facilities
where the survey was conducted. Written informed con-
sent was obtained from each participant before the admi-
nistration of questionnaires.
Results
Background characteristics of respondents and their
relation to overall pregnancy status
A total of 1,914 pregnant women were interviewed. The
mean age of these women was 25.6 ± 6.5 years, with the
majority (29.7%) aged between 20–24 years. Majority
(70%) indicated that the pregnancies they were carrying
were unintended (mistimed 39%, unwanted 31%). There
were more unintended pregnancies reported among
younger (90%) than older women (80%), (P < 0.001).
There was a trend towards reduced unintended preg-
nancies with increasing level of education. Prevalence of
unintended pregnancies was high among all religious
groups with the highest being among the traditionalists
(82%). Prevalence of intended pregnancies was relatively
higher amongst the Muslims (43%) and Catholics (36%),
(P < 0.001). Expectant mothers with five or more chil-
dren had high prevalence (61%) of unwanted pregnan-
cies compared to those with up to four children. Of the
256 respondents who were single, only a tenth of the
pregnancies were intended, in contrast to those who
were married. A third of those who were married tra-
ditionally, engaged or cohabiting had intended pregnan-
cies. The prevalence of unintended pregnancies among
students (n = 124) was noticeably high (90%) compared
to those who were employed in the formal sector as
civil/public servants (32% of the 84 respondents). Of
those in the informal sector (petty traders, fishmongers
and farmers), three out of every four pregnancies were un-
intended. Intended pregnancies amongst those living in the
two semi-urban settlements (Mankessim and Saltpond)
were higher than those in the rural areas (Biriwa and
Anomabo) (35% versus 20%), (P < 0.001) (Table 1).
Bivariate logistic regression analyses of unintended
pregnancies on independent variables
Unintended pregnancy (outcome variable) was regressed
on each of the identified independent variables (Table 2,
Model I). Only those independent variables that were
found to be significantly correlated (P < 0.05) with the out-
come were subjected to Bonferroni’s correction (Table 2,
Model II). Women aged 20 years and above, had signifi-
cantly lower odds of having unintended pregnancy (OR
0.83, 95% CI 0.77-0.89). Some factors that were found to
be significantly associated with increased odds of unin-
tended pregnancies are: not being married by ordinance
(Muslim or Christian wedding) (OR 1.41, 95% CI 1.30-
1.52); partner not living in the same house as the woman
(OR 2.15, 95% CI 1.70 -2.72) and high parity (OR 1.20,
95% CI 1.12-1.29).
Respondents who were aware of modern and traditional
family planning methods, and had ever used traditional
methods showed significantly lower odds of carrying unin-
tended pregnancy [OR 0.40, 95% CI(0.25-0.62); OR 0.50,
95% CI(0.40-0.64); OR 0.68, 95% CI(0.55-0.82) respec-
tively]. Education was not found to be a significant factor
influencing unintended pregnancies in this study.
Multivariate logistic regression analyses
Controlling for all factors listed in Model III, increasing
parity was significantly associated with increasing odds of
unintended pregnancy. The odds of carrying unintended
pregnancy among women with five or more children were
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Table 1 Background characteristics by pregnancy status
Overall pregnancy status (%)
Demographic characteristics Sample size Percent of total sample size (%) Intended Mistimed Unwanted Unintended*
Age**
15-19 340 17.8 9.2 32.3 58.5 90.8
20-24 569 29.7 31.7 45.0 23.4 68.3
25-29 483 25.3 37.7 42.0 20.3 62.3
30-34 291 15.3 38.1 35.1 26.8 61.9
35-39 172 9.0 28.5 36.1 35.5 71.5
40+ 56 2.9 19.6 25.0 55.4 80.4
TOTAL 1914 100.0 29.6 39.1 31.4 70.4
Education level**
None 414 21.6 23.0 39.0 38.0 77.0
Primary 429 22.4 24.8 39.3 36.0 75.2
Middle/JSS 843 44.1 30.0 40.4 29.6 70.0
SSS/SHS/VOC 166 8.7 41.2 36.4 22.4 58.8
Tertiary 62 3.2 69.4 27.4 3.2 30.7
TOTAL 1,914 100.0 29.6 39.1 31.3 70.4
Religion**
Christian 1,783 93.2 29.3 39.0 31.7 70.7
Muslim 88 4.6 39.8 36.4 23.9 60.2
Traditionalist 10 0.5 20.0 60.0 20.0 80.0
Other 33 1.7 22.6 41.9 35.5 77.4
TOTAL 1,914 100.0 29.6 39.1 31.3 70.4
Gravidity**
1 -2 1,025 53.8 31.8 36.7 31.5 68.2
3 -4 531 27.9 30.5 46.9 22.6 69.5
5+ 348 18.3 21.6 34.2 44.3 78.5
TOTAL 1,904^ 100.0 29.6 39.1 31.4 70.4
Parity**
0 673 35.2 30.9 31.1 38.0 69.1
1 -2 772 40.3 34.1 46.3 19.6 65.9
3 -4 353 18.4 23.1 42.2 34.8 76.9
5+ 116 6.1 11.2 27.6 61.2 88.8
TOTAL 1,914 100.0 29.6 39.1 31.4 70.4
Marital Status**
Married by Ordinance (Church/mosque) 236 12.4 49.6 32.6 17.8 50.4
Married (Traditional) 857 44.8 29.3 42.1 28.6 70.7
Engaged 282 14.7 38.1 40.2 21.7 61.9
Cohabitation 267 14.0 24.2 45.3 30.6 75.9
Divorced/Sep/Widowed 8 0.4 0.0 62.5 37.5 100.0
Single 256 13.4 9.6 26.7 63.8 90.4
Other 6 0.3 0.0 20.0 80.0 100.0
TOTAL 1,912^ 100.0 29.6 39.1 31.3 70.4
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higher than those with one to two children [AOR 6.06,
95% CI (3.24-11.38) versus AOR 1.48, 95% CI (1.14-1.93)].
Women with other marital arrangements showed signifi-
cantly higher odds of carrying unintended pregnancy com-
pared to those married by ordinance (Muslim or Christian
wedding). Single women showed the highest odds of
carrying unintended pregnancy [AOR 7.32, 95% CI (4.21-
12.75]. Women not living with their partners exhibited in-
creased odds of having unintended pregnancies compared
to women who lived with their partners (AOR 1.72, 95%
CI: 1.28 - 2.30). Awareness of traditional methods of family
planning (withdrawal and rhythm) was associated with
lower odds of having unintended pregnancy compared to
non-awareness (AOR 0.66, 95% CI (0.49-0.89) (Table 2
Model III).
Discussion
Factors which were identified to be significantly asso-
ciated with the tendency to consider the pregnancy
which women were carrying at the time of the survey to
be unintended, included parity, marital arrangement,
living arrangement with partner and awareness of tra-
ditional methods of contraception.
High parity was significantly associated with unin-
tended pregnancy. The expectation was that the level of
unintended pregnancy would be lower with increasing
parity. The result indicating high odds of unintended
pregnancies with increasing parity among women is an
observation which would need further investigation des-
pite similar findings from other studies. [12,21,22]. The
relatively low exposure of rural women in Ghana to
modern family planning [10] could partly explain this
finding. Another possibility is that, couples looking for a
particular gender may end up having more children than
intended; there is evidence that parents wanting to ba-
lance the sex of their children will continue to give birth
if all the children are of the same sex and especially if
parents have a desire for a son. Chaudhuri, S, demon-
strated from a study in India that the desire for sons, or
not having any son, was associated with an increase in
parity progression [23]. This finding supports prior re-
search in South East Asia [24-27].
Studies have persistently demonstrated higher odds of
unintended pregnancy among partners with other marital
arrangements compared to married couples [28-31].
Lachance-Grzela & Genevieve Bouchard, explain that the
advantage of married couples generally having favourable
and healthier pregnancies than unmarried couples occurs
only when the pregnancies are intended [28]. The fin-
ding that, women who reported other forms of marital
Table 1 Background characteristics by pregnancy status (Continued)
Occupation**
Fishmonger 318 16.6 21.5 38.6 39.9 78.5
Farmer 67 3.5 19.4 43.3 37.3 80.6
Petty trader 913 47.8 28.1 42.3 29.6 71.9
Civil/Public Servant 84 4.4 67.9 23.8 8.3 32.1
Student 124 6.5 9.8 30.9 59.4 90.2
Other 406 21.2 39.0 37.0 24.0 61.0
TOTAL 1,912^ 100.0 29.6 39.1 31.3 70.4
Area of residence**
Saltpond 422 22.2 36.3 38.9 24.9 63.7
Biriwa 231 12.1 21.2 35.9 42.9 78.8
Anomabo 324 17.0 20.1 41.1 38.9 79.9
Mankessim 567 29.8 34.0 36.5 29.5 66.0
Other 358 18.8 28.8 43.6 27.7 71.2
TOTAL 1,902^ 100.0 29.6 39.1 31.3 70.4
Religious Denomination**
Catholic 199 11.2 35.68 32.16 32.16 64.3
Protestant/Charis/pent 1,361 76.9 30.05 39.75 30.2 70.0
Muslim 81 4.6 43.21 39.51 17.28 56.8
Traditionalist 74 4.2 17.57 48.65 33.78 82.4
No/other religion 54 3.1 22.22 46.3 31.48 77.8
TOTAL 1,769^ 100.0 30.53 39.46 30.02 69.5
*Unintended (mistimed + unwanted), (Pearson Chi2 Statistic - **p <0.001), ^observed differences in total sample sizes (1914) are due to missing values.
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Table 2 Binary logistic regression analyses: models I&II (bivariate analyses) and model III (multivariate analyses)
Model I Model II Model III
Variables OR (95% CI) Unadjusted
P-value
Bonferroni
adjusted P-value
Adjusted Odds Ratio (AOR) P-value
Age (Ref: 15–19) NA NA
20-24 0.83 (0.77-0.89) <0.001 <0.001
25-29
30-34
35-39
40+
Educ status (Ref: none) NA NA
Primary 0.98 (0.92-1.03) 0.45 NA
Middle/JSS
SSS/SHS/Vocational
Tertiary
Ethnicity (Ref: fante) NA NA
Others 1.00 (0.98-1.02) 0.89 NA
Religion (Ref: christian) NA NA
Muslim 1.04 (0.99-1.09) 0.15 NA
Traditionalist
Others
Parity (Ref: 0)
1−2 1.20 (1.12-1.29) <0.001 1.48 (1.14-1.93) 0.004
3−4 2.64 (1.88-3.71) <0.001
5+ <0.001 6.06 (3.24-11.38) <0.001
Marital status (Ref: by ordinance)
Traditional rites 1.41 (1.30-1.52) <0.001 <0.001 1.81 (1.33-2.45) <0.001
Engaged, yet to be married 1.58 (1.10-2.28) 0.014
Cohabitation 2.91 (1.96-4.31) <0.001
Single 7.32 (4.21-12.75) <0.001
Partner age (Ref: 15–19) NA NA
20-29 0.97 (0.95-0.98) <0.001 <0.001
30-39
40+
Partner religion (Ref: christian) NA NA
Muslim 1.25 (1.06-1.47) 0.009 0.135
Traditionalist
Others
Partner has Chn. from other women (Ref: yes) NA NA
No 1.33 (1.08-1.64) 0.008 0.120
Years of marriage/relationship (Ref: <1Yr.) NA NA
1-4 yrs 1.02 (1.00-1.05) 0.019 0.285
Partner lives in same house as woman (Ref: yes)
No 2.15 (1.70-2.72) <0.001 <0.001 1.72 (1.28-2.30) <0.001
Partner has other spouses (Ref: yes) NA NA
No 1.47 (1.06-2.23) 0.019 0.285
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arrangements had higher odds of unintended pregnancies
compared to those married under the ordinance, presents
an issue for further investigation within the Ghanaian con-
text. It is possible that forms of marital arrangements
could have implications for stability of marriage and there-
fore the possibility of planning pregnancies. The high odds
of unintended pregnancies among single or unmarried
women are not unexpected. This is especially so when
pregnancy is considered to be a prelude to marriage or for
solidifying a relationship [29]. Fear of infertility in future
marital unions is a major driver behind this in some
communities.
Two non-pharmacological contraceptive methods proved
beneficial in preventing unintended pregnancies in this
study. Women who were aware of withdrawal and rhythm
as protective measures against unintended pregnancy,
were less likely to have unintended pregnancies compared
to those who were not aware. The socio-cultural context
within the rural setting, myths and fear of side effects of
modern contraceptives possibly influenced this finding.
As observed by Ikamari and colleagues [21] also,
formal education was not significantly associated with
pregnancy intendedness, contrary to expectation on this
correlate. There was however, a trend towards reduced
unintended pregnancy with increasing level of education
(Table 1), which is consistent with other studies [12,32].
It could be an emerging issue which would need further
investigation within the Ghanaian context.
Conclusions
This study has highlighted several factors associated with
unintended pregnancy: parity, marital arrangement, li-
ving arrangement with partner and awareness of tra-
ditional, non-pharmacological contraceptive methods.
These results indicate that various categories of women
would need to be targeted differently for family planning
messages and services. For instance, the National Centre
for Civic Education (NCCE), Ghana Health Service, reli-
gious bodies and Non-Governmental Organizations need
to intensify the campaign on the importance of couples to
opt for marriage by ordinance, since it has several advan-
tages over other forms of marital arrangement. This study
revealed that if partners lived together, the probability of
unintended pregnancies may reduce. Marriage by ordi-
nance may further strengthen this relationship and help to
reduce unintended pregnancies. Campaigns on sex balan-
cing aimed at encouraging parents to accept the sex of the
children they have could be carried out, in order to limit
the tendency to higher parity progression. This could be
fairly easy given the fact that there are no obvious sex
preferences in Ghana.
Family planning programmes may need to consider
promotion of traditional, non-pharmacological methods
alongside the modern methods, especially in rural set-
tings, to improve overall contraceptive prevalence rates.
For clients who do not want to adopt modern con-
traceptives despite all reassurances, the option of tra-
ditional methods should be offered them. This implies
that health workers may need to be trained adequately
to provide such services. Commitment from the Ghana
Health Service Family Planning Programme would be re-
quired if this is to succeed.
Unintended pregnancy may be of greatest risk to
mother and baby during the postpartum period. Family
planning interventions, especially targeting this period,
would be essential if the rates of unintended pregnancies
are to be reduced, to promote positive health outcomes.
In connection with this, pregnant women attending
Table 2 Binary logistic regression analyses: models I&II (bivariate analyses) and model III (multivariate analyses)
(Continued)
Gravidity (Ref: 1–2) NA NA
3−4 1.08 (1.12-1.14) 0.004 0.060
5+
Previous abortions/miscarriages (Ref: yes) NA NA
No 1.00 (1.00-1.0045) 0.043 0.645
first pregnancy
Awareness of modern FP (Ref: no)
Yes 0.40 (0.25-0.62) <0.001 <0.001 0.70 (0.42-1.17) 0.173
Awareness of traditional FP (Ref: no)
Yes 0.50 (0.40-0.64) <0.001 <0.001 0.66 (0.49-0.89) 0.007
Ever use of modern FP (Ref: no) NA NA
Yes 0.78 (0.64-0.95) 0.014 0.210
Ever use of traditional FP (Ref: no)
Yes 0.68 (0.55-0.82) <0.001 <0.001 0.95 (0.75-1.21) 0.672
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antenatal clinic (ANC) need to be targeted for family
planning counseling before they deliver. Couple coun-
seling should be actively explored by health workers as
part of the routine antenatal care of each pregnant
woman. It should be made a part of standard ANC
protocol and health workers required to ensure adhe-
rence during facility and community based care.
Study limitations
The threat of selection bias existed, but was highly miti-
gated, by ensuring that, the data collectors explained the
study objectives and their implications very well to the re-
spondents, before asking for consent. The time for the
study was short; and this was imposed by limited funding
and strict reporting requirements by funding agency.
Some of the data collectors abandoned the study because
of inadequate remuneration. New data collectors had to
be trained to continue data collection. This brought about
some delays in data analysis and reporting.
Abbreviations
ANC: Antenatal clinic; AOR: Adjusted odds ratio; CI: Confidence interval;
FP: Family planning; GHS: Ghana Health Service; LMIC: Low-and middle-income
countries; MDG: Millennium development goals; MHD: Municipal Health
Directorate; NCCE: National Commission for Civil Education; OR: Odds ratio;
PPFP: Postpartum family planning; UNFPA: United Nations Population Fund.
Competing interests
The authors declare that they have no competing interest.
Authors’contributions
SE and FB were responsible for the conceptualization of the study. SE and FB
were responsible for its design and implementation. SE and BY were
responsible for production of the initial draft of the manuscript. SE was
responsible for finalizing the manuscript after critical review by KAA. All
authors read and approved the final manuscript.
Authors’information
SE is a Public Health Physician and Lecturer in the Department of
Community Medicine, university of Cape Coast, Ghana; FB is a Public Health
Physician and Seniour Researcher at Centre for Health Research and
Implementation Support; BY is a Pharmacist and PhD Candidate at Georgia
State University, Atlanta, USA; KAA is a Professor in Population and Health at
the Faculty of Social Science, University of Cape Coast, Ghana.
Acknowledgements
We wish to acknowledge the cooperation of pregnant women in all four
health facilities where the study was conducted. We also wish to recognize
the work of the interviewers in the respective facilities, the heads and staff of
the facilities who supported the conduct of the study in diverse ways. We
are particularly grateful to the Mfantseman Municipal Health Directorate and
the management of the Saltpond Municipal Hospital for allowing the study
to be undertaken in their facilities.
Author details
1
Department of Community Medicine, University of Cape Coast, Cape Coast,
Ghana.
2
Centre for Health Research and Implementation Support, Accra,
Ghana.
3
Georgia State University, Atlanta, USA.
4
Department of Population
and Health, University of Cape Coast, Cape Coast, Ghana.
Received: 5 January 2014 Accepted: 28 July 2014
Published: 8 August 2014
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Cite this article as: Eliason et al.:Determinants of unintended pregnancies
in rural Ghana. BMC Pregnancy and Childbirth 2014 14:261.
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