Prevalence and determinants of unintended pregnancy in Ethiopia: A systematic review and meta-analysis of observational studies

BackgroundUnintended pregnancy has significant consequences for the health and welfare of women and children. Despite this, a number of studies with inconsistent findings were conducted to reduce unintended pregnancy in Ethiopia; unavailability of a nationwide study that determines the prevalence of unintended pregnancy and its determinants is an important research gap. Thus, this study was conducted to determine the overall prevalence of unintended pregnancy and its determinants in Ethiopia.MethodsWe searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias of observational studies. The heterogeneity of studies was also assessed using I2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the overall prevalence of unintended pregnancy and its determinants in Ethiopia. In addition, the subgroup analyses were performed to investigate how the prevalence of unintended pregnancy varies across different groups of studies.ResultsTwenty-eight studies that satisfy the eligibility criteria were included. We found that the overall prevalence of unintended pregnancy in Ethiopia was 28% (95% CI: 26–31). The subgroup analyses showed that the highest prevalence of unintended pregnancy was observed from the Oromiya region (33.8%) followed by Southern Nations Nationalities and Peoples’ region (30.6%) and the lowest was in Harar. In addition, the pooled prevalence of unintended pregnancy was 26.4% (20.8–32.4) and 30.0% (26.6–33.6) for community-based cross-sectional and institution-based cross-sectional studies respectively. The pooled analysis showed that not communicating with one’s husband about family planning was more likely to lead to unintended pregnancy (OR: 3.56, 95%CI: 1.68–7.53). The pooled odds ratio also showed that unintended pregnancy is more likely among women who never use family planning methods (OR: 2.08, 95%CI: 1.18–3.69). Furthermore, the narrative review of this study showed that maternal education, age, and household wealth index are strongly associated with an unintended pregnancy.ConclusionsIn this study, the prevalence of unintended pregnancy was high. Lack of spousal communication, never using family planning, maternal education, and household wealth level were significantly associated with an unintended pregnancy. This study implies the need to develop plans and policies to improve the awareness of contraceptive utilization and strengthen spousal communication related to pregnancy.背景 意外妊娠对妇女与儿童的健康及福祉具有重大影响。尽管如此，埃塞俄比亚既往为降低意外妊娠所开展的多项研究结论并不一致，且目前仍缺乏一项全国性研究以明确该国意外妊娠的流行率及其影响因素，这是当前重要的研究空白。因此，本研究旨在明确埃塞俄比亚意外妊娠的总体流行率及其影响因素。 方法 本研究检索了Google Scholar、PubMed、Science Direct、Web of Science、CINAHL及Cochrane Library数据库中的相关研究。采用观察性研究偏倚风险评估工具对每项原始研究进行质量评价。同时使用I²检验统计量评估研究间的异质性。对纳入数据进行合并，并采用随机效应元分析（random effect meta-analysis）模型拟合，以得出埃塞俄比亚意外妊娠的总体流行率及其影响因素。此外，本研究还开展了亚组分析，以探究不同研究分组间意外妊娠流行率的差异。 结果 本研究共纳入28项符合纳入标准的研究。结果显示，埃塞俄比亚意外妊娠的总体流行率为28%（95%置信区间：26%~31%）。亚组分析表明，奥罗米亚地区（Oromiya region）的意外妊娠流行率最高，达33.8%，其次是南方民族、国家与人民地区（Southern Nations Nationalities and Peoples’ region），为30.6%，最低的是哈勒尔地区（Harar）。此外，基于社区的横断面研究和基于机构的横断面研究的意外妊娠合并流行率分别为26.4%（95%CI：20.8%~32.4%）和30.0%（95%CI：26.6%~33.6%）。合并分析显示，未与丈夫就计划生育进行沟通的女性发生意外妊娠的风险更高（比值比（Odds Ratio，OR）：3.56，95%CI：1.68~7.53）。合并比值比结果还表明，从未使用过计划生育措施的女性更易发生意外妊娠（OR：2.08，95%CI：1.18~3.69）。此外，本研究的叙述性综述显示，母亲的受教育程度、年龄及家庭财富指数与意外妊娠密切相关。 结论 本研究显示，埃塞俄比亚意外妊娠流行率较高。配偶间缺乏沟通、从未使用计划生育措施、母亲受教育程度及家庭财富水平均与意外妊娠显著相关。本研究提示，有必要制定相关计划与政策，以提高避孕措施利用的认知度，并加强与妊娠相关的配偶间沟通。