How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania

Amon Exavery, Almamy Malick Kante, Ahmed Hingora, Godfrey Mbaruku, Senga Pemba, James F. Phillips

Research output: Contribution to journalArticle

Abstract

Background: Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation.Methods: Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation.Results: Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10-2.58) and 2.00 (95% CI 1.05-3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41-5.59) and 4.10 (95% CI 1.68-10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility.Conclusion: Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.

Original languageEnglish (US)
Article number35
JournalBMC Pregnancy and Childbirth
Volume13
DOIs
StatePublished - Feb 6 2013
Externally publishedYes

Fingerprint

Unwanted Pregnancies
Prenatal Care
Tanzania
Pregnancy
Gravidity
Health Facilities
Health Behavior
Marital Status
Religion
First Pregnancy Trimester
Parity
Health Services
Counseling
Multivariate Analysis
Cross-Sectional Studies
Logistic Models
Parturition

Keywords

  • ANC initiation
  • Mistimed pregnancy
  • Tanzania
  • Timing
  • Unwanted pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. / Exavery, Amon; Kante, Almamy Malick; Hingora, Ahmed; Mbaruku, Godfrey; Pemba, Senga; Phillips, James F.

In: BMC Pregnancy and Childbirth, Vol. 13, 35, 06.02.2013.

Research output: Contribution to journalArticle

Exavery, Amon ; Kante, Almamy Malick ; Hingora, Ahmed ; Mbaruku, Godfrey ; Pemba, Senga ; Phillips, James F. / How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. In: BMC Pregnancy and Childbirth. 2013 ; Vol. 13.
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AU - Pemba, Senga

AU - Phillips, James F.

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N2 - Background: Early antenatal care (ANC) initiation is a doorway to early detection and management of potential complications associated with pregnancy. Although the literature reports various factors associated with ANC initiation such as parity and age, pregnancy intentions is yet to be recognized as a possible predictor of timing of ANC initiation.Methods: Data originate from a cross-sectional household survey on health behaviour and service utilization patterns. The survey was conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania on 3,127 women from whom 910 of reproductive age who had given birth in the past two years and sought ANC at least once during pregnancy were selected for the current analysis. ANC initiation was considered to be early only if it occurred in the first trimester of pregnancy gestation. A recently completed pregnancy was defined as mistimed if a woman wanted it later, and if she did not want it at all the pregnancy was termed as unwanted. Chi-square was used to test for associations and multinomial logistic regression was conducted to examine how mistimed and unwanted pregnancies relate with timing of ANC initiation.Results: Although 49.3% of the women intended to become pregnant, 50.7% (34.9% mistimed and 15.8% unwanted) became pregnant unintentionally. While ANC initiation in the 1st trimester was 18.5%, so was 71.7% and 9.9% in the 2nd and 3rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2nd trimester was 1.68 (95% CI 1.10-2.58) and 2.00 (95% CI 1.05-3.82) times more likely for mistimed and unwanted pregnancies respectively compared to intended pregnancies. These estimates rose to 2.81 (95% CI 1.41-5.59) and 4.10 (95% CI 1.68-10.00) respectively in the 3rd trimester. We controlled for gravidity, age, education, household wealth, marital status, religion, district of residence and travel time to a health facility.Conclusion: Late ANC initiation is a significant maternal and child health consequence of mistimed and unwanted pregnancies in Tanzania. Women should be empowered to delay or avoid pregnancies whenever they need to do so. Appropriate counseling to women, especially those who happen to conceive unintentionally is needed to minimize the possibility of delaying ANC initiation.

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KW - ANC initiation

KW - Mistimed pregnancy

KW - Tanzania

KW - Timing

KW - Unwanted pregnancy

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