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

BMC Pregnancy and Childbirth

James F Phillips²  Senga Pemba³  Godfrey Mbaruku¹  Ahmed Hingora¹  Almamy Malick Kanté²  Amon Exavery¹ 

[1] Ifakara Health Institute (IHI), Plot 463, Kiko Avenue, off Old Bagamoyo Road, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania;Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA;Tanzanian Training Centre for International Health (TTCIH), Ifakara, Tanzania

关键词: Tanzania;    ANC initiation;    Timing;    Unwanted pregnancy;    Mistimed pregnancy;   

Others  :  1138234
DOI  :  10.1186/1471-2393-13-35

 received in 2012-10-31, accepted in 2013-01-30,  发布年份 2013

【 摘 要 】

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 1^st trimester was 18.5%, so was 71.7% and 9.9% in the 2^nd and 3^rd trimesters respectively. Multivariate analysis revealed that ANC initiation in the 2^nd 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 3^rd 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.

【 授权许可】

   
2013 Exavery et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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