Determinants and correlates of unintended pregnancy in polyclinic patients in Barbados: Patient and provider insights and the implications for health policy, service design and delivery

ABSTRACT

OBJECTIVE: To estimate the prevalence of unintended pregnancy in women attending the polyclinic for ante natalcare using direct and proxy measurements. SUBJECT AND METHODS: A piloted questionnaire was administered to a random sample of 300 women 15–44years (mean 25.5 ± 5.9 years). Direct measurements of unintended pregnancy were obtained from responses about the timing of the most recent or current pregnancy. Pregnancies were categorized as unintended, intended and ambivalent. Proxy measurement of unintended pregnancy was based on the proportion of women reporting at least one non-therapeutic abortion during their lifetime. RESULTS: Two-thirds (67.7%) reported an unintended pregnancy; most (50%, 95% CI 45.0, 56.3) were mistimed. The ratio of mistimed to unwanted pregnancy was 31. Approximately a quarter (24.7%) reported an intended pregnancy and 6.3% reported ambivalent pregnancy. Overall, 27.3% reported at least one non-therapeutic abortion. Of these, one-third (34.7%, p < 0.001) reported an abortion by age 30 years. The prevalence of nontherapeutic abortion was highest in women with technical/vocational education (33.7%) and lowest in womenwith at least secondary education (24.0%; p = 0.02). Theprevalence of non-therapeutic abortion was lowest in unemployed women (24.0%) compared to women employed by an employer (32.5%) or by self (31.7%; p =0.04). Higher levels of abortion were reported by women with partners 30–39 years (33.0%) or over 40 years(34.1%), compared to women with partners 20–29 years(24.6%; p = 0.01). CONCLUSION: Unintended pregnancy is high among polyclinic patients. Family planning programmes must be reframed to reduce unintended pregnancy.