Epidemiology of unintended pregnancies: regional insights from sub-Saharan Africa

Unintended pregnancy remains a significant public health issue globally, with sub-Saharan Africa experiencing a particularly severe burden. The aim of this study was to assess the prevalence and determinants of unintended pregnancy across 35 countries in sub-Saharan Africa. Data were obtained from the Demographic and Health Surveys (n = 373,298). Unintended pregnancies were defined as those that were either mistimed (i.e., occurring earlier than desired) or unwanted (i.e., not desired at all). Descriptive statistics were used to summarize the data, and multivariable logistic regression analysis was performed to examine the association between sociodemographic factors and unintended pregnancy. The analyses were conducted using Stata 16 software, with survey weights applied to account for the complex survey design. Descriptive analysis revealed that 27.6% of women reported their last pregnancy as unintended, with significant regional variation. The highest prevalence of unintended pregnancies was observed in South Africa (57.9%), while the lowest was in Burkina Faso (9.8%). In general, rural areas had a higher prevalence of unintended pregnancies compared to urban areas. Regression analysis identified significant sociodemographic factors associated with unintended pregnancy. Women in rural areas had lower odds of unintended pregnancy compared to urban residents (OR = 0.93, 95% CI 0.91–0.95). However, women with primary education were more likely to experience unintended pregnancies compared to those with no education (OR = 2.02, 95% CI 1.98–2.06), and those in the richest wealth quintile had significantly lower odds than those in the poorest quintile (OR = 0.81, 95% CI 0.79–0.84). Contraceptive use was also strongly associated with unintended pregnancy: women using no contraceptive method had 1.74 times higher odds of unintended pregnancy compared to those using modern methods (OR = 1.74, 95% CI 1.71–1.77). This study underscores the need for targeted, evidence-based interventions that address the sociodemographic factors contributing to unintended pregnancies in sub-Saharan Africa. Interventions should focus on improving access to contraceptive methods, promoting education, reducing socioeconomic disparitiesinequalities, and increasing media access to better inform reproductive health decisions. These efforts can help mitigate the high prevalence of unintended pregnancies in the region.