Prevalence and predictors of unintended pregnancy among antenatal women in Sierra Leone: A cross-sectional study

Unintended pregnancy remains a major contributor to adverse maternal and child health outcomes in sub-Saharan Africa, yet recent facility-based data from Sierra Leone are scarce. We aimed to determine the prevalence and identify factors associated with unintended pregnancies among antenatal clinic attendees at a major tertiary maternity hospital in Sierra Leone. We surveyed 1005 first-visit antenatal attendees at Princess Christian Maternity Hospital in Freetown between 19 March and 30 June 2024, using systematic sampling and multivariable logistic regression to identify independent predictors. Overall, 31.8% of women (95% CI 29.0 - 34.7) reported the current pregnancy as unintended; most were mistimed (30.0%) and the remainder unwanted (1.8%). Higher odds of unintended pregnancy were observed among women younger than 20 years (aOR 3.57, 95% CI 2.30 - 5.55), those who were unmarried (aOR 3.73, 95% CI 2.60 - 5.36), and those who were unemployed or students (aOR 1.74, 95% CI 1.25 - 2.42). Open partner communication about pregnancy (aOR 0.10, 95% CI 0.07 - 0.16) and partner desire for the pregnancy (aOR 0.05, 95% CI 0.03 - 0.09) were strongly protective. Nearly one in three pregnancies at Sierra Leone's principal referral maternity hospital is therefore unintended, with the burden falling on adolescents, unmarried women, and those with limited economic means. Interventions that integrate youth-friendly contraception services, partner-centred counselling, and broader female economic empowerment should be prioritised to reduce unintended pregnancies and improve maternal and child health.