Prevalence of unintended pregnancy and associated factors among women attending antenatal care at a tertiary public health facility in Northern Uganda: a cross-sectional study

Unintended pregnancy is a preventable driver of maternal and neonatal morbidity in low- and middle-income countries. Uganda continues to report high levels of unintended pregnancies, yet evidence from northern Uganda is sparse and largely limited to adolescents or specific risk groups. We assessed the prevalence and factors associated with unintended pregnancy among women attending antenatal care (ANC) at a tertiary public health facility in Northern Uganda. Between April 2025 and May 2025, we conducted a facility-based cross-sectional study enrolling pregnant women through systematic random sampling at Gulu Regional Referral Hospital in Gulu City, Uganda. Interviewer-administered structured questionnaires captured socio-demographic, reproductive, and partner-related characteristics. Unintended pregnancy was defined as a pregnancy that was mistimed or unwanted at the time of conception. Modified Poisson regression model with robust error variance was used to estimate crude and adjusted prevalence ratios with 95% confidence intervals. A two-sided p value < 0.05 was considered statistically significant. Of 414 eligible participants, with a median age of 24 years (interquartile range 21–29) years, 40.1% (n = 166; 95% CI: 35.4%–44.9%) reported the current pregnancy as unintended. After adjustment for potential confounders, unintended pregnancy was 54% more prevalent among pregnant women who had no male partner accompaniment during ANC visits compared to those who were accompanied (adjusted prevalence ratio (aPR) = 1.54; 95% CI: 0.99–2.38; p = 0.05), suggesting a potential association between lack of partner support and unintended pregnancy. Age, marital status, education, employment status, age at marriage, and age at sexual debut were not independently associated. Unintended pregnancy was common among women attending ANC at Gulu Regional Referral Hospital. While lack of male partner accompaniment showed a borderline association with unintended pregnancy, no measured variable demonstrated clear independent statistical evidence of association in the adjusted analysis. These findings support continued attention to pregnancy intention within antenatal care and family planning services and highlight the need for further research on contextual and reproductive determinants in this setting.