Factors associated with unplanned and ambivalent pregnancies: a cross-sectional study in a maternity hospital in Rio de Janeiro, Brazil

The ability to decide whether and when to become pregnant is a sexual and reproductive right guaranteed by Brazilian law; however, its exercise still faces barriers, reflecting inequalities and gaps between public policies and lived realities. Unplanned pregnancy (UP) is a global public health issue associated with adverse perinatal, infant, and maternal outcomes. Therefore, this study aimed to analyze the social, economic, historical, and reproductive determinants of unplanned pregnancy among adult women receiving care at a maternity hospital in the city of Rio de Janeiro. A cross-sectional study was conducted between October 8, 2024, and March 31, 2025. The sample included 334 women aged ≥ 18 years who were pregnant or up to 30 days postpartum, with a live newborn and fluent in Portuguese. The Brazilian version of the London Measure of Unplanned Pregnancy (LMUP) was used to assess pregnancy planning, along with a structured questionnaire to collect socioeconomic, demographic, sexual and reproductive history variables, access to health services, and experiences of discrimination and violence. Multinomial logistic regression with a hierarchical approach was performed to assess associations between exposure variables and unplanned pregnancy. Among participants, 31.5% reported unplanned pregnancy, 29.7% planned pregnancy, and 38.8% expressed ambivalent feelings regarding pregnancy planning. In the adjusted analysis, unplanned pregnancy was associated with not having a paid employment (OR = 1.97; 95% CI 1.02–3.80), not living with a partner (OR = 4.42; 95% CI 2.01–9.70), history of physical violence (OR = 2.38; 95% CI 1.08–5.25), receipt of contraceptives at primary health care units (OR = 2.11; 95% CI 1.05–4.25), and diagnosis of arterial hypertension (OR = 3.16; 95% CI 1.10–9.13). At the proximal level, a higher number of previous pregnancies (OR = 1.70; 95% CI 1.24–2.34) and use of emergency contraception (OR = 2.93; 95% CI 1.28–6.70) were positively associated with unplanned pregnancy, whereas a history of spontaneous abortion (OR = 0.17; 95% CI 0.07–0.45) or stillbirth (OR = 0.18; 95% CI 0.05–0.61) showed inverse associations. The findings suggest that social, economic, relational, and reproductive factors may influence pregnancy planning. Partner status, labor market participation, experiences of violence, and prior reproductive outcomes played an important role in this process. These results indicate that unplanned pregnancy should be understood within the framework of social determinants of health and reinforce the need for public policies and primary health care actions that promote women’s reproductive autonomy and informed decision-making.