Determinants of Unintended Pregnancy and Induced Abortion among Female Youths in Western Regional Hospital, Nepal

Introduction: Youth are more susceptible to unwanted pregnancies; this may be explained by the fact that youths are facing various problems with regards to their reproductive health needs including age at marriage, contraceptive use, social, cultural and economic barriers in accessing the family planning services, their educational level as well as occupational opportunities. The study assessed the determinants of unintended pregnancies and induced abortion among female youths aged 15-25 years in Western Regional Hospital, Pokhara. Methods: A cross sectional hospital-based study was conducted among 125 female youths visiting Western Regional Hospital, Pokhara. Ethical approval was taken before starting data collection. The respondents were interviewed using semi structured questionnaire. All the data collected in the proformas were entered and assimilated using SPSS 21, statistical analysis software. Descriptive statistics including chi square and p-value was applied. Results: Among 125 female respondents, 72.8% of the respondents had unwanted pregnancy and 24% had history of abortion. Out of all the unwanted pregnancies, 86.7% had induced abortion with p-value <0.05, x2 = 67.41. The financial problems of the respondents were found to be the prime determinant of unwanted pregnancy and induced abortion, proportion being 52.8% and 55.2% respectively, whereas to keep gap between the births (12.8%) was also associated. The association between use of contraceptive methods and unwanted pregnancy was not found to be statistically significant with the p-value of >0.05. Conclusions: The prevalence of unintended pregnancy and induced abortion were high and most of the induced abortion was the result of unwanted pregnancy. The economic problem of the respondents was the prime factor associated with induced abortion.


INTRODUCTION
The problem of unwanted pregnancies is very big worldwide but still underreported in many communities due to its sensitive nature. 1 In developing countries more than one-third of all pregnancies are considered unintended and about 19% ends up in abortion. 2 Adolescent girls are far more likely to become pregnant unintended and thus pregnancies are more likely to end in induced abortion. The total contraceptive prevalence rate in Nepal is 52.6% combining both modern and traditional methods. This is far less than the country's targeted goal of 67%. 3 An understanding of the magnitude of unintended pregnancy, induced abortion among youths as well as the factors that are associated with them at the community level is very crucial in designing and implementing interventions that could be tailored to youths needs there by contributing in the attainment of the Sustainable Development Goal 3. Thus, the main aim of the study was to assess the determinants of unwanted pregnancies and induced abortion among female youths aged 15-25 years.

METHODS
Descriptive cross-sectional study was conducted from October 2016-May 2018 in Western Regional Hospital, Pokhara among 125 female youths. It is a referral hospital for Western Region. It has total 325 beds and provides service to more than 700 patients every day. It also provides Safe Abortion Services, which receives about 30-35 patients every month. The study was commenced after taking ethical approval from the Institutional Review Board, Institute of Medicine, Tribhuvan University. Each patient or case selected was enrolled after informed consent and with right to withdraw at any time if uncomfortable. The patient's confidentiality was maintained.
Inclusion criteria: Female youths aged 15-25 years who visited to safe abortion clinic, Western regional hospital, Pokhara with unintended pregnancy.
Exclusion Criteria: Female youth who were unable to respond to the interviewer Data was collected using semi structured questionnaire with open and closed end questions. The questionnaire consisted of sociodemographic characteristics of respondents, history of pregnancies and induced abortion, knowledge about contraceptives, use of contraceptives, and other factors influencing and related to unwanted pregnancies and induced abortion among youths. All the data collected in the proformas were entered and assimilated using SPSS 21, statistical analysis software. Frequencies of variables were generated; tabulation and percentages were used to illustrate study findings. Chi square test was used to test the association between the dependent variables and independent variables.

RESULTS
Among 125 pregnant females visiting Western Regional hospital/ CAC clinic reported that 91(72.8%) had unwanted pregnancies and 34(27.2%) had wanted pregnancies.  There was significant association between unwanted pregnancy and abortion among female youths (<0.05)  There was no significant association between awareness of FP methods and the rate of unwanted pregnancy In contrast to Acharya et al, the proportion of women that reported mistimed pregnancy (11.2%) was slightly less than that of women who reported unwanted pregnancy (13.4%). 1 Out of 125 female youths 94(75.2%) were aged between 20-25 years, the mean age was found out to be 20 (SD=3). The majority of respondents 114(91.2%) belonged to Hindu religion and 120(96%) were married. Most of the female youths 59(47.2%) had secondary education; however 62(49.6%) respondents were housewives. As regards to age, youths aged 20-25 years were more likely to have unwanted pregnancy 71(75.5%) compared to age 15-20 years with p value <0.05 which was statistically significant. As for religion, marital status and occupation of the respondents, the association was found to be statistically significant with p value <0.05. However, regarding the level of education, the association was not statistically significant, majority of the respondents having secondary level education 50(84.7%), who have their pregnancies unwanted and the p value was >0.05.
In contrast a study done in Ethiopia (6) reported that 33 % of women reported to have their recent pregnancy unintended and among all these pregnancies half (50%) of them ended in induced abortion. Most of them were teenagers (OR 4.2 95% CI 1.4-10.5), those married at the age of less than 20 years (OR 2.1 95% CI 1.9, 4.7), have been reported to have higher chance of experiencing unwanted pregnancy and 31% of women with induced abortion were students. A study done in Kenya showed that women with at least secondary education had their first sexual intercourse delayed by at least three year. This plays a big part in the reduction of the rate of unwanted pregnancy and induced abortion among youths. 5 According to this study majority of the respondents who did not want pregnancies had financial issues accounted for 52.8%. However, 16(12.8%) of the respondents wanted to have gap between the births, 14(11.2%) wanted to continue their studies, 8(6.4%) had their family completed, 6(4.8%) had failed IUCD and 4(3.2%) had fear of being out casted due to social problems. Similarly, most of the respondents mentioned that the reason for having induced abortion was due to financial problems 69(55.2%), followed by want to have gap between births 19(15.2%). 16(12.8%) of the respondents wanted to have further education whereas 11(8.8%) had their family completed. Among the respondents, 6(4.8%) had employment needs and 4(3.2%) aborted due to fear of being out casted.
In this study, out of all the study respondents, majority of them 102(81.6%) have heard of family planning information.

CONCLUSIONS
The prevalence of unintended pregnancy and induced abortion were high and most of the induced abortion was the result of unwanted pregnancy. The economic problem of the respondents was the prime factor associated with induced abortion. There was low utilization of contraceptives among female youths but its association with the rate of unwanted pregnancy was found not to be statistically significant