Association between pregnancy wantedness and utilization of maternal health services by adolescent girls and young women at their first live birth in Uganda: Analysis of the 2011 and 2016 Demographic and Health Surveys

Abstract Background: Unwanted and mistimed pregnancies are postulated to affect the utilization of maternal health services particularly among adolescent girls and young women (AGYW). We investigated the association between pregnancy wantedness and utilization of maternal health services by AGYW in Uganda. Methods: We analyzed data from the 2011 and 2016 Uganda Demographic and Health Surveys among women whose most recent live birth in each survey’s 5-year recall period was their first birth and who were ≤ 24 years old at the time of their first birth. The outcome variables for this study included utilization of antenatal care (ANC) (categorized as “optimal” if ≥ 4 visits or “poor” if < 4 visits), health facility delivery (yes/no), utilization of postnatal care (PNC) (yes/no), and utilization of the continuum of all three maternal health services (fully utilized and partially utilized). The main independent variable was pregnancy wantedness, categorized as wanted at the time of conception versus unwanted (wanted later or not wanted at all). Data were analyzed using STATA 14. We performed descriptive analysis and logistic regression (bivariate and multivariable) for each survey separately. Results: We included a total of 741 (in 2011) and 1,828 (in 2016) AGYW (10 to 24 years at the time of their first live birth). The percentage of them that said their first pregnancy was unwanted was 42.0% in 2011 and 45.9% in 2016. In 2011, AGYW with unwanted pregnancies were less likely to utilize optimal ANC compared to those who wanted their pregnancies (AOR=0.64, 95%CI=0.43-0.96). Additionally, pregnancy wantedness was associated with utilization of the continuum of maternal health services in 2011 (AOR = 0.63, CI = 0.40 - 0.99). In 2016, pregnancy wantedness was not significantly associated with ANC utilization (AOR 0.93, CI = 0.73 - 1.17). There was no association between pregnancy wantedness and delivery in a health facility or utilization of PNC in both surveys (p-value >0.05). Conclusion: Our results showed that although pregnancy wantedness was associated with utilization of ANC and the continuum of maternal health services in 2011. However, in 2016, pregnancy wantedness was not associated with the utilization of any maternal health services.