Magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in low- and middle-income countries: An umbrella review of systematic review and meta-analysis

Background: To date, findings from systematic reviews and meta-analyses on unintended pregnancies in low-income and middle-income countries (LMICs) are inconsistent, posing challenges for preventive efforts. Therefore, the aim of this study is to determine the magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in LMICs: an umbrella review of systematic review and meta-analysis.

Methods: PubMed, Scopus, Science Direct, Web of Science, as well as databases specific to systematic reviews, such as the Cochrane Database, have investigated the magnitude, risk factors, and adverse outcomes of unintended pregnancy in LMICs. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates from the included studies regarding the magnitude and predictors of unintended pregnancy were then pooled and summarised using random-effects meta-analysis models.

Results: We included 13 systematic review and meta-analysis (SRM) studies involving 1 446 122 women. The summary estimate for the magnitude of unintended pregnancy was 28.38% (95% CI = 23.06-33.7%, I² = 100%). From the umbrella review, the reported factors and complications of statistical significance were as follows: maternal illiteracy (AOR = 3.79; 95% CI = 1.36-8.94), being unmarried (AOR = 12.98; 95% CI = 1.88-27.85), lack of communication with the husband about family planning (AOR = 3.43; 95% CI = 1.68-5.19), inability to attend antenatal care (AOR = 1.4; 95% CI = 0.62-2.17), never using family planning (AOR = 1.4; 95% CI = 0.62-2.17), maternal depression (AOR = 1.72; 95% CI = 0.81-2.64), stunting (AOR = 1.76; 95% CI = 1.25-2.48), and parity 3.83 (AOR = 1.3; 95% CI = 1.3-11.3).

Conclusions: The pooled magnitude of unintended pregnancies in LMICs was high. Therefore, it is crucial to integrate family planning and maternal health care services to prevent unintended pregnancy. Additionally, interventions targeting rural, unmarried, less-educated, and adolescent women are important for preventing unintended pregnancies in LMICs.