Concept of unintended pregnancy
Unintended pregnancy (UP) is a critical concern for demographers and public health practitioners, as it influences fertility understanding and the prevention of unwanted childbearing Accurately measuring pregnancy intentions is vital for comprehending fertility-related behaviors, forecasting fertility rates, and identifying unmet contraceptive needs Additionally, it plays a significant role in assessing the impact of pregnancy intentions on maternal and child health, designing effective family planning programs, and evaluating community-based initiatives aimed at preventing unplanned pregnancies.
Research on unintended pregnancy (UP) reveals that while definitions may vary globally and regionally, they share common themes UP is primarily characterized as an unplanned, unwanted, or unmet need pregnancy These terms highlight the complexities surrounding the issue of unintended pregnancies.
- UP is the situation when a pregnancy comes sooner than desired or when a woman does not have any intention of having a baby (Johnson et al 2004)
- UP is reported to have been either unwanted (i.e., it occurred when no children, or no more children, were desired) or mistimed (i.e., it occurred earlier than desired) (Hernandez, 2013)
Unintended pregnancy (UP) refers to a pregnancy that is either unwanted, meaning the woman did not wish to have any or more children, or mistimed, indicating that the pregnancy occurred sooner than she had planned (Brown & Eisenberg, 1995; Santelli et al., 2003).
- UP’s definition covers pregnancies which are mistimed, unplanned or unwanted at the time of conception (Mamboleo, 2012)
In this study, unintended pregnancy (UP) is defined by the level of knowledge students possess to effectively recognize and address UP situations This includes understanding prevention methods, the appropriate use of contraceptives, and the correct management of UP consequences.
Situation of unintended pregnancy
The United Nations is urging nations to prioritize reproductive health and disseminate health information to women, aiming to decrease the rate of unplanned pregnancies both in the short and long term.
Unintended pregnancies (UP) significantly impact women globally, affecting both married and unmarried individuals In 2010, UP accounted for 41% of the 208.2 million pregnancies worldwide, with Latin America experiencing the highest rate at 58% North America followed with 48%, while Asia and Europe reported rates of 38% and 44%, respectively Among the 21 million adolescent pregnancies in developing countries, nearly half (49%) were unintended, with varying rates across regions: 43% in Asia, 45% in Africa, and 74% in Latin America The prevalence of UP is particularly concerning among young women, with rates of 79% for those aged 15-17 and 64% for those aged 18-24 per 1,000 young women in 2011.
In Ghana, the prevalence of unintended pregnancy is notably high, particularly among women aged 15-19 (71.7%) and 20-29 (36.9%) This issue is not limited to Ghana, as unintended pregnancies are increasingly recognized as a significant public health concern among youth in both developed and developing nations, including Thailand Health statistics from Thailand indicate that in 2012, there were 801,737 total births, with 129,451 of these births occurring to adolescent girls.
In Thailand, there are 355 cases of pregnant mothers aged 15-19 years daily, with one third being unintended pregnancies (Chatprapa, Tepanata & Phupong, 2015) In contrast, Vietnam reports that just over 10% of women aged 15-24 experience unintended pregnancies (Vinh & Tuan, 2015) Additionally, a study in China revealed that 31.8% of female university students faced unintended pregnancies (Wang et al.).
Unintended pregnancies are a significant concern for youth in Vientiane, particularly among college and university students Additionally, Laos faces a critical challenge with unmet contraceptive needs, with rates recorded at 19.9% in 2012 and 14.3% in subsequent years for women of reproductive age.
2017 (LSIS, 2012) Laos has the highest adolescent pregnancy rate in the region, with
94 births in 1000 adolescents girls aged 15-19 being pregnant (UNFPA, 2016)
Table 1.2 Situation of unintended pregnancies by region or country
Region or country Year UP (%) Age Source of data
Latin America 2011 58.0% Reproductive age women
Phupong, 2015 Developing countries 2016 49.0% 15 - 19 World Health
Despite claims of a 29% decline in unplanned pregnancies (UP) in developed regions and 20% in developing regions, UP remains a global issue among youth, often linked to individual characteristics, knowledge, attitudes, practices, and the age of first sexual intercourse (Thongnopakun, Pumpaibool & Somrongthong, 2018) In South Africa, adolescent pregnancies continue to rise, even with government efforts to improve contraception access (Anyanwu, Goon & Tugli, 2013) Additionally, young people face challenges due to the limited availability of youth-friendly sexual health services, particularly affecting unmarried women This lack of access and quality care hampers the effective application of knowledge regarding UP (Sychareun, Phongsavan, Hansana).
High fertility rates among young people aged 15-24 are prevalent in many Southeast Asian countries, with the Lao PDR experiencing a significant rate of teenage pregnancies This trend highlights a critical gap in sexual knowledge and the need for effective sexual education among adolescents.
Knowledge of unintended pregnancy
An unintended pregnancy (UP) refers to a pregnancy that is either unwanted or mistimed, occurring when individuals do not wish to have children or when the timing is not ideal Understanding UP is crucial for assessing population fertility and addressing the unmet need for contraception and family planning Knowledge of unintended pregnancies is vital as it can help decrease maternal mortality and the incidence of unsafe abortions among women.
For this study, a knowledge of UP is comprised of three main groups:
1 Knowledge about the prevention of unintended pregnancy
2 Knowledge about the risk of unintended pregnancy
3 Knowledge about the consequences of unintended pregnancy
1.3.1 Knowledge about the prevention of unintended pregnancy
Understanding the prevention of unplanned pregnancies (UP) is crucial for addressing this public health issue, as many teenagers lack access to information on sexually transmitted diseases and contraceptive methods (Steenbergen, Essink & Vongxay, 2017) Research indicates that adolescents with lower educational attainment tend to become sexually active at an earlier age and possess inadequate knowledge of contraceptives (Martins et al., 2006) For example, over half of young men and a quarter of young women demonstrate limited understanding of contraceptive options, with three-fifths underestimating the effectiveness of oral contraceptives (Frost, Lindberg & Finer, 2012) Additionally, a study by Sonia Purr (2007) revealed that awareness of emergency contraception among female college students in Chandigarh, India, was alarmingly low, with only 7.3% aware of emergency contraceptive pills (ECP) and 14.7% knowing the correct timing for their use Similarly, a study in Tanzania's Kilimanjaro region found that most undergraduate students aged 18 had limited knowledge of contraception, with past contraceptive use reported at 43.6%, which had decreased to 40.4% in their current usage (Sweya, Msuya, Mahande).
& Manongi, 2016) These studies showed that the prevention of unintended pregnancy was related to an awareness of contraceptives for sexual activities
Bankole et al (2009) found that in ten countries, young people primarily understood condom use for preventing STIs rather than for pregnancy prevention The study suggested that a high incidence of unprotected sex indicated both unprotected sexual exposure and a lack of contraceptive use In South Africa, at least 50% of youths are sexually active by a young age.
16, and 50%–60% of them had never known using condoms (Anderson, 2006) In this study, the authors found that using condoms to protect against pregnancy took
A study conducted in Uganda revealed that among young female university students aged 21, there was a 38.6% knowledge rate regarding pregnancy prevention among second-year students While general awareness of contraceptives was nearly universal at 99.6%, only 22.1% of the students were informed about female condoms (Nsubuga, Sekandi, Sempeera & Makumbi, 2016).
A study conducted in 2015 among university students in Bangkok revealed that 42.5% of participants had poor knowledge regarding unintended pregnancy, indicating a significant gap in understanding among teenagers While many students were aware of condom use as a contraceptive method, there was a notable lack of knowledge about emergency contraceptive pills and other contraceptive options This highlights the urgent need for more comprehensive education programs on reproductive health.
A study conducted in South Africa revealed that over 74% of females experienced unintended pregnancies due to a lack of knowledge, with 55% unaware of the associated risks Understanding emergency contraceptives can significantly lower the risk of unintended pregnancies by 75% to 99% when taken within 72 hours of sexual intercourse.
A study conducted in Vientiane, Laos, assessed young people's awareness and attitudes towards emergency contraceptive pills (ECPs) by interviewing 500 young adults in entertainment venues The findings revealed that only 22.4% of respondents were aware of ECPs, while just 17.9% understood their correct and effective use Additionally, 63.8% expressed concerns about potential health effects and side effects The study indicated that knowledge of ECPs was positively correlated with increasing age (Sychareun, Hansana, Phengsavanh & Phongsavan, 2013).
Research indicates that awareness of contraceptive methods, including pills and condoms, significantly influences the prevention of unintended pregnancies among young students Unintended pregnancies (UP) can lead to adverse economic, social, and health consequences for women.
HUPH fourth and two-fifths of maternal deaths could be averted if unplanned pregnancies were prevented by using a knowledge of contraceptives and using condoms (Grindlay et al., 2018)
1.3.2 Knowledge of risk for unintended pregnancy
Understanding the risk factors for unplanned pregnancies (UP) is crucial for sexually active women High-risk behaviors include inconsistent or improper use of contraceptives, or engaging in sexual intercourse without any contraception (CDC, 2013) Early initiation of sexual activity significantly increases the likelihood of adolescent pregnancies (Sychareun et al., 2013) Additionally, experiences of forced or unwanted sex, often linked to domestic violence or rape, pose serious risks (Hathaway et al., 2000) Substance abuse, including alcohol and drugs, along with not living in a stable family environment, further elevates the risk of UP (Panova et al., 2016) Moreover, age is a significant factor in Iran, where older women tend to have a higher prevalence of unplanned pregnancies.
Improving knowledge about unintended pregnancy (UP) and addressing misconceptions regarding modern contraceptives can significantly influence the behavior of young people A study highlighted that 71% of unmarried youths in Vietnam are aware that a girl can become pregnant from her first sexual encounter This underscores the importance of education in promoting safe practices among the youth.
1.3.3 Knowledge of consequences of unintended pregnancy
Unintended pregnancy (UP) poses significant challenges to public health, often resulting in school dropouts (Yazdkhasti et al., 2015) A common outcome of UP is abortion (Huan & Blum, 2013), which can also contribute to mental health issues, including depression (Bahk et al., 2015), and may lead to social stigmas (Bửttcher et al.).
2019) and long-term negative health effects including infertility and maternal death
In many developing countries, poverty, malnutrition, and a lack of sanitation and
HUPH education contribute to serious health consequences for women and their families experiencing an unintended pregnancy (Klima, 1998)
Unintended pregnancies (UP) significantly impact public health, with nearly one million teenage girls becoming pregnant each year (Shaw, 2009) Female students, particularly those with limited knowledge about UP, are at a higher risk of dropping out of school (Baiden, Awini & Clerk, 2002) The academic consequences of UP include increased dropout rates, repeaters, poor performance, and difficulties in graduating (Fekede, 2015) In many countries, low education levels and inadequate health knowledge lead to severe repercussions from UP, such as abortion, infertility, child abandonment, and maternal deaths (Palamuleni & Adebowale, 2014) Clearly, UP and the associated lack of awareness represent a significant public health challenge.
Unintended pregnancies (UP) are associated with significant social and economic repercussions Research indicates that around 28% of unintended pregnancies in developing countries could be prevented (Haffejee et al., 2017) The consequences of UP affect not only the mother and child but also extend to families, communities, and society as a whole This can profoundly influence a woman's life trajectory and exacerbate disparities in pregnancy planning, perpetuating a cycle of disadvantage (Vexler & Suellentrop, 2006).
Low literacy is a significant factor contributing to teenage pregnancy (TP), as highlighted by Vongxay (2019) Many teenagers lack access to sexual education and are unaware of the consequences of TP Although most wish to avoid pregnancy, insufficient knowledge about prevention methods and ineffective use of contraceptives often lead to unintended pregnancies This situation frequently results in teenagers dropping out of school in Laos, ultimately limiting their future opportunities and hindering their ability to achieve their dreams.
Factors associated with a knowledge of unintended pregnancy
Previous research indicates that age is a significant factor influencing knowledge of unintended pregnancy (UP) In Brazil, individuals under 20 years old are more likely to experience mistimed pregnancies and UP (Theme-Filha et al., 2016) Additionally, a study found a statistically significant correlation between a student's age and their understanding of emergency contraception (EC) (Mishore, Woldemariam & Huluka, 2019).
Age significantly influences contraceptive knowledge among Ethiopian female students, with those aged 20 and above being approximately seven times more knowledgeable than their counterparts under 20 (Bugssa, 2015).
In Tanzania, age was one of the factors significantly associated with an awareness of contraception among female undergraduates (p 0.05)
Table 3.11: Sexual behaviours associated with a knowledge of UP
The individual factors related to sexual behaviour did not significantly associate with a knowledge of unintended pregnancy (p-value=0.107, Table 3.11) after undergoing the univariate analysis
Table 3.12: Interpersonal factors (parents’ education) associated with a knowledge of UP
Primary school 46 (79.3) 12 (20.7) 0.2 (0.0-1.4) 0.126 Secondary school 86 (67.7) 41 (32.3) 0.4 (0.0-2.4) 0.377 Higher education 146 (69.9) 63 (30.1) 0.4 (0.0-2.1) 0.311
Primary school 70 (82.3) 15 (17.7) 0.6 (0.2-1.6) 0.332 Secondary school 116 (67.8) 55 (32.2) 1.3 (0.5-3.2) 0.483 Higher education 72 (63.7) 41 (36.3) 1.6 (0.6-3.9) 0.278
The univariate logistic regression analysis indicated that students with illiterate parents did not show a statistically significant difference in their knowledge of UP compared to those whose parents had completed primary, secondary, or tertiary education, with a P-value greater than 0.05 (Table 3.12).
Table 3.13: Interpersonal factors (family communication about sex education) associated with a knowledge of UP
Discuss sex issues with mother
Discuss the use of contraceptive methods with mother
Discuss sex issues with father
Discuss the use of contraceptive methods with father
Univariate logistic regression analysis revealed that female students who discussed contraceptive methods with their mothers had over twice the knowledge of UP compared to those who did not engage in such discussions (P-value0.05)
Furthermore, the sources of information about birth control from various forms of media were found to be not significantly associated with a knowledge of UP after undergoing univariate analysis (P> 0.05, Table 3.15)
Multivariate logistic regression analysis of factors associated with female students’ knowledge of unintended pregnancy
Table 3.16: Factors associated with a knowledge of unintended pregnancy
Knowledge of unintended pregnancy Low
CI) AOR (95% CI) p-value Age (in years)
Discuss the use of contraceptive methods with mother
Table 3.16: Factors associated with a knowledge of unintended pregnancy (con.t)
Knowledge of unintended pregnancy Low
CI) AOR (95% CI) p-value Discuss about sexual intercourse with close friends
The multivariate logistic regression analysis was conducted by including significant variables from the univariate analysis, which had a P value of less than 0.05 These variables included age, place of residence, education, faculty, discussions about contraceptive methods with mothers, and conversations regarding sexual intercourse and the consequences of unplanned pregnancies (UP) with close friends A backward stepwise selection method was utilized to identify the factors most strongly associated with knowledge of UP, maintaining a significance level of p < 0.05 for the final model.
The study identified key factors influencing knowledge of unintended pregnancy among students Notably, those enrolled in the Faculty of Environmental Sciences demonstrated a lower odds ratio (AOR=0.5, 95% CI=0.2-0.9; P-value=0.043) In contrast, students who occasionally discussed sexual intercourse with close friends showed increased awareness (AOR=1.7, 95% CI=1.0-3.0; P-value=0.040) Additionally, conversations about the consequences of unintended pregnancy with friends were linked to higher knowledge levels (AOR=1.6, 95% CI=1.0-2.7; P-value=0.038).
Discussion of the knowledge of unintended pregnancy
This study revealed that nearly half of the respondents were aware of unintended pregnancy (UP) and recognized the effectiveness of condoms in preventing it Female students demonstrated a strong understanding that condom use significantly lowers the risk of UP and is one of the most effective birth control methods during sexual intercourse Compared to previous research, such as studies in South Africa (30% awareness), Uganda (22.1% awareness), and Tanzania (24.3% awareness), our participants showed a higher level of knowledge regarding condom use for UP prevention This increase in awareness may be attributed to the urban background of our participants, their exposure to various media platforms like television, Facebook, and YouTube, and the larger size of our study population.
Our study revealed that only 22.5% of NUOL students understood that emergency pills should be taken before sexual intercourse, while 25.7% recognized the importance of using them within 72 hours to prevent unintended pregnancy (UP) This indicates a lower level of awareness compared to Chatprapa's study, which found that 38.2% of female students were knowledgeable about the correct use of emergency pills.
2015) and a study in Ethiopia which found that 62% of female students knew
A study in India found that only 14.7% of students correctly identified the appropriate timing for using emergency contraceptive pills (ECPs), which is lower than the findings of our research Similarly, a study in the Lao PDR revealed that only 17.9% of young people were aware of ECPs, indicating a lower level of contraceptive knowledge compared to our results The discrepancies in awareness may be attributed to differences in participant characteristics, such as age, study location, and population type, as well as cultural factors and access to sexual education information.
The study found that 46.7% of participants recognized that watching erotic movies could lead to sexual intercourse, while over half acknowledged that drugs and alcohol increase the risk of unintended pregnancies Additionally, nearly 40% of female students believed that denial could reduce the risk of sexual activity Similar research in Bangkok in 2015 indicated that a significant percentage of female undergraduates also linked early sexual experiences and the consumption of erotic films to heightened sexual behavior and unintended pregnancies However, a notable difference emerged, as 80% of respondents in the Bangkok study agreed that denial could mitigate sexual risk, which may be attributed to the similar age demographics of the participants It is important to note that Chatprapa's research was conducted in a different year and location, potentially influencing the findings.
The current study highlights that the primary consequence of UP is school dropout, a finding consistent with Baiden's research, which indicated that many university students in Ghana recognized the termination of their studies as a significant effect of UP.
Teenage pregnancies often lead to school dropout, as evidenced by a study in the Lao PDR (Sychareun et al., 2018) Similar to previous research, participants in this study relied on media sources for information about unintended pregnancy outcomes, highlighting a significant gap in their understanding of sexual health issues This lack of knowledge leaves students unaware of the full consequences of unintended pregnancies In contrast, studies from African countries reveal that unsafe abortion is a predominant consequence of unintended pregnancies, with nearly 80% of respondents identifying it as a major issue (Palamuleni & Adebowale, 2014; Fekede, 2015).
The current study reveals that two-thirds of respondents possess inadequate knowledge regarding unintended pregnancy (UP), aligning with findings from a study at Chulalongkorn University in Thailand, which indicated a similar lack of sex education among female students Additionally, research among South African youth found that over half of the females attributed unintended pregnancies to insufficient sexual education This underscores the critical need for improved knowledge and awareness surrounding sexual health to prevent unintended pregnancies.
The current study and previous research indicate that participants have limited access to sexual education, both in schools and through discussions with family and friends While some schools offer sexual education, the quality is often compromised due to a lack of trained teachers A study in Vietnam revealed that unmarried youths also lack knowledge about sexual education, highlighting inadequate teaching quality and limited access to youth-friendly sexual and reproductive health (SRH) services Furthermore, there is a notable absence of targeted policies addressing youth SRH, which is essential for preventing unintended outcomes.
HUPH pregnancy for youths Moreover, the Vietnamese study subjects experienced poor communication with their family about a knowledge of UP and rarely explored topics relating to sexuality (Vinh & Tuan, 2015)
The literature review revealed that prior research in Laos has seldom addressed the knowledge of Unintended Pregnancies (UP) Instead, the majority of studies concentrated on reproductive health topics, particularly the use of contraception methods like condoms and emergency pills, as well as the prevention of pregnancy and HIV/AIDS (Sychareun, Hansana, Phengsavanh).
Most prior research on contraception has primarily focused on usage rather than directly exploring knowledge of Unintended Pregnancies (UP) Studies have highlighted aspects of UP knowledge, including prevention, risks, and consequences, but there remains a significant gap in understanding the broader context of this knowledge.
This study aims to enhance understanding of students' knowledge of safe sex, contraceptives, and family planning at the National University of Laos The findings will assist policymakers and program managers in developing effective policies and initiatives to address unintended pregnancy issues among students.
Factors associated with a knowledge of unintended pregnancy among students
The following key findings of this present study show the factors which were significantly and insignificantly associated with a knowledge of UP
The study's findings indicate that participant age did not significantly correlate with knowledge of UP, contrasting with a Brazilian study by Theme-Filha et al (2016), which found that individuals under 20 years old had a significant association with UP knowledge.
A study in Ethiopia revealed that individuals aged 20 and older had a knowledge of contraception that was seven times greater than those under 20 (Bugssa, 2015) Similarly, research in Tanzania found a significant association between the age of female undergraduate respondents and their awareness of contraception, with a p-value of less than 0.0001 (Kara, Benedicto & Mao, 2019).
A study in India established a significant link between education and knowledge of UP (Kapoor, Patel & Nayak, 2018), which our research corroborates by showing that Environmental Science students are notably knowledgeable about UP In Gaborone, Botswana, it was found that female university students in higher academic years (p = 0.001) had a greater understanding of UP prevention, particularly regarding emergency contraception (Kgosiemang & Blitz, 2018) Conversely, our study revealed no significant association (p = 0.217) between students' academic year and their knowledge of UP, potentially attributed to demographic differences.
Our study found that students' knowledge of unintended pregnancy (UP) was significantly influenced by their place of residence, with those from central Laos demonstrating a better understanding than their peers from other regions Research in the Lao PDR corroborated these findings, indicating that participants in the central region were more informed about UP compared to those in less accessible areas, where geographical barriers and a lack of youth-friendly health clinics hindered knowledge Additionally, previous studies have shown that urban students possess greater knowledge of UP than those from rural areas.
UP prevention in a study in Chonburi province, Thailand (Thongnopakun,
Pumpaibool & Somrongthong, 2018), and that female students who lived in urban areas were a factor that was associated with a good knowledge about the prevention of UP (Abiodun et al., 2017)
The current study found that students with moderate to positive attitudes towards UP were more likely to be aware of it compared to those with poor attitudes However, there was no significant association between attitude and knowledge of UP (p-value > 0.05), indicating that a positive attitude does not guarantee good knowledge This contrasts with a previous study in Thailand, which reported a positive relationship between attitude and knowledge of UP (Chatprapa, Tepanata & Phupong).
The study's findings indicate that participants' sexual behavior did not significantly correlate with their knowledge of unintended pregnancy (UP) Conversely, research in Chonburi, Thailand, demonstrated that university students with prior sexual experience viewed it as a means to enhance their health literacy, particularly regarding unintended pregnancy and its prevention This experience was notably linked to an increased understanding of unintended pregnancy prevention strategies.
A study conducted in Beijing revealed that college students lacked knowledge and strategies to prevent risky sexual behaviors, highlighting the significant impact of knowledge on their sexual conduct (Zhou, 2012) Conversely, research in Tanzania indicated that prior sexual experience was closely linked to awareness of contraceptive methods, emphasizing the importance of sexual education (Sweya, Msuya, Mahande).
A study in Nigeria revealed that over 25% of female students had engaged in sexual intercourse, while nearly 50% demonstrated a strong understanding of emergency contraceptives (Abiodun et al., 2017; Manongi, 2016).
Previous research has indicated a correlation between parents' education levels and their ability to provide information on sexuality and unintended pregnancy prevention, as noted by UNFPA (2013) Additionally, a study by Mishore, Woldemariam, and Huluka (2019) found a statistically significant link between parental literacy and knowledge of emergency contraception (EC) However, our study did not reveal any significant association between parents' education levels and knowledge of unintended pregnancy among female students at NUOL.
The current study found no significant association between family communication and knowledge of unintended pregnancy (P-value > 0.05), potentially due to embarrassment or lack of confidence in discussing sexual issues Despite the importance of family communication in understanding unintended pregnancy, a study in Vietnam revealed that only about one-fifth of female youths had conversations with their parents about sexuality This gap in communication and knowledge is largely attributed to cultural barriers that hinder effective discussions on this sensitive topic (Vinh & Tuan, 2015).
Our study found a significant association between friends' communication and knowledge of unintended pregnancy (P-value