DOI: 10.60719/aphrc-2025-042
title: Strengthening Evidence for Programming on Unintended Pregnancy, Developing and Validating Measures of Unintended Pregnancy and Reasons for Contraceptive Non-use among Married Women in Nairobi’s Informal Settlements

description: Measuring unintended pregnancies is important for demographers and public health workers worldwide. Pregnancy intentions and attendant fertility-related behaviors have significant implications on forecasting fertility rates, designing family planning programs and estimating the unmet need for contraception. However, most current estimates of the levels of unintended pregnancy in developing countries are derived from retrospective reporting on the last pregnancy or childbirth in Demographic and Health Surveys (DHS). An unintended pregnancy in these surveys is classified as one that is reported to have been mistimed (occurred earlier than planned) or unwanted (occurred when no more children were desired). Such measures of pregnancy intentions, that are dichotomous and retrospective, have been shown to be overly simplistic and suffer from reporting bias. Application of measures which capture the multidimensionality of fertility intentions in a prospective longitudinal study have been proposed as being better approaches to capture the complexity of unintended pregnancy. Given the potential advantages of prospective measurements, it is unfortunate that only few studies of this nature have been undertaken in developing countries. The presence of numerous health and demographic surveillance systems (HDSS) in several developing countries offer the opportunity to strengthen the evidence on unintended pregnancy by developing and validating the use of such measures through their longitudinal data collection mechanisms.

The overall objective of this study is to develop and validate new measures of unintended pregnancy and reasons for non-use of contraceptives in developing countries. Such tools would provide an improved understanding of the determinants and dynamics of pregnancy intentions, contraceptive decision-making and use, and the impact of fertility intentions on pregnancy outcomes, especially in settings where fertility intentions may be high or ambiguous and where contraceptive use is low and unmet need high. The study will be carried out in Korogocho and Viwandani in Nairobi, Kenya, where the African Population and Health Research Center (APHRC) has been running the Nairobi Urban and Health Demographic Surveillance System (NUHDSS) since 2002. The study is being implemented in two phases. In the first phase (completed), a conceptual framework and draft module, consisting of a questionnaire and a protocol for its administration was developed through a consultative process and review of the literature. The module was developed in collaboration with the London School of Hygiene and Tropical Medicine, the Population Council, and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). During the second phase, the module will be administered two times to married or cohabiting women aged between 15 and 39 years old living in the demographic surveillance area: at baseline to generate baseline measures of the key variables, and after twelve (12) months. There might be the possibility of a third wave, but the implementation of the third wave will depend on receipt of additional funding.

Data will be collected through face-to-face interviews with eligible women randomly sampled from the NUHDSS. Predictive validity of pregnancy and contraceptive measures will be assessed using factor analysis and multivariate regression analysis to assess the independent net effect of explanatory variables on outcome variables of interest.