Prevalence, determinants and outcomes of unplanned pregnancy and perspectives on termination of pregnancy among women in Nganglam, Bhutan.

ABSTRACT

Introduction: The objectives of this cross sectional study were to determine prevalence, determinants, and outcomes of unplanned pregnancy among women in Nganglam, a town in southeastern Bhutan. It also gauged opinions of women and healthcare providers towards abortion. Methods: A total of 683 women attending health clinics were consecutively interviewed using a semi-structured questionnaire. The core group for analysis was 490 women who indicated their recent pregnancy as planned or unplanned. Percentages, χ2 tests, and multivariate logistic regression analyses were used to determine prevalence and differences in unintended pregnancy by demographic characteristics. Results: The prevalence of unplanned pregnancy was 20.2%. Higher education, employed status of partner, higher parity, and non-use of contraceptives significantly increased the odds of unplanned pregnancy. Over half (58.4%) of the women said they knew someone to have crossed Indian borders to avail abortion services. Overall, 23% women supported legal abortion but majority (64%) were ambivalent. Given specific circumstances, both participants and health care providers supported some scenarios (life of mother, severe anomaly in fetus, rape and incest, maternal mental health) and opposed some circumstances as reasons for abortion (desired number of children met, contraception failure, not wanting to marry, poverty). Conclusions: One in five women in our setting in Bhutan experienced unplanned pregnancy. Programs to promote family planning are required among populations most at risk for unplanned pregnancy. Awareness programs are required to encourage use of effective contraceptive methods among Bhutanese women.