Unintended Pregnancies in Bangladesh: A Call for Accurate Measurement and Improved Family Planning

A study comparing two methods of measuring unintended pregnancy in Bangladesh found that the DHS underestimates the prevalence, with the London measure showing a higher rate of 31.0%. This highlights the need for improved family planning services and more accurate tools for understanding pregnancy intentions.

A study comparing two methods of measuring unintended pregnancy in Bangladesh has revealed substantial discrepancies, suggesting that the issue may be more prevalent than previously reported. Conducted by researchers from Jatiya Kabi Nazrul Islam University and the University of Newcastle, the study highlights significant differences between the widely used Demographic and Health Survey (DHS) method and the London Measure of Unplanned Pregnancy. The findings point to the likelihood that the DHS underestimates the rate of unintended pregnancies, potentially masking the true scale of the issue and its consequences for maternal and child health.

Comparing Two Measures of Unintended Pregnancy

The research was based on a cross-sectional survey conducted in four randomly selected districts in Bangladesh: Kurigram, Mymensingh, Pabna, and Satkhira. Data were collected from 1,200 women who had recently given birth and were visiting hospitals for postnatal care. The study aimed to compare the prevalence of unintended pregnancy using the DHS measure and the London Measure of Unplanned Pregnancy, as well as to explore the extent of discordance between the two methods. The DHS is a globally recognized tool for measuring pregnancy intentions, but it relies on relatively simplistic questions that may not capture the full complexity of pregnancy planning, particularly in low- and middle-income countries. In contrast, the London measure is a more detailed tool that asks about contraceptive use, feelings about pregnancy both at conception and after birth, and the level of agreement between partners regarding the pregnancy.

Discordant Findings Reveal a Larger Issue

The results of the study were striking. According to the DHS measure, 24.3% of the pregnancies were unintended. However, when measured using the London Measure of Unplanned Pregnancy, this figure rose to 31.0%. Moreover, 27.1% of the women gave discordant responses, meaning that their answers differed between the two methods. This level of discordance points to a significant underestimation of unintended pregnancy when using the DHS alone. The researchers noted several factors that were associated with discordant responses, including older maternal age, having more than two children, being in a lower wealth quintile, living in a rural area, and the sex of the last child, with discordance more likely when the last child was female.

The Health Implications of Unintended Pregnancies

The implications of these findings are profound. Unintended pregnancies are associated with a range of negative outcomes for both mothers and children, including delayed or inadequate maternal healthcare, increased risks of stillbirth, preterm birth, and low birth weight, as well as higher rates of maternal and neonatal mortality. In Bangladesh, where access to safe abortion services is limited and maternal health resources are often strained, these risks are particularly pronounced. The study suggests that the true scale of unintended pregnancy and, by extension, the burden on the healthcare system may be much greater than previously thought. This has significant implications for public health policy, particularly in terms of family planning programs.

Strengthening Family Planning Programs

The researchers emphasized the need for more comprehensive family planning services that are tailored to the specific needs of women in Bangladesh. In particular, they pointed to the importance of expanding access to modern contraception and providing more effective sex education, especially in rural areas and among economically disadvantaged groups. The study also highlighted the need for better preconception care, noting that many women reported not taking any health-related actions, such as taking folic acid or seeking medical advice, before becoming pregnant.

A Call for More Accurate Surveys

One of the key advantages of the London measure is its ability to capture a more nuanced picture of pregnancy intentions. By asking multiple questions about different aspects of pregnancy planning, it provides a more accurate reflection of women’s experiences, including the influence of partners and the role of contraception. In contrast, the DHS measure relies on just two questions, which can lead to oversimplified or inaccurate reporting. For example, women may change their views about a pregnancy after birth, or they may feel pressure to report a pregnancy as intended even if it was not planned. The London measure helps to account for these complexities by considering a broader range of factors.

The study’s findings suggest that Bangladesh’s family planning programs may need to be significantly strengthened in order to address the issue of unintended pregnancies more effectively. In particular, there is a need to focus on reaching younger women, those in rural areas, and those from lower-income backgrounds, who are most likely to experience unintended pregnancies. The researchers also recommended that the London Measure of Unplanned Pregnancy be incorporated into future national surveys in Bangladesh and other low- and middle-income countries. This would provide a more accurate picture of the prevalence of unintended pregnancies and help guide policy decisions aimed at reducing their occurrence and mitigating their impact on maternal and child health.

The study underscores the importance of using more comprehensive tools to measure pregnancy intentions, particularly in settings where unintended pregnancies can have serious consequences for health and wellbeing. By adopting more nuanced approaches like the London measure, policymakers can better understand the true scale of the issue and develop more targeted interventions to improve outcomes for women and children in Bangladesh and beyond. The study’s findings call for urgent action to strengthen family planning services and ensure that all women have the information and resources they need to make informed decisions about their reproductive health.