This study has attempted to investigate the influencing factors such as demographic, socioeconomic, socio-cultural, access to health information/services and knowledge and ever use of family planning methods on unintended pregnancy. Present study showed that unintended pregnancy is common among Nepalese women. It indicates higher demand for family planning program. The result of this study suggests that all women, regardless of age, socioeconomic, or socio-cultural status, would benefit from increased efforts to ensure that pregnancies are intended.
The bivariate analysis showed that the variables such as age, total children ever born, age at first marriage, literacy status, radio exposure, travel time to the nearest family planning source, family planning workers' visit, religion, women's autonomy and knowledge about family planning methods are important in explaining unintended pregnancy. The multivariate analysis supported some of the findings of the bivariate analysis and indicated a different pattern of effect for few other variables. In the multivariate analysis, age of women, ideal number of children, age at first marriage, radio exposure, religion and knowledge about family planning methods were found to have statistically significant influence on unintended pregnancy.
This study has shown that the higher the age of women, the higher the probability of having current pregnancy as unintended. It is similar to the study conducted in currently married pregnant women in Iran [6
] and all women of reproductive age in Nigeria [17
A contradictory result was observed from the logistic regression regarding the association of ideal number of children on an unintended pregnancy. In the multivariate analysis, ideal number of children was negatively associated with unintended pregnancy indicating that those women who desired more children were less likely to experience unintended pregnancy. One reason could be more people (93%) live in rural areas and rural women perceive greater benefit from having more children. Hence our sample reflected that the decline in desired family size in Nepal resulted in increased exposure to the risk of having unintended pregnancy.
Like the study in Japan [5
], we found significant negative relationship between age at first marriage and unintended pregnancy in Nepal. One of the reasons could be that early marriage leads to earlier initiation of sexual intercourse, which exposes women to an extended period when they are at risk of getting pregnant and is thus related to a higher likelihood of experiencing unintended pregnancy. The other reason could be that the women who married early may have limited access to services or may experience particular difficulty in practicing contraception.
The multivariate results showed that those who have had regular access to mass media (radio) were less likely to report unintended pregnancy compared to those who have not. It means mass media has played an important role in reducing unintended pregnancy because it gives wider range of knowledge [18
] and leads to adopt contraception and sensitizes couple about the family norms so that they have low parity and low unintended pregnancy [20
Unintended pregnancy was more common in non-Hindu women compared to Hindu women. One of the reasons could be that Hindu women are likely to accept pregnancy as "Given by God" or "Treasure of the Family". The other reason might be due to considerable proportion (38%) of Muslim women included in non-Hindu category. Islam restricts women's activities in ways that other religions do not [22
We hypothesized that women who have higher knowledge about family planning methods (more than average) are less likely to experience unintended pregnancy. Our result supports the hypothesis that if a woman has higher knowledge of family planning methods, she is more likely to be aware of the benefits of those methods which in turn will motivate her to use the family planning methods and be less likely to have unintended pregnancy. The similar result is found in Ecuador as well [23
In this study, there was no significant association between the experience of unintended pregnancy and women's education as in Japan [5
], and occupation like the study found in Iran [6
]. In Japan, most of the women are educated and they prefer not to have children or to have fewer children compared to other Asian countries. So there is no significant difference in the experience of unintended pregnancy among different educational levels of Japanese women. In case of Nepal, the literacy rate of women is very low and a large number of women do not have more than primary education and other social cultural factors strongly influence the intended pregnancy status; hence education is statistically not significant. However, it should not be concluded that education is not significantly related to intended pregnancy status and thus we should not ignore the importance of education for the better life of women.
Similarly, contrary to the hypothesis, the present study found that women's autonomy has no significant impact on unintended pregnancy. In this study, women's autonomy was measured from the final say on their 'own health care' and 'spending their own earned money'. This is because in a patriarchal society, women are often given less opportunity to be self-supporting and have to depend on the male partners/relatives for their survival [24
] and the possibility that women who earned cash are associated with households of low economic status and the job itself was low status jobs.
Although statistically not significant, women who had exposure to Television and lived near health facilities had lower chances of unintended pregnancy than women in the comparison group. Ever use of family planning method has significant relationship with intended pregnancy status of women in many literatures. However, the result from this study is not similar to those findings. Some of the reasons identified were the complexity of using contraceptive or lack of methods choice and financial barriers hindering effective use of contraceptive methods. It was seen that the individual or community perception about contraception is an important factor, which affects contraceptive use. Similarly, misconception leads to discontinuation and decreased use of contraception and increases the level of unintended pregnancy [10
]. Thus it can be argued that misconception about family planning methods exist among Nepalese women. High family planning method failure among married women in the reproductive age is also prevalent in Nepal [13
]. However it does not imply that contraceptive use is not an important determinant of unintended pregnancy among married pregnant women in Nepal, it rather reflects the situation that the variable ever use of family planning methods acts indirectly on unintended pregnancy in this study.
The concept of "intended ness of pregnancy" is complex and it would probably be better to treat it as a continuous rather than a bicategorical variable [25
]. Women are often ambivalent about their intention to become pregnant or not. Nonetheless, measures of unintended pregnancy that use the intended/unintended dichotomy remain valuable because they allow us to assess trends over time and differences among population subgroups [26
]. It has been shown that the perception of intended ness of pregnancy varies during the gestational period and after the delivery [27
]. The use of a measure of mistimed pregnancies may be especially problematic, since a birth can be mistimed by a short amount of time or a longer period of time, each possibly having different implications [1
]. Furthermore, many studies compare only intended pregnancies to unintended pregnancies, but do not examine mistimed and unwanted pregnancies separately, even though studies that do separate unwanted from mistimed pregnancies have found many differences in the mother's interpretation of pregnancy intention and the outcomes associated with it [1
]. Moreover, if we take children born in the preceding five years or life time, that information may in fact underestimate unplanned childbearing since women may rationalize unplanned births and declare them as planned once they occur. The data used in this paper recorded the intendedness of current pregnancy among the currently pregnant women. It also minimizes underreporting of unintended pregnancy as well as reduces recall bias. In that sense, our study must be less biased than other studies that interview women at different times after delivery.
There are some limitations to interpret the results of this study. First, as pointed out previously, we restricted our subjects to only currently pregnant married women at the time of survey, so obtained prevalence of women with experience of unintended pregnancy should not be generalized to the general population in Nepal. The main objectives of this study are to determine the prevalence and examine the factors influencing unintended pregnancy among currently pregnant married women in Nepal. Thus we intentionally selected a group of women who were currently pregnant during the period of survey, though risk factors of mistimed and unwanted pregnancy is not same, Second, because a cross sectional design of the study and all of the items analyzed in the logistic regression analysis were information at the time of survey, the analysis can only provide evidence of statistical association between those items and the experience of unintended pregnancy and cannot show the cause-effect relationships.