Pregnancy Intentions and Maternal Health Behaviours: Observational Study in 18 African Countries

Objective: This study explores the relationship between pregnancy intentions and maternal health behaviours. Design and Setting: Secondary data analysis of recent (2018–2023), cross-sectional demographic and health surveys from 18 sub-Saharan African countries. Population: Survey respondents were women aged 15–49 years old with a child less than a year old who responded to survey questions about their pregnancy intentions for that child (N = 39 936). Methods: Logistic regressions and meta-analysis using fixed effects explored the relationship between pregnancy intentions and maternal health behaviours across study countries adjusting for sociodemographic and contextual variables. Measures: Pregnancy intentions were defined as intended versus unintended. Maternal health behaviours included (i) early ANC, (ii) 4+ ANC contacts (ANC4+), (iii) 3+ doses of intermittent preventive treatment of malaria in pregnancy (IPTp3+), (iv) Mosquito net use in pregnancy, (v) receipt of tetanus toxoid and (vi) immediate breastfeeding. Results: Overall, 25% of women did not want their index pregnancy (ranging from 13% in Burkina Faso to 49% in Gabon). Unintended pregnancies were associated with reduced odds of early ANC (aOR: 0.68, 95% CI: 0.63, 0.73), ANC4+ (AOR: 0.70; 95% CI: 0.65, 0.75), IPTp3+ (AOR: 0.87; 95% CI: 0.81, 0.94), receiving tetanus toxoid (AOR: 0.74; 95% CI: 0.68, 0.80) and immediate breastfeeding (AOR: 0.83; 95% CI: 0.80, 0.87). Conclusions: Study findings corroborate the role of reproductive health agency and pregnancy preparedness in optimising maternal health behaviours and subsequent outcomes. Integration of reproductive health services, malaria service delivery and social and behaviour change interventions can help to improve pregnancy outcomes.