Unintended Pregnancy Among Antenatal Women at A Tertiary Maternity Hospital in Sierra Leone: Prevalence and Associated Factors

Abstract Background Unintended pregnancy remains a significant public health challenge in sub-Saharan Africa, with far-reaching consequences for maternal and child health. This study aimed to investigate the prevalence and associated factors of unintended pregnancy among antenatal women at a tertiary maternity hospital in Sierra Leone. Methods A cross-sectional study was conducted among 1,005 pregnant women attending their first antenatal visit at Princess Christian Maternity Hospital, Freetown, from March to June 2024. Participants were selected using systematic sampling. Data were collected through a semi-structured questionnaire and analyzed using descriptive statistics and multivariable logistic regression. Results The prevalence of unintended pregnancy was 31.8% (95% CI: 29.0-34.7%), with 30.0% mistimed and 1.8% unwanted. Factors independently associated with unintended pregnancy included age below 20 years (aOR: 3.57, 95% CI: 2.30-5.55, p<0.001), non-married status (aOR: 3.73, 95% CI: 2.60-5.36, p<0.001), and unemployment or student status (aOR: 1.74, 95% CI: 1.25-2.42, p=0.001). Women who communicated with their partner about pregnancy (aOR: 0.10, 95% CI: 0.07-0.16, p<0.001) and whose pregnancy was desired by their partner (aOR: 0.05, 95% CI: 0.03-0.09, p<0.001) had significantly lower odds of unintended pregnancy. Conclusion The high prevalence of unintended pregnancy, particularly among younger, unmarried, and economically vulnerable women, underscores the urgent need for targeted interventions. Enhancing partner communication and male involvement in family planning could significantly reduce unintended pregnancies. These findings could inform the development of comprehensive reproductive health strategies in Sierra Leone and similar settings.