Unintended pregnancy among women in Nepal: Socioeconomic, fertility, and contraceptive determinants from the 2022 NDHS

ABSTRACT Background Globally, nearly half of all pregnancies are unintended, with a disproportionately high occurrence in LMIC countries. Unintended pregnancies present significant public health challenges, leading to an elevated risk of unsafe abortions, maternal mortality, and substantial economic burdens. While Nepal has made progress in reducing its unintended pregnancy rate over the past three decades, the high rate of abortion for unintended pregnancies remains a serious concern. This study examines the association of unintended pregnancies among Nepalese women with socioeconomic, fertility, and contraceptive factors, providing evidence to guide policy and interventions for improved reproductive health outcomes. Methods Utilizing weighted data from the 2022 Nepal Demographic and Health Survey (NDHS), this cross-sectional study included 2,992 married women aged 15– 49. The primary outcome was unintended pregnancy, while the main exploratory variable was unmet need for contraception, determined by a DHS-endorsed algorithm. We also examined various socio-demographic and reproductive factors, including age, education, wealth, and desire for more children. The data were analyzed using descriptive statistics, bivariate analysis (chi-square test), and multivariable logistic regression to identify significant predictors. Results The study found a prevalence of 27.9% for unintended pregnancy and 29.4% for unmet need for contraception. The highest rates of unintended pregnancies were observed in women aged 35–49 and 15–19, as well as in those with lower education and wealth levels. Multivariable logistic regression revealed that having an unmet need for contraception was the strongest predictor (aOR = 14.05, 95% CI = 6.14– 14.89). Other significant factors included current use of contraception (aOR = 9.56, 95% CI = 6.14–14.89), not desiring more children (aOR = 2.28, 95% CI = 1.83– 2.83), being in the poorest wealth quintile, and having a husband with only primary education. Regional disparities were also evident, with Karnali Province reporting the highest rate of unintended pregnancies (38%). Conclusions This study establishes a strong link between unmet contraceptive needs and unintended pregnancies in Nepal. The findings highlight the critical importance of improving access to family planning services and addressing systemic barriers to consistent contraceptive use. Interventions should be tailored to vulnerable subgroups, particularly adolescents, older women, and those in the poorest wealth quintiles. A comprehensive approach that supports informed reproductive choices is essential for reducing unintended pregnancies and advancing reproductive health outcomes in Nepal. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Nearly half of all pregnancies worldwide are unintended, with a higher burden in low- and middle-income countries. ⇒ Unmet need for contraception is a major contributor to unintended pregnancies. ⇒ Evidence on the direct link between unmet contraceptive need and unintended pregnancy in South Asia, especially Nepal, is limited. ⇒ Nepal has reduced unintended pregnancy rates overall, but abortions among unintended pregnancies have increased, and unmet need for contraception remains high. WHAT THIS STUDY ADDS ⇒ Shows a strong, independent association between unmet need for contraception and unintended pregnancy in Nepal. ⇒ Women with unmet need were over 14 times more likely to report unintended pregnancy than those without unmet need. ⇒ Identifies key socio-demographic predictors: younger age, lower wealth, limited husband’s education, and completed fertility preferences. ⇒ Reveals significant provincial disparities in unintended pregnancy rates across Nepal. ⇒ Highlights systemic barriers to effective and consistent contraceptive access despite national family planning efforts. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Provides robust evidence to guide reproductive health and family planning policy in Nepal. ⇒ Supports strengthening FP-2030 commitments with a focus on underserved populations. ⇒ Calls for ensuring consistent availability of modern contraceptives at all levels of the health system. ⇒ Recommends integrating culturally sensitive counseling, adolescent-focused reproductive health education, and male partner involvement. ⇒ Suggests future research should explore socio-cultural barriers through mixed-methods approaches to inform targeted interventions.