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Abstract:
Background: Unintended pregnancies may have
detrimental consequences for women’s well-
being and reproductive health, particularly
in lower to middle-income countries. Women’s
involvement in household decision-making,
particularly related to their health, is
considered instrumental in promoting
contraceptive use and other determinants of
unintended pregnancy. This study aims to
contribute to the existing body of knowledge
on women’s reproductive health by exploring
if women’s autonomy within the household
helps prevent unintended pregnancy in
Pakistan.
Methods: To explore the association between
women’s autonomy and pregnancy intendedness,
this study posits a direct relationship
between women’s autonomy and pregnancy
intendedness, and a moderating role of
women’s autonomy in the relationship between
contraceptive use and perceived pregnancy
intendedness. A sample of 8,228 married women
age 15–49 who have experienced a pregnancy in
the five years before the survey was
extracted from Pakistan Demographic and
Health Survey 2017–18. The dependent variable
was pregnancy intendedness, which was
categorized into planned, mistimed, and
unwanted. A chi-square test was used to
validate the association of each explanatory
variable with pregnancy intendedness. The
study then employed a multinomial logit model
to compare the risk of mistimed and unwanted
pregnancies among reproductive age women
relative to the planned pregnancies. To
capture the moderating role of women’s
decision autonomy, an interactive effect of
life-time contraception and women’s autonomy
was estimated in the final model along with
all covariates.
Results: The bivariate analysis found a
significant association between women’s
autonomy and pregnancy intendedness at the 5%
significance level, except for high autonomy.
After accounting for other factors, the
analysis shows that women’s autonomy and
pregnancy intendedness are not significantly
associated. The interactive influence of
women’s autonomy and contraceptives was found
to be insignificantly associated with
pregnancy intendedness. The relative risk of
mistimed and unwanted pregnancies were more
prevalent pregnancies among women who ever
utilized contraceptives, had terminated a
pregnancy, had more sons, and belonged to
wealthy families. The husband’s education was
inversely associated with unintended
pregnancy.
Conclusion: The study concluded that women’s
autonomy and the interactive effect of
women’s autonomy and contraceptive use on
pregnancy intendedness are not significant in
Pakistan when other factors are considered.
This may be due to data limitations,
particularly those related to biased gender
norms and patriarchal values in the
construction of women’s decision autonomy.
The study results call for more in-depth
investigation into social norms and
patriarchal values that govern women’s
reproductive behavior in Pakistan.
Women’s Autonomy and Unintended Pregnancy among Reproductive Age Women in Pakistan (PDF, 1689K)