High Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study

High Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study Ebisse Dirirssa, Eyerusalem Elias, Henok Misileke, Ashenafi Zelalem, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7654458/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Contraceptive failure is a major global reproductive health issue, refers to the occurrence of unexpected pregnancy despite the use of a contraceptive method. It is associated with factors such as age, education, marital status, contraceptive method, parity and adherence. In Ethiopia, contraceptive failure rates are reported at 9.1–10.3%, but studies are limited and mainly focus on women seeking abortions, overlooking those who continue pregnancies. The current study aims to provide updated data on magnitude and associated factors of contraceptive failure among pregnant women attending ANC in Addis Ababa, Ethiopia. Methods A cross sectional study was conducted among 385 pregnant women attending ANC with prior contraceptive use. Data was collected through structured interviewer-administered questionnaires addressing sociodemographic characteristics, contraceptive practices, and adherence. Statistical analysis was performed using SPSS version 27. Bivariate and Multivariate logistic regression analysis were performed with p- values of < 0.25 and < 0.05 respectively. Results Women younger than 25 years accounted for 23.1% of the participants. Two-third had completed secondary education and beyond. Second-tier contraceptive were the most commonly used method, reported by over two-third women. The overall contraceptive failure rate was 19.2%(CI: 15.3% – 23.1%). Significant factors included use of third-tier methods (AOR = 5.6, CI: 1.7–18.2), first-tier contraceptive methods (AOR = 0.07, 95% CI: 0.01–0.29), medium adherence (AOR = 8.2, CI: 3.2–21.9), low adherence (AOR = 5.6, CI: 1.9–16.1), prior failure (AOR = 3.0, CI: 1.2–7.7), and having three or more children was associated with vastly increase odds (AOR = 22.2), though with very wide confidence interval (CI: 2.2–285.3). Conclusion The current study revealed a high prevalence of contraceptive failure among pregnant women attending ANC. Contraceptive tier, adherence, parity, and prior failure were strongly associated. Promoting first and second tier contraceptive method, strengthening user education, ensuring adherence and follow-up support for women with past failures may help reduce risk of future contraceptive failure. Contraceptive failure Pregnant women Adherence Unintended pregnancy Ethiopia Figures Figure 1 Figure 2 Introduction Contraceptive failure refers to the occurrence of unexpected pregnancy despite the use of a contraceptive method ( 5 ). This includes both contraceptive-related failure (i.e., contraceptives did not work as expected) and user-related failure (i.e., stemming from incorrect or inconsistent use) ( 5 ). A study done in USA showed contraceptive failure of 10.3 in 2010.( 1 ) Another study done Ghanaian urban environment showed a failure rate of contraception was 7.9% ( 4 ). A study in Ethiopia’s Harari region found a 10.3% failure rate, while in Debre Marko, 9.1% of women became pregnant while using contraception ( 5 , 6 ). Globally, failure rates vary by method ranging from 0.3% for implants and 1.2% for IUDs, 2% of injectable to 6–9% for pills and condoms, and up to 17–19% for traditional methods like withdrawal and periodic abstinence ( 8 ). Ethiopia, the second most populous country in Africa, has a total fertility rate of 4.1 children per woman. Despite the need for population control, only 41% of married women aged 15–49 use any family planning method, 40% use modern methods and 1% use traditional ones. Injectables are the most popular modern method (27%), followed by implants (9%), IUDs (2%), and pills (2%). Use of modern methods varies across regions, from as low as 3% in Somali to as high as 50% in Amhara and 48% in Addis Ababa ( 7 ). First-tier contraceptives are methods with the highest effectiveness, typically with < 1% failure rate with typical use. These methods are long-acting reversible contraceptives (LARCs) and permanent methods. Second-tier contraceptives are user-dependent hormonal methods with moderate effectiveness, typically with a failure rate of 4–7% with typical use examples include injectables and pills.Third-tier contraceptives are barrier or behavioral methods such as condom, withdrawal and periodic abstinence with lower effectiveness, with typical-use failure rates > 13%.( 15 ) Contraceptive failure contributes substantially to raising levels of unintended births and induced abortion. A study done in 19 developing countries found that about 75% of pregnancies from contraceptive failure were carried to term, with most reported as unwanted or mistimed. Around 10% ended in fetal loss, largely due to induced abortion. The median contribution of failure to all unintended births for all 19 surveys was about 15%, and the contribution to fetal loss was 12% ( 9 ). Unintended pregnancies can lead to poor maternal care, contributing to over 1 million preventable stillbirths and 3.6 million neonatal deaths annually. ( 10,11) Children from unplanned pregnancies are less likely to be breastfed, more likely to be stunted, and face higher child mortality risks ( 12 ). Most existing studies on contraceptive failure primarily focus on women who seek abortions, often overlooking those who continue their pregnancies. In Sub-Saharan Africa, particularly Ethiopia, research on contraceptive failure among pregnant women with diverse pregnancy outcomes remains limited. This study aims to provide updated data on magnitude and associated factors of contraceptive failure among pregnant women attending Kality health center and Tirunesh Bejing General Hospital, Addis Ababa, Ethiopia. Methodology Study Population An institution-based cross-sectional study was conducted from March 1 to April 30, 2025, among patients who visited Kality 05 Health Center and Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. Participants were selected based on the inclusion criteria: pregnant women receiving care at either facility, with a history of contraceptive use, and willing to participate during the study period. Exclusion criteria included severe emergency illness, inability to provide consent, or being under 18 without a consenting legal guardian. Using a conservative proportion and a p-value threshold of 0.5 to ensure maximal variability, the initial sample size was calculated as 385, and with a 10% non-response rate, the final sample size was 424. Data Sources and Collection Procedures A stratified random sampling technique was used, treating the two health facilities as separate strata. Participants were selected in a 2:1 ratio, with more from Kality 05 Health Center due to higher patient flow. All pregnant women visiting either facility for ANC services during the study period were eligible. Participants were randomly selected daily using the lottery method from available charts. Data were collected through a face-to-face interviewer-administered structured questionnaire, adapted from similar Ethiopian studies and pretested for quality. It included socio-demographic details, medical history, and other clinical information. Completed questionnaires were checked daily for completeness and accuracy. All data were securely stored with restricted access to ensure confidentiality. Outcomes The occurrence of contraceptive failure was assessed by the following question: “How did this pregnancy happen? / Were you using contraceptive during the sexual intercourse where they most likely had conceived?” “I planned to become pregnant and did not use any contraception”, “Stopped method due to side effects”, “Stopped method due to personal reason”, “Become pregnant while using contraceptive”. Women who stated they had used a contraceptive method at the intercourse where they most likely had conceived were considered as having experienced contraceptive failure. Women who stated they had planned to become pregnant and women who stated they stopped method due to side effects or personal reason were considered as not having experienced contraceptive failure. Statistical Analysis The data collected from Kality 05 Health Center and Tirunesh Beijing General Hospital were entered into SPSS version 27 and subsequently checked and cleaned for accuracy and completeness. Following this, numerical coding was applied, and the data were securely stored by the researchers. Univariate analysis was conducted to examine the distribution of each variable. Bivariate analysis was used to assess the association between two variables, using a p-value threshold of 0.25 to determine potential statistical associations. Variables that showed multiple associations were further analyzed using multivariable logistic regression. In this model, a 95% confidence interval (CI) and a p-value of less than 0.05 were used to identify statistically significant associations. All data analyses were performed by the researchers using SPSS version 27 software. Results Characteristics of study participants Socio demographic characteristics Out of the total sample, 385 pregnant women participated, giving a response rate of 90.8%. The majority 265 women(68.8%) were from Kality Health Center, while the remaining 120 (31.2%) were from TBGH. More than half of the participants 203 (52.7%) were aged between 25 and 30 years. Regarding religion 268 women (69.6%) were Orthodox Christians, 67 (17.4%) were Protestants and 47 (12.2%) Muslims. In terms of educational status 158 women (41.0%) had completed secondary education, and 88 (22.9%) had pursued education beyond the secondary level. Nearly half of respondents 184 (47.8%) were housewives, constituting the largest occupational group in the study. The vast majority of participants 369 (95.8%)were married.(Table 1 ) Table 1 Sociodemographic and Reproductive Health Characteristics of pregnant women attending ANC, Addis Ababa, Ethiopia 2025 Sociodemographic and Reproductive Health Characteristic Number Percent (%) Age (Years) 15–18 2 0.5 19–24 87 22.6 25–30 203 52.7 31–35 67 17.4 36–40 23 6 > 40 3 0.8 Monthly household income (ETB) 10000 ETB 82 21.3 Educational status No formal education 28 7.3 Primary school 111 28.8 Secondary school 158 41 More than secondary education 88 22.9 Marital status Married 369 95.8 Single 10 2.6 Divorced 2 0.5 Living in union 3 0.8 Widowed 1 0.3 Gravida Primigravida 107 27.2 2 121 31.4 3 94 24.4 4 40 10.4 Grand gravida 23 6 Para Nullipara 123 31.9 Primipara 132 34.3 2 91 23.6 3 29 7.5 4 6 1.6 Grand multipara 4 1 History of emergency contraceptive use Yes 102 26.5 No 283 73.5 Total 385 100 Underlying health conditions Among the 385 respondents, 11 reported having an underlying medical or gynecologic condition. The most common case was Myoma, accounting for 3 cases (27.3%). All participants denied a chronic medication use history. Reproductive Health Characteristics According to Fig. 1 the most commonly used method prior to the current pregnancy was the injectable (Depo-Provera) 144(37.4%), followed by oral contraceptive pills at 109 (28.3%) and implants at 84 (21.8%). For analysis, contraceptive methods were classified into tiers based on typical-use failure rates. Tier 1 included implants and IUDs. Tier 2 included injectables and oral pills. Tier 3 included condoms, withdrawal, periodic abstinence, and breastfeeding, which was categorized due to its high typical-use failure rate when not strictly following Lactational Amenorrhea Method (LAM) criteria. Tier 4 consisted of emergency contraceptive pills. A history of abortion was reported by 103, (26.8%) women. Counseling prior to contraceptive use was received by 55.8% women, whereas 44.2% did not receive any. Awareness of contraceptive failure was reported by 49.6%, while the remaining 50.4% women were unaware. Most participants 336 (87.3%) had high adherence to their method as prescribed, 27 (7%) had medium adherence, and 22 (5.7%) had low adherence. Contraceptive failure prior to the current pregnancy was experienced by 41 (10.6%) of respondents, while the remaining 344 (89.4%) reported no such failure. Additionally, 15 (3.9%) of participants indicated having had an induced abortion due to contraceptive failure before their current pregnancy. A majority of respondents, 274 (71.2%), reported that their current pregnancy was planned, while 111 (28.8%) indicated it was unplanned. Among the 111 women who didn’t plan current pregnancy 89 (80.2%) women suggested pregnancy was mistimed and the remaining 22(19.88%) as unwanted pregnancy. In response to their current pregnancy status, 142 women (36.9%) expressed an intention to switch to a different contraceptive method, 138 (35.8%) planned to continue using the same method with improved adherence, 103 (26.8%) were uncertain about their future contraceptive use, and 2 women (0.5%) reported that they did not intend to use any contraceptive method. Magnitude of Contraceptive Failure During current pregnancy 74 (19.2%(95% CI: 15.3% – 23.1%)) of respondents experienced contraceptive failure, whereas 311 (80.8%) did not. According to Fig. 2 among all participants, the majority 266 women (69.1%) had intentionally discontinued contraception in order to conceive. However, 74 (19.2%) became pregnant while still using a contraceptive method, indicating method failure. Additionally, 31 (8.1%) stopped using contraception due to side effects, and 14 (3.6%) for personal reasons. Factors Associated with Contraceptive Failures During bi-variate analysis marital status, income, gravidity, parity, history of abortion, counseling about contraceptive, contraceptive method, adherence, history of emergency contraceptive use, history of contraceptive failure and history of induced abortion due to contraceptive failure were found to be associated with contraceptive failure. However, multivariate logistic regression analysis, showed associations of parity, contraceptive method, adherence and history of contraceptive failure with contraceptive failure. Third-tier contraceptive use increased the odds by 5.6 times (AOR = 5.6, CI: 1.7–18.2) compared to second-tier use. Whereas use of first-tier contraceptive methods was associated with reduced odds of contraceptive failure, with users having 0.07 times lower odds of failure compared to users of second-tier methods (AOR = 0.07, 95% CI: 0.01–0.29). Medium adherence to contraception resulted in an 8.2 times higher odds of failure (AOR = 8.2, CI: 3.2–21.9), and low adherence was associated with a 5.6 times increased odds (AOR = 5.6, CI: 1.9–16.1) compared to high adherence. A history of previous contraceptive failure increased the odds by threefold (AOR = 3.0, CI: 1.2–7.7). Finally, the odds of having contraceptive failure is 22.2 times (AOR = 22.2, CI: 2.2–285.3) higher for women with three or more children as compared to women with no children. (Table 2 ) Table 2 Multivariate Analysis of contraceptive failure in pregnant women attending ANC, Addis Ababa, Ethiopia 2025 Variable Category Contraceptive Failure Yes Contraceptive Failure No COR (95% CI) AOR(95% CI) P-value Parity 0 23 100 1 1 1 15 117 0.6(0.3–1.1) 1.4(0.6–3.5) 0.83 2 21 70 1.3(0.7–2.5) 6.7(1.2–45.5) =3 7 22 2.7(1.2-6.0) 22.2(2.2-285.2) < 0.05 Contraceptive method used prior to current pregnancy Emergency contraceptive pill(4th) 11 11 3.9( 1.6–9.5) 3.4(0.99–11.8) 0.05 3rd Tier Contraceptives 9 8 4.3(1.6-12.18)** 5.6(1.7–18.2) < 0.01 2nd Tier contraceptives 52 201 1 1 1st tier contraceptives 2 91 0.08(0.01–0.28)** 0.07(0.01–0.29) < 0.01 Adherence to Contraceptive High Adherence 49 287 1 1 Medium Adherence 16 11 8.5(3.8–19.9)** 8.2(3.2–21.9) < 0.01 Low Adherence 9 13 4.1(1.6–9.9)** 5.6(1.9–16.1) < 0.01 History of contraceptive failure No 56 288 1 1 Yes 18 23 4.0(2.0-7.9)** 3.0(1.2–7.7) < 0.01 Key: ** - significant Association, CI – Confidence Interval, AOR –Adjusted Odds Ratio, COR – Crude odds ratio Discussion Contraceptive failure was reported by 19.2% of the pregnant women interviewed. The association was strong for women with three or more children, using Third-tier contraceptive use, Partial adherence and non-adherence to contraception and history of previous contraceptive failure. Among women experiencing contraceptive failure, Oral contraceptive pill was the method most often used, followed by Emergency contraceptive pill. The magnitude of contraceptive failure among pregnant women in this study was 19.2% (CI: 15.3% – 23.1%). This rate is higher compared to the United States and Ghana, where failure rates are reported at 10.3% and 7.9%, respectively ( 1 , 4 ). Similarly, this rate exceeds those in other Ethiopian regions, like Harari (10.3%) and Debre Markos (9.1%) ( 5 , 6 ). Possible reasons for this discrepancy may include variations in type of Contraceptive method used with a higher use of second tier contraceptive and emergency contraceptive pill noted and adherence behavior in the respective settings. Women with 3 or more children had significantly higher odds of contraceptive failure (AOR = 22.188) compared to women with no children though the confidence interval is very wide( CI: 2.2-285.3). This might be because of the small number of women with in this category which suggest this finding should be interpreted with caution. Despite this the finding contrasts with the global DHS data showing higher failure among women with 0–2 children but aligns with findings from Denmark, where failure rates were higher among women with two or more births. ( 3 , 13 ). A figure from Debre Markos showed, Women who had living children had 2.1 times higher odds of contraceptive use compared to those who had no children ( 6 ). Suggesting that women with more children may rely more heavily on contraception and may still experience failure despite high motivation to avoid pregnancy. Method selection was another crucial element; Third-tier contraceptive methods were associated with a 5.6-fold increase in failure risk (AOR = 5.589). This is consistent with global findings that methods such as withdrawal, periodic abstinence, and condoms are less effective ( 8 ). Similarly in Harari study also emphasized emergency contraceptive use as a risk factor ( 5 ). This may be explained by the greater reliance on user behavior and lower intrinsic efficacy of third-tier and emergency contraceptive methods. Adherence played a crucial role. Medium and low adherence to contraceptive use were strongly associated with increased failure rates medium adherence (AOR = 8.177) and low adherence (AOR = 5.593). This is in line with findings from the Harari region, where inconsistent use increased failure risk by fourfold ( 5 ). Non-adherence may be rooted in side effects, misunderstandings, or sociocultural barriers that disrupt proper and consistent use. A history of contraceptive failure also significantly increased the risk of subsequent failure (AOR = 3.017). This suggests that affected women may not be receiving tailored counseling or may continue to select methods ill-suited to their context. Factors such as being unmarried and history of emergency contraceptive use, although initially showing elevated crude odds, were not statistically significant after adjusting for confounders. This may be due the limited number of unmarried women and women with history of emergency contraceptive or variations in the way variables interact in different settings. Contrary to expectations, neither education nor wealth showed a significant association with contraceptive failure in this study. While other reports have linked lower education to higher failure rates ( 2 ), this was not observed here possibly due to widespread use of non-user dependent methods like injectable and implants, which require minimal user involvement. The Harari study also found no significant link between education and failure ( 5 ). Although global data have indicated that poorer women particularly those using pills and condoms are more likely to experience failure ( 13 ), this association did not emerge in the present findings. The predominance of user-independent methods may have reduced the impact of socioeconomic factors on correct use and overall effectiveness. Limitations of the study While this study provides valuable insight into contraceptive failure among pregnant women, some of the limitations we have observed include: First, women with contraceptive failure may be overrepresented, as the study included only pregnant women and excluded those who successfully avoided pregnancy. Second, the study was done in an urban context in Ethiopia; therefore the findings may not be applicable to rural or low-resource locations with varying healthcare access and socioeconomic situations. Although an effort was made to include participants from a region considered close to rural areas, this may not have fully addressed the urban-rural disparity. Third, this study primarily included women attending antenatal care, excluding those who presented for abortion care or other obstetric/gynecologic emergencies, which may have influenced the estimated magnitude of contraceptive failure and its associated factors. Fourth, the strong association between having three or more children and contraceptive failure was based on a small number of women in this category, resulting in an imprecise estimate with a very wide confidence interval. Therefore, this finding should be interpreted with caution and requires confirmation in larger studies. Finally, information on contraceptive use prior to pregnancy relied on self-reports, which may be inaccurate due to memory lapse, misunderstanding of method use, or reluctance to disclose sensitive information. To address this data collection was done in a confidential and private manner, and the questionnaire focused primarily on recent contraceptive use to improve accuracy. Conclusion The magnitude of contraceptive failure among pregnant women found in this study was significant and high. The association was strong for Women with three or more children, using first and third-tier contraceptive use, medium adherence and low adherence to contraception and history of previous contraceptive failure. Promoting first and second -tier contraceptive use, high-quality counseling including about consistent use, particularly for user-dependent contraceptive methods such as oral contraceptive pill, emergency contraceptive pill and the traditional methods and follow-up support for women with past failures can improve method choice, adherence, and reduce risk of future failure. Additionally, to obtain a more comprehensive understanding of contraceptive failure, future studies should include women with a variety of pregnancy outcomes including live births, ectopic pregnancy, spontaneous abortions, and induced abortion. Declarations Ethical Concerns Ethical clearance was obtained from the Myungsung Medical College Ethical Review Committee and the Addis Ababa Health Bureau (Ref: አ/አ/ጤ/2/026/17). Permissions were also obtained from Kality 05 Health Center and Tirunesh Beijing General Hospital. Written informed consent was obtained after explaining the study's purpose and risks. Participants were informed of their right to withdraw at any time without affecting their care. Names were excluded from questionnaires, and all data were anonymous, encrypted, and securely stored to protect participant privacy. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding The current research was financially supported by Myungsung Medical College , which provided a total fund of 7,500 Ethiopian Birr (ETB) . The funding was utilized solely for research-related purposes, including data collection, materials, and other necessary expenses. The funding institution had no role in the study design, data collection, analysis, interpretation of results, or in the decision to publish this work. We gratefully acknowledge the financial support provided by Myungsung Medical College. Author Contribution E.D., E.E., and H.M. contributed to conceptualization, data curation, formal analysis, methodology, funding acquisition, and writing the original draft. A.Z. provided supervision, managed the project, conducted formal analysis, and contributed to writing through review and editing. S.G. and T.T. offered supervision and assisted with writing through review and editing. S.J.K. oversaw supervision and project administration, secured funding, and contributed to writing through review and editing. Acknowledgement Firstly and foremost, we would like to express our sincere gratitude to Myungsung Medical College for the opportunity and facility to conduct research, especially the Department of Public Health, for providing vital information and resources that played a key role in completing the research methodology course. We are also deeply thankful to the volunteer participants who willingly and enthusiastically took part in our study. Finally we would like to acknowledge the facility member at Tirunesh Beijing General Hospital and Kality 05 Health Center who were cooperative and supportive during the data collection period. Data Availability All data generated and/or analyzed during the current study are included in this article References Sundaram A, Vaughan B, Kost K, Bankole A, Finer LB, Trussell J. Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth. Perspect Sex Reprod Health. 2017;49(1):7–16. 10.1363/psrh.12017 . Kiran A, Upadhyay RP, Mahapatra B, Singh PK, Kumar K, Dixit A et al. Socio-economic differentials in contraceptive discontinuation in India [Working Paper No. 229]. Singapore: Asia Research Institute, National University of Singapore; 2014. Vejlgaard VR. Contraceptive failure—results from a study conducted among women with accepted and unaccepted pregnancies in Denmark. Contraception. 2002;66(2):81–7. 10.1016/s0010-7824(02)00210-7 . Bawah AA, Sato R, Asuming P, Henry EG, Agula C, Agyei-Asabere C, et al. Contraceptive method use, discontinuation and failure rates among women aged 15–49: evidence from selected low-income settings in Kumasi, Ghana. Contracept Reprod Med. 2021;6(1):9. 10.1186/s40834-021-00151-y . Desta G, Assefa NMA, Oljira LCA. Contraceptive failure rate and associated factors among pregnant women in Harari Region, Ethiopia [Master's thesis]., Harar. Ethiopia: Haramaya University; 2018. https://ir.haramaya.edu.et/hru/bitstream/handle/123456789/3108/Gedamnesh%20Desta%20Tesfu.pdf?isAllowed=y&sequence=1 . Accessed April 30, 2025. Alemu L, Yisma A, Azage M. Contraceptive use and associated factors among women seeking induced abortion in Debre Markos Town, Northwest Ethiopia: a cross-sectional study. Reprod Health. 2020;17(1):99. 10.1186/s12978-020-00950-2 . Ethiopian Public Health Institute (EPHI) and ICF. Ethiopia Mini Demographic and Health Survey 2019: Final Report. Maryland, USA: EPHI and ICF;: Rockville; 2021. Bradley SEK, Croft TN, Bankole A, Rutstein SO. Global contraceptive failure rates: who is most at risk? Stud Fam Plann. 2019;50(1):3–24. 10.1111/sifp.12085 . Cleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Stud Fam Plann. 2004;35(2):104–20. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health. Paediatr Perinat Epidemiol. 2008;22(3):235–47. 10.1111/j.1365-3016.2008.00995.x . Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77. 10.1016/S0140-6736(13)60996-4 . Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. 10.1016/S0140-6736(13)60937-X . Polis CB, Bradley SEK, Bankole A, Onda T, Croft T, Singh S. Contraceptive failure rates in the developing world: an analysis of Demographic and Health Survey data in 43 countries. Contraception. 2016;94(1):11–20. 10.1016/j.contraception.2016.03.005 . Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: final response. J Clin Epidemiol. 2011;64(3):258–63. 10.1016/j.jclinepi.2010.02.023 . World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization; 2015. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7654458","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":529096861,"identity":"64081ab0-73ce-4cdd-9012-ab7096a99485","order_by":0,"name":"Ebisse 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tsegazeab","middleName":"","lastName":"Tsehaye","suffix":""},{"id":529096870,"identity":"5506dac0-a3cf-4a1a-a76b-2545e7e94e36","order_by":6,"name":"Song-Jung Kim","email":"","orcid":"","institution":"Myungsung Medical School","correspondingAuthor":false,"prefix":"","firstName":"Song-Jung","middleName":"","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2025-09-19 04:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7654458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7654458/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93637709,"identity":"9eda891b-3837-408d-be60-41a4dc6360cf","added_by":"auto","created_at":"2025-10-16 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01:54:25","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83840,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7654458/v1/bf5d85deeb0bfd3196b102fb.html"},{"id":93637708,"identity":"f61ebf57-148e-4071-91be-379b1812b11c","added_by":"auto","created_at":"2025-10-16 01:54:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":125039,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphic representation of contraceptive method used by pregnant women attending ANC\u003c/strong\u003e \u003cstrong\u003e, Addis Ababa, Ethiopia 2025\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7654458/v1/d1560ddf929d759af3b01790.jpg"},{"id":93637710,"identity":"b1d36a1f-a5f1-44a2-8f77-fadab6c93d25","added_by":"auto","created_at":"2025-10-16 01:54:24","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":183692,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphic representation how participants assume pregnancy happened in pregnant women attending ANC, Addis Ababa, Ethiopia 2025\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7654458/v1/4aba3c01644ecb5cb6ca1980.jpg"},{"id":97673550,"identity":"ea749ca5-9633-4312-b33b-f4fdccd169a7","added_by":"auto","created_at":"2025-12-08 09:40:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1472360,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7654458/v1/f4ac066b-fb7b-4b6e-befd-569a08b7e29e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHigh Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eContraceptive failure refers to the occurrence of unexpected pregnancy despite the use of a contraceptive method (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This includes both contraceptive-related failure (i.e., contraceptives did not work as expected) and user-related failure (i.e., stemming from incorrect or inconsistent use) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A study done in USA showed contraceptive failure of 10.3 in 2010.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Another study done Ghanaian urban environment showed a failure rate of contraception was 7.9% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A study in Ethiopia\u0026rsquo;s Harari region found a 10.3% failure rate, while in Debre Marko, 9.1% of women became pregnant while using contraception (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Globally, failure rates vary by method ranging from 0.3% for implants and 1.2% for IUDs, 2% of injectable to 6\u0026ndash;9% for pills and condoms, and up to 17\u0026ndash;19% for traditional methods like withdrawal and periodic abstinence (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEthiopia, the second most populous country in Africa, has a total fertility rate of 4.1 children per woman. Despite the need for population control, only 41% of married women aged 15\u0026ndash;49 use any family planning method, 40% use modern methods and 1% use traditional ones. Injectables are the most popular modern method (27%), followed by implants (9%), IUDs (2%), and pills (2%). Use of modern methods varies across regions, from as low as 3% in Somali to as high as 50% in Amhara and 48% in Addis Ababa (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFirst-tier contraceptives are methods with the highest effectiveness, typically with \u0026lt;\u0026thinsp;1% failure rate with typical use. These methods are long-acting reversible contraceptives (LARCs) and permanent methods. Second-tier contraceptives are user-dependent hormonal methods with moderate effectiveness, typically with a failure rate of 4\u0026ndash;7% with typical use examples include injectables and pills.Third-tier contraceptives are barrier or behavioral methods such as condom, withdrawal and periodic abstinence with lower effectiveness, with typical-use failure rates\u0026thinsp;\u0026gt;\u0026thinsp;13%.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eContraceptive failure contributes substantially to raising levels of unintended births and induced abortion. A study done in 19 developing countries found that about 75% of pregnancies from contraceptive failure were carried to term, with most reported as unwanted or mistimed. Around 10% ended in fetal loss, largely due to induced abortion. The median contribution of failure to all unintended births for all 19 surveys was about 15%, and the contribution to fetal loss was 12% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Unintended pregnancies can lead to poor maternal care, contributing to over 1\u0026nbsp;million preventable stillbirths and 3.6\u0026nbsp;million neonatal deaths annually. ( 10,11) Children from unplanned pregnancies are less likely to be breastfed, more likely to be stunted, and face higher child mortality risks (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost existing studies on contraceptive failure primarily focus on women who seek abortions, often overlooking those who continue their pregnancies. In Sub-Saharan Africa, particularly Ethiopia, research on contraceptive failure among pregnant women with diverse pregnancy outcomes remains limited. This study aims to provide updated data on magnitude and associated factors of contraceptive failure among pregnant women attending Kality health center and Tirunesh Bejing General Hospital, Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Population\u003c/h2\u003e\u003cp\u003eAn institution-based cross-sectional study was conducted from March 1 to April 30, 2025, among patients who visited Kality 05 Health Center and Tirunesh Beijing General Hospital in Addis Ababa, Ethiopia. Participants were selected based on the inclusion criteria: pregnant women receiving care at either facility, with a history of contraceptive use, and willing to participate during the study period. Exclusion criteria included severe emergency illness, inability to provide consent, or being under 18 without a consenting legal guardian.\u003c/p\u003e\u003cp\u003eUsing a conservative proportion and a p-value threshold of 0.5 to ensure maximal variability, the initial sample size was calculated as 385, and with a 10% non-response rate, the final sample size was 424.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Sources and Collection Procedures\u003c/h3\u003e\n\u003cp\u003eA stratified random sampling technique was used, treating the two health facilities as separate strata. Participants were selected in a 2:1 ratio, with more from Kality 05 Health Center due to higher patient flow. All pregnant women visiting either facility for ANC services during the study period were eligible. Participants were randomly selected daily using the lottery method from available charts.\u003c/p\u003e\u003cp\u003eData were collected through a face-to-face interviewer-administered structured questionnaire, adapted from similar Ethiopian studies and pretested for quality. It included socio-demographic details, medical history, and other clinical information. Completed questionnaires were checked daily for completeness and accuracy. All data were securely stored with restricted access to ensure confidentiality.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe occurrence of contraceptive failure was assessed by the following question: \u0026ldquo;How did this pregnancy happen? / Were you using contraceptive during the sexual intercourse where they most likely had conceived?\u0026rdquo; \u0026ldquo;I planned to become pregnant and did not use any contraception\u0026rdquo;, \u0026ldquo;Stopped method due to side effects\u0026rdquo;, \u0026ldquo;Stopped method due to personal reason\u0026rdquo;, \u0026ldquo;Become pregnant while using contraceptive\u0026rdquo;. Women who stated they had used a contraceptive method at the intercourse where they most likely had conceived were considered as having experienced contraceptive failure. Women who stated they had planned to become pregnant and women who stated they stopped method due to side effects or personal reason were considered as not having experienced contraceptive failure.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe data collected from Kality 05 Health Center and Tirunesh Beijing General Hospital were entered into SPSS version 27 and subsequently checked and cleaned for accuracy and completeness. Following this, numerical coding was applied, and the data were securely stored by the researchers. Univariate analysis was conducted to examine the distribution of each variable. Bivariate analysis was used to assess the association between two variables, using a p-value threshold of 0.25 to determine potential statistical associations. Variables that showed multiple associations were further analyzed using multivariable logistic regression. In this model, a 95% confidence interval (CI) and a p-value of less than 0.05 were used to identify statistically significant associations. All data analyses were performed by the researchers using SPSS version 27 software.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of study participants\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eSocio demographic characteristics\u003c/h2\u003e\u003cp\u003eOut of the total sample, 385 pregnant women participated, giving a response rate of 90.8%. The majority 265 women(68.8%) were from Kality Health Center, while the remaining 120 (31.2%) were from TBGH. More than half of the participants 203 (52.7%) were aged between 25 and 30 years. Regarding religion 268 women (69.6%) were Orthodox Christians, 67 (17.4%) were Protestants and 47 (12.2%) Muslims. In terms of educational status 158 women (41.0%) had completed secondary education, and 88 (22.9%) had pursued education beyond the secondary level. Nearly half of respondents 184 (47.8%) were housewives, constituting the largest occupational group in the study. The vast majority of participants 369 (95.8%)were married.(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and Reproductive Health Characteristics of pregnant women attending ANC, Addis Ababa, Ethiopia 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociodemographic and Reproductive Health Characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly household income (ETB)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1000 ETB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1001\u0026ndash;3000 ETB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3001\u0026ndash;5000 ETB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5001\u0026ndash;10000 ETB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10000 ETB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than secondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving in union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravida\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimigravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrand gravida\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePara\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNullipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrand multipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of emergency contraceptive use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e385\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eUnderlying health conditions\u003c/h3\u003e\n\u003cp\u003eAmong the 385 respondents, 11 reported having an underlying medical or gynecologic condition. The most common case was Myoma, accounting for 3 cases (27.3%). All participants denied a chronic medication use history.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eReproductive Health Characteristics\u003c/h2\u003e\u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e the most commonly used method prior to the current pregnancy was the injectable (Depo-Provera) 144(37.4%), followed by oral contraceptive pills at 109 (28.3%) and implants at 84 (21.8%). For analysis, contraceptive methods were classified into tiers based on typical-use failure rates. Tier 1 included implants and IUDs. Tier 2 included injectables and oral pills. Tier 3 included condoms, withdrawal, periodic abstinence, and breastfeeding, which was categorized due to its high typical-use failure rate when not strictly following Lactational Amenorrhea Method (LAM) criteria. Tier 4 consisted of emergency contraceptive pills.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA history of abortion was reported by 103, (26.8%) women. Counseling prior to contraceptive use was received by 55.8% women, whereas 44.2% did not receive any. Awareness of contraceptive failure was reported by 49.6%, while the remaining 50.4% women were unaware. Most participants 336 (87.3%) had high adherence to their method as prescribed, 27 (7%) had medium adherence, and 22 (5.7%) had low adherence. Contraceptive failure prior to the current pregnancy was experienced by 41 (10.6%) of respondents, while the remaining 344 (89.4%) reported no such failure. Additionally, 15 (3.9%) of participants indicated having had an induced abortion due to contraceptive failure before their current pregnancy. A majority of respondents, 274 (71.2%), reported that their current pregnancy was planned, while 111 (28.8%) indicated it was unplanned. Among the 111 women who didn\u0026rsquo;t plan current pregnancy 89 (80.2%) women suggested pregnancy was mistimed and the remaining 22(19.88%) as unwanted pregnancy. In response to their current pregnancy status, 142 women (36.9%) expressed an intention to switch to a different contraceptive method, 138 (35.8%) planned to continue using the same method with improved adherence, 103 (26.8%) were uncertain about their future contraceptive use, and 2 women (0.5%) reported that they did not intend to use any contraceptive method.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMagnitude of Contraceptive Failure\u003c/h2\u003e\u003cp\u003eDuring current pregnancy 74 (19.2%(95% CI: 15.3% \u0026ndash; 23.1%)) of respondents experienced contraceptive failure, whereas 311 (80.8%) did not. According to Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e among all participants, the majority 266 women (69.1%) had intentionally discontinued contraception in order to conceive. However, 74 (19.2%) became pregnant while still using a contraceptive method, indicating method failure. Additionally, 31 (8.1%) stopped using contraception due to side effects, and 14 (3.6%) for personal reasons.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eFactors Associated with Contraceptive Failures\u003c/h2\u003e\u003cp\u003eDuring bi-variate analysis marital status, income, gravidity, parity, history of abortion, counseling about contraceptive, contraceptive method, adherence, history of emergency contraceptive use, history of contraceptive failure and history of induced abortion due to contraceptive failure were found to be associated with contraceptive failure. However, multivariate logistic regression analysis, showed associations of parity, contraceptive method, adherence and history of contraceptive failure with contraceptive failure. Third-tier contraceptive use increased the odds by 5.6 times (AOR\u0026thinsp;=\u0026thinsp;5.6, CI: 1.7\u0026ndash;18.2) compared to second-tier use. Whereas use of first-tier contraceptive methods was associated with reduced odds of contraceptive failure, with users having 0.07 times lower odds of failure compared to users of second-tier methods (AOR\u0026thinsp;=\u0026thinsp;0.07, 95% CI: 0.01\u0026ndash;0.29). Medium adherence to contraception resulted in an 8.2 times higher odds of failure (AOR\u0026thinsp;=\u0026thinsp;8.2, CI: 3.2\u0026ndash;21.9), and low adherence was associated with a 5.6 times increased odds (AOR\u0026thinsp;=\u0026thinsp;5.6, CI: 1.9\u0026ndash;16.1) compared to high adherence. A history of previous contraceptive failure increased the odds by threefold (AOR\u0026thinsp;=\u0026thinsp;3.0, CI: 1.2\u0026ndash;7.7). Finally, the odds of having contraceptive failure is 22.2 times (AOR\u0026thinsp;=\u0026thinsp;22.2, CI: 2.2\u0026ndash;285.3) higher for women with three or more children as compared to women with no children. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate Analysis of contraceptive failure in pregnant women attending ANC, Addis Ababa, Ethiopia 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContraceptive Failure Yes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eContraceptive Failure No\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAOR(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6(0.3\u0026ndash;1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.4(0.6\u0026ndash;3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3(0.7\u0026ndash;2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.7(1.2\u0026ndash;45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;=3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.7(1.2-6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.2(2.2-285.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContraceptive method used prior to current pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency contraceptive pill(4th)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.9( 1.6\u0026ndash;9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.4(0.99\u0026ndash;11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3rd Tier Contraceptives\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.3(1.6-12.18)**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5.6(1.7\u0026ndash;18.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2nd Tier contraceptives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1st tier contraceptives\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e91\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.08(0.01\u0026ndash;0.28)**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.07(0.01\u0026ndash;0.29)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdherence to Contraceptive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh Adherence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedium Adherence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e8.5(3.8\u0026ndash;19.9)**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e8.2(3.2\u0026ndash;21.9)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eLow Adherence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.1(1.6\u0026ndash;9.9)**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5.6(1.9\u0026ndash;16.1)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of contraceptive\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003efailure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e23\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.0(2.0-7.9)**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.0(1.2\u0026ndash;7.7)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eKey: ** - significant Association, CI \u0026ndash; Confidence Interval, AOR \u0026ndash;Adjusted Odds Ratio, COR \u0026ndash; Crude odds ratio\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eContraceptive failure was reported by 19.2% of the pregnant women interviewed. The association was strong for women with three or more children, using Third-tier contraceptive use, Partial adherence and non-adherence to contraception and history of previous contraceptive failure. Among women experiencing contraceptive failure, Oral contraceptive pill was the method most often used, followed by Emergency contraceptive pill.\u003c/p\u003e\u003cp\u003eThe magnitude of contraceptive failure among pregnant women in this study was 19.2% (CI: 15.3% \u0026ndash; 23.1%). This rate is higher compared to the United States and Ghana, where failure rates are reported at 10.3% and 7.9%, respectively (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Similarly, this rate exceeds those in other Ethiopian regions, like Harari (10.3%) and Debre Markos (9.1%) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Possible reasons for this discrepancy may include variations in type of Contraceptive method used with a higher use of second tier contraceptive and emergency contraceptive pill noted and adherence behavior in the respective settings.\u003c/p\u003e\u003cp\u003eWomen with 3 or more children had significantly higher odds of contraceptive failure (AOR\u0026thinsp;=\u0026thinsp;22.188) compared to women with no children though the confidence interval is very wide( CI: 2.2-285.3). This might be because of the small number of women with in this category which suggest this finding should be interpreted with caution. Despite this the finding contrasts with the global DHS data showing higher failure among women with 0\u0026ndash;2 children but aligns with findings from Denmark, where failure rates were higher among women with two or more births. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A figure from Debre Markos showed, Women who had living children had 2.1 times higher odds of contraceptive use compared to those who had no children (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Suggesting that women with more children may rely more heavily on contraception and may still experience failure despite high motivation to avoid pregnancy.\u003c/p\u003e\u003cp\u003eMethod selection was another crucial element; Third-tier contraceptive methods were associated with a 5.6-fold increase in failure risk (AOR\u0026thinsp;=\u0026thinsp;5.589). This is consistent with global findings that methods such as withdrawal, periodic abstinence, and condoms are less effective (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Similarly in Harari study also emphasized emergency contraceptive use as a risk factor (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This may be explained by the greater reliance on user behavior and lower intrinsic efficacy of third-tier and emergency contraceptive methods.\u003c/p\u003e\u003cp\u003eAdherence played a crucial role. Medium and low adherence to contraceptive use were strongly associated with increased failure rates medium adherence (AOR\u0026thinsp;=\u0026thinsp;8.177) and low adherence (AOR\u0026thinsp;=\u0026thinsp;5.593). This is in line with findings from the Harari region, where inconsistent use increased failure risk by fourfold (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Non-adherence may be rooted in side effects, misunderstandings, or sociocultural barriers that disrupt proper and consistent use. A history of contraceptive failure also significantly increased the risk of subsequent failure (AOR\u0026thinsp;=\u0026thinsp;3.017). This suggests that affected women may not be receiving tailored counseling or may continue to select methods ill-suited to their context.\u003c/p\u003e\u003cp\u003eFactors such as being unmarried and history of emergency contraceptive use, although initially showing elevated crude odds, were not statistically significant after adjusting for confounders. This may be due the limited number of unmarried women and women with history of emergency contraceptive or variations in the way variables interact in different settings.\u003c/p\u003e\u003cp\u003eContrary to expectations, neither education nor wealth showed a significant association with contraceptive failure in this study. While other reports have linked lower education to higher failure rates (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), this was not observed here possibly due to widespread use of non-user dependent methods like injectable and implants, which require minimal user involvement. The Harari study also found no significant link between education and failure (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Although global data have indicated that poorer women particularly those using pills and condoms are more likely to experience failure (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), this association did not emerge in the present findings. The predominance of user-independent methods may have reduced the impact of socioeconomic factors on correct use and overall effectiveness.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations of the study\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhile this study provides valuable insight into contraceptive failure among pregnant women, some of the limitations we have observed include:\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFirst, women with contraceptive failure may be overrepresented, as the study included only pregnant women and excluded those who successfully avoided pregnancy.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSecond, the study was done in an urban context in Ethiopia; therefore the findings may not be applicable to rural or low-resource locations with varying healthcare access and socioeconomic situations. Although an effort was made to include participants from a region considered close to rural areas, this may not have fully addressed the urban-rural disparity.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThird, this study primarily included women attending antenatal care, excluding those who presented for abortion care or other obstetric/gynecologic emergencies, which may have influenced the estimated magnitude of contraceptive failure and its associated factors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFourth, the strong association between having three or more children and contraceptive failure was based on a small number of women in this category, resulting in an imprecise estimate with a very wide confidence interval. Therefore, this finding should be interpreted with caution and requires confirmation in larger studies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFinally, information on contraceptive use prior to pregnancy relied on self-reports, which may be inaccurate due to memory lapse, misunderstanding of method use, or reluctance to disclose sensitive information. To address this data collection was done in a confidential and private manner, and the questionnaire focused primarily on recent contraceptive use to improve accuracy.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe magnitude of contraceptive failure among pregnant women found in this study was significant and high. The association was strong for Women with three or more children, using first and third-tier contraceptive use, medium adherence and low adherence to contraception and history of previous contraceptive failure. Promoting first and second -tier contraceptive use, high-quality counseling including about consistent use, particularly for user-dependent contraceptive methods such as oral contraceptive pill, emergency contraceptive pill and the traditional methods and follow-up support for women with past failures can improve method choice, adherence, and reduce risk of future failure. Additionally, to obtain a more comprehensive understanding of contraceptive failure, future studies should include women with a variety of pregnancy outcomes including live births, ectopic pregnancy, spontaneous abortions, and induced abortion.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eEthical Concerns\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Ethical clearance was obtained from the Myungsung Medical College Ethical Review Committee and the Addis Ababa Health Bureau (Ref: አ/አ/ጤ/2/026/17). Permissions were also obtained from Kality 05 Health Center and Tirunesh Beijing General Hospital.\u003c/p\u003e\u003cp\u003e Written informed consent was obtained after explaining the study's purpose and risks. Participants were informed of their right to withdraw at any time without affecting their care. Names were excluded from questionnaires, and all data were anonymous, encrypted, and securely stored to protect participant privacy.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe current research was financially supported by \u003cb\u003eMyungsung Medical College\u003c/b\u003e, which provided a total fund of \u003cb\u003e7,500 Ethiopian Birr (ETB)\u003c/b\u003e. The funding was utilized solely for research-related purposes, including data collection, materials, and other necessary expenses. The funding institution had no role in the study design, data collection, analysis, interpretation of results, or in the decision to publish this work.\u003c/p\u003e\u003cp\u003eWe gratefully acknowledge the financial support provided by Myungsung Medical College.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.D., E.E., and H.M. contributed to conceptualization, data curation, formal analysis, methodology, funding acquisition, and writing the original draft. A.Z. provided supervision, managed the project, conducted formal analysis, and contributed to writing through review and editing. S.G. and T.T. offered supervision and assisted with writing through review and editing. S.J.K. oversaw supervision and project administration, secured funding, and contributed to writing through review and editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eFirstly and foremost, we would like to express our sincere gratitude to Myungsung Medical College for the opportunity and facility to conduct research, especially the Department of Public Health, for providing vital information and resources that played a key role in completing the research methodology course. We are also deeply thankful to the \u003cb\u003evolunteer participants\u003c/b\u003e who willingly and enthusiastically took part in our study. Finally we would like to acknowledge the facility member at Tirunesh Beijing General Hospital and Kality 05 Health Center who were cooperative and supportive during the data collection period.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated and/or analyzed during the current study are included in this article\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSundaram A, Vaughan B, Kost K, Bankole A, Finer LB, Trussell J. Contraceptive failure in the United States: estimates from the 2006\u0026ndash;2010 National Survey of Family Growth. Perspect Sex Reprod Health. 2017;49(1):7\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1363/psrh.12017\u003c/span\u003e\u003cspan address=\"10.1363/psrh.12017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKiran A, Upadhyay RP, Mahapatra B, Singh PK, Kumar K, Dixit A et al. Socio-economic differentials in contraceptive discontinuation in India [Working Paper No. 229]. Singapore: Asia Research Institute, National University of Singapore; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVejlgaard VR. Contraceptive failure\u0026mdash;results from a study conducted among women with accepted and unaccepted pregnancies in Denmark. Contraception. 2002;66(2):81\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0010-7824(02)00210-7\u003c/span\u003e\u003cspan address=\"10.1016/s0010-7824(02)00210-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBawah AA, Sato R, Asuming P, Henry EG, Agula C, Agyei-Asabere C, et al. Contraceptive method use, discontinuation and failure rates among women aged 15\u0026ndash;49: evidence from selected low-income settings in Kumasi, Ghana. Contracept Reprod Med. 2021;6(1):9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40834-021-00151-y\u003c/span\u003e\u003cspan address=\"10.1186/s40834-021-00151-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDesta G, Assefa NMA, Oljira LCA. Contraceptive failure rate and associated factors among pregnant women in Harari Region, Ethiopia [Master's thesis]., Harar. Ethiopia: Haramaya University; 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ir.haramaya.edu.et/hru/bitstream/handle/123456789/3108/Gedamnesh%20Desta%20Tesfu.pdf?isAllowed=y\u0026amp;sequence=1\u003c/span\u003e\u003cspan address=\"https://ir.haramaya.edu.et/hru/bitstream/handle/123456789/3108/Gedamnesh%20Desta%20Tesfu.pdf?isAllowed=y\u0026amp;sequence=1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed April 30, 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlemu L, Yisma A, Azage M. Contraceptive use and associated factors among women seeking induced abortion in Debre Markos Town, Northwest Ethiopia: a cross-sectional study. Reprod Health. 2020;17(1):99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12978-020-00950-2\u003c/span\u003e\u003cspan address=\"10.1186/s12978-020-00950-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEthiopian Public Health Institute (EPHI) and ICF. Ethiopia Mini Demographic and Health Survey 2019: Final Report. Maryland, USA: EPHI and ICF;: Rockville; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBradley SEK, Croft TN, Bankole A, Rutstein SO. Global contraceptive failure rates: who is most at risk? Stud Fam Plann. 2019;50(1):3\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/sifp.12085\u003c/span\u003e\u003cspan address=\"10.1111/sifp.12085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCleland J, Ali MM. Reproductive consequences of contraceptive failure in 19 developing countries. Stud Fam Plann. 2004;35(2):104\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health. Paediatr Perinat Epidemiol. 2008;22(3):235\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-3016.2008.00995.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-3016.2008.00995.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(13)60996-4\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(13)60996-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlack RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(13)60937-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(13)60937-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePolis CB, Bradley SEK, Bankole A, Onda T, Croft T, Singh S. Contraceptive failure rates in the developing world: an analysis of Demographic and Health Survey data in 43 countries. Contraception. 2016;94(1):11\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.contraception.2016.03.005\u003c/span\u003e\u003cspan address=\"10.1016/j.contraception.2016.03.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: final response. J Clin Epidemiol. 2011;64(3):258\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jclinepi.2010.02.023\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2010.02.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization; 2015.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Contraceptive failure, Pregnant women, Adherence, Unintended pregnancy, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7654458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7654458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eContraceptive failure is a major global reproductive health issue, refers to the occurrence of unexpected pregnancy despite the use of a contraceptive method. It is associated with factors such as age, education, marital status, contraceptive method, parity and adherence. In Ethiopia, contraceptive failure rates are reported at 9.1\u0026ndash;10.3%, but studies are limited and mainly focus on women seeking abortions, overlooking those who continue pregnancies. The current study aims to provide updated data on magnitude and associated factors of contraceptive failure among pregnant women attending ANC in Addis Ababa, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross sectional study was conducted among 385 pregnant women attending ANC with prior contraceptive use. Data was collected through structured interviewer-administered questionnaires addressing sociodemographic characteristics, contraceptive practices, and adherence. Statistical analysis was performed using SPSS version 27. Bivariate and Multivariate logistic regression analysis were performed with p- values of \u0026lt;\u0026thinsp;0.25 and \u0026lt;\u0026thinsp;0.05 respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWomen younger than 25 years accounted for 23.1% of the participants. Two-third had completed secondary education and beyond. Second-tier contraceptive were the most commonly used method, reported by over two-third women. The overall contraceptive failure rate was 19.2%(CI: 15.3% \u0026ndash; 23.1%). Significant factors included use of third-tier methods (AOR\u0026thinsp;=\u0026thinsp;5.6, CI: 1.7\u0026ndash;18.2), first-tier contraceptive methods (AOR\u0026thinsp;=\u0026thinsp;0.07, 95% CI: 0.01\u0026ndash;0.29), medium adherence (AOR\u0026thinsp;=\u0026thinsp;8.2, CI: 3.2\u0026ndash;21.9), low adherence (AOR\u0026thinsp;=\u0026thinsp;5.6, CI: 1.9\u0026ndash;16.1), prior failure (AOR\u0026thinsp;=\u0026thinsp;3.0, CI: 1.2\u0026ndash;7.7), and having three or more children was associated with vastly increase odds (AOR\u0026thinsp;=\u0026thinsp;22.2), though with very wide confidence interval (CI: 2.2\u0026ndash;285.3).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe current study revealed a high prevalence of contraceptive failure among pregnant women attending ANC. Contraceptive tier, adherence, parity, and prior failure were strongly associated. Promoting first and second tier contraceptive method, strengthening user education, ensuring adherence and follow-up support for women with past failures may help reduce risk of future contraceptive failure.\u003c/p\u003e","manuscriptTitle":"High Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 01:54:20","doi":"10.21203/rs.3.rs-7654458/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"955f207d-d8c7-42fa-883b-e685d8b040c5","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-06T14:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-16 01:54:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7654458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7654458","identity":"rs-7654458","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}