A 3-Year Retrospective Study of Unintended Pregnancy in a Developed Multi-Ethnic Asian Community: A Call for Better Healthcare System for Family Planning

Background: Termination of pregnancy poses avoidable risk to women. Women who seek referrals from primary care professionals (PCP) to gynaecologists to manage their unintended pregnancy (UP) are potentially at-risk. The study aimed to determine the prevalence, demographic profiles and associated factors in a developed community requesting for referrals from PCPs for UP. Methods: The sociodemographic and clinical data were extracted from the electronic medical records of pregnant multi-ethnic Asian women at eight Singapore public primary care clinics from July 2017 to June 2020. Their variables were computed and compared among women of different age bands using appropriate statistical tests. Logistic regression was used to identify the factors associated with UP referrals. Results: Among 9794 gravid women, 974 of them requested gynaecologist referrals to terminate UP over the 3-year period, constituting a prevalence of 9.94%. The mean age of women requesting such referrals was 29.7±7 years. 10.7% of them had more than one prior UP and 15.7% were foreigners. Majority of women were married, did not require social assistance nor had comorbidities. Low proportion of them (2.9%) were prescribed contraceptives. Multivariable logistic regression analysis showed that women of Indian ethnicity, single, aged 40 years, were more likely to request referrals for UP. Conclusions: One in ten gravid women sought referrals for UP, especially the adolescents and older women, and Indian ethnicity. An accessible, community-based healthcare service to educate and counsel women on family planning is urgently needed to mitigate unnecessary risk from UP and maintain their reproductive health.