Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study

Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional 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 Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study Negalign Mechal, Mustefa Negash, Hailemichael Bizuneh, Ferid A Abubeker This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-154728/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Pregnancies complicated by cardiovascular disease carry a high risk of morbidity and mortality. Contraception offers a unique opportunity to avoid unintended pregnancy and/or optimize preconception cardiac health status. Such planning will also allow possible modification of medical therapy that can be detrimental to the growing fetus. However, unmet need for contraception can become a barrier to achieving these goals. This research was aimed to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease. Methods A facility-based cross-sectional study was conducted from February 1 – May 31/2020. A convenient sampling technique was used to enroll 284 reproductive age women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College. Data was collected through an exit interview using a structured and pretested questionnaire. Descriptive, bivariate, and multivariate methods were used to analyze the level of unmet need and its associated factors. Results The overall unmet need for contraception was 36%. The majority of the respondents lack counseling on contraception use. The most common reasons for non-use of a contraceptive method was fear of drug side effects and drug interaction. Unmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8–24.7) and those who lack partner support on contraception use (AOR = 6.2, CI: 1.91–19.8). Unmet need was also found to be more likely among women who have never used contraception before (AOR = 3.2, CI 1.12–8.92). Conclusion Unmet need for contraception was high in this high-risk population group. Tailored counseling can alleviate fear and concerns about contraceptive use. Appropriate strategies that enhance male partner involvement should also be implemented. Sexual & Reproductive Medicine Obstetrics & Gynecology Unmet need contraception cardiovascular disease chronic medical disease low-income country Figures Figure 1 Figure 2 Background Pregnancies complicated by cardiovascular disease (CVD) are associated with significant obstetric and fetal complications. There appears to be a geographic variation in the epidemiology of maternal cardiovascular disease. Globally, hypertensive disorders are the most frequent CVD complicating 5–10% of all pregnancies. Congenital heart diseases are the second leading CVD during pregnancy in the developed world whereas rheumatic valvular heart diseases are more frequently encountered in the developing world and commonly occur in women of reproductive age [ 1 , 2 ]. Recent advances in medical and obstetric care have enabled the majority of women with cardiovascular morbidity to successfully undergo pregnancy [ 3 ]. However, cardiac disease remains the leading cause of maternal mortality in the developed world. In addition, it is the most common indirect cause of maternal death in low/middle-income countries [ 2 , 4 ]. The risk of perinatal & maternal morbidity and mortality are directly associated with the type and severity of the CVD. For example, pulmonary hypertension and Eisenmenger’s syndrome carry a 50% risk of maternal death during pregnancy [ 3 , 5 ]. Similarly, women with severely impaired ventricular function, severe left heart obstruction, or dilated aorta due to Marfan syndrome are at a significantly increased risk of morbidity and mortality. Pregnancy should ideally be avoided in these women and if pregnancy occurs, termination should be discussed [ 1 ]. Thus, concerted efforts that enable women to avoid unintended pregnancy are highly imperative. Evidence-based guidance is available from the World Health Organization (WHO) to help guide clinicians in counseling and provision of safe and effective contraception methods for women with various medical conditions or medically-relevant characteristics [ 6 ]. The WHO medical eligibility criteria (MEC) has been modified to further stratify the risk of pregnancy in heart disease into classes I through IV [ 7 ]. Most patients with CVD have multiple visits before conception, offering a golden opportunity for contraceptive counseling. However, studies show a high rate of unintended pregnancy among patients with chronic medical conditions such as cardiac illness, diabetes, hypertension, and asthma [ 8 ]. Studies among women with CVD showed 40–65% of pregnancies were unintended [ 9 , 10 ]. Furthermore, cardiac illness was found to be one of the most common medical indications for termination of pregnancy [ 11 ]. All women with CVD can benefit from preconception counseling, which should include a detailed discussion of the risk of pregnancy. The ability to plan a pregnancy is key in improving pregnancy outcomes, and planned pregnancy and birth spacing are crucial to prevent complications of cardiovascular illness during pregnancy [ 3 , 9 ]. To this end, appropriate planning is essential to ensure that pregnancy is either avoided or postponed until the woman’s cardiovascular illness is optimized. For those women considering pregnancy, potentially teratogenic medications can be switched to safer medications when possible. Consistent use of contraceptives is crucial to achieving all these goals [ 7 , 12 ]. Contraceptive utilization offers a unique opportunity and has a pivotal role to play in reducing maternal morbidity and mortality in women with CVD. Thus, information regarding rates of unmet need for contraception is especially important as removing barriers of contraceptive uptake can reduce the incidence of unintended pregnancy and thereby prevent potential maternal and neonatal complications [ 1 , 7 ]. Unmet need for contraception has been extensively studied among women in the general population and to some extent in different subpopulations such as women living with HIV [ 13 – 15 ]. However, there are no studies among women with cardiovascular disease. The aim of this study was therefore to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease. Methods Study design and setting A facility-based cross-sectional study was conducted at the cardiac clinic of Saint Paul’s Hospital Millennium Medical College (SPHMMC), in Addis Ababa, Ethiopia from February 1 to May 31, 2020. SPHMMC is a tertiary teaching hospital and mainly servers as a public referral center. The cardiac clinic runs two days per week from 8:00 AM to 5: 00 PM and is visited by an average of 40-50 patients per day. Study population Currently married or in-union women of reproductive age (15–49 years) with cardiovascular disease attending the cardiac clinic of the hospital were eligible for the study. We excluded women who presented with acute medical conditions and unable to give consent and women who were visiting the cardiac clinic for the first time. Sample size and sampling The required sample size was determined using a single population proportion formula with an assumption of a 95% confidence interval and 0.05 margin of error. Since no previous study has been done in the setting, the proportion of women with unmet need was assumed to be 50%. After making finite population correction and adding 5% to compensate for non-response, the final sample size was calculated to be 291. A Convenient sampling method was used to identify and include all the study participants. Data collection Data was collected through an exit interview of sampled women using a structured and pretested questionnaire. The questionnaire used in this study was developed by referring to various literature and the algorithm to assess unmet need was adopted from the DHS analytical studies definition of unmet need revised in 2012 [ 16 ]. The data collection tool was prepared in English and translated into Amharic and translated back to English again to check for consistency. A pre-test was done on 10% (29) participants before data collection. Four trained and experienced data collectors were supervised by the principal investigator during the interview. Data processing and analysis All the filled questionnaires were verified by the principal investigator. Consecutive code was given to each case and the data was explored again for inconsistencies and missing values. After completeness and coding of questionnaires were checked, data were analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). Univariate analyses were carried out to describe the data. The DHS algorithm was applied to assess the unmet need for contraception. A two-stage process was then carried out to identify variables associated with unmet need. Bivariate associations between unmet need and covariates were explored using a Chi-square test. Variables with a p-value of less than 0.2 in binary logistic regression were selected as candidates for multivariate logistic regression to control for possible confounding factors. Finally, multivariate logistic regression with odds ratio and 95% confidence interval were computed to assess the presence and strength of association between unmet need and explanatory variables. A p-value of less than 0.05 was taken as statically significant. Operational definitions Unmet need for contraception: percentage of women who (1) are not pregnant and not postpartum amenorrhoeic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrhoeic and their last birth in the last 2 years was mistimed or unwanted. Total demand for contraception: refers to women with unmet need plus the percentage of women currently using contraception (representing “met need”). Proportion of demand satisfied: the percentage of women using contraception divided by the percentage of women with demand for contraception. Ethical considerations Ethical clearance for the study was obtained from the Institutional Review Board of SPHMMC before the start of data collection. All participants were informed about the purpose of the study and its procedures. It was made clear to all subjects that participation was voluntary. Privacy and confidentiality of study participants were ensured throughout the study. All participants provided written informed consent. Results Socio-demographic characteristics of study participants A total of 291 eligible women were approached for the interview. Out of these, 7 were non-responders (5 did not consent to the study, and 2 discontinued the interview) which makes the response rate 97.6%. The majority of the study subjects were between the age of 19-34 years with a mean age of 34 ± 7.4 years. Three fourth of them were married (Table 1). Table 1: Socio-Demographic characteristics of study subjects, Addis Ababa, Ethiopia, 2020 Characteristics Frequency (n) Percentage (%) Age (years) 15-19 7 2.5 20-24 23 8.1 25-29 48 16.9 30-34 78 27.5 35-39 62 21.8 40-44 48 16.9 45-49 18 6.3 Level of education No formal education 53 18.7 Primary 67 23.6 Secondary 83 29.2 Technical/vocational 23 8.1 Higher 58 20.4 Marital status Married 214 75.4 In union (living with a man) 70 24.6 Occupation Student 16 5.6 Unemployed 16 5.6 Housewife 135 47.5 House servant 9 3.2 Daily laborer 20 7.0 Merchant 55 19.4 Government employee 33 11.6 Private employee 16 5.6 Other 16 5.6 Monthly income (Ethiopian Birr) No monthly income 171 60.2 Less than 1000 7 2.5 1001- 3000 54 19.0 3001-5000 25 8.8 More than 5001 27 9.5 Sexual and reproductive characteristics of study participants Among 284 interviewed women, 198 (69.8%) have used a modern contraceptive method at least once in their lifetime. There were 51 pregnant women during the study, of which 25 (49%) had an unintended pregnancy. More than 87% of the participant were sexually active within the past year and close to 70% reported sexual activity in the month preceding the study. Cardiac care and follow up The most commonly observed cardiovascular disease were hypertension 90 (31.7%), chronic rheumatic valve disease 89 (31.3%), and congenital heart disease 47 (16.4%). The duration of chronic care and treatment range from 3 months to 20 years and the median duration was 36 months (IRQ: 24-73). Contraceptive counseling One-third of women discussed the risks of unintended pregnancy and future pregnancy plans with their care providers. In addition, 117 (41.2%) were counseled on contraceptive utilization whereas only 25% were linked with the family planning unit of the hospital. Unmet need for contraception and associated factors Figure 1 shows the stepwise algorithm used to calculate unmet need for contraception in the sampled population. The overall unmet need for contraception was 36.0 %, with 26.8% having unmet need for spacing and 9.2 % for limiting. The main reasons for not using contraceptive methods were fear of side effects and drug interactions, not having frequent sex, and not being married (Table 2). The contraceptive utilization (representing the met need) was 30.2%. Thus, the demand for contraception was 66.2% and the demand satisfied was 45.6% (Figure 2). Table 2: Reasons for not using contraceptives among women with unmet need, Addis Ababa, Ethiopia, 2020 Reason for not using Frequency (N) Percentage (%) Perceived low risk of pregnancy No having frequent sex 24 23.5 Not married 18 17.7 Breastfeeding 13 12.8 Up to God/fatalistic 8 7.8 Method related reasons Fear of drug side effect and interaction 30 29.4 Lack of awareness 3 2.9 Opposition to use Partner opposing 4 3.9 Other 2 2 Total 102 100 Bivariate and multivariate logistic regression analyses were done to explore factors associated with unmet need. Bivariate analyses showed that five variables: marital status, counseling on contraceptive use, previous use of a contraceptive method, counseling on risks of unintended pregnancy, and partner support on contraceptive use were associated with unmet need. In subsequent multivariate logistic regression marital status, counseling on contraceptive use, previous use of a contraceptive method, and partner support on contraceptive use remained independently associated with unmet need (Table 3). Unmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8-24.7) and those who lack partner support on contraception use (AOR=6.2, CI: 1.91-19.8). Unmet need was also found to be more likely among those who have never used a contraceptive method in the past (AOR=3.2, 95% CI: 1.12-8.92) (Table 3). Other variables like age, educational status, occupation, income, ever giving birth, and duration of follow-up were not found to be significantly associated with unmet need for contraception. Table 3: Association of independent variables with unmet need for contraception among study subjects, Addis Ababa, Ethiopia, 2020. Characteristics Unmet need Crudes OR (95% CI) Adjusted OR (95%CI) p-value No Yes Marital status 0.04 Married 171 43 1.00 1.00 Living with man 11 59 21.3 (10.3-44.1) 9.4 (2.9-30.6) * Counseled on use of contraceptives <0.001 Yes 77 6 1.00 1.00 No 105 96 11.7 (4.8-28.2) 6.7 (1.8-24.7) * Previously used a contraceptive method <0.001 Yes 151 48 1.00 1.00 No 31 54 5.5 (3.17-9.48) 3.2 (1.12-8.92) * Counseled on the risk of unintended pregnancy 0.06 Yes 71 21 1.00 1.00 No 102 76 2.52 (1.42-4.46) 0.5 (0.15-1.81) Don’t remember 9 5 1.88 (0.57-6.22) 0.8 (0.08-8.14) Partner support on contraceptive use <0.001 Yes 135 45 1.000 1.00 No 19 49 7.7 (4.13-14.5) 6.2 (1.91-19.8) * I don’t know 28 8 0.86 (0.36-2.02) 1.3 (0.23-7.71) * Statically significant CI- Confidence interval OR- Odds ratio Discussion Contraceptive utilization has been identified as an effective strategy to prevent maternal morbidity and mortality and enable women and couples to achieve their reproductive goals. However, unmet need for contraceptives continues to undermine efforts to achieve these global targets [ 17 , 18 ]. While several studies evaluated levels of unmet need and associated factors among women in the general population, there is a lack of evidence for women with medical comorbidities. This is particularly true in low-income settings. Thus, this study aimed to fill the evidence gap about unmet need among women with medical comorbidities in general and cardiovascular conditions in particular. The overall unmet need for contraception was 36% in this study. This is higher than the figures reported in the Ethiopian Demographic and Health Survey (EDHS) 2016, 22% at the national level, and 11% in Addis Ababa [ 19 ]. Though the settings are different, these discrepancies are particularly important as contraceptive utilization in this particular patient population has a pivotal role to play in reducing maternal morbidity and mortality. Women in this study had a higher demand for contraception compared to women in the general population (66.2% vs. 58%). Only 45.6% of this demand is met which is much lower than the demand satisfied at the national level (62%) and in Addis Ababa (84%) [ 19 ]. This clearly indicates how significant contraceptive service is for this group of population and the need to design tailored service provision models to address their needs. The rate of contraceptive utilization in our study was low compared to studies from developed countries. Studies done in the USA and Germany showed 75% of adult women with congenital heart disease were using a method of contraception [ 10 , 20 ]. Similarly, in a study done at Gondar University hospital in northern Ethiopia among diabetic and hypertensive patients, the contraceptive use rate was 53.3% [ 21 ]. These differences can be explained by differences in socio-demographic characteristics of study participants and institutional variations in contraceptive counseling and service provision. In this study, the association between variables and unmet need was assessed. Women who have not been counseled on contraceptive utilization were six times more likely to have unmet need. Indeed, the most frequent reason for contraception non-use among women with unmet need was related to a perceived low risk of pregnancy. Furthermore, 30% of women with unmet need reported fear of side effects and drug interaction as a reason for not using a contraceptive method. This highlights the need to incorporate appropriate counseling sessions that inform women of the risk of unintended pregnancy and its impact on their health. A multidisciplinary team composed of cardiologists, family planning, and maternal-fetal medicine specialists can deliver individualized counseling on contraception and pregnancy [ 7 , 22 ]. These sessions increase women’s contraceptive knowledge, address their concerns and fears, and clear misconceptions about contraception. These coordinated efforts will also ensure women are provided with contraceptive methods that are effective and safe for their particular condition and can serve as a gateway for other reproductive health services other than family planning [ 22 , 23 ]. Women who have never used a contraceptive method in the past were more likely to have unmet need. A possible explanation for this finding is that previous users are more likely to be well informed and experienced on potential adverse effects of contraceptive methods. This suggests that, once a woman has tried contraception methods, she is likely to continue using it provided that other barriers are addressed [ 24 ]. Having partner support on contraception use was another important factor associated with unmet need for contraception. Thus, strategies that engage male partners in contraceptive counseling sessions and foster open discussion among couples while respecting woman’s autonomy can improve contraceptive utilization [ 25 , 26 ]. The strength of this study includes the utilization of a standardized and validated DHS definition of unmet need. Though the algorithm was initially designed for women in the general population, it has been widely implemented across different subpopulations. Furthermore, this tool allows valid comparison across settings and over time [ 16 ]. Thus, this study can serve as a benchmark to track the impacts of future interventions. Due to limited resources, this study did not examine provider factors related to contraceptive counseling or referral practice which can influence unmet need. Thus, further research that explores the knowledge, attitude, and practice of providers is warranted. Conclusion The study revealed a high rate of unmet need for contraception among women with CVD. The most common reasons for not using contraception appear to be amenable to tailored interventions. Individualized counseling by a multidisciplinary team that includes healthcare providers at the follow-up clinics can alleviate fear, correct misconceptions, address barriers to contraceptive use. Additionally, male partner involvement in contraceptive counseling should be encouraged. Abbreviations AOR Adjusted Odds Ratio CI Confidence Interval CVD Cardiovascular Disease EDHS Ethiopia Demographic and Health Survey MEC Medical Eligibility Criteria SPHMMC Saint Paul’s Hospital Millennium Medical College WHO World Health Organization Declarations Ethics approval and consent to participate The study was approved by the institutional review board of Saint Paul’s Hospital Millennium Medical College (Ref No. P.M 23/401). Permission to collect data was obtained from the Department of Internal Medicine and the Department of Obstetrics and Gynecology. All participants provided written informed consent. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This study was funded by Saint Paul’s Hospital Millennium Medical College. The funder of the study had no role in study design, data collection, analysis, interpretation, or writing of the report. Authors’ contribution NM and FAA conceptualized the study. NM, MN, HB, and FAA wrote the initial draft of the study. NM oversaw the data collection. NM and FAA did the analysis. NM wrote the first draft of the manuscript. MN and HB interpreted the data and provided critical revisions. All authors contributed to and approved the final version of the manuscript to be published. Acknowledgment We would like to thanks the Department of Obstetrics and Gynecology and the Department of internal medicine, and the cardiac clinic of Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. 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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-154728","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":8925564,"identity":"2964614b-b440-4837-8fcd-5d1e97937237","order_by":0,"name":"Negalign Mechal","email":"","orcid":"","institution":"St Paul's Hospital Millennium Medical College, Department of Obstetrics and Gynecology","correspondingAuthor":false,"prefix":"","firstName":"Negalign","middleName":"","lastName":"Mechal","suffix":""},{"id":8925565,"identity":"09a14da2-16eb-4e86-b648-08b70e2fa472","order_by":1,"name":"Mustefa Negash","email":"","orcid":"","institution":"St Paul's Hospital Millennium Medical College, Department of Obstetrics and Gynecology","correspondingAuthor":false,"prefix":"","firstName":"Mustefa","middleName":"","lastName":"Negash","suffix":""},{"id":8925566,"identity":"753b58d6-8b66-4904-a5c6-126afb707ea6","order_by":2,"name":"Hailemichael Bizuneh","email":"","orcid":"","institution":"St Paul's Hospital Millennium Medical College, Epidemiology Unit, Department of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Hailemichael","middleName":"","lastName":"Bizuneh","suffix":""},{"id":8925567,"identity":"bb2f1095-a922-49dc-9c8e-8d721beda215","order_by":3,"name":"Ferid A Abubeker","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYBAC9gYGhgM8DAwJDAzMBxgYGyCiEvi08ByAa2FLQNGCUxtICwNEC48BkVrYex8eeMNgl8fff+bz58Id26L5G5gP3uZhsKnDqYXnuMHBOQzJxRI3crdJzzxzO3fGAbZkax6GNJy22EukMRzmYWBObLjBu42Zt+127gYGHjNpHobDuB0m/wykpT5x/vkzjz9DtPB/A2r5j1uLBBtIy+HEDQdyGKShtrABtRzArYUnjeHgHIPjxYY30sykZwK1zDjMZmw5xyBZsgGXFvZjzB/eVFTnyZ0//PhzIVBLf3vzwxtvKuz4cdkCAQYQihlBGuDXAAfMRKobBaNgFIyCEQYA3jpUtGUJnqEAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-2624-544X","institution":"St Paul's Hospital Millennium Medical College","correspondingAuthor":true,"prefix":"","firstName":"Ferid","middleName":"A","lastName":"Abubeker","suffix":""}],"badges":[],"createdAt":"2021-01-25 19:14:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-154728/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-154728/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":5355073,"identity":"9b926c2a-dafc-48e1-8e9e-ed3340fe9900","added_by":"auto","created_at":"2021-01-28 23:00:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38807,"visible":true,"origin":"","legend":"Illustration of calculated unmet need for contraception among study subjects, Addis Ababa, Ethiopia, 2020.","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-154728/v1/d5956e296105bd13e92ea5ae.png"},{"id":5354900,"identity":"bbe3c1db-ed1c-4044-b102-48a3b7c2b2b0","added_by":"auto","created_at":"2021-01-28 22:54:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21764,"visible":true,"origin":"","legend":"The percentage of unmet need, met need, and demand satisfied for contraception among study subjects, Addis Ababa, Ethiopia, 2020.","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-154728/v1/7577e83469808a3858093450.png"},{"id":13653123,"identity":"7bf2d9d6-233a-4af3-8203-b797f2931793","added_by":"auto","created_at":"2021-09-17 09:52:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1059968,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-154728/v1/684d3d96-e25e-4d9c-9e15-61b65f2759cb.pdf"}],"financialInterests":"","formattedTitle":"Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003ePregnancies complicated by cardiovascular disease (CVD) are associated with significant obstetric and fetal complications. There appears to be a geographic variation in the epidemiology of maternal cardiovascular disease. Globally, hypertensive disorders are the most frequent CVD complicating 5\u0026ndash;10% of all pregnancies. Congenital heart diseases are the second leading CVD during pregnancy in the developed world whereas rheumatic valvular heart diseases are more frequently encountered in the developing world and commonly occur in women of reproductive age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent advances in medical and obstetric care have enabled the majority of women with cardiovascular morbidity to successfully undergo pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, cardiac disease remains the leading cause of maternal mortality in the developed world. In addition, it is the most common indirect cause of maternal death in low/middle-income countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe risk of perinatal \u0026amp; maternal morbidity and mortality are directly associated with the type and severity of the CVD. For example, pulmonary hypertension and Eisenmenger\u0026rsquo;s syndrome carry a 50% risk of maternal death during pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similarly, women with severely impaired ventricular function, severe left heart obstruction, or dilated aorta due to Marfan syndrome are at a significantly increased risk of morbidity and mortality. Pregnancy should ideally be avoided in these women and if pregnancy occurs, termination should be discussed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Thus, concerted efforts that enable women to avoid unintended pregnancy are highly imperative.\u003c/p\u003e\u003cp\u003eEvidence-based guidance is available from the World Health Organization (WHO) to help guide clinicians in counseling and provision of safe and effective contraception methods for women with various medical conditions or medically-relevant characteristics [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The WHO medical eligibility criteria (MEC) has been modified to further stratify the risk of pregnancy in heart disease into classes I through IV [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost patients with CVD have multiple visits before conception, offering a golden opportunity for contraceptive counseling. However, studies show a high rate of unintended pregnancy among patients with chronic medical conditions such as cardiac illness, diabetes, hypertension, and asthma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Studies among women with CVD showed 40\u0026ndash;65% of pregnancies were unintended [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, cardiac illness was found to be one of the most common medical indications for termination of pregnancy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll women with CVD can benefit from preconception counseling, which should include a detailed discussion of the risk of pregnancy. The ability to plan a pregnancy is key in improving pregnancy outcomes, and planned pregnancy and birth spacing are crucial to prevent complications of cardiovascular illness during pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. To this end, appropriate planning is essential to ensure that pregnancy is either avoided or postponed until the woman\u0026rsquo;s cardiovascular illness is optimized. For those women considering pregnancy, potentially teratogenic medications can be switched to safer medications when possible. Consistent use of contraceptives is crucial to achieving all these goals [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContraceptive utilization offers a unique opportunity and has a pivotal role to play in reducing maternal morbidity and mortality in women with CVD. Thus, information regarding rates of unmet need for contraception is especially important as removing barriers of contraceptive uptake can reduce the incidence of unintended pregnancy and thereby prevent potential maternal and neonatal complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Unmet need for contraception has been extensively studied among women in the general population and to some extent in different subpopulations such as women living with HIV [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, there are no studies among women with cardiovascular disease. The aim of this study was therefore to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA facility-based cross-sectional study was conducted at the cardiac clinic of Saint Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC), in Addis Ababa, Ethiopia from February 1 to May 31, 2020. SPHMMC is a tertiary teaching hospital and mainly servers as a public referral center. The cardiac clinic runs two days per week from 8:00 AM to 5: 00 PM and is visited by an average of 40-50 patients per day.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCurrently married or in-union women of reproductive age (15\u0026ndash;49 years) with cardiovascular disease attending the cardiac clinic of the hospital were eligible for the study. We excluded women who presented with acute medical conditions and unable to give consent and women who were visiting the cardiac clinic for the first time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe required sample size was determined using a single population proportion formula with an assumption of a 95% confidence interval and 0.05 margin of error. Since no previous study has been done in the setting, the proportion of women with unmet need was assumed to be 50%. After making finite population correction and adding 5% to compensate for non-response, the final sample size was calculated to be 291. A Convenient sampling method was used to identify and include all the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected through an exit interview of sampled women using a structured and pretested questionnaire. The questionnaire used in this study was developed by referring to various literature and the algorithm to assess unmet need was adopted from the DHS analytical studies definition of unmet need revised in 2012 [\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e]. The data collection tool was prepared in English and translated into Amharic and translated back to English again\u0026nbsp;to check for consistency. A pre-test was done on 10% (29) participants before data collection. Four trained and experienced data collectors were supervised by the principal investigator during the interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the filled questionnaires were verified by the principal investigator. Consecutive code was given to each case and the data was explored again for inconsistencies and missing values. After completeness and coding of questionnaires were checked, data were analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA).\u003c/p\u003e\n\u003cp\u003eUnivariate analyses were carried out to describe\u0026nbsp;the data. The DHS algorithm was applied to assess the unmet need for contraception. A two-stage process was then carried out to identify variables associated with unmet need. Bivariate associations between unmet need and covariates\u0026nbsp;were explored using a Chi-square test. Variables with a p-value of less than 0.2 in binary logistic regression were selected as candidates for multivariate logistic regression to control for possible confounding factors. Finally, multivariate logistic regression with odds ratio and 95% confidence interval were computed to assess the presence and strength of association between unmet need and explanatory variables. A p-value of less than 0.05 was taken as statically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnmet need for contraception: percentage of women who (1) are not pregnant and not postpartum amenorrhoeic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrhoeic and their last birth in the last 2 years was mistimed or unwanted.\u003c/p\u003e\n\u003cp\u003eTotal demand for contraception: refers to women with unmet need plus the percentage of women currently using contraception (representing \u0026ldquo;met need\u0026rdquo;).\u003c/p\u003e\n\u003cp\u003eProportion of demand satisfied: the percentage of women using contraception divided by the percentage of women with demand for contraception.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance for the study was obtained from the Institutional Review Board of SPHMMC before the start of data collection.\u0026nbsp;All participants were informed about the purpose of the study and its procedures. It was made clear to all subjects that participation was voluntary. Privacy and confidentiality of study participants were ensured throughout the study. All participants provided written informed consent.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of study participants \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 291 eligible women were approached for the interview. Out of these, 7 were non-responders (5 did not consent to the study, and 2 discontinued the interview) which makes the response rate 97.6%. The majority of the study subjects were between the age of 19-34 years with a mean age of 34 \u0026plusmn; 7.4 years. Three fourth of them were married (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-Demographic characteristics of study subjects, Addis Ababa, Ethiopia, 2020\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e15-19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e20-24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e25-29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e30-34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e27.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e35-39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e21.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e40-44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e45-49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eNo formal education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e29.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eTechnical/vocational\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e20.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e214\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e75.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIn union (living with a man)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e24.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eStudent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eHousewife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e47.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eHouse servant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e3.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eDaily laborer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eMerchant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eGovernment employee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e11.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ePrivate employee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMonthly income (Ethiopian Birr)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eNo monthly income\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e171\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e60.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eLess than 1000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e1001- 3000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e3001-5000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eMore than 5001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSexual and reproductive characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 284 interviewed women, 198 (69.8%) have used a modern contraceptive method at least once in their lifetime. There were 51 pregnant women during the study, of which 25 (49%) had an unintended pregnancy. More than 87% of the participant were sexually active within the past year and close to 70% reported sexual activity in the month preceding the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCardiac care and follow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most commonly observed cardiovascular disease were hypertension 90 (31.7%), chronic rheumatic valve disease 89 (31.3%), and congenital heart disease 47 (16.4%). The duration of chronic care and treatment range from 3 months to 20 years and the median duration was 36 months (IRQ: 24-73).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContraceptive counseling \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne-third of women discussed the risks of unintended pregnancy and future pregnancy plans with their care providers. In addition, 117 (41.2%) were counseled on contraceptive utilization whereas only 25% were linked with the family planning unit of the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnmet need for contraception and associated factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the stepwise algorithm used to calculate unmet need for contraception in the sampled population. The overall unmet need for contraception was 36.0 %, with 26.8% having unmet need for spacing and 9.2 % for limiting.\u003c/p\u003e\n\u003cp\u003eThe main reasons for not using contraceptive methods were fear of side effects and drug interactions, not having frequent sex, and not being married (Table 2).\u003c/p\u003e\n\u003cp\u003eThe contraceptive utilization (representing the met need) was 30.2%. Thus, the demand for contraception was 66.2% and the demand satisfied was 45.6% (Figure 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Reasons for not using contraceptives among women with unmet need, Addis Ababa, Ethiopia, 2020\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eReason for not using\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived low risk of pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eNo having frequent sex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eNot married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e17.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eBreastfeeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e12.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eUp to God/fatalistic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e7.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMethod related reasons\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eFear of drug side effect and interaction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e29.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eLack of awareness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eOpposition to use\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ePartner opposing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eTotal \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e102\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBivariate and multivariate logistic regression analyses were done to explore factors associated with unmet need. Bivariate analyses showed that five variables: marital status, counseling on contraceptive use, previous use of a contraceptive method, counseling on risks of unintended pregnancy, and partner support on contraceptive use were associated with unmet need. In subsequent multivariate logistic regression marital status, counseling on contraceptive use, previous use of a contraceptive method, and partner support on contraceptive use remained independently associated with unmet need (Table 3).\u003c/p\u003e\n\u003cp\u003eUnmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8-24.7) and those who lack partner support on contraception use (AOR=6.2, CI: 1.91-19.8). Unmet need was also found to be more likely among those who have never used a contraceptive method in the past (AOR=3.2, 95% CI: 1.12-8.92) (Table 3).\u003c/p\u003e\n\u003cp\u003eOther variables like age, educational status, occupation, income, ever giving birth, and duration of follow-up were not found to be significantly associated with unmet need for contraception.\u003c/p\u003e\n\u003cp\u003eTable 3: Association of independent variables with unmet need for contraception among study subjects, Addis Ababa, Ethiopia, 2020.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"96\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnmet need\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eCrudes OR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e171\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eLiving with man\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e21.3 (10.3-44.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e9.4 (2.9-30.6)\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003eCounseled on use of contraceptives\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e11.7 (4.8-28.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e6.7 (1.8-24.7)\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003ePreviously used a contraceptive method\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e5.5 (3.17-9.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e3.2 (1.12-8.92)\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003eCounseled on the risk of unintended pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2.52 (1.42-4.46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e0.5 (0.15-1.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eDon\u0026rsquo;t remember\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.88 (0.57-6.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e0.8 (0.08-8.14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003e\u003cstrong\u003ePartner support on contraceptive use\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e7.7 (4.13-14.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e6.2 (1.91-19.8)\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"205\"\u003e\n\u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e0.86 (0.36-2.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e1.3 (0.23-7.71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" width=\"593\"\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003eStatically significant\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; CI- Confidence interval \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; OR- Odds ratio\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":" \u003cp\u003eContraceptive utilization has been identified as an effective strategy to prevent maternal morbidity and mortality and enable women and couples to achieve their reproductive goals. However, unmet need for contraceptives continues to undermine efforts to achieve these global targets [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. While several studies evaluated levels of unmet need and associated factors among women in the general population, there is a lack of evidence for women with medical comorbidities. This is particularly true in low-income settings. Thus, this study aimed to fill the evidence gap about unmet need among women with medical comorbidities in general and cardiovascular conditions in particular.\u003c/p\u003e \u003cp\u003eThe overall unmet need for contraception was 36% in this study. This is higher than the figures reported in the Ethiopian Demographic and Health Survey (EDHS) 2016, 22% at the national level, and 11% in Addis Ababa [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Though the settings are different, these discrepancies are particularly important as contraceptive utilization in this particular patient population has a pivotal role to play in reducing maternal morbidity and mortality.\u003c/p\u003e \u003cp\u003eWomen in this study had a higher demand for contraception compared to women in the general population (66.2% vs. 58%). Only 45.6% of this demand is met which is much lower than the demand satisfied at the national level (62%) and in Addis Ababa (84%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This clearly indicates how significant contraceptive service is for this group of population and the need to design tailored service provision models to address their needs.\u003c/p\u003e \u003cp\u003eThe rate of contraceptive utilization in our study was low compared to studies from developed countries. Studies done in the USA and Germany showed 75% of adult women with congenital heart disease were using a method of contraception [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, in a study done at Gondar University hospital in northern Ethiopia among diabetic and hypertensive patients, the contraceptive use rate was 53.3% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These differences can be explained by differences in socio-demographic characteristics of study participants and institutional variations in contraceptive counseling and service provision.\u003c/p\u003e \u003cp\u003eIn this study, the association between variables and unmet need was assessed. Women who have not been counseled on contraceptive utilization were six times more likely to have unmet need. Indeed, the most frequent reason for contraception non-use among women with unmet need was related to a perceived low risk of pregnancy. Furthermore, 30% of women with unmet need reported fear of side effects and drug interaction as a reason for not using a contraceptive method. This highlights the need to incorporate appropriate counseling sessions that inform women of the risk of unintended pregnancy and its impact on their health. A multidisciplinary team composed of cardiologists, family planning, and maternal-fetal medicine specialists can deliver individualized counseling on contraception and pregnancy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These sessions increase women\u0026rsquo;s contraceptive knowledge, address their concerns and fears, and clear misconceptions about contraception. These coordinated efforts will also ensure women are provided with contraceptive methods that are effective and safe for their particular condition and can serve as a gateway for other reproductive health services other than family planning [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWomen who have never used a contraceptive method in the past were more likely to have unmet need. A possible explanation for this finding is that previous users are more likely to be well informed and experienced on potential adverse effects of contraceptive methods. This suggests that, once a woman has tried contraception methods, she is likely to continue using it provided that other barriers are addressed [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHaving partner support on contraception use was another important factor associated with unmet need for contraception. Thus, strategies that engage male partners in contraceptive counseling sessions and foster open discussion among couples while respecting woman\u0026rsquo;s autonomy can improve contraceptive utilization [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe strength of this study includes the utilization of a standardized and validated DHS definition of unmet need. Though the algorithm was initially designed for women in the general population, it has been widely implemented across different subpopulations. Furthermore, this tool allows valid comparison across settings and over time [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Thus, this study can serve as a benchmark to track the impacts of future interventions.\u003c/p\u003e \u003cp\u003eDue to limited resources, this study did not examine provider factors related to contraceptive counseling or referral practice which can influence unmet need. Thus, further research that explores the knowledge, attitude, and practice of providers is warranted.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eThe study revealed a high rate of unmet need for contraception among women with CVD. The most common reasons for not using contraception appear to be amenable to tailored interventions. Individualized counseling by a multidisciplinary team that includes healthcare providers at the follow-up clinics can alleviate fear, correct misconceptions, address barriers to contraceptive use. Additionally, male partner involvement in contraceptive counseling should be encouraged.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopia Demographic and Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMEC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Eligibility Criteria\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPHMMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSaint Paul\u0026rsquo;s Hospital Millennium Medical College\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review board of Saint Paul\u0026rsquo;s Hospital Millennium Medical College (Ref No. P.M 23/401).\u0026nbsp;Permission to collect data was obtained from the Department of Internal Medicine and the Department of Obstetrics and Gynecology. All participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Saint Paul\u0026rsquo;s Hospital Millennium Medical College. The funder of the study had no role in study design, data collection, analysis, interpretation, or writing of\u003cbr /\u003e the report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNM and FAA conceptualized the study. NM, MN, HB, and FAA wrote the initial draft of the study. NM oversaw the data collection. NM and FAA did the analysis. NM wrote the first draft of the manuscript. MN and HB interpreted the data and provided critical revisions. All authors contributed to and approved the final version of the manuscript to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thanks the Department of Obstetrics and Gynecology and the Department of internal medicine, and the cardiac clinic of Saint Paul\u0026rsquo;s Hospital Millennium Medical College, Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRegitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstr\u0026ouml;m-Lundqvist C, Cifkova R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P: \u003cstrong\u003e2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC)\u003c/strong\u003e. \u003cem\u003eEur Heart J \u003c/em\u003e2018, \u003cstrong\u003e39\u003c/strong\u003e(34):3165-3241.\u003c/li\u003e\n\u003cli\u003eThorne S: \u003cstrong\u003ePregnancy and native heart valve disease\u003c/strong\u003e. \u003cem\u003eHeart \u003c/em\u003e2016, \u003cstrong\u003e102\u003c/strong\u003e(17):1410-1417.\u003c/li\u003e\n\u003cli\u003eRoos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A, Jondeau G, Budts W, Grewal J, Sliwa K: \u003cstrong\u003ePregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)\u003c/strong\u003e. \u003cem\u003eEur Heart J \u003c/em\u003e2019, \u003cstrong\u003e40\u003c/strong\u003e(47):3848-3855.\u003c/li\u003e\n\u003cli\u003eSliwa K, Libhaber E, Elliott C, Momberg Z, Osman A, Z\u0026uuml;hlke L, Lachmann T, Nicholson L, Thienemann F, Roos-Hesselink J: \u003cstrong\u003eSpectrum of cardiac disease in maternity in a low-resource cohort in South Africa\u003c/strong\u003e. \u003cem\u003eHeart \u003c/em\u003e2014, \u003cstrong\u003e100\u003c/strong\u003e(24):1967-1974.\u003c/li\u003e\n\u003cli\u003eYuan S-M: \u003cstrong\u003eEisenmenger syndrome in pregnancy\u003c/strong\u003e. \u003cem\u003eBrazilian journal of cardiovascular surgery \u003c/em\u003e2016, \u003cstrong\u003e31\u003c/strong\u003e(4):325-329.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization: \u003cstrong\u003eMedical eligibility criteria for contraceptive use. 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Croft, Joy D. Fishel, and Charles F. Westoff. 2012. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25\u003c/strong\u003e. Calverton, Maryland, USA: ICF International.\u003c/li\u003e\n\u003cli\u003eUnited Nations, Department of Economic and Social Affairs, Population Division (2017): \u003cstrong\u003eWorld Family Planning 2017 - Highlights (ST/ESA/SER.A/414)\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eAhmed S, Li Q, Liu L, Tsui AO: \u003cstrong\u003eMaternal deaths averted by contraceptive use: an analysis of 172 countries\u003c/strong\u003e. \u003cem\u003eThe Lancet \u003c/em\u003e2012, \u003cstrong\u003e380\u003c/strong\u003e(9837):111-125.\u003c/li\u003e\n\u003cli\u003eCentral Statistical Agency (CSA) [Ethiopia] and ICF: \u003cstrong\u003eEthiopia Demographic and Health Survey 2016.\u003c/strong\u003e Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.\u003c/li\u003e\n\u003cli\u003eVigl M, Kaemmerer M, Seifert-Klauss V, Niggemeyer E, Nagdyman N, Trigas V, Bauer U, Schneider K-TM, Berger F, Hess J: \u003cstrong\u003eContraception in women with congenital heart disease\u003c/strong\u003e. \u003cem\u003eThe American journal of cardiology \u003c/em\u003e2010, \u003cstrong\u003e106\u003c/strong\u003e(9):1317-1321.\u003c/li\u003e\n\u003cli\u003eMekonnen TT, Woldeyohannes SM, Yigzaw T: \u003cstrong\u003eContraceptive use in women with hypertension and diabetes: cross-sectional study in northwest Ethiopia\u003c/strong\u003e. \u003cem\u003eInternational journal of women's health \u003c/em\u003e2015, \u003cstrong\u003e7\u003c/strong\u003e:957.\u003c/li\u003e\n\u003cli\u003eLindley KJ, Conner SN, Cahill AG, Madden T: \u003cstrong\u003eContraception and pregnancy planning in women with congenital heart disease\u003c/strong\u003e. \u003cem\u003eCurr Treat Options Cardiovasc Med \u003c/em\u003e2015, \u003cstrong\u003e17\u003c/strong\u003e(11):50.\u003c/li\u003e\n\u003cli\u003eWaqas H, Azmat SK, Mohsina B, Muhammad I: \u003cstrong\u003eDetermining the factors associated with unmet need for family planning: a cross-sectional survey in 49 districts of Pakistan\u003c/strong\u003e. \u003cem\u003ePakistan Journal of Public Health \u003c/em\u003e2011, \u003cstrong\u003e1\u003c/strong\u003e(1):21-27.\u003c/li\u003e\n\u003cli\u003eAdebowale SA, Palamuleni ME: \u003cstrong\u003eDeterminants of unmet need for modern contraception and reasons for non-use among married women in rural areas of Burkina Faso\u003c/strong\u003e. \u003cem\u003eAfrican Population Studies \u003c/em\u003e2014, \u003cstrong\u003e28\u003c/strong\u003e(1):499-514.\u003c/li\u003e\n\u003cli\u003eRaj A, Ghule M, Ritter J, Battala M, Gajanan V, Nair S, Dasgupta A, Silverman JG, Balaiah D, Saggurti N: \u003cstrong\u003eCluster randomized controlled trial evaluation of a gender equity and family planning intervention for married men and couples in rural India\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2016, \u003cstrong\u003e11\u003c/strong\u003e(5):e0153190.\u003c/li\u003e\n\u003cli\u003eKriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, Smit JA: \u003cstrong\u003eMale partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa\u003c/strong\u003e. \u003cem\u003eReproductive health \u003c/em\u003e2019, \u003cstrong\u003e16\u003c/strong\u003e(1):89.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"contraception-and-reproductive-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"carm","sideBox":"Learn more about [Contraception and Reproductive Medicine](http://contraceptionmedicine.biomedcentral.com)","snPcode":"40834","submissionUrl":"https://submission.nature.com/new-submission/40834/3","title":"Contraception and Reproductive Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Unmet need, contraception, cardiovascular disease, chronic medical disease, low-income country ","lastPublishedDoi":"10.21203/rs.3.rs-154728/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-154728/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnancies complicated by cardiovascular disease carry a high risk of morbidity and mortality. Contraception offers a unique opportunity to avoid unintended pregnancy and/or optimize preconception cardiac health status. Such planning will also allow possible modification of medical therapy that can be detrimental to the growing fetus. However, unmet need for contraception can become a barrier to achieving these goals. This research was aimed to determine the rate of unmet need for contraceptives and associated factors among women with cardiovascular disease.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA facility-based cross-sectional study was conducted from February 1 \u0026ndash; May 31/2020. A convenient sampling technique was used to enroll 284 reproductive age women with cardiovascular disease having follow-up at Saint Paul\u0026rsquo;s Hospital Millennium Medical College. Data was collected through an exit interview using a structured and pretested questionnaire. Descriptive, bivariate, and multivariate methods were used to analyze the level of unmet need and its associated factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall unmet need for contraception was 36%. The majority of the respondents lack counseling on contraception use. The most common reasons for non-use of a contraceptive method was fear of drug side effects and drug interaction. Unmet need for contraception was found to be more likely among those who have not been counseled on contraceptive utilization (AOR 6.7, CI 1.8\u0026ndash;24.7) and those who lack partner support on contraception use (AOR\u0026thinsp;=\u0026thinsp;6.2, CI: 1.91\u0026ndash;19.8). Unmet need was also found to be more likely among women who have never used contraception before (AOR\u0026thinsp;=\u0026thinsp;3.2, CI 1.12\u0026ndash;8.92).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eUnmet need for contraception was high in this high-risk population group. Tailored counseling can alleviate fear and concerns about contraceptive use. Appropriate strategies that enhance male partner involvement should also be implemented.\u003c/p\u003e","manuscriptTitle":"Unmet need for contraception and associated factors among women with cardiovascular disease having follow-up at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-28 22:54:43","doi":"10.21203/rs.3.rs-154728/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-02-16T00:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"decision","content":"Major Revision","date":"2021-02-16T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-02-04T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2021-01-29T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-26T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-01-26T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-25T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-24T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-24T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2021-01-22T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"contraception-and-reproductive-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"carm","sideBox":"Learn more about [Contraception and Reproductive Medicine](http://contraceptionmedicine.biomedcentral.com)","snPcode":"40834","submissionUrl":"https://submission.nature.com/new-submission/40834/3","title":"Contraception and Reproductive Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05169b08-dd09-4055-88b9-fb9a86b3922d","owner":[],"postedDate":"January 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":2117883,"name":"Sexual \u0026 Reproductive Medicine"},{"id":2117884,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2022-05-02T00:21:42+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-28 22:54:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-154728","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-154728","identity":"rs-154728","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}