The role of health facility level factors on unintended pregnancy: Evidence from a population- level data linkage study

Objective: The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women’s homes, on the occurrence of unintended pregnancy that resulted in a live birth. Methods: We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5,051 women of reproductive age, who had at least one live birth within three years of the survey. The outcome variable was women’s intention to conceive at their most recent pregnancy that ended with a live birth. The explanatory variables were the health facility, individual, household, and community-level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables. Results: Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI, 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancy that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women’s homes. Conclusion: The availability of health facilities near women’s homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and increasing the number of health facilities are recommended.