What are the relationships between the degree of pregnancy intention and key maternal and neonatal health outcomes in the Mchinji district of Malawi

Background Every year 85 million women experience an unintended pregnancy. Unintended pregnancies may pose increased risks to mother and baby but the evidence is scarce and methodologically limited. This research aims to fill the gap in our knowledge about the pattern of pregnancy intention and the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country. Methods I validated the London Measure of Unplanned Pregnancy (LMUP) in the Chichewa language and used it to assess the degree of pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi. Pregnancy outcome was ascertained after the neonatal period. I analysed these data to examine the determinants of pregnancy intention and the relationships between pregnancy intention and pregnancy outcomes using multivariate hierarchical regressions. I conducted focus group discussions on postpartum family planning (PPFP). Results The Chichewa LMUP is valid in Malawi and shows a similar pattern of pregnancy intention to the UK. Young, unmarried women having their first child, older, married women who have completed their family or who have recently given birth and women who have experienced depression or intimate partner violence are at increased risk of unintended pregnancies. The more unplanned a woman’s pregnancy is, the less likely she is to access adequate care. More planned pregnancies have a lower risk of postnatal depression and possibly stillbirth; there was no significant relationship between pregnancy intention and miscarriage, low birthweight or neonatal death. Conclusion To prevent unintended pregnancies, at-risk women should be targeted by family planning services. These services, particularly PPFP, need strengthening. Including the LMUP in routine antenatal care would identify women who are at risk of inadequate care uptake, stillbirth and postnatal depression. During pregnancy these women should be given additional support to mitigate these risks. They should be followed-up postnatally to detect depression and prevent future unintended pregnancies through PPFP.