Unplanned pregnancy is an important public health issue in developed and developing countries because of its negative association with the social and health outcomes for both mothers and children. Globally, about 210 million women throughout the world discover that they are pregnant when they miss a menstrual period or have a positive pregnancy test every year. However, out of this 15% of pregnant women spontaneously miscarry or experience a stillbirth. Another 22% end their pregnancy by abortion. Thus, only about twothirds of known pregnancies each year 133 million result in the birth of a baby [1].

Unplanned pregnancies are important cause maternal deaths. Pregnancies that occur too early, too late or too frequently can lead to illness during pregnancy and complications at the time of birth [2].

Globally, there were an estimated 287,000 maternal deaths in 2010, of this developing countries account for 99% (284,000). At the country level, 10 countries comprised 60% of the global maternal deaths, out of this Ethiopia ranked 7^th by 9,000 maternal deaths in 2010. The global maternal mortality ratio (MMR) in 2010 was 210 maternal deaths per 100,000 live births [3]. However, Ethiopian MMR in 2012 EDHS report were 676 per 100,000 live births which was higher as compared to the global average [4]. 95% of unsafe abortions occur in developing countries.

In many poor countries, treatment of these complications consumes up to half of hospital budgets for obstetrics and gynecology [5]. Every year in sub-Saharan Africa, approximately 14 million unintended pregnancies occur and a sizeable proportion is due to poor use of short-term hormonal methods [6].

In southeast Ethiopia, a study in Harar town showed that from a total of 983 females aged 15–49 years who were interviewed, 225 (33.3%) reported that their most recent pregnancies were unintended [7]. Use of contraception could reduce the share of maternal mortality caused by unsafe abortion by up to 15% [8].

Unplanned pregnancy occurs even among contraceptive users mainly through incorrect or inconsistent use and contraceptive discontinuation. Also unavailability of method choice or restricted access, contraceptive failure, use a variety of contraceptive methods during their lifetime stop using an effective method and delay taking up a new one and switching methods as their circumstances change leads UP [9]. In Ethiopia the vast majority of UP 95% occur among the women who do not practice contraception at all and the remaining 2% are attributable to failures of traditional methods.

More than seven in 10 women who want to avoid pregnancy either do not practice contraception or use a relatively ineffective traditional method. Totally the percentage of unplanned birth decreased from 35% 2005 to 29% in 2011 [10].

According to studies conducted in different parts of Ethiopia the prevalence of UP were showed 27.9% in Kersa District East Hararge in 2010, 36% in Ganji Woreda, West Wollega Oromia Region in 2013 and 42.4% in Damote Gale woreda respectively [11].

According to the National Health Survey in 2014, 31% of the reproductive age women use any type of contraceptive. Those who use modern contraceptives are still low 29%. Those who ages 40 or above only 22% use modern contraceptives, while those below forty years 40% of them use modern contraceptives [12].

Study area and period

The study was conducted at Hambiso Health Centre, Hambiso town, North Shoa, Oromia Region, Ethiopia from June 10, 2017 to July 24, 2017. Hambiso town is located 126 km from Addis Ababa in North direction.

The total population of the town is 26,000 with females 14518 (55.8%) and males 11482 (44.2%). The town has one health center and four private clinics.

Study design

A facility based cross sectional study was conducted on pregnant women who visited ANC follow up at Hambiso Health center.

Study population

All pregnant women who attended ANC follow up at Hambiso Health Center during the study period.

Inclusion criteria and exclusion criteria

Pregnant women who visited ANC unit during the data collection period and who fulfilled the inclusion criteria were included. Pregnant women who had hearing, speech problem and critically ill were excluded from the study.

Sample size and sampling technique

The sample size was determined based on the single population proportion formula using Z² × p × q/d² with a 95% confidence interval, 5% margin of error and an assumption that 29% of pregnant women are have unplanned pregnancy in the area.

However, due to the fact that, the total pregnant women attending in the health care system were less than 10,000 and we used correction formula to come up with the final sample size.

Convenient sampling technique were used because the pregnant women attending the ANC unite in the area were quite limited and it was almost less than 200.

Where,

ni: The initial sample size required

P- National prevalence of unplanned pregnancies among woman in reproductive age=29% (17)

d- The margin of sampling error tolerated, mostly 5%.

Where,

nf=final sample size

n=total study population which is 316

N=source population which is 350

Data collection method and instrument

The data was collected by face to face interview using structured questionnaire. The questionnaire was translated in to local languages. The data collectors were health officer and midwifery, both of them were working at ANC unit.

In order to check the validity and reliability of the questionnaire, pilot study was conducted on 5% of the actual sample size at Hambiso town, Degem woreda and North Shoa zone Oromia region. The questionnaire was modified based on information obtained from pretest results as necessary.

From the total 165 study participants, only 159 fulfilled the inclusion criteria and gave their consent to participate in the study.

Thus, the response rate was 96.4%. As the below table indicates oromoethnicity (63.2%) and orthodox religion (84.8%) were the largest group among the study participants (Table 1).

Table 1: Socio demographic characteristics at Hambiso Health Center, Hambiso town (July, 2017).

The below table is demonstrating how much of the pregnant women are aware of contraceptives use (Table 2). Thus, majority (97.5%) of the respondents have heard about modern contraceptives use and the advantages and the disadvantages of modern contraceptives from health care providers.

Table 2: Awareness and practice of respondents toward modern contraceptives at Hambiso Health Center, Hambiso town (July, 2017).

Almost 96 (60.4%) have used modern contraceptives at least once and injectable one Inject able (Depo-Provera) were used by majority of them (59.4%).

From all the respondents, 39.6% of them have never used modern contraceptives and the main reason were fear of side effects (26.1%) and husband influence (22.3%). The figure below is indicating the main barriers for not to use modern contraceptives in the study area (Figure 1).

Figure 1: Reasons for not using modern contraceptives among pregnant women following ANCat Hambiso health center, Hambiso town, Oromia Region, Ethiopia (July, 2017).

Distribution of respondents by status of their current pregnancy

Out of the total participants, 56 (35.2%) respondents claimed their current pregnancy was unplanned (Figure 2).

Figure 2: Reasons for the occurrence of unplanned pregnancy among women following ANC at Hambiso health center, Hambiso town (July, 2017).

Twenty four (42.9%) claimed that the reason for their unplanned pregnancy was because it was miss timed that is they require the pregnancy in the future, which was followed by husband influence (21.4%).

Perception on average number of children

Most of the respondents 54 (34%) perceived that 3 children in a life is enough while only 2 (1.3%) wish to have a single child. Those who claimed their current pregnancy was unplanned none of them wanted to have five and above children while those with planned current pregnancy 16.3% of them wish to have. Most of the respondents 120 (75.5%) believe that modern contraceptives enable them to get the number of children they desire (Tables 3 and 4).

Table 3: Preferred numbers of children planned to have among ANC attendants at Hambiso health center, Hambiso town (July, 2017).

Table 4: Association between unplanned pregnancy with modern contraceptive, formal education, religion and income among the respondents.

This study has shown that the proportion of unplanned pregnancy among pregnant women is high (35.2%) of women claimed their current pregnancy was unplanned. This is higher than the national figure 29% [13] and almost comparable with that of Ganji Woreda, West Wollega Oromia Region, Ethiopia conducted in February, 2013, which was found to be 36% [14] it is because the sociodemographic characteristics of both populations are nearly comparable. It was found to be higher in proportion to the study conducted in Kersa eastern Ethiopia in 2010 which was 27.9% [15]. This might be due to diverse tradition in this study and 85% of Kersa participants were illiterate and Muslim dominant area so every child is taken as gift of God. Globally the prevalence of unplanned pregnancy is 38% [16] which is larger than the finding in this study. In sub-Saharan Africa (SSA) 39% of pregnancies are unintended, ranges from 30% in Western Africa to 59% in Southern Africa in 2014.

Those who desires to have smaller number of children in a life time are more likely to have unplanned pregnancy which is similar to studies performed in Ganji Woreda, West Wollega Oromia Region, Ethiopia conducted in February 2013 [16], in rural and urban community of Khartoum state Sudan 2014 [4] and in Nigeria 2006 [5]. Those who claimed their current pregnancy was unplanned none of them wanted to have five and above children while those with planned current pregnancy 16.3% of them wish to have. Those who claimed their current pregnancy was planned none of them wanted to have a single child while those with unplanned current pregnancy 3.4% of them wish to have.

This study showed that unplanned pregnancy increases as the level of education increases and the relation was extremely significant (0.0001), these findings were in line with study in Khartoum state Sudan 2014 [4] and a study in Kersa, eastern Ethiopia, 2010 [16]. Modern contraceptive had highly significant association with the unintended pregnancy (P=0.0207), this is in line with the studies conducted in Ganji Woreda, West Wollega Oromia Region, Ethiopia February 2013 [16], in New York Guttmacher Institute, 2010 [15] and World Health organization, word health statistics, 2009 [9].

The most frequent reasons mentioned by the participants in this study to refer the pregnancy as unplanned was miss timed, which means they want to become pregnant in the near or late future time. In this study 24 (42.9%) was miss timed which was analogous with the study finding in Khartoum state Sudan 2014 [4] which is 82.5%.

This study also revealed that there was no significant level of association between religion and low level income of the respondents and occurrence of unplanned pregnancy, which is comparable with the findings study in Khartoum state Sudan 2014 [4]. Most of the participants were followers of orthodox religion 84.8% which was followed by Muslim 8.3%.

According to the results of this study most of the respondents were in the age group of 25-29 years which was 47.7% followed by those between 20-24 years which was 25.9%. About 4 (2.5%) of the respondents were under 19 years old which indicates teenage pregnancy was much lower than the national figure which is 12% Ethiopia Demographic and Health Survey, 2011. This could be that the study area is semi urban type and so expected to have lower teenage marriage.

The findings of this study revealed the prevalence of unplanned pregnancy was higher than the national figure and comparable with study in Ganji. Unplanned pregnancy was associated with contraceptive use and educational level. However, there was no association found with religion, income level and ethnicity of the respondents.

The authors are pleased to acknowledge the data collectors, study participants, Hambiso Health Office, Oromia Regional Health Bureau for their unreserved contributions to the success of this study. The authors would also like to extend their gratitude to the administrators for their facilitation. had covered questionnaire duplication and data collection fee.