The Impact of Women’s Fertility Knowledge on the Incidence of Unintended Pregnancy (A Survey among the Clients of Health Centers in Zarrin Shahr City in 2022)

Unintended pregnancy is considered a concern based on human rights and public health approaches. In the program of action of the International Conference on Population and Development in Cairo in 1994, it was emphasized that couples and individuals have a basic right to make free and responsible decisions about the number and spacing of children (1). Unintended pregnancy is an important public health concern in both developing and developed countries, because it has many social and health consequences (2). Global estimates of the incidence of unintended pregnancy and its consequences were first published in 1995. Based on those estimates, it was estimated that 38% of all pregnancies were unintended, and more than half of them, i.e. 22% of all pregnancies, ended in abortion (3). Some previous studies (26, 27) have found a relationship between women’s fertility knowledge and unintended pregnancy. Therefore, fertility knowledge should be considered as one of the most important variables affecting unintended pregnancy. Fertility knowledge is defined as a process during which men and women become aware of their potential for childbearing (28). Accurate knowledge and understanding about fertility facts is essential for women and couples in making appropriate decisions about whether, when and how to get pregnant (29). Several studies (30-36) that have been conducted among various samples have shown the low level of fertility knowledge among the investigated samples. The few studies conducted in Iran (37-39) have also shown insufficient fertility knowledge among men and women. No study was found that specifically examined the relationship between fertility knowledge and unintended pregnancy, so this research is an attempt to study the effect of fertility knowledge on the incidence of unintended pregnancy among married women of reproductive age.

The present quantitative study was carried out with survey method in 2022. The statistical population of the present study was all married women aged 15 to 49 attending the health centers of Zarrin-shahr city in Isfahan province. For this purpose, 400 women of the statistical community were randomly surveyed. Zarrin-Shahr city had 6 health centers, and by referring to all 6 centers, a total of 400 eligible women surveyed. A questionnaire was used to collect data. The questionnaire consisted of two parts: the first part included individual questions as well as questions related to fertility, and the second part included the measurement of fertility knowledge, which was used from the standard questionnaire (40). The aforementioned questionnaire consists of 9 multiple-choice questions, one of which is the correct answer. If all 9 items are answered correctly, the score will be 9, and if all the questions are answered incorrectly, the score will be zero, so the range of women’s fertility knowledge scores based on this scale fluctuates between zero and 9. In this study, for a better understanding of women’s fertility knowledge, the final score of each respondent has been converted into a range of scores from zero to 100. The age of the spouses, the place of birth of the women, the years of education of the spouses, the employment status of the spouses, the duration of marriage, the household monthly income and the class identity of the women were the independent variables. Unintended pregnancy of women was also a dependent variable.

The results showed that 52.3 percent of women, that is, more than half of them, had low fertility knowledge, while 13.8 percent of them had a lot of this knowledge. The results showed that 25% of the studied women had a history of at least one unintended pregnancy. There was a positive and significant correlation between fertility knowledge and unintended pregnancy. An increase in the level of fertility knowledge was correlated with a decrease in unintended pregnancy. The increase in age of women and their husbands was associated with an increase in unintended pregnancy, that is, they recorded a positive and significant correlation. The findings also showed that increasing the duration of marriage is associated with a significant increase in unintended pregnancies. This means that the correlation between the duration of marriage and unintended pregnancy is positive and significant. The increase in the level of education of women and their husbands was related to the reduction of unintended pregnancies. The mentioned positive correlation was statistically significant. The variables of employment status of women and husbands, place of birth of women, class identity of women and household monthly income of women had no significant correlation with unintended pregnancy. The results of the regression analysis showed that fertility knowledge is the only variable that has a statistically significant effect on the odds of unintended pregnancy. Increasing fertility knowledge had led to a decrease in the incidence of unintended pregnancy. Age, spouse’s age, spouse’s education, duration of marriage are variables that had significant bivariate relationships with unintended pregnancy, which lost their significance after controlling other research variables. The odds ratio showed that increasing one unit of fertility knowledge can reduce the odds of unintended pregnancy by 1.6%. The coefficients of determination showed that the used regression model is able to predict between 7.9% and 11.7% of the odds of unintended pregnancy.

Based on the findings of this research and considering the relatively low score of women in fertility knowledge, it can be said that the promotion and improvement of women’s fertility knowledge should be given serious attention in health and population programs. The low knowledge of women’s fertility in the discussion of infertility also confirms the importance of addressing this issue at the macro level. If women’s knowledge of the factors affecting infertility increases, it may affect the level of fertility and decrease the childlessness ratio of the population. Improving fertility knowledge, according to the evidence reviewed in this research, can lead to a reduction in unintended pregnancies and subsequently to a reduction in induced abortions. Reducing induced abortions can also increase the health level of mothers and even reduce maternal mortality. Therefore, in general, it can be said that the promotion of fertility knowledge can affect the quality of women’s and mothers’ health on the one hand, and even the population’s size on the other hand.