Effect of sexual violence on planned, mistimed and unwanted pregnancies among women of reproductive age in sub-Saharan Africa: A multi-country analysis of Demographic and Health Surveys

Introduction: Sexual violence plays a key role in women's pregnancy intention. We investigated the influence of sexual violence on planned, mistimed, and unwanted pregnancies in sub-Saharan Africa (SSA). Materials and methods: Data from the Demographic and Health Survey (DHS) of 22 countries in SSA were used in this study. Both descriptive and inferential analyses were conducted. We carried out a multinomial logistic regression analysis to examine the effect of sexual violence on planned, mistimed, and unwanted pregnancies. STATA version 14.2 was used to carry out all analyses. Statistical significance was declared at p<0.05. Results: At the descriptive level, we found that 74.1% of women of reproductive age in SSA had planned pregnancies, with the remaining 25.9% having either mistimed (20.4%) or unwanted (5.5%) pregnancies. Women in Nigeria had the lowest proportion of mistimed pregnancies (7.5%) whereas those in Burundi had the greatest percentage of unwanted pregnancies (12.4%). Women who had history of sexual violence had increased risk of mistimed [ARRR = 1.5, CI = 1.3-1.7] and unwanted pregnancies [ARRR = 1.6, CI = 1.3-2.0], compared to those with no history of sexual violence. Women aged 40-44 [ARRR = 3.3, CI = 1.4-7.6] and 45-49 [ARRR = 4.4, CI = 1.7-11.2] had higher risk of unwanted pregnancies, compared to women aged 15-19. Women who were cohabiting had higher risk of mistimed [ARRR = 1.3, CI = 1.1-1.4] and unwanted pregnancies [ARRR = 1.6, CI = 1.3-2.1], compared to married women. Conclusion: Sexual violence plays a key role in mistimed and unwanted pregnancies. It is, therefore, prudent to develop various assessment techniques to detect sexual violence in unions and refer victims to appropriate services to diminish the risk of mistimed and unwanted pregnancies. Our findings provide a basis for developing and implementing policies and interventions aimed at reducing mistimed and unwanted pregnancies.