Association between unintended pregnancy and stillbirth among women in Zambia:  analysis of the Zambia demographic and health survey 2018 data

Shadrick Kahilu Kayeye; Mapoma Christopher Chabila

Shadrick Kahilu Kayeye The University of Zambia, Department of Demography, Population Sciences, Monitoring and Evaluation https://orcid.org/0000-0001-8464-154X
Mapoma Christopher Chabila The University of Zambia, Department of Demography, Population Sciences, Monitoring and Evaluation

Keywords: Unintended pregnancy, stillbirth, women of childbearing age

Abstract

In 2021, Zambia’s stillbirth rate stood at 14.8 per 1,000 births, surpassing the global target of fewer than 12 stillbirths per 1,000 total births by 2030 (National Institute for Health Research, 2021). This study aimed to investigate the relationship between unintended pregnancy (UP) and stillbirth among women of reproductive age (15–49 years) in Zambia. Unintended pregnancy was defined as pregnancies reported as mistimed or unwanted, while stillbirth was defined as fetal death occurring at or after 28 weeks of gestation. Using secondary data from the 2018 Zambia Demographic Health Survey (ZDHS) with a sample size of 7,672 births, this study applied bivariate analysis and binary logistic regression to identify factors associated with stillbirth. Results showed that UP was significantly associated with a lower risk of stillbirth (AOR = 0.072, p-value = 0.037, 95% CI: 0.006, 0.849). In line with the study's objectives, further analysis revealed significant findings on the interactions between UP, background characteristics, maternal health, and their effects on stillbirth. The interaction between UP and maternal occupation (AOR = 2.949, p-value = 0.027, 95% CI: 1.133, 7.678) and intimate partner violence (AOR = 2.852, p-value = 0.018), was found to significantly increase the risk of stillbirth. Additionally, the interaction between UP and maternal health characteristics, such as limited antenatal care visits (AOR = 7.718, p-value = 0.020, 95% CI: 1.200, 6.779) and smoking (AOR = 38.851, p-value = 0.004, 95% CI: 3.166, 476.714), were found to increase the risk of stillbirth among women with UP. These findings underscore the importance of addressing socio-economic and maternal health factors when tackling stillbirth risk, particularly among women with unintended pregnancies. Interventions aimed at improving antenatal care, reducing intimate partner violence, and implementing tobacco cessation campaigns for pregnant women are essential for reducing stillbirth rates. Further research is necessary to explore the mechanisms linking unintended pregnancy with adverse birth outcomes and to refine public health strategies.

Author Biographies

Shadrick Kahilu Kayeye, The University of Zambia, Department of Demography, Population Sciences, Monitoring and Evaluation

Shadrick Kayeye holds a Master of Population Studies degree and a Bachelor of Arts degree in Demography with Economics from the University of Zambia. He has completed the first year of a Master of Evaluation program from the University of Melbourne. He holds various short course certificates which include Gender and leadership in market systems development, DHIS2, Advanced Project Management, Leadership and Management, Epi Info, Survey CTO, Kobo Toolbox, Stata, Cspro, Epi info, Epi data, SPSS, Mortpak and Ms Excel. He is skilled in mixed methods research, management, monitoring, and evaluations of projects. He worked as Head of Research and Evaluation at Financial Sector Deepening Zambia, Evaluation Consultant at Keno Institute of Training and Research, M&E and Knowledge Management Specialist at ChildFund Zambia, M&E Specialist at ICAP Zambia, Research Officer at Zambia Research and Development Centre (ZRDC), M&E & Research Manager at Comprehensive HIV Management Program (CHAMP) and Administrative coordinator for Field Epidemiology Training Program at the Zambia National Public Health Institute (MoH/US CDC). He has supported research and evaluations in the areas of health, financial inclusion, agriculture, early child development, child protection and gender mainstreaming among others.

Mapoma Christopher Chabila, The University of Zambia, Department of Demography, Population Sciences, Monitoring and Evaluation

Chabila C. Mapoma is a Lecturer and an Associate Professor of Demography and Population Studies in the Department of Population Sciences, Demography, Monitoring and Evaluation (DPSME). He holds a PhD in Population studies (UNZA/SANPAD), a Master of Laws in Demography (PEKING) and a Bachelor’s degree in Demography (UNZA). Mapoma has participated and spearheaded a number of research and evaluation activities in Zambia including the ICF/MoH and ZamStats Zambia Demographic and Health Surveys of 2007, 20013/14, 2018 and 2023; he led the research on Violence Against Children Survey with the MSYCD, MoG, UNICEF and CDC; he also has led the production of 2017-2019 Gender Status Report with the Division of Gender and GIZ/SADC. At Global level, Mapoma has been a contributing author (country expert) on a number of global papers under the Global Burden of Diseases (GBD) program housed by the Institute of Health Metric and Evaluation – University of Washington. The forum coordinates Global Publications on contemporary Demographic and Health Issues including emergencies – such as COVID, Malaria and Reproductive health. At regional (SADC) level, he has collaborated to publish a number of papers on topics affecting the SADC region including HIV/AIDS, Obesity and obesity related cancers. In recent times at country level, with support from Bloomberg Data for Health and UNICEF, Mapoma has been instrumental in supporting the Department of National Registration Passports and Citizenship (MoHA, DNRPC) to improve CRVS in Zambia with a focus on birth and death registration especially Verbal Autopsy (VA). Currently, Mapoma and colleagues within and outside UNZA is working on studies on Maternal and Perinatal Death Review Surveillance (MPDSR) with the aim of publishing manuscripts and policy briefs for the Ministry of Health and UNFPA.