Umeå International School of Public Health, Department of Public Health and Clinical Medicine, Umeå University, SE-90185, Sweden.
Int J Equity Health. 2010 Jun 3;9:14. doi: 10.1186/1475-9276-9-14.
It has been estimated that each year 80 million women in the world experience an unintended pregnancy. In Ecuador, recent research has revealed that 36.3% of total births are unintended; the research also details significant geographical, ethnic and socioeconomic variations. These studies focused on individual risk factors and were based on large national surveys where local samples, particularly from rural remote areas, were small. The purpose of this study was to investigate the influence of contextual and individual factors on unintended pregnancies in the Amazon Basin of Ecuador.
Women aged 15-44 were selected through an ongoing community-based cross-sectional survey conducted in the Orellana province between May and December 2006. Data were fitted using multilevel logistic regression, adjusting for both individual-level and community-level factors as fixed effects and allowing for heterogeneity between communities.
The overall prevalence of unintended pregnancy was 62.7%. Two-thirds (73.7%) of indigenous women reported having had at least one unintended pregnancy. Being young, single, and indigenous were significant risk factors for unintended pregnancy, alongside having low access to education and having more than two children. No relationship was found between socioeconomic status and the use of contraceptives. All the variation between communities was explained by individual-level factors.
This study showed the significance of individual factors in increasing the risk of unintended pregnancy, while the role of community factors was found to be negligible. In order for all women to be able to realize their right to reproductive autonomy, there needs to be a diverse range of solutions, with particular attention paid to cultural issues.
据估计，全世界每年有 8000 万女性经历意外怀孕。在厄瓜多尔，最近的研究表明，36.3%的总分娩是意外的；该研究还详细说明了显著的地理、种族和社会经济差异。这些研究侧重于个体风险因素，并基于大型全国性调查，其中来自农村偏远地区的当地样本很小。本研究旨在调查厄瓜多尔亚马逊流域的情境和个体因素对意外怀孕的影响。
通过 2006 年 5 月至 12 月在奥雷利亚纳省进行的一项正在进行的基于社区的横断面调查，选择了 15-44 岁的女性。使用多水平逻辑回归拟合数据，调整个体和社区层面的因素作为固定效应，并允许社区之间存在异质性。
意外怀孕的总体患病率为 62.7%。三分之二（73.7%）的土著妇女报告至少有一次意外怀孕。年轻、单身和土著是意外怀孕的显著风险因素，与教育程度低和有两个以上孩子有关。社会经济地位与避孕药具的使用之间没有关系。社区之间的所有差异都可以用个体因素来解释。
本研究表明，个体因素在增加意外怀孕风险方面的重要性，而社区因素的作用则微不足道。为了使所有妇女都能够实现生殖自主权，需要有多种解决方案，特别要关注文化问题。
