Introduction
Methods
Data
Country | Country code | Survey year | Sample size | Gross domestic product per capitaa | |
---|---|---|---|---|---|
Household | Children 0–59 months | ||||
Low-income countriesb | |||||
Afghanistan | AF | 2015 | 24,395 | 32,026 | 1808 |
Bangladesh | BD | 2014 | 17,300 | 5381 | 2979 |
Benin | BJ | 2011–2012 | 17,422 | 12,712 | 1779 |
Burkina Faso | BF | 2010 | 14,424 | 14,455 | 1421 |
Burundi | BI | 2010 | 8596 | 7558 | 708 |
Cambodia | KH | 2014 | 15,825 | 7029 | 3113 |
Chad | TD | 2014–2015 | 17,233 | 18,024 | 2059 |
Comoros | KM | 2012 | 4482 | 3000 | 1403 |
Congo Democratic Republic | CD | 2013–2014 | 18,171 | 18,010 | 692 |
Gambia | GM | 2013 | 6217 | 7795 | 1593 |
Guinea | GN | 2012 | 7109 | 6720 | 1197 |
Haiti | HT | 2012 | 13,181 | 7025 | 1585 |
Liberia | LR | 2013 | 9333 | 7300 | 817 |
Malawi | MW | 2010 | 24,825 | 19,093 | 1061 |
Mali | ML | 2012–2013 | 10,105 | 9982 | 1787 |
Mozambique | MZ | 2011 | 13,919 | 10,657 | 952 |
Nepal | NP | 2011 | 10,826 | 5240 | 2042 |
Niger | NE | 2012 | 10,750 | 12,125 | 867 |
Rwanda | RW | 2014–2015 | 12,699 | 7629 | 1620 |
Sierra Leone | SL | 2013 | 12,629 | 11,411 | 1854 |
Tajikistan | TJ | 2012 | 6432 | 4889 | 2343 |
Tanzania | TZ | 2015–2016 | 12,563 | 9780 | 2510 |
Togo | TG | 2013–2014 | 9549 | 6670 | 1316 |
Uganda | UG | 2011 | 9033 | 7621 | 1665 |
Zimbabwe | ZW | 2010–2011 | 9756 | 5416 | 1456 |
Lower-middle-income countriesb | |||||
Armenia | AM | 2010 | 6700 | 1453 | 6508 |
Cameroon | CM | 2011 | 14,214 | 11,156 | 2614 |
Congo Brazzaville | CG | 2011–2012 | 11,632 | 8927 | 5665 |
Cote d’Ivoire | CI | 2011–2012 | 9686 | 7402 | 2650 |
Egypt | EG | 2014 | 28,175 | 15,227 | 10,049 |
Ghana | GH | 2014 | 11,835 | 5597 | 3894 |
Honduras | HN | 2011–2012 | 21,362 | 10,719 | 4491 |
Indonesia | ID | 2012 | 43,852 | 17,672 | 9283 |
Kenya | KE | 2014 | 36,430 | 9811 | 2819 |
Kyrgyz Republic | KG | 2012 | 8040 | 4267 | 2870 |
Lesotho | LS | 2014 | 9402 | 3051 | 2760 |
Nigeria | NG | 2013 | 38,522 | 30,252 | 5448 |
Pakistan | PK | 2012–2013 | 12,943 | 11,483 | 4429 |
Philippines | PH | 2013 | 14,804 | 7099 | 6366 |
Senegal | SN | 2014 | 4231 | 13,122 | 2202 |
Yemen | YE | 2013 | 17,351 | 15,731 | 3879 |
Zambia | ZM | 2013–2014 | 15,920 | 13,020 | 3582 |
Upper-middle-income countriesb | |||||
Colombia | CO | 2010 | 51,447 | 17,487 | 10,901 |
Dominican Republic | DO | 2013 | 11,464 | 3628 | 11,888 |
Gabon | GA | 2012 | 9755 | 5787 | 17,595 |
Jordan | JO | 2012 | 15,190 | 9993 | 10,243 |
Namibia | NA | 2013 | 9849 | 4892 | 9140 |
Peru | PE | 2012 | 27,218 | 9454 | 10,944 |
Total | 746,796 | 494,778 |
Variables
Outcome variables
Exposure variable
Control variables
Variable | Definition | Mean | SD |
---|---|---|---|
Outcome variables | |||
Antenatal care | = 1 if mother received four or more antenatal care, 0 otherwise | 0.58 | 0.49 |
Supervised delivery | = 1 if delivery assisted by a health professional such as a midwife, doctor or nurse. 0 otherwise | 0.52 | 0.50 |
Child vaccination | = 1 if the child completed the WHO recommended immunization schedule for four routine vaccines, 0 otherwise | 0.49 | 0.50 |
Stunting | = 1 if the height-for-age Z-score (HAZ) of the child is below minus two SD from the median of the reference population, defined by the WHO growth standards, 0 otherwise | 0.33 | 0.47 |
Underweight | = 1 if the weight-for-height Z-Score (WHZ) of the child is below minus two SD from the median of the reference population, defined by the WHO growth standards, 0 otherwise | 0.21 | 0.41 |
Wasting | = 1 if the weight-for-age (WAZ) of the child is below minus two SD from the median of the reference population, defined by the WHO growth standards, 0 otherwise | 0.11 | 0.31 |
Exposure variable | |||
Unwanted pregnancy | = 1 if the pregnancy is unwanted, 0 otherwise | 0.09 | 0.28 |
Wanted pregnancy (Ref.) | = 1 if the pregnancy is wanted, 0 otherwise | 0.91 | 0.28 |
Birth characteristics | |||
Male | = 1 if the child is male, 0 otherwise | 0.51 | 0.50 |
Female (Ref.) | = 1 if the child is female, 0 otherwise | 0.49 | 0.50 |
Age of child (years) | Child’s age in years | 2.40 | 1.43 |
Birth order# 1 (Ref.) | = 1 if the birth order of the child is one, 0 otherwise | 0.26 | 0.44 |
Birth order# 2 | = 1 if the birth order of the child is two, 0 otherwise | 0.22 | 0.41 |
Birth order# 3 and above | = 1 if the birth order of the child is three or above, 0 otherwise | 0.51 | 0.50 |
Household-level covariates | |||
Mother’s age at birth (< 20 years) | = 1 if the mother’s age at birth is less than 20 years, 0 otherwise | 0.10 | 0.30 |
Mother’s age at birth (19 < years < 41) (Ref.) | = 1 if the mother’s age at birth is between 20 and 40 years, 0 otherwise | 0.85 | 0.36 |
Mother’s age at birth (> 40 years) | = 1 if the mother’s age at birth is greater than 40 years, 0 otherwise | 0.05 | 0.21 |
Mother’s marital status—married (Ref.) | = 1 if the mother is married, 0 otherwise, 0 otherwise | 0.84 | 0.37 |
Mother’s marital status—formally married | = 1 if the mother is formally married, 0 otherwise | 0.16 | 0.37 |
Mother’s education (years) | Mother’s education in years | 5.38 | 4.94 |
Household socio-economic status, 1st quintile (Ref.) | 1 = if the socio-economic status of the household is in the first (lowest) quintile, 0 otherwise | 0.20 | 0.40 |
Household socio-economic status, 2nd quintile | 1 = if the socio-economic status of the household is in the second quintile, 0 otherwise | 0.20 | 0.40 |
Household socio-economic status, 3rd quintile | 1 = if the socio-economic status of the household is in the third quintile, 0 otherwise | 0.20 | 0.40 |
Household socio-economic status, 4th quintile | 1 = if the socio-economic status of the household is in the fourth quintile, 0 otherwise | 0.20 | 0.40 |
Household socio-economic status, 5th quintile | 1 = if the socio-economic status of the household is in the fifth (highest) quintile, 0 otherwise | 0.20 | 0.40 |
Rural | 1 = if the child resides in a rural area, 0 otherwise | 0.67 | 0.47 |
Urban (Ref.) | 1 = if the child resides in an urban area, 0 otherwise | 0.33 | 0.47 |
Country-level covariates | |||
Log gross domestic product per capita | Natural log of gross domestic product per capita at purchasing power parity, constant 2011 international $ | 8.11 | 0.79 |
Log public health expenditures per capita | Natural log of public health expenditures per capita at purchasing power parity, constant 2011 international $ | 3.95 | 0.82 |
Country fixed effects covariates | |||
48 dummy variables for countries | = 1 if the child was born in the country, 0 otherwise (dummy variable for Nigeria was used as Ref. ) | – | – |
Statistical analysis
Results
Unwanted pregnancy in LMICs
Unwanted pregnancy and maternal/child healthcare and child health outcomes
Antenatal stage | Intranatal stage | Postpartum stage | Health outcomes | |||
---|---|---|---|---|---|---|
Antenatal carea | Supervised delivery | Vaccination | Stuntingb | Underweightb | Wastingb | |
Exposure variable | ||||||
Unwanted pregnancy | − 3.6*** | 0.6 | 1.4* | − 1.1 | − 1.3* | − 0.5 |
(− 5.4 to − 1.9) | (− 1.2 to 2.4) | (− 0.1 to 2.9) | (− 2.7 to 0.5) | (− 2.7 to 0.1) | (− 1.6 to 0.6) | |
Wanted birth (Ref.) | ||||||
Birth characteristics | ||||||
Male | 1*** | 1.6*** | 0.2 | 4.4*** | 2.6*** | 1*** |
(0.3 to 1.7) | (0.9 to 2.3) | (− 0.4 to 0.8) | (3.6 to 5.1) | (2 to 3.2) | (0.6 to 1.5) | |
Female (Ref.) | ||||||
Age of child (years) | 0.1 | − 2.5*** | 2.9*** | 3.8*** | 0.7*** | − 1.9*** |
(− 0.3 to 0.5) | (− 2.8 to − 2.1) | (2.6 to 3.3) | (3.5 to 4.1) | (0.4 to 1) | (− 2.1 to − 1.7) | |
Birth order# 1 (Ref.) | ||||||
Birth order # 2 | − 6.4*** | − 7.9*** | − 1.3*** | 1.9*** | 0.6 | 0.1 |
(− 7.6 to − 5.1) | (− 9 to − 6.8) | (− 2.2 to − 0.3) | (0.9 to 3) | (− 0.5 to 1.7) | (− 0.5 to 0.8) | |
Birth order # 3 and above | − 9.7*** | − 13.2*** | − 3.5*** | 1.8*** | 1.3*** | 0.1 |
(− 10.9 to − 8.5) | (− 14.4 to − 11.9) | (− 4.5 to − 2.5) | (0.7 to 2.9) | (0.4 to 2.3) | (− 0.5 to 0.7) | |
Household-level covariate | ||||||
Mother’s age at birth (< 20 years) | − 8.2*** | − 6.1*** | − 6.7*** | 5.9*** | 3.5*** | 0.8* |
(− 9.7 to − 6.8) | (− 7.6 to − 4.6) | (− 7.8 to − 5.5) | (4.4 to 7.4) | (2.3 to 4.6) | (0.1 to 1.6) | |
Mother’s age at birth (19 < years < 41) (Ref.) | ||||||
Mother’s age at birth (> 40 years) | 0.7 | 4.7*** | − 0.8 | − 1.4* | − 0.9 | 0.3 |
(− 0.6 to 2.1) | (2.9 to 6.6) | (− 2.4 to 0.8) | (− 3 to 0.2) | (− 2.2 to 0.4) | (− 0.6 to 1.1) | |
Mother’s marital status (formally married) | − 4.8*** | 2.3*** | − 2.6*** | 0.1 | − 0.7 | − 0.4 |
(− 5.9 to − 3.6) | (0.8 to 3.7) | (− 3.6 to − 1.6) | (− 0.9 to 1.1) | (− 1.5 to 0.2) | (− 0.9 to 0.2) | |
Mother’s education (years) | 2.5*** | 2.7*** | 1.7*** | − 1.1*** | − 0.8*** | − 0.2*** |
(2.3 to 2.6) | (2.6 to 2.9) | (1.6 to 1.9) | (− 1.3 to − 1) | (− 0.9 to − 0.7) | (− 0.3 to − 0.2) | |
Household socio-economic status, 1st quintile (Ref.) | ||||||
Household socio-economic status, 2nd quintile | 7*** | 9*** | 7.9*** | − 3.5*** | − 3.4*** | − 1.1*** |
(5.8 to 8.2) | (7.2 to 10.7) | (6.4 to 9.3) | (− 4.7 to − 2.3) | (− 4.4 to − 2.3) | (− 1.9 to − 0.4) | |
Household socio-economic status, 3rd quintile | 12.4*** | 17.4*** | 11.4*** | − 6.9*** | − 5.7*** | − 1.7*** |
(11.1 to 13.8) | (15.4 to 19.4) | (9.8 to 13) | (− 8.3 to − 5.6) | (− 6.9 to − 4.6) | (− 2.6 to − 0.9) | |
Household socio-economic status, 4th quintile | 19.1*** | 27.2*** | 15*** | − 10.8*** | − 8.4*** | − 1.9*** |
(17.6 to 20.6) | (25 to 29.3) | (13.3 to 16.8) | (− 12.3 to − 9.3) | (− 9.6 to − 7.2) | (− 2.8 to − 0.9) | |
Household socio-economic status, 5th quintile (highest) | 28.2*** | 39.4*** | 18.8*** | − 17.5*** | − 12.7*** | − 3.1*** |
(26.4 to 30.1) | (37 to 41.8) | (16.9 to 20.6) | (− 19.4 to − 15.6) | (− 14.2 to − 11.2) | (− 4.1 to − 2.1) | |
Rural | − 5.4*** | − 11.1*** | 0.2 | − 0.9 | − 1.6** | − 1** |
(− 6.8 to − 4) | (− 12.9 to − 9.2) | (− 1.2 to 1.7) | (− 2.2 to 0.5) | (− 2.7 to − 0.4) | (− 1.9 to − 0.2) | |
Urban (Ref.) | ||||||
Country-level covariates | ||||||
Log gross domestic product per capita | − 24.9*** | 4.8*** | 16.6*** | − 13.1*** | − 14.8*** | 0.6 |
(− 35.7 to − 14.1) | (4.4 to 14) | (7.3 to 25.9) | (− 22 to − 4.3) | (− 22.9 to − 6.7) | (− 5.2 to 6.4) | |
Log public health expenditures per capita | − 1 | 3.4*** | − 4.7*** | − 5.4*** | − 3*** | 0.8 |
(− 2.8 to 0.8) | (2.1 to 4.7) | (− 6 to − 3.3) | (− 6.9 to − 3.9) | (− 4.2 to − 1.7) | (− 0.2 to 1.8) | |
Pseudo-R-square | 0.256 | 0.272 | 0.121 | 0.081 | 0.111 | 0.075 |
N | 346,502 | 494,584 | 480,759 | 275,571 | 282,953 | 273,835 |