Ambivalence in Pregnancy Intentions: The Effect of Quality of Care and Context among a Cohort of Women Attending Family Planning Clinics in Kenya

Eliud Wekesa, Population Council
Ian D. Askew, Population Council
Timothy Abuya, Population Council

Understanding ambivalence/ambiguity in pregnancy intentions is essential for research and program efforts of preventing unwanted childbearing in sub-Saharan Africa. This paper investigates the effect of quality of care of reproductive health (QRH) services and context on ambivalence among a prospective cohort of family planning (FP) clinic clients (n=1957) in Central Kenya. We used logistic regression with random effects to assess the predictive effect of QRH services on pregnancy ambivalence controlling for background characteristics. About 43% of women expressed ambivalence about becoming pregnant at one point, while 57% remained unequivocal during observation. The QRH of a facility was negatively associated with ambivalence of its clients (OR 0.95; p-value=0.003). Other factors independently associated with pregnancy ambivalence among women were age, marital status, number of surviving children, having achieved desired fertility and HIV status of the woman. There is, therefore, need for health providers to accurately assess pregnancy intentions of FP clients for appropriate counseling.