Effect of pregnancy intention on completion of maternity continuum of care in Sub-Saharan Africa: systematic review and meta-analysis

Background: The maternity continuum of care is a strategy to provide timely and quality maternal and child healthcare through preconception, pregnancy, childbirth, postnatal, and the early childhood periods. The maternity continuum of care effectively reduces global maternal and neonatal deaths. However, several factors are reported to cause low completion of the maternity continuum of care in sub–Saharan Africa. There has been substantial debate in the literature as to whether pregnancy intention influences the completion of the maternity continuum of care. Although several studies have been conducted to determine the influence of pregnancy intention on the completion of the maternity continuum of care, findings are inconsistent and have not been systematically reviewed. Therefore, this review aims to determine the effect of pregnancy intention on the completion of the maternity continuum of care in sub–Saharan African countries. Methods: A systematic search of articles was performed from MEDLINE Complete, CINAHL Complete, PsycINFO, EMBASE, Maternity & Infant Care, Global Health, Scopus, and Web of Science. The identified articles were imported into Covidence and independently screened by two researchers for abstract and title, and then full-text. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The Cochran’s Q test and I2 were used for assessing the potential heterogeneity of the studies. Publication bias was assessed using Egger’s regression test and inspection of a funnel plot. A fixed-effects meta-analysis model was used to compute the effect of pregnancy intention on the completion of the maternity continuum of care. Results: Ten studies involving 343,932 participants were included in the final analysis. The pooled estimate of the meta-analysis found that women with intended pregnancy had 2.12 times higher odds of completing the maternity continuum of care (pooled odds ratio: 2.12, 95% CI: 1.33, 3.36) as compared to women with unintended pregnancy. Conclusion: Intended pregnancy has a statistically significant positive effect on completing the maternity continuum of care. Policymakers and healthcare providers need to implement strategies to encourage women to plan their pregnancies through the strengthening of pre-conception care and contraceptive counselling to prevent unintended pregnancies. Systematic review registration: PROSPERO CRD42023409134.