To the best of our knowledge, this study is the first to assess the factors correlated with current pregnancy status and unwanted pregnancy during the COVID-19 confinement among 369 Lebanese women. Our results showed that 11.1% of women were pregnant, of whom 22.0% reported unwanted pregnancies. Recently, several large-scale studies aimed to explore pregnancy and fertility during the coronavirus pandemic, but no results are published yet. Also, available data on the impact of a disaster on reproduction and fertility are contradictory. Some studies reported increased birth rates following short-term disasters (24, 25), while others showed a decrease in pregnancies (26, 27). Globally, coronavirus affects the reproductive choice of both those who choose to conceive and those who do not. Indeed, worrying thoughts surrounding this pandemic may influence sexual activity, and employment loss and economic instability may lead to delay in pregnancy. Thus, there will still be individuals who could not regulate their reproductive decisions. Also, women planning to conceive will be concerned about the care and treatment they get during pregnancy while in confinement. The prevalence of unwanted pregnancies in this study is lower than that reported in other countries (ranging from 26–50%) (28–35), which may not reflect the actual rate of unwanted pregnancies in the Lebanese community, as our sample may not be representative of the entire population of pregnant women in Lebanon.
Our results showed that women who never worked had a higher probability of being pregnant, consistent with those of other studies reporting that socially disadvantaged women who never worked had a higher likelihood of being pregnant and consider childbearing as an escape from their poverty and financial strain (36–39). Unmet need for family planning and poor reproductive control were more likely to increase subsequent and repeated pregnancies (40). Also, poverty and unfavorable socioeconomic conditions increase the rate of fertility, as disempowered women would engage in spontaneous and unprotected sexual activity despite higher parity and family growth (41). Additionally, the lack of communication within the couple, absence of sex education, and lack of family planning awareness were more likely to increase the number of pregnancies (41). Working women are aware of delaying pregnancy due to work demands, expanding their social network, and developing knowledge about birth control (42). During the COVID-19 lockdown, working women faced job and income loss and gained more time at home with their families, which could be associated with increased intimacy and sexual activity in couples (43, 44).
Our study found that younger age was among the factors significantly related to motherhood, consistent with previous research showing that the incidence of pregnancy increases among younger women living in a lower socioeconomic environment (45–47). Socially disadvantaged women show higher reproductive practice but have limited control over their fertility and are subject to a greater risk of maternal morbidity and mortality (48). Our results also showed that younger women were less likely to smoke during pregnancy, in agreement with previous findings (49–52). A study of a representative sample of 1858 Dutch mothers found that women who smoked before pregnancy were younger, less educated, and lived without a partner (53). Also, women who successfully quit smoking during pregnancy were more likely to have a higher level of education and a partner who did not smoke before and during pregnancy (53).
Moreover, studies have found that the prevalence of infertility and the time it takes to conceive are higher in smokers than in non-smokers (54–57). Also, the chemicals in cigarettes could affect any stage of the reproductive process of both sexes (58, 59). However, a supportive relationship between spouses has a positive impact on pregnancy, as it enables them to quit smoking (60–62).
Our study showed that having already children and using contraceptives are associated with a lower probability of pregnancy. Indeed, families with multiple children may consider any potential pregnancy as unwanted and rely on birth control methods to prevent pregnancy (63–66). Moreover, educated and empowered women are more likely to take control of their reproductive health and household management (67–69); they would refuse to have forced intercourse or unwanted pregnancy, using contraception methods to avoid further childbearing and unsafe abortion (70–72). Additionally, women of advanced maternal age, with adequate education and free from financial constraints, have more access to contraceptives than their peers (73, 74). Several factors encourage couples to use family planning effectively, including regular sexual activity, good communication between partners regarding their reproductive health and child-rearing, financial hardship, and job instability (75). Thus, older couples and well-educated spouses engage in fertility regulation interventions, which reduces unwanted pregnancies and induced abortions and contributes to small family size (69, 76, 77).
Findings from this study have shown that women subject to psychological violence may have a lower probability of pregnancy and a very high probability of unwanted pregnancy, in line with previous results showing a strong correlation between domestic violence and unintended pregnancy (78–80). In a recent study conducted in Ireland during the COVID-19 pandemic among 70 women, 4.3% reported relationship deterioration with their partners, and 11% stated that there were tensions between family members confined in the same household (81). The COVID-19 lockdown has raised many challenges such as stress, anxiety, financial difficulties, and social isolation that have impacted the mental health status of women and their relationship with their partners and family members; such conditions can aggravate the risk of violence in families and worsen situations at homes (82). Although not conclusively established, experiences of violence may also be associated with risky behaviors and poor pregnancy outcomes (83). It is essential to document the long-term physical and psychological impacts of abuse and the role these interactions can play in rising stress associated with a spectrum of negative health outcomes (83). Moreover, it is unclear whether the lockdown has a negative or positive impact on the mental health status of women and how the severity or frequency of violence experienced by abused women changes during pregnancy (81).
Our results showed that women who visit their physician for routine checkups have a lower probability of unwanted pregnancy. Similarly, previous findings have shown that providing women with birth control techniques and counseling reduces unplanned pregnancies and abortions (84–86). A prospective study of 10,000 reproductive-aged women found that structured counseling could improve knowledge and consistent use of contraceptive methods, which lowers the rate of unintended pregnancy, abortion, and births (87). The unmet need for contraception, unreliable or inaccurate use of contraceptive methods, and misinformation about adverse effects, especially for hormonal or long-acting reversible contraceptives, are at the core of unwanted pregnancies (88). Therefore, gynecologist counseling will provide women with sufficient information about the different contraceptive methods, including their effectiveness, availability, risks, and benefits, resulting in controlling birth and decreasing unwanted pregnancies (89). During the COVID-19 pandemic, regular checkup visits may be delayed or interrupted to lower the risk of exposure to the virus, but telemedicine or any telehealth method could overcome this problem.