The Kingdom of Saudi Arabia is in the furthermost part of southwestern Asia. It is a modern nation that adheres to Islam. Marriage is a legal and cultural prerequisite for having children in Saudi Arabia, and having children outside this frame is rare or underreported. The fertility rate in 2024 will be 2.148 per woman, which is 1.24% lower than that in 2022. [20] Many reasons can explain this decline, such as an increase in the modernization of Saudi women, access to social media, and increased involvement in education and the workforce. In addition, the healthcare system is free for any Saudi citizen, allowing easy access to different healthcare services, including antenatal, postnatal, and family planning services.
Most available contraceptive methods are free, but unfortunately, long-term contraceptive methods such as intrauterine contraceptive devices and subdermal implants incur additional costs for women in some health sectors. The prevalence of contraceptive use among married Saudi women aged 15–49 years is estimated to be between 21 and 34%. [21]
In Saudi Arabia, abortion is prohibited (Haram) both in the Muslim religion and legally. Nevertheless, it can be permitted for medical reasons or if the continuation of the pregnancy puts the mother's or baby's life in danger.
Unplanned or unintended pregnancies are significant health issues globally and regionally. [2, 3]
The prevalence of unplanned pregnancy and hesitancy to become pregnant among the study population was 17.6% and 19.4%, respectively. This percentage is lower than that in other countries, such as Ethiopia (26%), Sweden (31%), and Brazil (67%). [22–24] This is because most study participants live in the city and have good socioeconomic status and easy, free access to health care; these factors can explain the lower prevalence compared to other counties.
Another study among 105 Qatari women (all of whom had access to family planning services) showed a low prevalence of unintended pregnancy, 2.6%, which can be explained by the small sample size or the easy access to family planning and antenatal clinics, as described by the author. [25]
Nationally, the prevalence in this study (17.6%) is considered low compared to that in studies conducted in the central and western provinces of Saudi Arabia in 2014 and 2022, which showed a prevalence of 53% and 26.4%, respectively [6, 7]. This reduction can be explained by improving physical and virtual access to the health care system, mass media education, and the availability of contraceptive methods at the level of primary health care. Saudi Arabia also addressed fatal and maternal health as a priority in the Saudi Vision 2030 health care objectives.
Furthermore, this study showed that unplanned pregnancy decreases as the number of children in the family increases, similar to findings from the unintended pregnancies-in-the-middle east-and-north-Africa report; this can be explained by maternal maturation as well as improved experience and access to various contraceptive methods. [26] This finding contradicts the finding from a study conducted in Sydney, where unplanned pregnancies were more common among women with high parity (more than three children), which reflects unmet family planning and postpartum health services in that area. [27]
Most studies have revealed that maternal age, educational level, and family income determine the prevalence of unplanned pregnancy. [28–30] Likewise, the rate of unplanned pregnancy can decline if the risk factors are addressed. One study conducted in India showed a decrease in the prevalence of unplanned pregnancy by improving maternal education, family income, and better access to family planning services; this association concurs with the findings in this study, where unplanned pregnancies tend to be lower among mothers with higher educational levels and better incomes, which can result in easy access to health services as well as better knowledge and understanding of contraception and family planning services. Furthermore, the same study also showed that the rate of unsafe abortions and unwanted children can decrease as well, which was not addressed in this research. [31]
A significant risk factor not addressed in this study is the relationship between being sexually abused and unplanned pregnancy, which was discussed with a cohort of young Australian women; they concluded that being sexually abused is significantly correlated with unintended pregnancy and unwanted babies. Although the prevalence of sexually abused women attending primary health care in Saudi Arabia was estimated to be 16.75%, this relation was not addressed in this study, which can be an implication for future studies. [32–33]
There was a significant association between unplanned pregnancy and having thought or committed action to terminate the pregnancy; these findings were also confirmed by other studies that showed that unplanned pregnancy could result in unsafe abortions, postpartum bleeding, postpartum depression, and poor infant outcomes such as low birth weight and neonatal deaths. [7, 34]
Although this study did not show an association between the decision to maintain an unplanned pregnancy and the relationship with one's partner, one study conducted among 517 women in Belgium showed a lower rate of relationship satisfaction when the partners had an unplanned pregnancy, which contradicts the findings of this research. [35] Our results can be attributed to some cultural and Muslim backgrounds supporting the idea that children are a gift from God. Every child is sent with wealth, and we cannot oppose what God gave us. Another explanation could be that the unplanned pregnancy was not discussed with the partner, as explained by the participant's answer to the question (does your partner want this baby?) In this study, 13% of participants with unplanned pregnancies responded, "Do not know."
The same Belgian study reported that women with unplanned pregnancies do not tend to prepare for their pregnancy health (taking folic acid or maternal vitamins). This finding was demonstrated in our study but was not statistically significant. [35]
Contraception knowledge use and the management of common side effects are essential determinants of unplanned pregnancy, as demonstrated in this study; as in most studies worldwide, this study revealed a statistically significant association. Meeting women's contraceptive needs during their reproductive life can decrease the rate of unplanned pregnancy and improve maternal and fetal outcomes. One Bangladeshi study showed that not meeting the parent's contraceptive needs resulted in 37% of unintended pregnancies. [36] Contraceptive satisfaction was maintained through proper health education and spending time with the women to explain contraceptive options and smartphone applications. [36–37]