Socioeconomic, fertility and contraceptive determinants of unintended pregnancy among married women in Nepal: evidence from the 2022 NDHS.

INTRODUCTION: Globally, nearly half of pregnancies are unintended, particularly in low- and middle-income countries like Nepal, contributing to unsafe abortions and maternal mortality. Despite progress, Nepal continues to face high abortion rates linked to unintended pregnancies. This study investigates socioeconomic, fertility and contraceptive factors associated with unintended pregnancy to inform policies and interventions for Nepalese women. METHODS: Using Nepal Demographic and Health Survey 2022 data from 2992 married Nepalese women aged 15-49, we assessed factors associated with unintended pregnancy through descriptive statistics, χ2 tests and multivariable logistic regression accounting for complex survey design. Primary factors included age, education, wealth, fertility intentions and contraceptive use before last pregnancy. Unmet need was described but excluded as a predictor due to outcome overlap. RESULTS: The prevalence of unintended pregnancy was 27.9%, while unmet need for contraception stood at 29.4%. Highest rates were observed among adolescents (15-19), women aged 35-49 and those with lower education and wealth. Multivariable logistic regression revealed that not desiring more children (adjusted OR (aOR)=2.90, 95% CI 2.36 to 3.57), contraceptive use before the last pregnancy (aOR=1.26, 95% CI 1.04 to 1.52), belonging to the poorest wealth quintile (aOR=1.69, 95% CI 1.21 to 2.37) and having a husband with only primary education (aOR=1.63, 95% CI 1.11 to 2.40) were significantly associated with unintended pregnancy. Regional disparities were notable, with Karnali Province reporting the highest unintended pregnancy rate at 38%. CONCLUSION: These findings underscore the urgent need to expand access to family planning services and address structural barriers, particularly for vulnerable groups such as adolescents, older women and the economically disadvantaged. Tailored interventions that promote consistent contraceptive use and support informed reproductive decision-making are essential to reducing unintended pregnancies and improving maternal and reproductive health outcomes in Nepal. A comprehensive, equity-focused strategy is critical to ensuring all women can exercise control over their reproductive lives.