Changes in unintended pregnancy among adolescent girls and young women in Nepal: evidence from the Nepal demographic and health surveys, 2001–2022

Abstract Background Unintended pregnancy remains an important reproductive health concern among adolescent girls and young women, with potential implications for health, education, employment, and socioeconomic opportunities. Evidence on changes in unintended pregnancy over time and its associated factors among married women aged 15–24 years in Nepal remains limited. This study examined changes in unintended pregnancy from 2001 to 2022 and factors associated with unintended pregnancy in the 2022 survey. Methods Data from the Nepal Demographic and Health Surveys (NDHS) conducted in 2001, 2006, 2011, 2016, and 2022 were analyzed among married women aged 15–24 years who had at least one child or were currently pregnant. Weighted frequencies and cross-tabulations were used to examine changes across surveys, and multivariable binary logistic regression was used to identify factors associated with unintended pregnancy in 2022. Results The prevalence of unintended pregnancy increased from 25.7% in 2001 to 27.5% in 2006, declined to 23.2% in 2011 and 20.3% in 2016, and increased again to 26.4% in 2022. In 2022, women with unmet need for spacing (AOR = 5.78, 95% CI: 3.68–9.08) or limiting (AOR = 5.46, 95% CI: 3.17–9.40) had higher odds of unintended pregnancy than those with no unmet need. Higher odds were also observed among women with basic education (AOR = 1.71, 95% CI: 1.07–2.73) and secondary or higher education (AOR = 2.61, 95% CI: 1.57–4.34). Pregnancy-related pressure from husbands or family was associated with higher odds, while mobile-phone ownership was associated with lower odds (AOR = 0.66, 95% CI: 0.46–0.94). Women in the Hill region had higher odds than those in the Mountain region (AOR = 2.05, 95% CI: 1.14–3.69). Conclusion Unintended pregnancy fluctuated between 2001 and 2022, declining through 2016 before increasing again in 2022. In 2022, unmet need for family planning, pregnancy-related pressure, education, and Hill residence were associated with higher odds, while mobile-phone ownership was associated with lower odds. These findings highlight the importance of accessible family planning services and support for women’s participation in decisions regarding pregnancy and childbearing.