Unintended pregnancy and associated factors among women on antiretroviral therapy in selected public hospitals, Addis Ababa, Ethiopia: A mixed-method study

Unintended pregnancy remains a public health concern among women living with HIV, despite expanded access to antiretroviral therapy (ART) and reproductive health services. Evidence on its prevalence and associated factors among women receiving ART in Ethiopia is limited. This study assessed the prevalence of unintended pregnancy and associated factors among women receiving ART in selected public hospitals in Addis Ababa, Ethiopia. A facility-based mixed-methods cross-sectional study was conducted among 384 women from June 12 to July 18, 2025. Quantitative data were collected using an interviewer-administered questionnaire and clinical record review. Participants were selected through systematic random sampling, while 14 participants were purposively selected for in-depth interviews. Quantitative data were analyzed using binary logistic regression, and qualitative data were analyzed thematically. The prevalence of unintended pregnancy was 38.8% (n = 149). Higher odds of unintended pregnancy were observed among women who did not use contraception after HIV diagnosis (AOR = 4.77; 95% CI: 2.85–8.04), had been diagnosed with HIV for ≥5 years (AOR = 2.77; 95% CI: 1.44–5.34), had inadequate sexual and reproductive health counseling (AOR = 1.86; 95% CI: 1.08–3.20), or had not disclosed their HIV status to partners (AOR = 1.92; 95% CI: 1.11–3.31). Compared with women with no formal education, those with primary, secondary, and higher education had lower odds of unintended pregnancy (AOR = 0.31; 95% CI: 0.17–0.56; AOR = 0.24; 95% CI: 0.11–0.51; and AOR = 0.11; 95% CI: 0.02–0.66, respectively). Qualitative findings highlighted fear of side effects, partner opposition, contraceptive misconceptions, inadequate counseling, and fragmented services as contributors to contraceptive non-use and unintended pregnancies. More than one-third of women receiving ART experienced unintended pregnancy, highlighting gaps in integrated reproductive health services. Strengthening family planning integration into ART care and improving reproductive counseling may help reduce unintended pregnancy.