Comparison of two question sequences for assessing pregnancy intentions

A Multidimensional and Longitudinal Exploratory Study of the Stability of Pregnancy Contexts in the United States

Objective

Evaluate the longitudinal stability of six pregnancy contexts, including intention, in a diverse cohort of individuals experiencing delivery, abortion, or miscarriage.

Methods

We enrolled individuals 16-44 years of age with pregnancies <24 weeks gestation in this longitudinal study between June 2014 and June 2015 in four US urban clinics. We assessed six pregnancy contexts (intention, wantedness, planning, timing, desirability, and happiness) at enrollment and 3-month follow-up. We constructed three-level categorical measures for each context defined as favorable, ambivalent, or unfavorable. We used Wilcoxon sign tests to evaluate changes in paired observations between pregnancy context measures over time and by pregnancy outcome.

Results

Among 121 participants at median gestational age of 7 weeks and 3 days, we found intention, wantedness, planning, timing, and happiness remained unchanged from enrollment in early pregnancy to 3-month follow-up. Individuals demonstrated changes in desirability; pregnancy assessments shifted toward less desirable from enrollment to follow-up (p = 0.01) (i.e., desired to ambivalent, or ambivalent to undesired). Among participants choosing delivery (57%), assessments shifted toward more favorable planning (i.e., unplanned to ambivalent, or ambivalent to planned) (p < 0.01), and less favorable desirability (i.e., desired to ambivalent or ambivalent to undesired) (p < 0.01) at follow-up. Among participants choosing abortion (28%), assessments shifted toward more unfavorable planning (i.e., planned to ambivalent, or ambivalent to unplanned) at follow-up (p < 0.01).

Conclusion

In multidimensional, longitudinal assessment, pregnant participants' perspectives on five of six pregnancy contexts remained unchanged between enrollment and 3-month follow-up; only desirability shifted. Pregnancy planning perspectives differed by pregnancy outcome.Human Research Subjects Protection Program: 1310012926.

Assessing Short-Term Fertility Intentions and Their Realisation Using the Generations and Gender Survey: Pitfalls and Challenges

The use of fertility intention questions to study individual childbearing behaviour has developed rapidly in recent decades. In Europe, the Generations and Gender Surveys are the main sources of cross-national data on fertility intentions and their realisation. This study investigates how an inconsistent implementation of a question about wanting a child now affects the cross-country comparability of intentions to have a child within the next three years and their realisation. We conduct our analysis separately for women and men at prime and late reproductive ages in Austria, France, Italy and Poland. The results show that the overall share of respondents intending to have a child at some point in their life is similar in all four analysed countries. However, once the time horizon and the degree of certainty of fertility intentions are included, substantial cross-country differences appear, particularly in terms of proceptive behaviour and, consequently, the realisation of fertility intentions. We conclude that the inconsistent questionnaire adaptation makes it very difficult to assess the role of country context in the realisation of childbearing intentions.

The association of maternal psychosocial stress with newborn telomere length

BACKGROUND

Telomere length in early life predicts later length, and shortened telomere length among adults and children has been linked to increased risk of chronic disease and mortality. Maternal stress during pregnancy may impact telomere length of the newborn.

METHODS

In a diverse cohort of 355 pregnant women receiving prenatal and delivery care services at two hospitals in San Francisco, California, we investigated the relationship between self-reported maternal psychosocial stressors during the 2nd trimester of pregnancy and telomere length (T/S ratio) in newborn umbilical cord blood leukocytes. We examined financial strain, food insecurity, high job strain, poor neighborhood quality, low standing in one's community, experience of stressful/traumatic life events, caregiving for a dependent family member, perceived stress, and unplanned pregnancy. We used linear regression and Targeted Minimum Loss-Based Estimation (TMLE) to evaluate the change in the T/S ratio associated with exposure to each stressor controlling for maternal age, education, parity, race/ethnicity, and delivery hospital.

RESULTS

In TMLE analyses, low community standing (-0.09; 95% confidence interval [CI]-0.19 to 0.00) and perceived stress (-0.07; 95% CI -0.15 to 0.021 was marginally associated with shorter newborn telomere length, but the associations were not significant after adjusting for multiple comparisons. All linear regression estimates were not statistically significant. Our results also suggest that the association between some maternal stressors and newborn telomere length varies by race/ethnicity and infant sex.

CONCLUSIONS

This study is the first to examine the joint effect of multiple stressors during pregnancy on newborn TL using a flexible modeling approach.

Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: Evidence from a nationally representative cross-sectional survey

Background

The Continuum of Care (CoC; defined as accessing the recommended healthcare services during pregnancy and the early postpartum period) is low in lower-middle-income countries (LMICs). This may be a major contributor to the high rates of pregnancy-related complications and deaths in LMICs, particularly among women who had an unintended pregnancy. With a lack of research on the subject in Bangladesh, we aimed to examine the effect of unintended pregnancy on CoC.

Methods

Data from 4,493 mother-newborn dyads who participated in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Women’s level of CoC was generated from responses to questions on the use and non-use of three recommended services during the course of pregnancy: four or more antenatal care (ANC) visits, skilled birth attendance (SBA) during delivery, and at least one postnatal care (PNC) visit within 24 hours of giving birth. Global recommendations of service use were used to classify CoC as high (used each of the recommended services), moderate (used at least two of the three recommended services), and low/none (no PNC, no SBA, and ≤3 ANC visits). Women’s pregnancy intention at the time of conception of their last pregnancy (ending with a live birth) was the major exposure variable, classified as wanted, mistimed, and unwanted. Unadjusted and adjusted (with individual-, household-, and community-level factors) multilevel multinomial logistic regression models were used to assess the association between unintended pregnancy and level of CoC.

Results

In Bangladesh, the highest level of CoC occurred in only 12% of pregnancies that ended with live births. This figure was reduced to 5.6% if the pregnancy was unwanted at conception. The antenatal period saw the greatest drop in CoC, with 65.13% of women receiving at least one ANC visit and 26.32% having four or more ANC visits. Following the adjustment of confounders, an unwanted pregnancy was found to be associated with 39% and 62% reduced odds of women receiving moderate and high levels of CoC, respectively, than those with a wanted pregnancy. Having a mistimed pregnancy was found to be associated with a 31% reduction in odds of women achieving a high CoC than women with a wanted pregnancy.

Conclusion

Almost nine in ten women did not achieve CoC in their last pregnancy, which was even higher when the pregnancy was unintended. Given that the ANC period has been identified as a critical time for intervention for these women, it is necessary for policies to scale up current maternal healthcare services that provide in-home maternal healthcare services and to monitor the continuity of ANC, with a particular focus on women who have an unintended pregnancy. Integration of maternal healthcare services with family planning services is also required to ensure CoC.

On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure, Timing of Assessment, Women's Characteristics and Outcome of Pregnancy

OBJECTIVES

Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention.

METHODS

We compared the test-retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher's exact tests, and calculated odds ratios to estimate effect size.

RESULTS

The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51-0.66); the DHS had moderate reliability (0.56-0.58). The LMUP's stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p = 0.033), number of children (p = 0.048) and postnatal depression (p < 0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy.

CONCLUSIONS FOR PRACTICE

The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.

Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis

OBJECTIVES

To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries.

METHODS

A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics.

RESULTS

A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25-39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted).

CONCLUSIONS

Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.

Comparing the order of the London Measure of Unplanned Pregnancy and the Demographic and Health Survey question on pregnancy intention in a single group of postnatal women in Malawi - the effect of question order on assessment of pregnancy intention

Objective

To investigate the effect of question order on women’s responses to the London Measure of Unplanned Pregnancy (LMUP) or the pregnancy intention question of the Demographic and Health Survey (DHS) when both are asked in the same survey. We collected data on pregnancy intention from a cohort of 4244 pregnant women in Malawi who were re-interviewed at 1, 6 and 12 months postnatally. Women in Zone 1 were asked the LMUP, then antenatal questions, then the DHS pregnancy intention question, women in Zone 2 were asked the DHS pregnancy intention question, then antenatal questions, then the LMUP; women in Zone 3 were only asked the DHS pregnancy intention question. We used linear regression to compare the LMUP score and ordinal regression to compare DHS categorisations of pregnancy intention across Zones, adjusting for baseline socioeconomic differences between the Zones.

Results

We found no effect of question order on the assessment of pregnancy intention by the LMUP. There were differences in the assessment of pregnancy intention when the pregnancy intention question in the DHS was used, however this seemed to be due to baseline sociodemographic differences between the groups of pregnant women being compared, and not due to question order.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3577-1) contains supplementary material, which is available to authorized users.

A Rare Presentation of the Syndrome of Inappropriate Antidiuretic Hormone in a 12-Year-Old Girl as the Initial Presentation of an Immature Ovarian Teratoma

BACKGROUND

Immature ovarian teratoma is very rare in childhood. We report on a 12-year-old girl with immature ovarian teratoma who presented initially with syndrome of inappropriate antidiuretic hormone.

CASE

A 12-year-old girl presented with acute abdomen and distention. Initial laboratory tests showed hyponatremia (sodium, 123 mmol/L), that did not respond to fluid management. Computed tomography imaging showed a 15 cm × 9 cm × 20 cm mass in the right ovary with multifocal internal fat, and dystrophic calcifications. She underwent exploratory laparotomy with a right salpingo-oophorectomy, omentectomy, and peritoneal stripping. The pathology revealed metastatic immature teratoma. Hyponatremia resolved soon after the surgery.

SUMMARY AND CONCLUSION

Although a rare diagnosis, immature ovarian teratoma must be considered in a girl who presents with abdominal mass and hyponatremia.

Neither Accidental Nor Intended: Pregnancy as an Adolescent Identity Project Among Hispanic Teenage Mothers in Doña Ana County, New Mexico

Social scientists have dispelled teen pregnancy’s public characterization as inherently pathological and instead frequently study teen reproductive practices as the result of either socioeconomic and cultural constraints or individual processes of identity construction. Through semistructured interviews with 15 young Hispanic mothers in southern New Mexico, I consider both macro-level contexts and individual-level identification processes in understanding teens’ reproductive decision making. Highlighting narratives of sexual and reproductive passivity in the region’s impoverished colonias, I describe how young women in these communities explained their pregnancies as the result of what I have termed sterility cuentos, their boyfriends’ false stories of sterility. I go on to tease apart the contradictory narratives of girls in metropolitan Las Cruces who called their pregnancies accidents despite wanting and planning to become pregnant. Through thematic narrative analysis, I argue that teen pregnancy can be thought of as part of a larger adolescent identity project in which teens in particular social locations reproduce, negotiate, and/or reconstruct various axes of their identities through their reproductive decisions within the context of significant constraints. I conclude by considering implications for teen pregnancy prevention efforts in light of this vast diversity in how Hispanic teens become pregnant and experience motherhood.

Comparison of a Timing-Based Measure of Unintended Pregnancy and the London Measure of Unplanned Pregnancy

CONTEXT

Unintended pregnancy is a universal benchmark for reproductive health, but whether variations reflect differences in measurement and how well measures predict pregnancy outcomes warrant further examination. U.S. and British measures of unintended and unplanned pregnancy offer a useful comparison.

METHODS

Some 220 women seeking pregnancy testing at the Columbia University Medical Center in 2005 responded to three pregnancy measures: a binary timing-based measure of unintended pregnancy (TMUP); a multi-item measure of timing-based intentions and planning behaviors, the London Measure of Unplanned Pregnancy (LMUP); and a measure combining intentions (from the TMUP) and how women would feel about a positive pregnancy test. Six-month pregnancy status was assessed among 159 respondents. Estimates of unintended and unplanned pregnancy were calculated using the TMUP and the LMUP, and receiver operating characteristic (ROC) curves were generated to assess congruence.

RESULTS

According to the TMUP, 76% of pregnancies were unintended; by contrast, LMUP scores categorized 39% as unplanned. The ROC curve indicated that expanding the range of scores for classifying pregnancies as unplanned on the LMUP would achieve greater congruence between these measures. At six months, the proportion of pregnancies that had ended in abortion was 42% of those classified as unintended using the TMUP, 60% of those classified as unplanned using the LMUP and 71% of those that women said they had not intended and were very upset about.

CONCLUSIONS

U.S. and British measures of unintended pregnancy are not directly comparable, and a measure combining intentions and feelings may better predict pregnancy outcomes.

The sensitivity of measures of unwanted and unintended pregnancy using retrospective and prospective reporting: evidence from Malawi

A thorough understanding of the health implications of unwanted and unintended pregnancies is constrained by our ability to accurately identify them. Commonly used techniques for measuring such pregnancies are subject to two main sources of error: the ex post revision of preferences after a pregnancy and the difficulty of identifying preferences at the time of conception. This study examines the implications of retrospective and prospective measurement approaches, which are vulnerable to different sources of error, on estimates of unwanted and unintended pregnancies. We use eight waves of closely-spaced panel data from young women in southern Malawi to generate estimates of unwanted and unintended pregnancies based on fertility preferences measured at various points in time. We then compare estimates using traditional retrospective and prospective approaches to estimates obtained when fertility preferences are measured prospectively within months of conception. The 1,062 young Malawian women in the sample frequently changed their fertility preferences. The retrospective measures slightly underestimated unwanted and unintended pregnancies compared to the time-varying prospective approach; in contrast the fixed prospective measures overestimated them. Nonetheless, most estimates were similar in aggregate, suggesting that frequent changes in fertility preferences need not lead to dramatically different estimates of unwanted and unintended pregnancy. Greater disagreement among measures emerged when classifying individual pregnancies. Carefully designed retrospective measures are not necessarily more problematic for measuring unintended and unwanted fertility than are more expensive fixed prospective ones.

Effects of initiating a contraceptive implant on subsequent condom use: A randomized controlled trial

OBJECTIVE

To evaluate whether initiation of a contraceptive implant, a method of long-acting reversible contraception, reduces condom use, as measured by a biomarker of recent semen exposure [prostate-specific antigen (PSA)].

STUDY DESIGN

We conducted a randomized controlled clinical trial in which 414 Jamaican women at high risk for sexually transmitted infections (STIs) attending family planning clinics received the contraceptive implant at baseline ("immediate" insertion arm, N=208) or at the end ("delayed" insertion arm, N=206) of a 3-month study period. Participants were tested for PSA at baseline and two follow-up study visits and were asked about their sexual activity and condom use.

RESULTS

At baseline, 24.9% of women tested positive for PSA. At both follow-up visits, the prevalence of PSA detection did not significantly differ between the immediate versus delayed insertion arm [1-month: 26.1% vs. 20.2%, prevalence ratio (PR)=1.3, 95% confidence interval (CI)=0.9-1.9; 3-month: 25.6% vs. 23.1%, PR= 1.1, 95% CI=0.8-1.6]. The change in PSA positivity over the three study visits was not significantly larger in the immediate arm compared to the delayed arm (1-sided p-value of .15).

CONCLUSIONS

Contraceptive implants can be successfully introduced into a population at high risk of unintended pregnancy and STIs without a biologically detectable difference in unprotected sex in the short term. This information strengthens the evidence to support promotion of implants in such populations and can help refine counseling for promoting and maintaining use of condoms among women who choose to use implants.

IMPLICATIONS

Sex unprotected by a condom was not higher over 3 months in women receiving a contraceptive implant, compared with those not receiving the implant.

Pregnancy intendedness and the association with physical, sexual and emotional abuse - a European multi-country cross-sectional study

BACKGROUND

Unintended pregnancies are common and when not resulting in a termination of pregnancy may lead to unintended childbirth. Unintended pregnancies are associated with increased health risks, also for women for whom pregnancy continues to childbirth. Our objective was to present the prevalence of unintended pregnancy in six European countries among pregnant women attending routine antenatal care, and to investigate the association with a history of physical, sexual and emotional abuse.

METHODS

A prospective cross-sectional study, of 7102 pregnant women who filled out a questionnaire during pregnancy as part of a multi-country cohort study (Bidens) with the participating countries: Belgium, Iceland, Denmark, Estonia, Norway and Sweden. A validated instrument, the Norvold Abuse Questionnaire (NorAq) consisting of 10 descriptive questions measured abuse. Pregnancy intendedness was assessed using a single question asking women if this pregnancy was planned. Cross-tabulation, Chi-square tests and binary logistic regression analysis were used.

RESULTS

Approximately one-fifth (19.2 %) of all women reported their current pregnancy to be unintended. Women with an unintended pregnancy were significantly younger, had less education, suffered economic hardship, had a different ethnic background from the regional majority and more frequently were not living with their partner. The prevalence of an unintended pregnancy among women reporting any lifetime abuse was 24.5 %, and 38.5 % among women reporting recent abuse. Women with a history of any lifetime abuse had significantly higher odds of unintended pregnancy, also after adjusting for confounding factors, AOR for any lifetime abuse 1.41 (95 % CI 1.23-1.60) and for recent abuse AOR 2.03 (95 % CI 1.54-2.68).

CONCLUSION

Women who have experienced any lifetime abuse are significantly more likely to have an unintended pregnancy. This is particularly true for women reporting recent abuse, suggesting that women living in a violent relationship have less control over their fertility.

Gender Equity, Opportunity Costs of Parenthood, and Educational Differences in Unintended First Births: Insights from Japan

We examine educational differences in the intendedness of first births in Japan using data from a nationally representative survey of married women (N = 2,373). We begin by describing plausible scenarios for a negative, null, and positive educational gradient in unintended first births. In contrast to well-established results from the U.S., we find evidence of a positive educational gradient in Japan. Net of basic demographic controls, university graduates are more likely than less-educated women to report first births as unintended. This pattern is consistent with a scenario emphasizing the high opportunity costs of motherhood in countries such as Japan where growing opportunities for women in employment and other domains of public life have not been accompanied by changes in the highly asymmetric roles of men and women within the family. We discuss potential implications of this suggestive finding for other low-fertility settings.

Pregnancy intentions, maternal behaviors, and infant health: investigating relationships with new measures and propensity score analysis

The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87-100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers' background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.

Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania

BACKGROUND

While unintended pregnancies pose a serious threat to the health and well-being of families globally, characteristics of Tanzanian women who conceive unintentionally are rarely documented. This analysis identifies factors associated with unintended pregnancies-both mistimed and unwanted-in three rural districts of Tanzania.

METHODS

A cross-sectional survey of 2,183 random households was conducted in three Tanzanian districts of Rufiji, Kilombero, and Ulanga in 2011 to assess women's health behavior and service utilization patterns. These households produced 3,127 women age 15+ years from which 2,199 gravid women aged 15-49 were selected for the current analysis. Unintended pregnancies were identified as either mistimed (wanted later) or unwanted (not wanted at all). Correlates of mistimed, and unwanted pregnancies were identified through Chi-squared tests to assess associations and multinomial logistic regression for multivariate analysis.

RESULTS

Mean age of the participants was 32.1 years. While 54.1% of the participants reported that their most recent pregnancy was intended, 32.5% indicated their most recent pregnancy as mistimed and 13.4% as unwanted. Multivariate analysis revealed that young age (<20 years), and single marital status were significant predictors of both mistimed and unwanted pregnancies. Lack of inter-partner communication about family planning increased the risk of mistimed pregnancy significantly, and multi-gravidity was shown to significantly increase the risk of unwanted pregnancy.

CONCLUSIONS

About one half of women in Rufiji, Kilombero, and Ulanga districts of Tanzania conceive unintentionally. Women, especially the most vulnerable should be empowered to avoid pregnancy at their own will and discretion.

Partner support and impact on birth outcomes among teen pregnancies in the United States

PURPOSE

Despite hypothesized relationships between lack of partner support during a woman's pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.

METHODS

In a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.

RESULTS

Even after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.

CONCLUSIONS

Having partner support or involvement during a teenager's pregnancy may reduce the likelihood of having a poor birth outcome.

Prevalence of unintended pregnancy and its associated factors among sexually active never-married youth in Shanghai

AIMS

This study was conducted to determine the prevalence and the associated factors for unintended pregnancy among never-married sexually active youth (15-24 years old) in Shanghai.

METHODS

Using a probability sample (n = 765, including 502 males and 263 females) from 2006, we estimated prevalence of unintended pregnancy involvement for females and males by demographic factors and its associations with contextual and behavioural factors, guided by a social-ecological framework.

RESULTS

Weighted proportion analyses estimated that 13.8% of females and 17.7% of males had been involved in an unintended pregnancy, and 99.0% and 90.5% of such pregnancies were reported to have ended in abortion by females and males, respectively. Controlling for sexual behaviour factors and residence history, multivariate hazard analyses with Weibull functions found increased hazard among older female youth (19-21 vs. 15-18 years old) but decreased hazard among older male youth (15-18 vs. 19-21/22-24 years old) as compared with the younger groups. Parallel analyses of unintended pregnancy's associations with contextual factors by sex also suggested that female unintended pregnancy involvement was more likely to be associated with family factors (family living arrangements and maternal education), while unintended pregnancy involvement among males was only associated with school factors (school climate and sex education on pregnancy) and perceived neighbourhood contraceptive services access.

CONCLUSIONS

Sexually active and never-married youth are at considerable risk of unintended pregnancy and abortion in Shanghai. Age- and sex-specific strategies will be needed if China is going to be successful in addressing unintended pregnancy.

Are Hispanic Women Happier About Unintended Births?

Reducing unintended pregnancies - particularly among Hispanic and Black women, who have relatively high rates - is a key public health goal in the United States. However, descriptive literature has suggested that Hispanic women are happier about these pregnancies compared with White and Black women, which could mean that there is variation across groups in the consequences of the resulting births. The purpose of this study was to examine variations in happiness about unintended births by race-ethnicity and to assess possible explanations for these differences. Using data from the National Survey of Family Growth (n=1,462 births) I find that Hispanic women report being happier about unintended births compared with White and Black women. Higher happiness among Hispanics was particularly pronounced among a subgroup of women: those who were foreign-born and very religious. Overall, results confirm previous findings that intention status alone is incomplete for capturing pregnancy experiences. Happiness offers complementary information that is important when making comparisons by race-ethnicity and nativity.

Determinants of unwanted pregnancies in India using matched case-control designs

BACKGROUND

In India, while the total fertility rate has been declined from 3.39 in 1992-93 to 2.68 in 2005-06, the prevalence of unintended pregnancy is still stagnant over the same period. A review of existing literature shows that within the country, there are variations in fertility preferences between different regions. Also there is a strong argument that the availability of a health facility at the village level plays an important role in reshaping the fertility behavior of women. Keeping in mind the fact that there is no information at the village level (which is the lowest geographical boundary) in the recent round of National Family Health Survey (NFHS-3), the specific objective of this study is to examine the impact of individual and household level variables on unwanted pregnancies without controlling the village level variation. Further, once the village level variation (i.e. unobserved variation) has been controlled, it is necessary to study whether there has been any alteration in the contribution of factors from earlier results of without adjusting the village level variation.

METHODS

This paper attempts to examine the associated factors of unwanted pregnancies, without matching the village and after matching the village, by using the matched case-control design. Nationwide data from India's latest NFHS-3 conducted during 2005-06 was used for the present study. Frequency and pair wise matching has been applied in the present paper and conditional logistic regression analysis was used to work out the models and to find out the factors associated with unwanted pregnancies.

RESULTS

A major finding of this study was that 1:3 case-control study (without matching the village) shows that women belonging to non Hindu/Muslim religion, Scheduled Tribe, women who have experienced child loss and if the previous birth interval is 24 through 36 months were significant predictors of unwanted pregnancy. However, this relationship did not hold significant after village wise matching. Other factors such as Muslim religion, women and their partners with high school education and above, women belonging to the richest wealth index and if the sex of the last child was female, emerge as significant predictors of unwanted pregnancies.

CONCLUSIONS

This study clearly underscores the importance of adjusting the village (PSU) level variation in explaining unwanted pregnancies.

Gravidez não planejada no extremo Sul do Brasil: prevalência e fatores associados

Este estudo teve por objetivo identificar fatores associados à ocorrência de gravidez não planejada em Rio Grande, Rio Grande do Sul, Brasil. Em 2007, aplicou-se questionário padronizado a todas as parturientes residentes neste município, investigando sobre características demográficas e reprodutivas maternas, nível socioeconômico da família e assistência recebida na gestação e parto. A análise ajustada foi realizada utilizando-se regressão de Poisson com ajuste robusto da variância. Dentre as 2.557 gestantes incluídas no estudo, 65% não planejaram a gravidez. Após ajuste para confundimento, as seguintes variáveis mostraram-se significativamente associadas à gravidez não planejada: cor da pele parda/preta, idade inferior a 20 anos, sem companheiro, baixa renda familiar, aglomeração familiar, tabagismo e mais de um parto. Abortamento prévio mostrou-se protetor para a gravidez não planejada. A elevada ocorrência de gravidez não planejada, sobretudo entre aquelas com maiores riscos de complicações durante a gestação e o parto, indica a necessidade de se estabelecerem programas de saúde à atenção desta população.

Predictive ability and stability of adolescents' pregnancy intentions in a predominantly Latino community

Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents' intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.

Pregnancy intentions and teenage pregnancy among Latinas: a mediation analysis

CONTEXT

The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high.

METHODS

Prospective, time-varying data from 2001-2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression.

RESULTS

Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low power in a sexual relationship with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%.

CONCLUSIONS

Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.

Examining the predictive value of fertility preferences among Ghanaian women

Despite extensive research, doubts remain regarding the degree of correspondence between prior stated fertility preferences and subsequent fertility behavior. Preference instability is a factor that potentially undermines predictiveness. Furthermore, if other predictors of fertility substantially explain fertility, then knowledge of preferences may contribute little to explaining or predicting individual fertility behavior. In this study, we examined these aspects of the study of individual fertility preference-behavior consistency. Using a prospective multi-wave panel dataset, we modeled the monthly likelihood of conception, taking into account the dynamic nature of preferences, and controlling for changing reproductive life cycle factors and stable socioeconomic background predictors of fertility. We demonstrate from a sample of fecund married Ghanaian women that fertility preferences retain independent predictive power in the model predicting the likelihood of conception.

High rate of unintended pregnancy among pregnant women in a maternity hospital in Córdoba, Argentina: a pilot study

BACKGROUND

Although Argentina has a new law on Reproductive Health, many barriers continue to exist regarding provision of contraceptive methods at public healthcare facilities.

METHODS

We asked 212 pregnant women selected at random at the Maternity and Neonatal Hospital, Córdoba, Argentina, to participate in our descriptive study. Women were asked to complete a structured questionnaire. The objectives were to determine the rate of unintended pregnancies, reasons for not using contraception, past history of contraceptive use, and intended future use.

RESULTS

Two hundred women responded to the questionnaire. Forty percent of the women stated that they had never used contraception and pregnancy was declared unintended by 65%. In the unintended pregnancy group, almost 50% of women said that they had not been using a contraceptive method because they were "unaware about contraception", and 25% stated that their contraceptive method had failed. Almost 85% of women stated that they intended to use contraception after delivery.

CONCLUSION

Approximately two-thirds of all pregnancies in this sample were unintended. Although the data is limited by the small sample size, our findings suggest that our government needs to invest in counseling and in improving the availability and access to contraceptive methods.

Methodological issues in analyzing time trends in biologic fertility: protection bias

One method of assessing biologic fertility is to measure time to pregnancy (TTP). Accidental pregnancies do not generate a valid TTP value and lead to nonrandom missing data if couples experiencing accidental pregnancies are more fertile than the general population. If factors affecting the rate of accidental pregnancies, such as availability of effective contraception and induced abortion, vary over time, then the result may be protection bias in the estimates of fertility time trends. Six European data sets were analyzed to investigate whether evidence of protection bias exists in TTP studies of fertility trends in Europe over the past 50 years. Couples experiencing accidental pregnancies tended to be more fertile than the general population. However, trends in accidental pregnancy rates were inconsistent across countries and were insufficient to produce substantial bias in fertility trends in simulated data. Where protection bias is suspected, the authors demonstrate use of 2 multiple imputation methods to generate realizations for the missing TTP values for accidental pregnancies. Simulation studies show that both methods successfully reduce or eliminate protection bias. The authors also demonstrate that standard sensitivity analyses for dealing with accidental pregnancies provide an upper bound on the extent of any bias.

Domestic violence, contraceptive use, and unwanted pregnancy in rural India

This study examines the relationship between male-to-female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India. A central methodological focus of the study is the examination of retrospective and prospective measures of pregnancy unwantedness, contrasting their usefulness for specifying levels of unwanted pregnancy and its relationship with domestic violence. Data from India's 1998-99 National Family Health Survey and a 2002-03 follow-up survey for which women in four states were reinterviewed are analyzed, and the factors associated with the intersurvey adoption of contraception and the experience of an unwanted pregnancy are examined. Women who experience physical violence from their husbands are significantly less likely to adopt contraception and more likely to experience an unwanted pregnancy. A prospectively measured indicator of unwanted pregnancy identifies a higher prevalence of unwanted pregnancies than do the traditionally employed retrospective measures and is more successful in establishing a relationship between unwanted pregnancies and domestic violence. The results demonstrate a clear relationship between a woman's experience of physical violence from her husband and her ability to achieve her fertility intentions. The need to improve the measurement of pregnancy intendedness is clear, and a move toward using prospective measures as the standard is necessary.

Palestinian women's pregnancy intentions: Analysis and critique of the Demographic and Health Survey 2004

OBJECTIVES

The Palestinian DHS2004 reports on pregnancy intentions and their determinants are analyzed for the first time. Through this analysis, the survey instrument limitations are also highlighted.

METHODS

Data on 15-49 years old ever married, non-pregnant women reporting on their last pregnancy were selected from a nationally representative cross sectional survey dataset.

RESULTS

Older women were more likely not to desire the pregnancy at all, and younger women more likely to have desired to wait; with higher reports of not desiring the pregnancy at all or desiring to wait among those with a higher number of children; with higher reports of not desiring the pregnancy at all, or desiring to wait, among women who reported ever using family planning methods. Women who experienced prenatal and postnatal complications reported higher levels of having desired to wait or not having wanted the pregnancy at all, calling for the inclusion of process measures in pregnancy intention studies.

CONCLUSIONS

While some of our findings are comparable to those cited in the international literature, the analysis was limited to the type of questions asked in the Palestinian DHS survey. There is a need to further develop the survey instrument in order to address women's needs from a public health policy perspective. We call for the inclusion of additional social measures to identify some of the contextual factors that influence pregnancy intentions.

Modeling the process leading to abortion: an application to French survey data

In this study, we model women's recourse to induced abortion as resulting from a process that starts with sexual intercourse and contraceptive use (or nonuse), continues with the occurrence of an unintended pregnancy, and ends with the woman's decision to terminate the pregnancy and her access to abortion services. Our model includes two often-neglected proximate determinants of abortion: sexual practices and access to abortion services. We relate three sociodemographic characteristics--women's educational level, their relationship status, and their age--step by step to the stages of the abortion process. We apply our framework using data from the COCON survey, a national survey on reproductive health conducted in France in 2000. Our model shows that sociodemographic variables may have opposite impacts as the abortion process unfolds. For example, women's educational level can be positively linked to the probability of practicing contraception but negatively linked to the propensity to carry the unintended pregnancy to term. This conceptual framework brings together knowledge that is currently dispersed in the literature and helps to identify the source of abortion-rate differentials.

Pregnancy Intention and Contraceptive Use Among Adult Women

OBJECTIVES

We examined pregnancy intention measures and contraceptive use behaviors among reproductive-age women using data from two CDC-based surveillance systems.

METHODS

We analyzed data for women aged 18-44 from 4 states that collected information on pregnancy and contraceptive use from both the Behavioral Risk Factor Surveillance System (BRFSS, n = 4201) and the Pregnancy Risk Assessment Monitoring System (PRAMS, n = 7761) in 2000. Standard definitions of intended and unintended pregnancy were used.

RESULTS

BRFSS data show that 4% (95% CI: 2.8-5.2) of the women were pregnant at the time of interview and that 57% (95% CI: 41.9-71.9) of these pregnancies were intended. Women who had been pregnant within the last 5 years but were not currently pregnant reported that 61% (95% CI: 55.9-65.3) of their most recent pregnancies had been intended. According to PRAMS, 58% (95% CI: 56.5-60.5) of women with live births had intended pregnancies. Contraceptive use varied across the surveys; 68% (95% CI: 65.7-70.7) of all non-pregnant women from BRFSS and 87% (95% CI: 85.1-87.9) of women with a recent live birth from PRAMS reported using contraceptives.

CONCLUSIONS

Although contraceptive use differed between the BRFSS and PRAMS, the patterns of pregnancy intention were similar for women who had a pregnancy within the past 5 years, those who recently delivered a live-born infant, and those who were currently pregnant. It appears that reporting of pregnancy intention is not affected by timing of assessment across the two surveys.

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents

PURPOSE

Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy.

METHODS

The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group.

RESULTS

In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy.

CONCLUSIONS

Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Feasibility of the Current-Duration Approach to Studying Human Fecundity

Approaches for monitoring time trends in couples' fecundity and for studying its sensitivity to environmental factors are needed. Two approaches rely on the inclusion of a cross-sectional sample of couples currently "at risk" of pregnancy either with follow up (prevalent cohort) or without follow up (current-duration design). To illustrate the feasibility of the current-duration design, we contacted a random sample of 1204 French women age 18 to 44 years in 2004 and recruited those who were currently having unprotected sexual intercourse. The current duration since the beginning of unprotected intercourse was defined for 69 women (5.7%). An additional 15 women (1.2%) were planning to start trying to become pregnant within the next 6 months. Parametric methods allowed, based on current duration of unprotected intercourse, estimation of fecundity as if the couples had been followed prospectively. The estimated proportion of couples not pregnant after 12 months of unprotected intercourse was 34% (95% confidence interval [CI] = 15-54%). The accelerated-failure time model allows study of the influence of environmental factors on fecundity. As an illustration, tobacco smoking by the woman was associated with a doubling in the median duration of unprotected intercourse before pregnancy (adjusted time ratio = 2.4; 95% CI = 1.1-5.2). We quantified the influence of time trends in the prevalence of smoking on this estimate. We suggest ways to quantify or avoid other potential bias. In conclusion, it is possible to recruit a sample of couples currently having unprotected intercourse. The current-duration design appears feasible with approximately 5 times as many women eligible for study as for an incident cohort design.

Is conception delay a risk factor for reduced gestation or birthweight?

Previous studies have suggested an association between delays in conception and adverse perinatal outcomes, specifically, low birthweight and preterm birth. We investigated the relationship between conception delay (defined as >6 months to become pregnant) and three perinatal outcomes: low birthweight (LBW; <2500 g), preterm birth (PTB; <37 weeks), and small-for-gestational-age (SGA; <10th percentile weight for given gestational age) using data from the Collaborative Perinatal Project. The study cohort was limited to pregnancies with a known time-to-pregnancy (n = 8465; 15%). Generalised estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals [CI] for risk of adverse perinatal outcomes accounting for the clustering of pregnancy outcomes for women with more than one pregnancy. After adjusting for confounders, all ORs were close to the null (LBW, OR = 1.01; 95% CI = 0.86, 1.20), (PTB, OR = 1.10; 95% CI = 0.95, 1.27), (SGA, OR = 1.06; 95% CI = 0.91, 1.25). Thus, we found no evidence to support an adverse relationship between conception delay and decrements in gestation or birthweight among this select sample of fertile women, even after varying the cut-point for defining conception delay.

Grossesses survenant sous contraception orale : les leçons de l'étude GRECO

OBJECTIVES

The GRECO study has collected data on pregnancies, regardless of their outcome, that occurred in women taking an oral contraceptive.

PATIENTS AND METHODS

The analysis concerned 551 women prospectively recruited in services of gynaecology or obstetrics, termination of pregnancy centres, family planning centres or consultations of gynaecology in France throughout 2002 and who were 12 weeks pregnant or less.

RESULTS

Contraception used during the cycle of conception was an estroprogestative combination in 88% of cases, a microprogestative in 8.7%, a macroprogestative in 0.9% or another type of pill in 2.4%. Progestatives were levonorgestrel 59.0%, gestoden 17.2%, desogestrel 4.7%, norethisterone acetate 2.9%, norgestimate 1.8%, cyproterone acetate 2.0%, norgestrel 1.6%. When asked about the potential cause of the oral contraceptive failure, 76.9% of women reported events such as missed pills which were the most frequent cause of failure (60.8% of failures and 80.1% of events, 2.7+/-2.7 missed pills), followed by vomiting and diarrhoea. 81.5% of women chose to terminate their pregnancy.

DISCUSSION AND CONCLUSION

The GRECO study, despite its limitations (retrospective collection of missed pills data, declaratory data) showed that missed pills, even once, were the most common reason for oral contraceptive failure. The most frequent decision was the termination of pregnancy.

Studying time to pregnancy by use of a retrospective design

Biologic fertility can be measured using time to pregnancy (TTP). Retrospective designs, although lacking detailed timed information about behavior and exposure, are useful since they have a well-defined target population, often have good response rates, and are simpler and less expensive to conduct than prospective studies. This paper reviews retrospective TTP studies from a methodological viewpoint and shows how methodological problems can be avoided or minimized by appropriate study design, conduct, and analysis. Sensitivity analyses using data from four European retrospective TTP studies are presented to explore the issues. Although the identified biases tend to have small impacts, the effects are not systematic across studies, and sensitivity analyses are recommended routinely. Planning bias can be checked by comparing propensity to report contraceptive failures in different exposure groups. Medical intervention bias can be avoided by censoring and inclusion of unsuccessful pregnancy attempts. Truncation bias can be a serious problem if unrecognized, but it is avoidable with appropriate study design and/or analysis. Behavior change bias can be minimized by assessing the covariates at the beginning of unprotected intercourse. More complete inference is possible if the study design covers the whole population, not just those who achieve a pregnancy.

Profile of Mood States and parental attitudes in motherhood: comparing women with planned and unplanned pregnancies

BACKGROUND

Despite the availability of various contraceptive options, in some Western countries most pregnancies are unplanned. The objective of this longitudinal study was to assess the influence of planned and unplanned pregnancy on women's psychological well-being and on maternal attitude toward parenting in the first years after giving birth.

METHODS

A sample of 119 primiparous women (88 planned and 31 unplanned pregnancies) with normal pregnancy, uncomplicated vaginal delivery, and a healthy living baby completed the Profile of Mood States (POMS) instrument in the ninth month of pregnancy, and at 1, 6, and 12 months after birth, and the Parental Attitude Research Instrument (PARI) 2 years after the birth. The POMS evaluates mood disturbance and the PARI assesses maternal attitudes toward parenthood in general.

RESULTS

Women with unplanned pregnancies demonstrated a significantly more disturbed mood, both in pregnancy and in the first year after the birth. However, at approximately 2 years after childbirth there was no difference between the two groups of women in their rejection of the maternal role, and repressive and punitive maternal attitudes.

CONCLUSIONS

In primiparas of middle socioeconomic levels, unplanned pregnancy is a risk factor for moderate mood disturbances rather than for an inadequate parental educational role. The study findings demonstrate the need to prevent unplanned pregnancies, and to offer immediate health assistance when particular conditions arise.

Adolescent pregnancy intentions and pregnancy outcomes: a longitudinal examination

PURPOSE

(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.

METHODS

Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student's t-tests and regressions examined psychosocial differences between females who reported "any" and "no" pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.

RESULTS

Adolescents' reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (chi2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: chi2 = 19.08, df = 2, p < .01; Positive Results: chi2 = 8.84, df = 2, p = .015).

CONCLUSIONS

To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.

Conceptualisation, development, and evaluation of a measure of unplanned pregnancy

STUDY OBJECTIVE

To develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in the context of contemporary demographic trends and social mores and can be used in a variety of situations, including the production of population prevalence estimates.

DESIGN

A two stage study design: qualitative (inductive) methods to delineate the construct of pregnancy planning, and quantitative/psychometric methods to establish the means of measurement.

SETTING

Eight health service providers (comprising 14 clinics, including antenatal, abortion, and one general practitioner) across London, Edinburgh, Hertfordshire, Salisbury, and Southampton in the UK.

PARTICIPANTS

Samples comprised a mixture of pregnant (continuing pregnancy and opting for abortion) and recently pregnant (post-abortion and postnatal) women. At the qualitative stage, 47 women took part in depth interviews (20 of whom were re-interviewed after the birth of their baby). Items were pre-tested with 26 women, and two psychometric field tests were carried out with, respectively, 390 and 651 women.

MAIN RESULTS

A six item measure of unplanned pregnancy was produced. Psychometric testing demonstrated the measure's high reliability (Cronbach's alpha = 0.92; test-retest reliability = 0.97) and high face, content, and construct validity. Women's positions in relation to pregnancy planning are represented by the range of scores (0-12).

CONCLUSIONS

A psychometric measure of unplanned pregnancy, the development of which was informed by lay views, is now available. The measure is suitable for use with any pregnancy regardless of outcome (that is, birth, abortion, miscarriage) and is highly acceptable to women.

Correlates of unplanned and unwanted pregnancy among African-American female teens

BACKGROUND

Evidence suggests that unplanned/unwanted pregnancy may be an important antecedent of negative birth outcomes, such as low birth weight. This study identified correlates of perceiving a current pregnancy as both unplanned and unwanted among unmarried African-American adolescents aged 14-20 years.

METHODS

One hundred seventy pregnant adolescents were recruited during their first prenatal visit. Adolescents completed a face-to-face interview administered in private examination rooms. Adolescents also completed an in-depth self-administered survey. Measures were selected based on two potential influences: (1) relationships with boyfriends and (2) parent/family involvement. Age and parity were also assessed. Contingency table analyses were used to identify significant bivariate associations. Correlates achieving bivariate significance were entered into a forward stepwise logistic regression model.

RESULTS

Pregnancy was reported as unplanned and unwanted by 51.2% of the study population. In a multivariate analysis, adolescents indicating lower levels of parental involvement were about twice as likely (adjusted odds ratio [AOR]=2.05; 95% confidence interval [CI], 1.1-3.9, p<0.03) to report that their pregnancy was unplanned and unwanted. Adolescents who already had a child (AOR=2.3; 95% CI, 1.3-5.7, p<0.009) and those younger than 18 years old (AOR=2.3; 95% CI, 1.1-4.5, p<0.02) were more than twice as likely to report that their pregnancy was unplanned and unwanted. A variable assessing whether each adolescent's current boyfriend conceived the pregnancy approached significance (AOR=2.33; 95% CI, 0.99-5.46, p=0.052).

CONCLUSIONS

Findings provide initial evidence for specifically targeting intensified prenatal care programs to teens perceiving their pregnancy as unplanned and unwanted.

Women's life cycle and abortion decision in unintended pregnancies

OBJECTIVE

To study the impact of sociodemographic, financial, and reproductive factors and of characteristics related to intimate relationships on the decisions of women in different age groups about whether or not to continue an unintended pregnancy.

DESIGN

Cross sectional population based survey.

SETTING

Telephone interview survey between September 2000 and January 2001 in France. From a representative sample (n=14704) of 18 to 44 year old women, those who in the past five years had an abortion or whose last pregnancy was unintended were oversampled (sampling fraction=100%, n=1034) while the other women were randomly selected (sampling fraction =19%, n=1829). Altogether, 2863 women answered the questionnaire.

PARTICIPANTS

All women whose last pregnancy was unintended and ended in induced abortion or birth (n=645).

MAIN RESULTS

Factors associated with the abortion decision varied strongly according to age. Younger women's abortion decisions were mainly related to being a student and being single. Wanting to stop childbearing when the desired number of children was achieved best explained the decision to have an abortion among 25 to 34 year old women. Older women chose abortion especially when childbearing did not fit their work situation or when the relationship with the partner was unstable. A high level of education of a woman and her partner increased the likelihood of abortion, especially among young women.

CONCLUSIONS

The impact of socioeconomic and relationship factors on the decision to have an abortion is not the same at different stages in life, and refers to the social representations and perceptions of what good conditions are for being a mother.

Pregnancy wantedness: attitude stability over time

In this analysis we have compared two attitudinal reports, from interviews two years apart, of the same event for consistency over time. We have looked at women's self-reports, and at their proxy reports for partners' attitudes as well. The inconsistent reports of women's own views tended to shift slightly toward more favorable reports at the second interview (15 percent more positive versus 10 percent more negative). More specifically, 7.5 percent of women who reported at Time 1 that their most recent births had been unwanted switched to more favorable reports at Time 2, and about the same percentage of women who reported Table 4, the findings would suggest that some of the groups typically considered to be most "at risk" were those who were also most apt to report inconsistently. This findings should signal some concern in the policy community. Net of other factors, there is no effect of income, but a number of at-risk groups remained significantly more likely than others to change their reports over time. Of particular concern is the finding that women who reported their pregnancies as mistimed or unwanted were so much more likely to change their reports over time than were women who initially said that their pregnancies had been well timed. When we look at the direction of change, it is clear that, with some exceptions, the more "at risk" groups were more likely to shift in a more negative direction, while the less "at risk" groups were less likely to do so; and at times they were more likely to report more favorably at the second interview. Although somewhat hampered by small sample sizes in the analysis of Time 1 mistimed and unwanted reports, results confirmed that certain subgroups were not only more apt to report inconsistently, they were also more likely to do so in specific directions. To the extent that future survey questions can emphasize to respondents that they should focus on the time of conception, and not on current status, inconsistency across groups may be reduced.

Unintended pregnancy in a commercially insured population

OBJECTIVES

While much attention has been focused on unintended pregnancy in disadvantaged populations, few studies have focused on women in lower risk groups. This study, conducted in a national managed care organization, reports the prevalence of unintended pregnancy resulting in live births and examines associated factors

METHODS

Women ages 18-49 who delivered a live infant during a 6-month interval were eligible for the study. Telephone surveys were conducted after delivery. We report the rate of unintended pregnancy resulting in a live birth, and describe its association with sociodemographic and pregnancy-related factors, partner's intention status, and contraceptive use.

RESULTS

Of 1173 births, 29% were unintended. Women who reported that the partner did not want the pregnancy were 7.4 times more likely than women whose partner wanted the pregnancy to regard the pregnancy as unintended. Only 40% of the women with an unintended birth used birth control and 64% of those used less effective methods such as condoms and diaphragms.

CONCLUSIONS

In a population where the majority of women were married, educated, and with incomes over $40,000, almost 1/3 of the births resulted from unintended pregnancies. Future research is needed to help us better understand contradictions in pregnancy intention and contraceptive behavior. Comprehensive efforts are needed to promote consistent and correct use of contraception by women at risk for unintended pregnancy, and to involve male partners in family planning.

What is a 'planned' pregnancy? Empirical data from a British study

The terms "planned", "unplanned", "intended", "unintended", "wanted" and "unwanted" are often used in relation to pregnancy in health policy, health services and health research. This paper describes the findings relating to women's understanding of these terms from the qualitative stage of a British study. We found that when discussing the circumstances of their pregnancies, women tended not to use the above terms spontaneously. When asked to explain the terms, women were able to do so but there was considerable variation in understanding. Most, but not all, were able to apply the terms. Women applied the term "planned" only if they had met four key criteria. Intending to become pregnant and stopping contraception were not sufficient criteria, in themselves, to apply the term; partner agreement and reaching the right time in terms of lifestyle/life stage were also necessary. In contrast, "unplanned" was a widely applied term and covered a variety of circumstances of pregnancy. The other terms were less favoured, "unwanted" being positively disliked. We recommend that survey questions eliciting information on women's circumstances of pregnancy do not rely on the above terms in isolation and, further, that a more circumspect use of the terms in policy and clinical settings is required.

Adolescent pregnancy 1 year later: the effects of abortion vs. motherhood in Northeast Brazil

PURPOSE

To determine social and behavioral consequences of pregnancy and how these differed according to the pregnancy outcome (live birth or abortion) 1 year after the event.

METHODS

This was a prospective study of two groups of young women aged 12-18 years, one attending prenatal services and the other admitted for abortion complications at the same hospital in northeast Brazil. Adolescents who gave birth were subsequently classified as having intended or unintended pregnancies, and those who aborted were divided between those who terminated their pregnancies and those who miscarried. Baseline data were collected between 1995 and 1997 from all teens who met the eligibility criteria. Information was collected through one-on-one interviews using a questionnaire that was structured and precoded. Multiple logistic regression was used to identify characteristics that predicted outcomes at 1 year.

RESULTS

Teens who terminated their pregnancies were the most likely to be in school or working 1 year later. They also showed the greatest increase in self-esteem. The young mothers, however, had the highest self-esteem but perceived the impact of pregnancy on their lives as being more negative than they did initially. Group affiliation was not associated with the quality of partner relationships, which tended to deteriorate over time. The young mothers used contraception at 1 year at higher rates and had experienced fewer subsequent pregnancies than the two abortion groups.

CONCLUSIONS

The experience of adolescent pregnancy for this group of teens produced mixed findings, some more negative than others. Interventions to decrease the adolescent's desire to have a baby will have to be tailored differently from those designed to prevent an unintended pregnancy, but both are needed.