[How consistent are personal data? Analysis of statements on the planning status of pregnancies]

The consistency of responses on the planning status of births is analyzed using data from a longitudinal fertility survey being carried out by the Demographic Institute of the Austrian Academy of Sciences. Interviews were conducted in 1978 and 1981 with a sample of two marriage cohorts; in both sets of interviews a question was asked concerning the reaction to a pregnancy at the time the woman heard about it. "After linking the data for the pregnancies leading to first or second births, a consistency index suggested by Ryder and Westoff...was applied which distinguishes between random and nonrandom consistency. For the first births a proportion of 54.4% identical answers yields a consistency index of 38.0...; for second births a proportion of 53.7% identical answers results in [a] consistency index of 30.1...." Differential consistency is also analyzed according to selected socioeconomic and demographic variables as well as a variable measuring the correspondence of husband's and wife's desired family sizes in the opinion of the husband. (summary in ENG)

Exploring the concepts of intended, planned, and wanted pregnancy

BACKGROUND

A variety of terms have been used to define the intention status of pregnancies. The purpose of this study was to explore how women relate to these terms and how they define the intention status of their pregnancies. Improved understanding of how women use these terms may enhance communication between physicians, patients, and families.

METHODS

This qualitative study used in-depth semistructured interviews to explore how women defined the intention status of current, past, and hypothetical pregnancies. Eighteen women who were seeking prenatal care, elective abortion, or pregnancy testing were interviewed. Most of the subjects were interviewed in the first trimester of a current pregnancy. Four researchers independently reviewed the interview transcripts and summarized the points made by each subject.

RESULTS

Three major themes emerged from the interviews: (1) definitions of terms related to pregnancy varied substantially among women and seemed to be highly correlated to social and cultural influences; (2) the concepts of wanted and unwanted pregnancy were qualitatively distinct from the concepts of planned and unplanned pregnancies and seemed to be more relevant to the decision to continue or abort the pregnancy; and (3) attitudes of the male partners toward the pregnancies were very influential in how women defined their pregnancies.

CONCLUSIONS

Physicians should explore the attitudes and circumstances of pregnant women, rather than focusing on whether the pregnancy was planned. Support from the significant other and the woman's underlying values about parenthood seem to be of particular importance. Our results also suggest that further studies are needed to determine the best method for measuring the intention status of pregnancy for research and policy.

The effects of pregnancy planning status on birth outcomes and infant care

CONTEXT

The planning status of a pregnancy may affect a woman's prenatal behaviors and the health of her newborn. However, whether this effect is independent or is attributable to socioeconomic and demographic factors has not been explored using nationally representative data.

METHODS

Data were obtained on 9,122 births reported in the 1988 National Maternal and Infant Health Survey and 2,548 births reported in the 1988 National Survey of Family Growth. Multiple logistic regression analyses were employed to examine the effects of planning status on the odds of a negative birth outcome (premature delivery, low-birth-weight infant or infant who is small for gestational age), early well-baby care and breastfeeding.

RESULTS

The proportion of infants born with a health disadvantage is significantly lower if the pregnancy was intended than if it was mistimed or not wanted; the proportions who receive well-baby care by age three months and who are ever breastfed are highest if the pregnancy was intended. In analyses controlling for the mother's background characteristics, however, a mistimed pregnancy has no significant effect on any of these outcomes. An unwanted pregnancy increases the likelihood that the infant's health will be compromised (odds ratio, 1.3), but the association is no longer significant when the mother's prenatal behaviors are also taken into account. Unwanted pregnancy has no independent effect on the likelihood of well-baby care, but it reduces the odds of breastfeeding (0.6).

CONCLUSIONS

Knowing the planning status of a pregnancy can help identify women who may need support to engage in prenatal behaviors that are associated with healthy outcomes and appropriate infant care.

Sex ratio associated with timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of natural family planning

This was a multicentred, prospective study of pregnancies among women using natural family planning. The women maintained natural family planning charts of the conception cycle, recording acts of intercourse and signs of ovulation (cervical mucus changes, including peak day and basal body temperature). Charts were used to assess the most probable day of insemination relative to the day of ovulation and length of the follicular phase of the cycle. The sex ratio (males per 100 females) for 947 singleton births was 101.5, not significantly different from the expected value of 105. The sex ratio did not vary consistently or significantly with the estimated timing of insemination relative to the day of ovulation, with the estimated length of the follicular phase or with the planned or unplanned status of the pregnancy. Although these findings may be affected by imprecision of the data, the study suggests that manipulation of the timing of insemination during the cycle cannot be used to affect the sex of offspring.

Predicting maternal behaviors during pregnancy: does intention status matter?

CONTEXT

Women's behavior during pregnancy, which can affect the health of their infant, may be influenced by their attitude toward the pregnancy.

METHODS

Multivariate analyses of data from the 1988 National Maternal and Infant Health Survey and the 1988 National Survey of Family Growth were conducted to investigate whether women with unplanned births differ from other women in their pregnancy behavior, independent of their social and demographic characteristics.

RESULTS

Women with intended conceptions are more likely than similar women with unintended pregnancies to recognize early signs of pregnancy and to seek out early prenatal care, and somewhat more likely to quit smoking, but they are not more likely than women with comparable social and demographic characteristics to adhere to a recommended schedule of prenatal visits once they begin care, to reduce alcohol intake, or to follow their clinician's advice about taking vitamins and gaining weight. Social and demographic differences in these behaviors are largely unaffected by planning status, indicating that these differences are independently related to pregnancy behaviors.

CONCLUSIONS

Both the intendedness of a pregnancy and the mother's social and demographic characteristics are important predictors of pregnancy-related behavior.

Return of fertility following discontinuation of Norplant-II subdermal implants. ICMR Task Force on Hormonal Contraception

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal live births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and "other reasons," opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal deaths among women with pregnancies outside of family planning in Sichuan, China

To assess the impact of family planning status on maternal mortality, we analyzed data gathered in a community-based, maternal mortality surveillance study conducted by the Sichuan Health Department in the People's Republic of China during 1989-1991. The overall maternal mortality ratio, which included only deaths of pregnant women within family planning guidelines ("planned" pregnancies), was 78.9 per 100,000 livebirths. When the deaths of pregnant women outside of family planning ("unplanned" pregnancies) were included, the maternal mortality ratio doubled to 135.6 per 100,000 livebirths. The leading causes of death for women with "planned" and "unplanned" pregnancies were the same: hemorrhage, postpartum infection, pregnancy-induced hypertension, cardiac diseases, and pulmonary diseases. As among women with "planned" pregnancies, about 40% of maternal deaths among women with "unplanned" pregnancies occurred at home, and 20% occurred en route to a hospital. After controlling for the confounding effects of gravidity and education, the odds ratio of maternal death associated with "unplanned" pregnancy status was 2.6 [95% confidence interval (CI) = 2.0-3.7], which declined to 2.0 (95% CI = 1.4-2.9) with additional control for the effect of prenatal care visits. Our study indicates that women with "unplanned" pregnancies have a higher risk of maternal death, which is only partially attributed to less prenatal care.

Stress and coping in fathers of newborns: comparisons of planned versus unplanned pregnancy

The purpose of this survey was to identify stresses and coping styles in fathers of newborns, and to explore if these vary according to pregnancy planning. Data from 69 subjects were collected using the Ireton Personal Inventory and the Jalowiec Coping Scale. The most common and least often sources of stress or worry were reported. Fathers' predominant mode of coping was problem oriented. Compared to fathers with planned pregnancies, fathers with unplanned pregnancies were found to be significantly more stressed about numerous issues as well as feeling powerless in adapting to the arrival of a new infant. Implications for practice and research are explored.

The effect of induced abortion on subsequent fertility

OBJECTIVE

To investigate the effect of induced abortion on subsequent fertility.

DESIGN

1. Prospective cohort study of women who had an unplanned pregnancy at recruitment. 2. Retrospective study of women who had a planned pregnancy at recruitment.

SETTING

Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales, between 1976 and 1987.

SUBJECTS

1. Prospective study: Four hundred and thirty-three women with a recruitment unplanned pregnancy ending in induced abortion (abortion group) and 1035 women with a recruitment unplanned pregnancy which ended naturally (nonabortion group). All subsequently had a planned pregnancy, or were known to be trying to conceive at some point during the follow-up. 2. Retrospective study: Nine thousand two hundred and ninety-nine women who presented at recruitment with a planned pregnancy.

MAIN OUTCOME MEASURE

The women's estimated length of planning time, expressed as a fertility rate ratio.

RESULTS

Induced abortion was not related to future fertility. In the prospective study, the fertility rate ratio (FRR) of the abortion group relative to the nonabortion group was 0.94 (95% CI 0.83 to 1.07, P = 0.37). This result was supported by the retrospective study, which again showed no important difference between the two groups.

CONCLUSION

Induced abortion does not appear to have an important effect on future fertility.

Planned conception and infant functioning at age three months: a cross-cultural study

The conceptions of 53 American and 54 Greek infants were categorized as planned or unplanned on the basis of mothers' reports. At age three months in both cultural groups, infants in the planned category showed higher levels of cognitive processing and attachment to their mothers than did infants in the unplanned category, as shown by their differential vocal responses to mothers versus a female stranger.

Waiting time to pregnancy and pregnancy outcome among Danish workers in the textile, clothing, and footwear industries

The relationship between time from planned to achieved pregnancy and pregnancy outcome has been studied in a group of 18,658 workers in the textile, clothing and footwear industries. Information on pregnancy outcome and delay in conception in the period 1979-84 was collected by self administered questionnaires in 1985. The response rate was 70.3%. During the study period there had been 5,171 live births and 708 spontaneous abortions. Information on delay in conception was collected in broad categories. The data were analysed by means of a newly developed statistical parametric model in order to collect all possible information from the highly grouped data. Median waiting time before a pregnancy which ended in spontaneous abortion was 1.68 times longer than median waiting time before a pregnancy leading to a live birth. There seems to be a correlation between the length of the waiting time and abortion.

Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices

OBJECTIVES

The objectives were to measure rates of planned pregnancy and factors affecting these rates after use of very-long-acting contraceptive methods (Norplant or Norplant II implants, a levonorgestrel-releasing intrauterine contraceptive device, or the copper T (model TCu 380Ag) intrauterine contraceptive device.

STUDY DESIGN

The design was a concurrent, multicenter prospective study of 372 women who stopped contraception for planned pregnancy. Analysis was by life-table, log-rank, and standard chi 2 methods.

RESULTS

Pregnancy rates 12 and 24 months after cessation of contraceptive use were 82 and 89 per 100, respectively. Age at removal and family planning intentions at initiation of contraception were both significantly correlated with pregnancy rates (p less than 0.05), but former contraceptive regimen and duration of contraceptive use were not. Pregnancy outcomes did not deviate from normal limits and did not differ by contraceptive formerly used.

CONCLUSION

Contraceptive implants releasing 30 micrograms/day of levonorgestrel or intrauterine contraceptive devices releasing 20 micrograms/day of levonorgestrel or having copper surface areas of 380 mm2 are associated with normal fertility after use for women seeking pregnancy at termination. Durations of use do not affect pregnancy rates.

The incidence of unplanned and unwanted pregnancies among live births from health visitor records

A survey of health visitor records has indicated that approximately one-third of pregnancies resulting in live births are unplanned. The data further revealed an association between planning of pregnancies and socio-demographic variables and use of preventive health care for infants.

Female adolescents' compliance with contraceptive regimens

Although today's adolescents have access to a variety of contraceptive options, they remain inconsistent and suboptimal users of these methods. A particularly frustrating problem for those caring for adolescents is the issue of noncompliance with contraceptives, which is an important antecedent of adolescent pregnancy. In the future, new fertility-related developments such as subdermal hormonal implants may reduce the likelihood of noncompliance. For the present, however, systematic monitoring rather than only when noncompliance is suspected is essential in enhancing adolescents' contraceptive compliance.

The family center--a new form of organization for rural family planning

The history and functions of rural family planning centers in China are reviewed, with a focus on a center in Liaoning Province. "To date, more than 8,500 such centers have been established in 92.2 percent of the rural resident's groups. What the centers do is to give rural residents education and services in family planning, and help them educate themselves.... According to statistics, 99.3 per cent of the babies born in Liaoning Province in 1986 were planned. More than half of the counties and districts and over 90 per cent of the villages reported no unplanned births. The Province now leads the nation in fulfillment of family-planning goals."

Infant feeding in King Khalid University Hospital

SURVEY was carried out in King Khalid University Hospital between January 1985 and May 1986 to study the pattern of infant feeding. It was found that 76% of the respondents favoured breast-feeding while 58% preferred breast feeding only.

About 51 % of the mothers started weaning their chil dren between 6-12 months, while 21% weaned between 12-18 months. The most important reason for stopping breast-feeding was in order to have another pregnancy; this reason was more common among mothers who had female babies than males. An association was found between this reason and parity with an odds ratio of 2.9.

The planning of pregnancy among low-income women in central Harlem

A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, we have compared the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal mental health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The two groups did not differ in any other risk factor or in outcome in terms of birth weight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly based interventions that are not confined to the periconceptional period.

Desired pregnancy during adolescence

25 primiparous adolescents 13 to 18 yr. of age who actively desired or wanted pregnancy were compared with those who did not actively desire pregnancy to determine factors which contribute to wanting the pregnancy. Factors included peer expectations, marital status, fertility awareness, contraceptive use, and affective status. Positive status associated with marriage, especially among adolescents who conceived while single but subsequently married, was an important difference between desired and undesired pregnancies. Social expectations among peers seemed to reflect the greatest difference between desired and undesired pregnancy. The teens desiring pregnancy had a more positive peer expectation of being treated better after delivery. Non-utilization of birth control and surprise at conception was the same for desired and non-desired pregnancy although the majority of both groups knew where to get contraception.

Psychosocial stress and its relation to obstetrical complications

A Greek adaptation of the Schedule of Recent Experience of Holmes and Rahe was employed to study the relationship of psychosocial stress to symptoms during pregnancy, obstetric complications, family planning and breast feeding. An initial experiment with 130 pregnant women in the third trimester indicated that psychosocial stress was not related to education, whether they were from Athens or the provinces, nor age. The second experiment with 103 mothers 3 or 4 days after delivery indicated that high psychosocial stress is related to increased symptom scores during pregnancy and to obstetric complications. Symptoms were not related to obstetric complications, nor were family planning nor breast feeding. Psychosocial stress was also related to family planning and also to whether or not the mother breast fed.

Second pregnancies among teenage mothers

An analysis of data from the National Survey of Family Growth (NSFG) finds that 82 percent of sexually active teenage mothers were using contraceptives in the year following the birth of their first child; the majority of those who practiced contraception used the pill. The proportion of black teenagers using no method of birth control was higher than that for white teenagers, and it increased over the course of the year. Rates of nonuse were particularly high among black women younger than 18, only 68 percent of whom practiced contraception (compared with 85 percent of whites the same age). Examination of the data by marital status shows that women who married while they were pregnant were the most likely to practice contraception in the year following their first birth, while those who were single at the time of first birth were the least likely to do so (89 versus 74 percent). Blacks constituted the majority of women who were not married at the time of first birth, and of all marital subgroups, single blacks had the highest rate of nonuse (29 percent). The probability of a pregnancy during the year following a first birth for all teenage mothers was 17 percent. Pregnancy rates among women with incomes less than 150 percent of poverty level were nearly twice as high as rates among women who had incomes above that level--21 percent vs. 11 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Copper loss from the copper T model TCu22OC

The effect of mineral deposits on the copper dissolution rate of the Copper T Model TCu22OC was examined. 118 Copper T22OC devices removed from subjects for various medical and personal reasons after 12 to 72 months in utero were examined and graded based on the proportion of the total copper area covered with mineral deposits. The deposits increased in average size during the first three years of IUD use and then remained relatively constant. Seventeen percent of the devices were in situ for four or more years. Copper analysis was performed on 30 Copper T 22OC devices from selected periods of use : 12-14, 22-26, 36-39 and 48-72 months of use. The mean daily copper loss was 29.4 micrograms and the range, 7.3 to 62.1 micrograms. An inverse correlation between the amount of mineral deposit on the copper surface and the rate of copper loss was observed.

Inuit natality rhythms in the central Canadian Arctic

Seasonal variation in human natality is examined over a period of several decades for an isolated Inuit settlement in the central Canadian Arctic. The results substantiate earlier reports of the existence of a birth season in the first half of the year. The 2-decade period coinciding with the gradual concentration of the regional population into the settlement experienced a temporary disruption of this traditional rhythmic pattern. Family planning has been introduced in the modern period, yet birth seasonality is even more pronounced than during previous decades. Both planned and unplanned births occur predominantly in the first half of the year, indicating the paramount importance of behavioural and social responses to extreme seasonal variation.

Vaginal spermicides and outcome of pregnancy: findings in a large cohort study

By the end of 1980, 5729 singleton planned pregnancies, 1552 singleton unplanned pregnancies, and 81 multiple pregnancies had been observed among the 17032 participants in the Oxford-Family Planning Association contraceptive study. The outcome of these pregnancies was investigated in relation to the use of vaginal spermicides. There was some suggestion that spermicide use might have a small adverse effect on the risk of congenital malformations, especially among infants conceived as a result of contraceptive failure. There was not, however, any evidence of any other adverse effect of spermicide use. In particular, the results provide strong evidence against the hypothesis that spermicide use has any appreciable effect on the risk of spontaneous abortion.

Contraception and adolescent pregnancy

To identify reasons for increasing numbers of pregnant adolescents, questionnaires were distributed to teenagers with unplanned pregnancies to determine the level of their knowledge of contraception. Findings revealed that 94% of the subjects had an adequate knowledge of availability, while only 43% had an adequate overall knowledge of contraception. Subjects reported many misconceptions about contraceptives and a general lack of motivation concerning contraceptive use.

The child and family eight years after undesired conception. The child and family after undesired conception

This survey is a follow-up study, up to the age of 8 years of children reported to have been born from pregnancies not desired by the mother, in Northern Finland in 1966. The data were collected by means of a postal questionnaire sent separately to families and school teachers. Each child was signed a control, born from a desired pregnancy and similar at the time of birth as regards mother's marital status, parity, and place of residence and also the social class of the father. No difference between the groups was found in the emotional development of the children. School performance was poorer among the unwanted children, but the difference was statistically significant only in respect of the need for additional instruction in writing. Evidence was also found that the parents in the control families worried more about the health of their children than did those of the unwanted children. Even when the social standing of the families was matched as regards time of birth, the families with unwanted children showed more downward and less upward social mobility during the intervening 8 years than did the control families, and there were also indications of differences in lifestyle preference between the families. The conclusion was therefore drawn that undesired conception selects a subgroup of less capable families from each social class, and that the differences found in the children can also be explained by differences in social and economic standing between these two groups of families.

[Planning of pregnancy and birth control in the capital of Valladolid (author's transl)]

This work presents the results which the authors obtained by means of an inquiry carried out on 920 women with children, or women bearing their first child, in order to find out how many pregnancies are conceived deliberately in the capital of Valladolid and what kind of birth control was adopted by the couples in this capital in order to delay, postpone or prevent pregnancy. The authors come to the conclusion that, first, during the seventies a little less than 50% of the gestations in Valladolid were not planned or wanted. The first pregnancy is not planned in one out of four cases, of which nearly 50% are women under twenty years of age. The couples seek to control their reproduction once they have their first two children. From 30 years onward, seven out of ten pregnancies are neither planned nor wanted. Three quarters of the women investigated, or their husbands, use some method of birth control, normally of little efficacy, and this because of the method itself, or because of the deficient way they use it. "Coitus interruptus", alone or combined with other methods, is practised by two of three couples who seek to control their reproduction.

Attitudes of adolescents toward pregnancy and contraception

Teenage pregnancy rates are increasing, particularly among the younger age groups. The causes of this increase are varied. While many people assume that most adolescent pregnancies are unwanted and result from a lack of contraceptive knowledge and/or availability, our findings were quite to the contrary. In-depth interviews with 87 pregnant teenagers in a large Southern city revealed that almost all had knowledge of contraception and that most were happy about being pregnant. Multidisciplinary programs have been organized throughout the country to address the adolescent pregnancy problem. Our study emphasizes the fact that to be effective, such programs must be tailored to the individual target group and that concentrating on the increased dissemination of contraceptive knowledge and methods may not be the most effective approach in some groups.

Return of fertility after discontinuation of depot medroxyprogesterone acetate and intra-uterine devices in Northern Thailand

796 Thai women who stopped using the long-acting injectable contraceptive 'Depo-Provera' (medroxyprogesterone acetate) and 125 women who had an intra-uterine device removed to have a planned pregnancy were followed-up to ascertain the delay between conception and the end of contraception, and to determine the proportion of women who did not conceive in the 2 years after discontinuation. The median delay before conception was 5.5 months plus the estimated duration of the effect of the last injection of depo-provera and 4.5 months after discontinuing the IUD. Since depo-provera acts for approximately 15 weeks, women can except a median delay to conception of around 9 months after their last injection. The proportions of women who did not conceive within 1 year and within 2 years of stopping contraception by the two methods were similar. There was no evidence to suggest that prolonged use of depo-provera increases the delay before conception, and the return of fertility among never pregnant ex-users resembled that of ever pregnant ex-users.