Decision-making in case of an unintended pregnancy: an overview of what is known about this complex process

Introduction: Unintended pregnancies are a worldwide health issue, faced each year by one in 16 people, and experienced in various ways. In this study we focus on unintended pregnancies that are, at some point, experienced as unwanted because they present the pregnant person with a decision to continue or terminate the pregnancy. The aim of this study is to learn more about the decision-making process, as there is a lack of insights into how people with an unintended pregnancy reach a decision. This is caused by 1) assumptions of rationality in reproductive autonomy and decision-making, 2) the focus on pregnancy outcomes, e.g. decision-certainty and reasons and, 3) the focus on abortion in existing research, excluding 40% of people with an unintended pregnancy who continue the pregnancy. Method: We conducted a narrative literature review to examine what is known about the decision-making process and aim to provide a deeper understanding of how persons with unintended pregnancy come to a decision.Results: Our analysis demonstrates that the decision-making process regarding unintended pregnancy consists of navigating entangled layers, rather than weighing separable elements or factors. The layers that are navigated are both internal and external to the person, in which a 'sense of knowing' is essential in the decision-making process. Conclusion: The layers involved and complexity of the decision-making regarding unintended pregnancy show that a rational decision-making frame is inadequate and a more holistic frame is needed to capture this dynamic and personal experience.

Effects of repeated embryo flushing without PGF2α administration on luteal function, percentage of unwanted pregnancy and subsequent fertility in mares

BACKGROUND

PGF2α is commonly given at the end of embryo flushing (EF) to shorten the interval to the next oestrus and ovulation.

OBJECTIVES

To determine the effect of repeated EF on plasma progesterone concentration, percentage of mares with endometritis, unwanted pregnancy and subsequent fertility in mares flushed without the use of PGF2α .

STUDY DESIGN

Controlled experiments.

METHODS

Nine mares were inseminated in seven consecutive cycles (n = 63), to either perform an EF (n = 54) 7-9 days after ovulation or left pregnant (n = 9). PGF2α was not used to induce oestrus. Ultrasound examination and blood sampling were performed just before the EF and 72 h later to determine changes in progesterone concentration and signs of endometritis.

RESULTS

The overall percentage of positive EF/pregnancy was 55.5% (30/54) and 66.7% (6/9), respectively. The likelihood of pregnancy/positive EF in the first three cycles was 55.5% (15/29). This was not different (p > 0.1) from the fertility of the last four cycles (69.4%, 25/36). In five EF cycles (9.3%), mares had signs of endometritis and early luteolysis (progesterone <2 ng/mL) 72 h after EF. The reduction in progesterone concentration by 72 h after EF was greater (p < 0.05) for Day 9 (-2.3 ± 0.7 ng/mL) than Day 7 (-1.0 ± 0.8 ng/mL) or Day 8 (-1.3 ± 1.1 ng/mL) cycles. The progesterone concentration in non-flushed mares did not vary significantly during the sampled period (Day 7-12). There were 5 cycles in which the donor mare remained pregnant after the EF, although four were from a single mare.

MAIN LIMITATIONS

The mare population was limited to barren and maiden mares. The cycle order and operator allocation to each EF were not randomised.

CONCLUSIONS

EF induces a subtle, but significant reduction in progesterone concentrations compared with non-EF cycles. However, the percentage of mares with EF-induced full luteolysis is low (9.3%). The fertility of mares after repeated EF without administration of PGF2α was unaffected; however, there is a considerable risk of unwanted pregnancy (5/27 = 18.5%) in donors from which an embryo was not recovered.

A Rebuttal To Psychoanalytic Biography Of Mustafa Kemal Atatürk

Mustafa Kemal Atatürk (1881-1938) was the founder of the modern-day Turkish Republic. Although much has been published about his life, only one biography adopted a psychological/psychoanalytic perspective. The authors Vamık Volkan and Norman Itzkowitz argued that the main driving mechanism behind Atatürk's behavior was his narcissistic personality organization. Their framework considered Mustafa's birth, which occurred shortly after his elder brothers had passed away, and how his mother, presumably in a state of severe depression, could not provide adequate emotional care, which gave way to compensatory narcissistic tendencies in the child. For several decades, the hypothesis has remained unchallenged, and no serious review has yet been carried out. In this article, I argue that Mustafa Kemal was a highly intelligent and gifted child based on his well-developed verbal skills and his record as a high achiever at school. While considering the impact of adverse events in early childhood on cognitive development and personality, a review of historical texts revealed that his elder brothers died in 1883-not before Mustafa's birth, as the authors had believed. Thus, no serious event appears to have taken place in his early years when rapid brain development is thought to occur. Since the central premise has lost its integrity to support the biography, Volkan and Itzkowitz's hypothesis can no longer be regarded as tenable and viable.

ABANDONED CHILDREN IN ŠIBENIK FOUNDLING HOUSE AT THE END OF THE 19th CENTURY

The Šibenik Foundling House was an institution that cared for abandoned children before their adoption. The paper analysed the accommodation capacities of the foundling house from 1886 to 1900, using registers of baptisms and deaths from the provincial hospital in Šibenik as the basis for the analysis. An analysis of the received children was conducted based on how they arrived at the site and the level of knowledge about their origin or identity. From 1886 to 1900, the Šibenik Foundling House received three hundred and seventy-eight abandoned children with a yearly average of 25.2 children. Two hundred and forty-three children were brought to the hospital by their mothers as newborns, and their identities were recorded in the baptism registers, constituting 60.15% of the total number of residents in the Foundling House. One hundred and six received infants were foundlings—children without known identity—comprising 26.24% of the total number of baptisms in the hospital. Twenty-nine children were born in the hospital and left by unmarried mothers in the care of the Foundling House, making up 7.18% of all entries in the register of baptisms. The monthly distribution of received children shows a balanced distribution. The mortality rate of these children in the Foundling House was 32.80%. Children who did not have names and surnames were given to them by the priest who baptised them.

Social and Medical Characteristics of Neonates Who Were Abandoned in a Tertiary Maternity Hospital in Turkey

OBJECTIVE

This study aimed to investigate the characteristics of neonates who were aban- doned in a tertiary maternity hospital and to determine the accompanying morbidities.

MATERIALS AND METHODS

This hospital-based, retrospective descriptive study was conducted by evaluating the medical records between 2012 and 2019 in a tertiary hospital in İzmir.

RESULTS

During the study period, there were 76 women who left their babies in the hospital following delivery. Median age of the mothers was 23 (range 12-44) years. Among them, 31.5% (n = 24) were below 18 years of age. Seventy-three of the pregnancies (96%) were unwanted, 67 of the mothers were unmarried (88.16%), of which 17 revealed a history of rape (22.36%), and 2 of them were victims of incest (2.63%). Thirty-six (47.36%) neonates were female and 36 of them (47.36%) were delivered by cesarean section. The mean gestational age was 37.3 ± 2.2 weeks and the mean birth weight was 2927 ± 572 g. Twenty-one (27.63%) babies were born prematurely and 15 (19.73%) had low birth weight. Four babies (5.26%) had hypoglycemia, 3 (3.94%) had hyponatremia, 5 (6.57%) had hypocalcemia, and 3 (3.94%) had hypomagnesemia.

CONCLUSION

Unwanted pregnancies were found to be one of the key reasons for newborn aban- donment and linked to a higher risk of complications for both mother and child. To prevent unintended pregnancy and its negative effects, it is important to ensure that all adolescents have access to high-quality education in a safe and supportive learning environment, school- based health services, and increase access to contraceptive services, including emergency contraception and safe and legal abortion services.

To Save a Girl-Child, You Must Train a Boy-Child: A Note on Situational Irony

Despite numerous initiatives and resources to save and protect the health and sexual rights of girls and women, the persistently high rate of unwanted pregnancy, abortion, and sexual violence in sub-Saharan Africa (SSA) has remain a topical public health challenge. This study hypothesised that the continuous conspicuous omission of boys/men in the interventions to combat this menace could be a long-life impediment to the realisation of sustainable health for girls and women in the region. The study adopted a systematic review of extant population-based published studies from Scopus, Google Scholars, PubMed, EMBASE, and AJOL. Literature coverage included the post-United Nations' coordinated International Conference on Population and Development (ICPD), Cairo, 1994, which marked the beginning of a massive campaign for women/girls sexual rights. The obtained qualitative data were appraised and synthesised towards spurring policy recommendations for gender balanced initiatives on the sexual and reproductive health rights in SSA. The study highlighted that unwanted pregnancy occurs only when a boy/man has unprotected sex with a girl/woman without considering her choice or rights. It is considered ironic that the dominant factors are boys and men but many enlightenment initiatives/campaigns are concentrated on girls and women. The study developed a schematic save-a-girl-child framework that illustrated the possible dividends inherent in the training of a boy-child to achieve a safer world for the girls/women. It recommends increase in the exposure of boys and men to sexual education and counselling, which can motivate them to be supporters of family planning, supporters of only wanted pregnancy, wanted fatherhood, marital fidelity, intimate partners' harmonious living rather than violence, and wife or partner empowerment.

Exploring the psychosocial challenges faced by pregnant teenagers in Ditsobotla subdistrict

Background

Pregnant teenagers usually experience psychosocial challenges such as a great amount of stress when they have to deal with an unwanted pregnancy, unpreparedness for parenthood and a lack of income as well as labour and birth complications. These are further complicated by the stigma from their families, friends and community. Unaddressed psychosocial challenges during teenage pregnancy can adversely affect the health outcomes of both mother and the child.

Aim

This study explores and describes the psychosocial challenges faced by pregnant teenagers in the Ditsobotla subdistrict.

Setting

The study was conducted in three health centres in the Ditsobotla subdistrict.

Methods

A qualitative-exploratory-descriptive and contextual research design was used. Non-probability purposive and convenience sampling techniques were used to select the participants. Semistructured individual interviews through WhatsApp video calls were used to collect data, which were analysed using conventional content analysis.

Results

Three themes emerged from the findings of the study, namely psychological challenges, social challenges and suggestions to address psychosocial challenges faced by pregnant teenagers.

Conclusion

The findings established that pregnant teenagers in the Ditsobotla subdistrict are faced with psychosocial challenges which negatively impact their psychological health and social life. Suggestions made in this study have the potential to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict if implemented.

Contributions

The findings of this study provide important information that may be used to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict.

Childhood and cultural evolution

Already in 1912, Sabina Spielrein addressed the transforming and antagonistic movements of life that appear from conception in her work 'Destruction as the cause of coming into being'. Her writings form a bridge between Freud and Jung, as they establish the relationship between biological experiences and archetypes. In 1974 Lloyd deMause examined the intrinsic link between primary relational experiences, brain development and the system of beliefs and values of the Sapiens species. He outlined the parallel between the transformation of child education and cultural evolution. Reflecting this theoretical approach, in child psychotherapy we have the peculiar opportunity of resorting to experiences during pregnancy and birth, to gain a deeper understanding of self-expressions in spontaneous drawings, dreams and sand scenes.

Low utilisation of postnatal care among women with unwanted pregnancy: A challenge for Bangladesh to achieve Sustainable Development Goal targets to reduce maternal and newborn deaths

Pregnancy complications are the major cause of maternal and newborn deaths in low- and middle-income countries that are more frequently associated with unintended pregnancy. The World Health Organization (WHO) recommends postnatal care (PNC) for women and their newborns within 24 hr of birth to prevent pregnancy complications and associated adverse outcomes. We, therefore, examined the relationship between unintended pregnancy and PNC use in Bangladesh. Data from 4,493 women and newborn dyads were extracted from the 2014 Bangladesh Demographic and Health Survey and analysed. PNC was classified as: no PNC; some level of PNC (either the woman or her newborn missed PNC within 24 hr of birth but had at least one PNC visit within 42 days of birth); and WHO's recommended level of PNC (at least one PNC use for both the woman and her child within 24 hr of birth). Pregnancy intention at conception for the last live birth was categorised as wanted, mistimed or unwanted. Multilevel multinomial logistic regression modelling was used to assess the association between pregnancy intention and PNC use, adjusting for possible confounders. We found around 27% of participants had adhered to WHO's PNC use recommendations. Around 26% of pregnancies that resulted in live births were unintended at conception, including 15% of which were classified as mistimed and 11% as unwanted. Following adjustment of confounders, a 37% (OR = 0.63, 95% CI: 0.47-0.85) lower odds of using WHO's recommended level of PNC and a 33% (OR, 95% CI, 0.49-0.93) lower odds of some level of PNC were found for pregnancies that were unwanted relative to those that were wanted. No association was found between mistimed pregnancy and PNC use. Strengthening healthcare facilities and improving the linkage between women and existing healthcare facilities are important to ensure WHO's PNC recommendations are met for women experiencing an unwanted pregnancy.

The perpetuating cycle of unplanned pregnancy: underlying causes and implications in Eswatini

Unplanned pregnancies constitute a major health problem globally carrying negative social, economic and health consequences for individuals and families. In this study, we explored the underlying causes and implications of this phenomenon in Eswatini, a country with high rates of unplanned pregnancy. Three focus group discussions were conducted in January 2018 with female health workers called mentor mothers, chosen because they offer a twofold perspective, being both Swati women and health workers in socially and economically disadvantaged settings. Using inductive thematic analysis, we identified five sub-themes and an overarching theme called 'the perpetuating cycle of unplanned pregnancy' in the data. A social-ecological model was used to frame the results, describing how factors at the individual, relationship, societal and community levels interact to influence unplanned pregnancy. In this setting, factors such as perceived low self-esteem as well as poor conditions in the community drove young women to engage in transactional relationships characterised by abuse, gender inequality and unprotected sex, resulting in unplanned pregnancy. These pregnancies led to neglected and abandoned children growing up to become vulnerable, young adults at risk of becoming pregnant unintendedly, thus creating an iterative cycle of unplanned childbearing.

Magnitude of Unintended Pregnancy and Associated Factors Among Pregnant Women in Debre Markos Town, East Gojjam Zone, Northwest Ethiopia: A Cross-Sectional Study

Background

Unintended pregnancy is an important public health concern in both developing and developed countries due to its serious consequences for women, infants, families and communities, including the risk of unsafe abortion, delayed prenatal care, poor maternal mental health, poor child health outcomes and unemployment.

Objective

The aim of the study was to assess the prevalence and associated factors of unintended pregnancy among pregnant women in the town of Debre Markos in 2019.

Methods

The magnitude and associated factors of unintended pregnancy were assessed using a community-based cross-sectional study design. A multi-stage sampling technique was used to select five Kebeles (basic administrative units), and households were selected from the selected Kebeles using simple random sampling. A total of 580 samples were collected through standardized pretested questionnaires. Bivariate and multivariate logistic regression were used to analyze the relationship between the UP and independent variables.

Results

Of the pregnant women, 202 (34.8%) (95% CI: 30.9-38.7) participants had an unintended current pregnancy; of those 144 (24.8%) were mistimed pregnancies. Women aged 24 years were three times more likely to have an unintended pregnancy than those aged 35 years. Divorced and widowed women were four times more likely than women who were currently married to experience an unintended pregnancy. Gravidity 1-2 and 3-4 were 94% and 86% less likely than gravidity > 5 to experience an unintended pregnancy, and women who made family planning decisions on their own were less likely to have an unintended pregnancy.

Conclusion

According to this study, the prevalence of unintended pregnancy was 34.8% and unintended pregnancy was significantly correlated with women's age, marital status, gravidity and who made decisions on family planning. There is an obvious need to devise communication strategies on fertility and contraceptive issues between couples through peer education, and to encourage correct use of long-acting modern methods of family planning.

Contraceptive knowledge among women at risk of unintended pregnancy in Kingston, Jamaica

Low contraceptive knowledge may limit contraception initiation or continuation and, consequently, could represent an important, modifiable cause of unintended pregnancy. The objective of this analysis was to identify correlates of knowledge among women at risk of unintended pregnancy. We analyzed data from a study of 222 young women attending a public clinic in Kingston in November 2018 to March 2019. We measured contraceptive knowledge with seven questions on method reversibility, ability to use covertly, contraindications, and side effects. We used multivariable linear regression to evaluate the correlates of summary knowledge scores and report beta coefficients, which represent differences in mean summary knowledge scores. The mean knowledge score was low (2.7; range = 0-7). Only 30.2% of the participants correctly identified intrauterine devices as more effective than oral contraception, male condoms, and withdrawal. Women who reported that their provider discussed contraception scored higher (adjusted ß = 0.37, p = 0.05) than those not reporting this. Women who perceived implants as very/mostly safe scored higher (adjusted ß = 0.45, p = 0.01) than those perceiving the device as mostly/very unsafe. Finally, compared to contraception non-users, women using less-effective contraception had a lower score (adjusted ß = -0.40, p = 0.04) while those using effective contraception did not differ in scores (ß = -0.30, p = 0.18). Overall, we found poor contraceptive knowledge among young women in Kingston. Providers appeared to hold an important role in women's understanding of contraception.

Assessment of Knowledge, Attitudes, and Practices Regarding Emergency-Contraception Methods among Female Dangila Hidase High School Students, Northwest Ethiopia, 2019

Background

Emergency contraception is used after intercourse and before potential implantation, offering women a last chance to prevent pregnancy after unprotected sexual intercourse.

Objective

This study aimed to assess knowledge, attitudes, and practices regarding emergency contraception among female students at Dangila Hidase high school in northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted among female students at Dangila Hidase high school from from May 1 to 30, 2019. Systematic random sampling was used to select study participants. There were 1,219 students in Dangila Hidase high school. Of these, 625 of them were female students. There were 346 female students in grade 9 and 279 students from grade 10. Samples were allocated proportionally to each grade. A pretested self-administered structured questionnaire was used. Data were entered into Epi Info 3.5 and exported to SPSS 24 for analysis.

Results

A total of 262 female students aged 16–19 years were approached, and the response rate was 100%. Among respondents who had heard about emergency contraceptive, pills were the most commonly known method 98, 51.4%) followed by intrauterine contraceptive devices 42, 22.1%). A total of 75 (58.6%) participants had knowledge of the recommended number of pills to be taken. Of the 190 (72.5%) respondents who knew about emergency contraception, 147, 77.4%) had favorable attitudes toward its use. Of those who had had sexual intercourse 70, 26.7%), only 20 (28.6%) had used emergency contraception.

Conclusion

Even though there is information available about emergency contraception, there is a gap with regard to the correct time of use. The positive attitudes of the respondents could be an indication of a fertile environment for possible interventions and reduction in maternal morbidity and mortality resulting from unwanted pregnancies and related complications.

Legal and Ethical Considerations in the Delivery of Sexual Health Care in Tanzania

Tanzania is a country with multiple sexual health challenges including high rates of HIV/STIs, early sexual debut, forced sex, sexual dysfunction, and teen pregnancy. Training in sexual health care is limited, while courses on how to address the ethical aspects of sexual health are non-existent. To address this gap, this paper explores legal and ethical challenges to providing sexual health care in Tanzania. First, we describe the sexuo-cultural and epidemiologic challenges, and the key laws regulating sexual health. Six case studies identify ethical dilemmas in healthcare delivery. They are: (a) how to address sexual and intimate partner violence; (b) treatment of illegal or stigmatized key populations; (c) treatment of couples in HIV serodiscordant, non-monogamous, and/or polygamous relationships; (d) requests for and participation in illegal healthcare; (e) treatment of women and children in the presence of their husbands and fathers; and (f) addressing child sexual abuse. We apply the ethical principles of autonomy, justice, beneficence and non-malfeasance. A second challenge is ensuring confidentiality in a setting where medical record keeping practices vary widely, and violations to confidentiality are perceived as common. Finally, we identify a set of best practices in sexual healthcare delivery tailored to the Tanzanian context.

Correlates of Socio-Demographic Variables and Attitude to Condom Use in HIV/AIDS Prevention among Students in Some Selected Nigerian Universities

Background

Unprotected heterosexual sexual act has been correlated with unwanted pregnancy and sexually transmitted diseases (STDs) especially HIV/AIDS, which still has a high endemicity in Africa. This study aimed to determine the association between socio-demographic variables (SDVs), sexual experience, and the use of condom.

Setting and Design

This was a cross-sectional study comprising 542 undergraduate students, randomly selected from three Nigerian universities.

Methodology

Well-structured open-ended questionnaires were administered to respondents. Bivariate analysis was used to determine the association between SDVs and attitude to condom use and between the SDVs, sexual experience and the use of condom. Data were analyzed using Epi6 6.04 and SPSS 10.0 software packages. Pearson's Chi-square (χ²) and Fisher's exact tests were used as applicable. The level of significance was set at P < 0.05.

Results

Approximately 46% of the respondents were sexually active (consisting of about 71% of those 25-29 years old and 58% of the males [P < 0.001]). About 50.4% had a single sexual partner and 86.7% had "ever used" condom. The most common reasons given for use of condom were prevention of pregnancy (91.7%) and STDs (89.1%). All the SDV except religion significantly (P < 0.05) accounted for the disparity in sexual attitudes of the students. Those aged 25 years and above, males and Tiv tribe were more likely to indulge in sexual activities (P < 0.001). More females (98%) compared to males (83%) had ever used condom in their sexual experience (P = 0.010), while there was no significant association between any of the SDVs and use of condom in the last sexual exposure (P > 0.05).

Conclusion

SDVs play a role in determining the attitude of students towards condom use and sexual experiences. Programs regarding sexual and reproductive health including safe sex education especially among young Nigerian students should be developed or strengthened.

The Prevalence and Causes of Unwanted Pregnancy Among Woldia University Undergraduate Female Students: Implications for Psychosocial Intervention

Globally Unwanted pregnancy is a health related problem that affects girls, their families and social order. Of an estimated 210 million pregnancies that take place in the world each year, 38% are unwanted, out of which 22% end up with abortion. Unwanted pregnancy among teenagers is a serious risk health related problem in Ethiopia. Therefore, the aim of this study was to assess the prevalence and causes of unwanted pregnancy in Woldia University. 121 graduating class of technology Faculty, students was selected by using availability (convenient) sampling techniques. Questionnaire having both open ended and close ended items was developed and administrated for participants. The research was mixed in its nature, including both quantitative and qualitative approaches. The findings of this survey indicated that the bulk of the respondents were using whatever type of contraceptive methods like condom and oral contraceptives.Majorities of them used their allies as the major source of data. From the participants of this study, the majority of them have been fraught. Drinking alcohol and peer pressure were mentioned as a major cause of unwanted pregnancy. The majority of students have experienced an unwanted pregnancy in their campus life, but too little attention given by the university. Thus, university gender directorate office, student union, spiritual leadership, student dean and counselors should work together to minimize the trouble.

Contraception: what is the resistance all about?

PURPOSE

The aim of this study is to identify the aspects associated with resistance to contraception, providing healthcare workers with the necessary tools to increase compliance with contraception and, ultimately, reduce the rate of voluntary abortions.

MATERIAL AND METHODS

We performed a review of the literature published in Medline between 1st January 2000 and 31st July 2020. We included studies based on qualitative analyses, describing women's perception and attitudes towards contraception, including a population aged 15 years or older and conducted in either Europe or North America.

RESULTS

A total of 23 articles were included in the study. Resistance to contraceptive uptake was most frequently due to ambivalence about pregnancy, with up to 54% of ambivalent women reporting not using any means of contraception, and communication issues with the partner and/or health care provider, with a positive association found between communication with the partner and contraceptive use (OR 1.07; p < .050). Additional barriers to contraceptive use were the quality of the relationship with the partner, the perception of the risk of becoming pregnant after unprotected sexual intercourse, and unfamiliarity with contraception.

CONCLUSIONS

Family planning consultations should acknowledge the aspects that influence contraceptive uptake and address them as part of their consultations.

Having a child without wanting to? Estimates and contributing factors from a population-based survey in Sweden

Aims:

The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence.

Methods:

We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors.

Results:

Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective.

Conclusions:

Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions.

Factors affecting the decision to undergo abortion in Romania: Experiences at our clinic

RATIONALE, AIMS, AND OBJECTIVES

It is estimated that 25% of pregnancies worldwide end in induced abortion. In Romania, the abortion situation shows a specific pattern. Following the fall of the communist regime, first-trimester abortions were legalized, and between 1990 and 1992, the country's abortion rate was the highest in the world, with 182 abortions per 1000 women of reproductive age. However, there are currently no statistically reliable data, as some abortions are not reported. The purpose of this study was to identify the main circumstances that determine the choice to undergo abortion with all related potential risks, rather than using contraception.

METHOD

We conducted a prospective type 1 cohort study based on a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement that included women who presented at Bucur Maternity, Saint John Hospital, Bucharest, for abortion during the first trimester, between July and December 2018. The patients were asked to complete a 21-item questionnaire based on psychosocial data.

RESULTS

The study included 119 patients, with a mean age of 29.57 years. Their educational level was average (ie, 51.3%, 4.2%, and 8.4% had completed high school, elementary school, and college or university, respectively). Most women were married (46.2%), and 47.9% were unemployed. The main reason for deciding to undergo an abortion was poverty (P = .014), and guilt was correlated with this decision (P = .004).

CONCLUSION

The profiles of the women who chose to undergo an abortion as a family planning method were as follows: in the third decade of life, resident of urban areas, married, unemployed, and with a low family income. The main reasons for abortion were financial status, advanced maternal age, incompatibility of pregnancy with future plans, and the desire to postpone conception.

Contraceptive use at the time of and after an ectopic pregnancy: a retrospective cohort study

Objectives: Approximately, 1-2% of all pregnancies are ectopic; 25% of unintended pregnancies are conceived despite the use of contraception. The primary objective of our study was to explore the proportion of ectopic pregnancies (EPs) that were conceived during contraceptive use among women in Stockholm County. Secondary objectives were to establish the prevalence of contraceptive methods used at the time of EP and the intended contraceptive method after treatment completion.Methods: We performed a retrospective cohort study of 1180 women diagnosed with and treated for EP between 1 December 2013 and 30 April 2017 at all hospitals in Stockholm County. Demographic variables and contraceptive use before and after treatment were noted. Exclusion criteria were uncertainty about the diagnosis of EP in the patient records and planned treatment/follow-up outside Stockholm County.Results: A total of 222/1180 (18.8%) EPs were conceived during known contraceptive use. A total of 112/222 (50.5%) women with known use of contraception at the time of conception discontinued contraceptive use and 81/857 (9.5%) women with no prior use of contraception initiated contraceptive use. Among the 857 women, 520 (60.7%) expressed a desire to conceive. Results were compared using the Mann-Whitney U test or Fisher's exact test as appropriate.Conclusion: EP occurring during use of contraception is an unexplored problem. Contraceptive use decreased in women who were using contraception at the time of EP conception, leaving these women at risk of a subsequent unintended pregnancy. There should be more focus on contraceptive use after treatment for EP, in order to preserve fertility.

Infanticide in Senegal: results from an exploratory mixed-methods study

This article presents formative research on the practice of infanticide, the intentional killing or fatal neglect of a child less than one-year-old. We hypothesised that the abortion law in Senegal, one of the most restrictive in the world, contributes directly to the incidence of infanticide. We conducted a quantitative survey of 1016 women of reproductive age living in Senegal, and in-depth interviews with a sub-sample of 28 participants. Quantitative survey data were analysed to describe the frequencies, means, and ranges of key outcome variables. Qualitative data were analysed using modified grounded theory to identify key themes in the data. Awareness of infanticide was moderately high (60.3%) in the survey sample, and was primarily obtained through personal experience, rumours, and/or the media. Participants described two broad categories of infanticide, including passive infanticide through abandonment of the infant, versus active infanticide through suffocation, drowning or other means. Participants explicitly viewed infanticide as a direct result of the severe legal restrictions on abortion in Senegal, as well as the powerful social norms that dictate what is considered acceptable versus unacceptable childbearing in the country. Findings support the hypothesis that abortion laws and policies contribute to the occurrence of infanticide in Senegal, and suggest the need for additional, targeted research to better understand this link, and how findings can be used to inform policy reform.

Effect of counselling on maternal-fetal attachment in unwanted pregnancy: a randomised controlled trial

Purpose: The present study aimed to determine the effect of group counselling on Maternal-Fetal Attachment (MFA) in mothers with unwanted pregnancy.Methods: This study was a randomised clinical trial. The participants were 80 mothers with unwanted pregnancy during 28-34 weeks of pregnancy who referred to health centres of Karaj to receive prenatal care in 2018. The women were randomly assigned into intervention (N = 40) and control groups (N = 40). The intervention group received four weekly group counselling sessions to promote MFA and the control group received routine care. Cranley's Maternal-Fetal Attachment Scale was used to assess the attachment of mother to fetus at baseline and two weeks after counselling. An ANCOVA test was performed to evaluate the effect of intervention and the number of parity.Results: There was no significant difference between the two groups in terms of general health scores and attachment of mother to fetus at baseline, but after the intervention, the mean scores of MFA in the intervention group had a significant difference with the control group (p < 0.001); the ANCOVA test indicated that attachment scores were significant in terms of intervention and pregnancy group and attachment scores indicated further increase in the primipara group compared to the multipara group (p = 0.041).Conclusion: Considering the effectiveness of group counselling in improving MFA in unplanned pregnancy, it can be used in prenatal care.

Intimate Partner Violence and the Sexual and Reproductive Health Outcomes of Women in Ghana

Few studies have examined the relationships between intimate partner violence (IPV) and the sexual and reproductive health outcomes of women in sub-Saharan countries in general and Ghana specifically. This study began to fill the gap by investigating whether individual- and community-level IPV influenced unwanted pregnancy and pregnancy loss among women in Ghana. Nationally representative cross-sectional data were collected from 2,289 ever-married women, and multilevel modeling was used to estimate individual- and community-level effects. At the individual level, IPV was significantly associated with unwanted pregnancy and pregnancy loss. Women with experience of both physical and sexual violence were more likely to have reported an unwanted pregnancy and a pregnancy loss. However, only those experiencing sexual violence reported unwanted pregnancies. Similarly, community-level IPV was associated with sexual health outcomes. Respondents in communities with higher levels of sexual violence were significantly more likely to have had unwanted pregnancies. The findings corroborate calls for policy makers to consider IPV a reproductive health issue. They also emphasize the need to move beyond individual-level interventions to consider structural and community contexts when addressing the sexual and reproductive health outcomes of women in Ghana.

Knowledge and Parity: Perspectives of Usage of Emergency Contraceptive Pills among Women of a Rural Area of Delhi

Context:

Correct use of emergency contraceptive pills (ECPs) may prevent up to 95% of unwanted pregnancies which may significantly decrease unsafe abortions and maternal mortality.

Aims:

Assessment of knowledge and use of ECPs among women and to explore factors associated with them.

Materials and Methods:

This was a facility-based cross-sectional study. Data were collected using a prestructured, pretested questionnaire from 381 reproductive age women (15–49 years) selected by systematic random sampling. Statistical Package for the Social Sciences version 16 and Epi info (version 7.0.) were used for all statistical analyses. Descriptive analysis was performed, and results were expressed in terms of frequencies and percentages. The Chi-square and Fisher's exact test were used as tests of significance in univariate analysis. Determinants of use of ECPs were identified using logistic regression.

Results:

Of 381 women interviewed, awareness level of ECPs (ever heard about ECPs) was found to be 34% (n = 128). Ever use of emergency contraception was reported by 38 (9.7%). Age (odds ratio [OR] = 3.02, 95% confidence interval [CI] [1.88–4.87]), education (OR = 0.086, 95% CI [0.047–0.158]), husband's education (OR = 0.11, 95% CI [0.067–0.187]), socioeconomic status (OR = 6.14, 95% CI [3.28–11.51]), and family status (OR = 2.6, 95% CI [1.59–4.24]) were found to be significantly associated with the use of emergency contraceptives.

Conclusions:

The study identified that most respondents lack adequate knowledge about ECPs, and ever use of ECPs was very low. Factors that were associated with the use of ECPs were age, literacy, socioeconomic status, and knowledge about the method. Creating a sustainable awareness on ECPs and their use may serve them with power to control their parity.

Effects of Carrying an Unwanted Pregnancy to Term on Women's Existing Children

OBJECTIVE

To examine how receiving or being denied a wanted abortion affects the subsequent development, health, caregiving, and socioeconomics of women's existing children at time of seeking abortion.

STUDY DESIGN

The Turnaway Study is a 5-year longitudinal study with a quasi-experimental design. Women were recruited from January 2008 to December 2010 from 30 abortion facilities throughout the US. We interviewed women regarding the health and development of their living children via telephone 1 week after seeking an abortion and semiannually for 5 years. We compare the youngest existing children younger than the age 5 years of women denied abortion because they presented for care beyond a facility's gestational limit (Turnaway group) with those of women who received the abortion (Abortion group). We used mixed-effects regression models to test for differences in outcomes of existing children of women in the Turnaway group (n = 55 children) compared with existing children of women in the Abortion group (n = 293 children).

RESULTS

From 6 months to 4.5 years after their mothers sought abortions, existing children of women denied abortions had lower mean child development scores (adjusted β -0.04, 95% CI -0.07 to -0.00) and were more likely to live below the Federal Poverty Level (aOR 3.74, 95% CI 1.59-8.79) than the children of women who received a wanted abortion. There were no significant differences in child health or time spent with a caregiver other than the mother.

CONCLUSIONS

Denying women a wanted abortion may have negative developmental and socioeconomic consequences for their existing children.

Hormonal contraception used by adolescents and the risk of thromboembolic disease

This article summarizes the basic options for contraceptive security of adolescent girls, including benefits and risks of hormonal contraception. It also draws attention to the broader social context of unwanted pregnancies in this age group. Points out the main aspects of the care for young people and the most common health problems influencing use of contraceptives. Second part deals in detail with pathogenesis of thromboembolic disease and analyzes the major risk factors for its occurrence. It discusses the relationship between thrombophilic mutations to hormonal treatment and presents prescribing recommendations for risk groups of women. This text mainly underlines that the emergence of thromboembolism is multifactorial. Keywords: adolescent girl, unwanted pregnancy, hormonal contraception, risk factors of thromboembolism, prescribing recommendations.

Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health

BACKGROUND

Twenty states currently require that women seeking abortion be counseled on possible psychological responses, with six states stressing negative responses. The majority of research finds that women whose unwanted pregnancies end in abortion do not subsequently have adverse mental health outcomes; scant research examines this relationship for young women.

METHODS

Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed. Population-averaged lagged logistic and linear regression models were employed to test the relationship between pregnancy resolution outcome and subsequent depressive symptoms, adjusting for prior depressive symptoms, history of traumatic experiences, and sociodemographic covariates. Depressive symptoms were measured using a nine-item version of the Center for Epidemiologic Studies Depression scale. Analyses were conducted among two subsamples of women whose unwanted first pregnancies were resolved in either abortion or live birth: (1) 856 women with an unwanted first pregnancy between Waves 2 and 3; and (2) 438 women with an unwanted first pregnancy between Waves 3 and 4 (unweighted n's).

RESULTS

In unadjusted and adjusted linear and logistic regression analyses for both subsamples, there was no association between having an abortion after an unwanted first pregnancy and subsequent depressive symptoms. In fully adjusted models, the most recent measure of prior depressive symptoms was consistently associated with subsequent depressive symptoms.

CONCLUSIONS

In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.

Unwanted pregnancy, pregnancy loss, and other risk factors for intimate partner violence in the Democratic Republic of the Congo

The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.

Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: An expert roundtable discussion

BACKGROUND

Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low.

AIM

To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers.

METHOD

A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use.

RESULTS

Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required.

CONCLUSIONS

Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate.

The Effects of Gender-based Violence on Women's Unwanted Pregnancy and Abortion

The aim of this research is to understand how gender-based violence across the life-course affects the likelihood of abortion. Women outpatients (n = 309) revealed their exposure to four different forms of gender-based abuse: child sexual abuse (25.7 percent), teenage physical dating violence (40.8 percent), intimate partner violence (43.1 percent), and sexual assault outside an intimate relationship (22 percent). Logistic regressions revealed that no single form of gender-based abuse predicted abortion. The cumulative effect of multiple forms of abuse did increase the odds of having an abortion (OR = 1.39, CI = 1.13-1.69). Child sexual abuse predicted intimate partner violence (OR = 6.71, CI = 3.36-13.41). The cumulative effect of gender-based violence on women's reproductive health warrants further research. Priority should be given to screening for multiple forms of victimization in reproductive healthcare settings.

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

INTRODUCTION

Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception.

METHODS

This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value <0.05 was considered statistically significant.

RESULTS

27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928).

CONCLUSION

Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.

Prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant females in Kampala, Uganda: a facility based cross-sectional study

BACKGROUND

Sexual coercion is associated with sexually transmitted infections and unwanted pregnancies with consequential unsafe abortions and increased maternal morbidity and mortality. Current literature focuses mainly on its risk factors but less on its resultant deleterious health effects. We conducted a study to determine the prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant women.

METHODS

In a cross-sectional study, four hundred and sixteen (416) consenting pregnant females aged 15-24 years attending antenatal clinics in Lubaga division Kampala district in Uganda were enrolled using systematic sampling. Quantitative and qualitative data on sexual coercion were collected by female interviewers. Adjusted Prevalence Proportion Ratios (Adj. PPRs) of unwanted pregnancy and associated 95 % confidence intervals were estimated by generalized linear models with log link function and Poisson family distribution using robust variance estimator. Quantitative data were analyzed using Stata version 10.0, while qualitative data were analyzed using manifest content analysis.

RESULTS

Prevalence of sexual coercion was 24 % and was higher among those who had non consensual sexual debut (29.0 %) compared with those who had consensual sexual debut (22.6 %). The prevalence of unwanted pregnancy was 18.3 % and was higher among participants who had been sexually coerced relative to their counterparts (p < 0.001). History of sexual coercion in the past 12 months and non consensual sexual debut were associated with unwanted pregnancy [adj.PPR = 2.23, 95 % CI: (1.49-3.32)] and 1.72, 95 % CI: (1.16- 2.54)] respectively. Qualitative results indicated that different forms/contexts of sexual coercion, such as deception, transactional sex and physical force influenced unwanted pregnancies.

DISCUSSION

This study highlights that a quarter of our participants in our quantitative study had experienced sexual coercion in the past twelve months and nearly a third of these, had history of non consensual sexual debut. Unwanted pregnancy was higher among the sexually coerced and those who had non consensual sexual debut.

CONCLUSION

Sexual coercion among pregnant women aged 15-24 years in Kampala, Uganda is high and is significantly associated with unwanted pregnancy. Comprehensive sex education targeting young people (<25 years), along with availability and access to youth friendly centers may be useful in addressing sexual coercion and its negative outcomes.

Public reproductive health and 'unintended' pregnancies: introducing the construct 'supportability'

In this Perspectives paper, I outline the limitations of the concept of 'intentionality' in public reproductive health understandings of pregnancy. 'Intentionality', 'plannedness', 'wantedness' and 'timing' place individual cognitions, psychology and/or behaviors at the center of public health conceptualizations of pregnancies, thereby leaving the underlying social and structural dynamics under-examined. I propose a model that places 'supportability' at the center of thinking about pregnancies and that allows for an analysis of the intersection of individual cognitions, emotions and behavior with micro-level interactive spaces and macro-level issues.

Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden

Objective

To evaluate the cost‐effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy.

Design

Cost‐effectiveness model using efficacy and discontinuation data from published articles.

Setting

Societal perspective including direct and indirect costs.

Population

Women at risk of unintended pregnancy using reversible contraception.

Methods

An economic analysis was conducted by modeling the different health states of women using contraception over a 3‐year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching.

Main outcome measures

Cost‐effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality‐adjusted life‐year was calculated.

Results

Levonorgestrel intrauterine system 13.5 mg generated costs savings of €311 000 in a cohort of 1000 women aged 15–44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception.

Conclusion

Levonorgestrel intrauterine system 13.5 mg is a cost‐effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long‐acting reversible contraception methods could result in fewer unintended pregnancies, quality‐adjusted life‐year gains, as well as cost savings.

Fertility desires, unmet need for family planning, and unwanted pregnancies among HIV-infected women in care in Kinshasa, DR Congo

Introduction

We assessed the fertility desires, utilization of family planning (FP) methods, and incidence of pregnancies among HIV-infected women receiving care in an HIV clinic with an onsite FP services in Kinshasa, Democratic Republic of Congo.

Methods

Between November 2011 and May 2012, all HIV-infected women who attended a routine visit at the clinic were interviewed about their fertility desires and utilization of contraceptive methods using a structured questionnaire. Routine follow-up visit data were used to identify pregnancies recorded between the interview and June 2013.

Results

Overall, of the 699 HIV-infected women interviewed. 249 (35.7%) reported not wanting another child. Of the 499 (72.2%) participants who were sexually active at the time of interview, 177 (35.5%) were using an effective contraceptive method, including 70 (14.0%) women who reported using condoms consistently and 104 (20.8%) who were using injectable contraception. Overall, 88 (17.6%) sexually active participants who did not want another child were not using an effective FP method, and thus are considered to have had unmet need. During the median follow-up time of 22.2 (IQR: 20.2, 23.6) months, among all women interviewed, 96 (14.1%) became newly pregnant [pregnancy rate 9.3 (95%CI: 7.6, 11.4) per 100 women-years] including 21 (8.7%) among women who initially reported not wanting another child [unwanted pregnancy rate 5.8 (95%CI: 3.6, 9.3) per 100 women-years].

Conclusion

The persistence of relatively high unmet need among women receiving HIV care in a clinic with onsite FP services suggests the existence of barriers that must be identified and addressed.

Iranian Azeri women's perceptions of unintended pregnancy: A qualitative study

BACKGROUND

Many women, throughout their life cycle, experience unintended pregnancy and its subsequent induced abortion. Nonetheless, women's perceptions of this phenomenon - particularly in countries prohibiting elective abortion - are poorly known. The aim of this study was to explore Iranian Azeri women's perceptions of unintended pregnancy.

MATERIALS AND METHODS

This was a conventional content analysis study conducted in Tabriz, Iran. The data were collected through 31 semi-structured interviews with 23 women who had recently experienced an unintended pregnancy. The study participants were recruited using the purposive sampling method. Sampling started in March 2013 and continued until reaching data saturation, i.e. till August 2013. Data analysis was carried out concurrently with data collection. MAXQDA 10.0 software was employed for managing the study data.

RESULTS

The study data analysis process yielded the formation of three main themes including negative effects of unintended pregnancy on daily life, fear of being stigmatized with violating social norms, and abortion panic, which in turn constituted the broader overarching theme of "threat supposition." In other words, following an unintended pregnancy, the study participants had experienced different levels of fear and threat depending on their personal, family, and socio-cultural backgrounds.

CONCLUSIONS

Women perceive unintended pregnancy as a challenging and threatening situation. An unintended pregnancy can threaten women's lives through social deprivations, growing instability, and putting both mother and baby at risk for physical and psychosocial problems. On the other hand, an unsafe illegal abortion could have potentially life-threatening complications. To cope with such a situation, women need strong social support. Healthcare providers can fulfill such women's need for support by developing pre-abortion counseling services and providing them with professional counseling. Also, strengthening women's support system by policy-makers is recommended.

Early sex initiation and subsequent unsafe sexual behaviors and sex-related risks among female undergraduates in Wuhan, China

This study aims to explore the association between early sex initiation and subsequent unsafe sexual behaviors and risks among Chinese female undergraduates. Of 4769 participants, 863 (18.1%) reported ever having sexual intercourse. The mean age of sexual debut was 19.3 (±1.7) years. Females initiating sex earlier were more likely to have first sex with men who were not their "boyfriends" and less likely to take contraception, to use a condom at first encounter, to use contraception consistently in past year, and/or to use condom consistently during the course of a sexual intercourse. They were more likely to have multiple lifetime and concurrent sexual partners, to report pregnancy, and be diagnosed with sexually transmitted diseases. Comprehensive early sex education should be advocated for young people, not only teaching knowledge of physical health but also providing practical skills training for making them consciously delay start of sexual activity or protecting themselves during sexual intercourse.

Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women

BACKGROUND

Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort.

OBJECTIVE

Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status.

RESULTS

Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29).

CONCLUSION

Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.

High Educational Aspirations Among Pregnant Adolescents Are Related to Pregnancy Unwantedness and Subsequent Parenting Stress and Inadequacy

On the basis of theories of maternal identity development, role conflict, and childbearing motivation, the authors tested whether high educational aspirations among pregnant adolescents are related to the unwantedness of the pregnancy and whether pregnancy unwantedness leads to subsequent parenting stress and inadequacy. Longitudinal data from 100 first-time-pregnant, unmarried Latina adolescents (M age = 17.3 years) were analyzed. Results from structural equation path modeling confirmed these associations, with strong educational ambitions related to greater unwantedness of the pregnancy, which led to feeling trapped by parenting at 6 months postpartum, which in turn was related to unaffectionate parenting and feeling inadequate in mothering at 1 year postpartum. The potential long-term negative consequences of high educational aspirations for pregnant adolescents' adjustment to parenting are discussed.

Key determinants of induced abortion in women seeking postabortion care in hospital facilities in Ouagadougou, Burkina Faso

Introduction

Despite the universal recognition of unsafe abortion as a major public health problem, very little research has been conducted to document its precipitating factors in Burkina Faso. Our aim was to investigate the key determinants of induced abortion in a sample of women who sought postabortion care.

Materials and methods

A cross-sectional household survey was carried out from February to September 2012 in Ouagadougou, Burkina Faso. Data of 37 women who had had an induced abortion and 267 women who had had a spontaneous abortion were prospectively collected on sociodemographic characteristics, pregnancy and birth history, abortion experience, including previous abortion experience, and selected clinical information, including the type of abortion. A two-step regression analysis consisting of a univariate and a multivariate logistic regression was run on Stata version 11.2 in order to identify the key determinants of induced abortion.

Results

The findings indicated that 12% of all abortions were certainly induced. Three key factors were significantly and positively associated with the probability of having an induced abortion: whether the woman reported that her pregnancy was unwanted (odds ratio [OR] 10.45, 95% confidence interval [CI] 3.59–30.41); whether the woman reported was living in a household headed by her parents (OR 6.83, 95% CI 2.42–19.24); and if the woman reported was divorced or widowed (OR 3.47, 95% CI 1.08–11.10). On the contrary, being married was protective against induced abortion, with women who reported being married having an 83% (OR 0.17, CI 0.03–0.89) lower chance of having an induced abortion, even when the pregnancy was unwanted.

Conclusion

This study has identified three major determinants of induced abortion in Ouagadougou, Burkina Faso. Improved targeted programs on family planning counseling, methods of contraception, and availability of contraceptives should be widely promoted.

Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort

OBJECTIVE

To assess the relationship between unintended pregnancy and postpartum depression.

DESIGN

Secondary analysis of data from a prospective pregnancy cohort.

SETTING

The study was performed at the University of North Carolina prenatal care clinics.

POPULATION/SAMPLE

Pregnant women enrolled for prenatal care at the University of North Carolina Hospital Center.

METHODS

Participants were questioned about pregnancy intention at 15-19 weeks of gestation, and classified as having an intended, mistimed or unwanted pregnancy. They were evaluated for postpartum depression at 3 and 12 months postpartum. Log binomial regression was used to assess the relationship between unintended pregnancy and depression, controlling for confounding by demographic factors and reproductive history.

MAIN OUTCOME MEASURES

Depression at 3 and 12 months postpartum, defined as Edinburgh Postpartum Depression Scale score >13.

RESULTS

Data were analysed for 688 women at 3 months and 550 women at 12 months. Depression was more likely in women with unintended pregnancies at both 3 months (risk ratio [RR] 2.1, 95% confidence interval [95% CI] 1.2-3.6) and 12 months (RR 3.6, 95% CI 1.8-7.1). Using multivariable analysis adjusting for confounding by age, poverty and education level, women with unintended pregnancies were twice as likely to have postpartum depression at 12 months (RR 2.0, 95% CI 0.96-4.0).

CONCLUSION

While many elements may contribute to postpartum depression, unintended pregnancy could also be a contributing factor. Women with unintended pregnancy may have an increased risk of depression up to 1 year postpartum.