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Unintended Pregnancy All pregnancies should be intended that is, they should be consciously and clea

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Title: Unintended Pregnancy All pregnancies should be intended that is, they should be consciously and clea


1
Unintended Pregnancy All pregnancies should be
intended-that is, they should be consciously and
clearly desired at the time of conception.-
IOM Committee on Unintended Pregnancy

Perinatal Forum May 17, 2004
2
Intendedness question
  • Thinking back to just before you were
    pregnant, how did you feel about becoming
    pregnant?
  • You wanted to be pregnant sooner
  • You wanted to be pregnant later
  • You wanted to be pregnant then
  • You did not want to be pregnant then or any time
    in the future

3
Potential effects on response rates to
intendedness question
  • Individual-Level Effects
  • Misunderstand what is being asked
  • Language
  • Comprehension
  • Not able to answer
  • May refuse because question is intrusive
  • May refuse because suspicious of system
  • Interviewer Effects
  • Not explain purpose of questions
  • Not ask question directly
  • Interviewer uncomfortable with question
  • Poor practices/ not following protocol

4
Response Categories
  • Women were defined as having valid responses
    if they answered that their pregnancies were
  • Wanted sooner
  • Wanted later
  • Wanted then
  • Not wanted at all
  • In addition, women were classified as Dont
    Know if they indicated that they were unsure of
    their intentions at conception.
  • Finally, women were also classified as Refused
    if they refused the question, and Missing if no
    answer was recorded.

5
Refusing this question is associated with
refusing other questions...
51 of the women who refused to answer the
intendedness question refused to answer at least
one the other questions
6
Most women who were missing this question were
also missing the others...
98 of women missing the intendedness question
also were missing the other questions
7
Implications
Current ascertainment of unintended pregnancy
may seriously underreport those groups with or at
high risk for poor outcome, potentially diluting
the observed associations between intendedness at
conception and perinatal outcome.
8
Contraception use among American women, 1995
Source National Survey of Family Growth, 1995
9
Contraception Failure Rates, 1995After 12 months
of use
Family Planning Perspectives, volume 31, No. 2,
March/April 1999 , Contraceptive Failure Rates
New Estimates From the 1995 National Survey of
Family Growth, By Haishan Fu, Jacqueline E.
Darroch, Taylor Haas and Nalini Ranjit
10
Defining unintended pregnancy(from the IOM and
NSFG)
  • Intended pregnancies
  • Wanted at the time of conception, regardless of
    use of contraception at the time. Women who
    indicate they wanted to be pregnant sooner, or at
    that time, are considered to have intended
    pregnancies.
  • Unintended pregnancies
  • Not wanted at the time conception occurred,
    regardless of contraception.

11
Defining unintended pregnancy
  • Unintended pregnancy categories
  • Unwanted pregnancies
  • Conception occurred when the woman did not want
    pregnancy at any time in the future.
  • Mistimed pregnancies
  • Conception occurred at a time when the woman did
    not plan to become pregnant, although she may
    have planned to do so in the future

12
Data Sources for Unintended Pregnancy Information
  • National Survey of Family Growth (US)
  • Pregnancy Risk Assessment Monitoring System
    (PRAMS) Project (NYS)
  • Regional Perinatal Data System (FLR)
  • NYS Vital Statistics - induced abortions

13
Ever had an unintended pregnancy? US women age
15-44, 1995
  • Source NSFG 1995

14
What is the basis for considering unintended
pregnancy one of our leading public health
problems?
  • Magnitude/ frequency of occurrence
  • Breadth of populations affected
  • Association with significant maternal and child
    morbidity
  • Costs to the public/private health care system
  • Sensitivity to primary prevention

15
Impact of unintended pregnancy on physical
violence
  • women with unwanted or mistimed pregnancies had
    a higher prevalence of physical violence than did
    women with intended pregnancies, regardless of
    other characteristics.

14
12
10
8
6
4
2
0
Not
Not
wanted
16
Impact of unintended pregnancy on depression
  • A gap persists in the rate of depression among
    women giving birth to unwanted babies during
    pregnancy, at delivery, and six months
    post-partum.

pregnancy
after birth
pregnancy
after birth
17
Impact of unintended pregnancy on child
development
  • Pre-schoolers who were unintended at conception
    were 1) less likely to receive skills
    development opportunities, 2) less likely to have
    positive MCH relationships, and 3) scored lower
    on vocabulary scales, than did their intended
    counterparts.

18
Healthy People 2010 Objective 9.1 Increase to
70 the proportion of pregnancies that are
intended.
19
Progress Toward Healthy People 2010 Objective
9.1 In 2000 in the Finger Lakes region, 54 of
pregnancies were intended.
20
Pregnancy Intention in the United States, 1995
15.5 of pregnancies were mistimed and
resulted in a live birth
25.1 of pregnancies were mistimed and unwanted
and resulted in abortion
7.6 of pregnancies were unwanted and resulted
in a live birth
51.7 of pregnancies were intended and resulted
in live birth
21
Pregnancy intention in New York (not including
NYC) , 1999
27.3 of pregnancies were mistimed and resulted
in a live birth
20 of pregnancies were mistimed and unwanted
and resulted in abortion
44.9 of pregnancies were intended and resulted
in a live birth
7.8 of pregnancies were unwanted and resulted
in a live birth
22
Intended and unintended pregnancies, FLR, 1999
14 of pregnancies were mistimed and resulted in
a live birth
20.9 of pregnancies were mistimed/ unwanted and
resulted in abortion
4.6 of pregnancies were unwanted and resulted in
a live birth
42.6 of pregnancies were Intended and resulted
in a live birth
23
Summary Unintended pregnancy in US, NYS (not
NYC), FLR(percent)
24
Demographic associations with unintended
pregnancies which result in a live birth
25
Unintended pregnancy by 5-year age category, FLR,
1998-2003
20-24
15-19
25-29
30-34
35-39
40-44
45
Not Wanted
26
Unintended pregnancy and maternal race, FL 1998 -
2003
27
Unintended pregnancy and prenatal public program
participation, FL, 1998 2003
28
Unintended pregnancy and maternal education, FL
1998 - 2003among women age 20 and over
29
Unintended pregnancy and prenatal public program
participation, FL, 1998 2003
30
Prenatal behaviors
  • Women with unintended pregnancies receive
    prenatal care later than women with intended
    pregnancies
  • Women with unintended pregnancies use alcohol,
    tobacco, and other drugs more frequently than
    women with intended pregnancies

31
Unintended pregnancy and early prenatal care
entry, FL, 1998 - 2003
starting prenatal care during first trimester
32
Drug use and unintended pregnancy, FL, 1998 - 2003
33
Alcohol use and unintended pregnancy, FLR,
1998-2003(percent)
34
Smoking and unintended pregnancy, FL, 1998-2003
35
Summary and Conclusions
36
Women at risk for unintended pregnancy
  • Mistimed and unwanted pregnancies occurred in
    every demographic group (by age, race, education)
  • Younger women are at higher risk of mistimed
    pregnancies
  • Older women are at higher risk of unwanted
    pregnancies

37
The average woman with an unintended pregnancy
which resulted in birth...
  • Was not a teenager
  • Was of white, non-Hispanic heritage
  • Had Medicaid coverage
  • Had at least one pregnancy prior to this one
  • Lived in a non-urban area

38
Outcomes
  • Infants born to women whose pregnancies were
    unintended are more likely to be
  • low birth weight,
  • delivered preterm,
  • not breast fed,
  • placed in foster care/adoption.

39
Preterm delivery (pregnancy, FL, 1998 - 2003
40
Low birthweight (pregnancy, FLR 1998-2003
41
Breast feeding and unintended pregnancy, FL, 1998
2003intend to breastfeed at 6 weeks
42
Public Health/Clinical Focus
Through primary prevention, we are able to
avoid the potentially disastrous effects and
agonizing decisions that women with unintended
pregnancies face
43
Implications of findings
  • Effect of unintended pregnancies on womens
    lives?
  • Education
  • Employment
  • Family finances
  • Stress/ health
  • Cost of unintended pregnancy to society
  • Public funding now and in future
  • Child abuse/neglect

44
More information needed...
  • Barriers to effective contraception use
  • Methods that are reliable and acceptable
  • How to effectively address unintended pregnancy
    as a public health problem

45
Public Health/Clinical Focus
  • Secondary and tertiary prevention of
    unintended pregnancy
  • Transition from unintended conception to intended
    birth
  • Particularly focus upon pregnancies unwanted at
    conception
  • Bonding interventions
  • Social support
  • Parenting education
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