Differences between mistimed and unwanted pregnancies among women who have live births.Nearly one-third of live U.S. births are the result of an unintended pregnancy--one that was either mistimed mis·timetr.v. mis·timed, mis·tim·ing, mis·times To time inaccurately or inappropriately; misjudge the timing of: The basketball team mistimed the final play and lost the game. (occurred earlier than desired) or unwanted. (1) A study using data from the 1995 National Survey of Family Growth (NSFG NSFG National Survey of Family Growth NSFG Naked Stick Figure Guy ) estimated that 31% of pregnancies that resulted in a live birth were unintended. (2) The health effects of unintended pregnancies are commonly studied by combining data on mistimed pregnancies and unwanted pregnancies unwanted pregnancy Obstetrics A pregnancy that is not desired by one or both biologic parents. See Teen pregnancy. and considering the joint impact. (3) This is done for all unintended pregnancies and for those ending in a live birth. However, the meaning of mistimed and unwanted pregnancies, and the circumstances in which they occur, are important and have not been well described. A few studies have examined mistimed and unwanted pregnancies separately, (4) but they have examined a very limited range of characteristics; in addition, not all have directly compared mistimed with unwanted pregnancies. For example, Adams and colleagues compared women who had mistimed pregnancies and women who had unwanted pregnancies with women who had intended pregnancies. Women in both of the groups with unintended pregnancies were more likely than women with planned pregnancies to have smoked before conception; (5) however, the study did not compare the two unintended groups directly. Dye and colleagues found that women with unintended pregnancies were less likely than women with intended pregnancies to breast-feed breast-feed v. To feed a baby mother's milk from the breast; suckle. , and that women with unwanted pregnancies were less likely than women with mistimed pregnancies to do so. (6) Kost and colleagues, comparing mistimed and unwanted pregnancies, observed a similar relationship for breast-feeding breast-feeding /breast-feed·ing/ (brest´fed?ing) nursing; the feeding of an infant at the mother's breast. but found no between-group difference in the proportion accessing well-baby care. (7) Pulley pulley, simple machine consisting of a wheel over which a rope, belt, chain, or cable runs. A grooved pulley wheel like that used for ropes is called a sheave. and colleagues found degree of mistiming mis·time tr.v. mis·timed, mis·tim·ing, mis·times To time inaccurately or inappropriately; misjudge the timing of: The basketball team mistimed the final play and lost the game. to be associated with selected maternal characteristics, maternal behaviors and pregnancy outcomes, with the most positive behaviors and outcomes (e.g., initiating early prenatal care prenatal care, n the health care provided the mother and fetus before childbirth. , breast-feeding, having a full-term delivery and having a normal-birth-weight infant) seen among women who considered their pregnancy intended or only moderately mistimed. (8) That study examined only a few characteristics, however, and it did not compare mistimed pregnancies with unwanted pregnancies. We sought to examine the components of pregnancy intention and to assess whether women with a mistimed pregnancy and those with an unwanted pregnancy should be considered separately--analytically and in practice--rather than together. Our analysis used a large, population-based sample, enabling us to analyze a greater number of demographic and behavioral risk factors than were used in earlier studies. In this article, we focus on comparisons between women who report mistimed pregnancies and those who report unwanted pregnancies among respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. with a recent live birth. METHODS We analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. data from the Pregnancy Risk Assessment Monitoring System (PRAMS PRAMS Pregnancy Risk Assessment Monitoring System PRAMS Passenger Reservation And Manifesting System )--an ongoing population-based surveillance system developed, technically supported and funded in part by the Centers for Disease Control and Prevention--for 1998, the most recent survey year available at the outset of the study. PRAMS uses a mixed-mode data collection system to obtain self-reported information on perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth. per·i·na·tal adj. and maternal health Maternal health care is a concept that encompasses preconception, prenatal, and postnatal care. Goals of preconception care can include providing health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. indicators from mothers who recently gave birth to a live infant. A sample of eligible women is drawn from birth certificates each month in participating states. As many as three mailings are sent to selected respondents 2-6 months after the birth of their baby;, nonrespondents are followed up by telephone. Information from birth certificates is also collected, and can be analyzed in conjunction with data from the survey. Women whose live-born infant died are included in the sample. Women who gave birth outside their state of residence or who adopted their infant are excluded. More details of the methods used in PRAMS are described elsewhere. (9) We examined data from the 15 states that had fully implemented the PRAMS methods (Alabama, Alaska, Arkansas, Colorado, Florida, Illinois, Louisiana, Maine, New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). , New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures Area, 52,586 sq mi (136,198 sq km). Pop. , Oklahoma, South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. , Washington and West Virginia West Virginia, E central state of the United States. It is bordered by Pennsylvania and Maryland (N), Virginia (E and S), and Kentucky and, across the Ohio R., Ohio (W). Facts and Figures Area, 24,181 sq mi (62,629 sq km). Pop. ). The 1998 data set comprises the responses of 25,027 women, representing the 986,510 women who had Live births in these states in 1998. * Pregnancy intention was determined by the mother's response to the question "Thinking back to just before you got pregnant, how did you feel about becoming pregnant?" The pregnancy was defined as intended if the woman reported having wanted to be pregnant at conception or earlier. It was considered mistimed if the woman reported having wanted the pregnancy later, and unwanted if she had not wanted to become pregnant then or later. The response options included "I don't know Don't know (DK, DKed) "Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. ." Self-reported data from the PRAMS questionnaire yielded information on women's behaviors and experiences before, during and after the pregnancy. We looked at dichotomous di·chot·o·mous adj. 1. Divided or dividing into two parts or classifications. 2. Characterized by dichotomy. di·chot variables on smoking and drinking during the third trimester Noun 1. third trimester - time period extending from the 28th week of gestation until delivery trimester - a period of three months; especially one of the three three-month periods into which human pregnancy is divided of pregnancy. Prenatal care was categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat as delayed if the woman had started care after the 12th week of pregnancy. We considered a woman to have breast-fed breast·feed or breast-feed v. breast-fed , breast-feed·ing, breast-feeds v.tr. To feed (a baby) mother's milk from the breast; suckle. v.intr. To breastfeed a baby. her infant if she reported doing so currently or having done so at some point for more than one week. We classified a woman as a Medicaid beneficiary beneficiary Person or entity (e.g., a charity or estate) that receives a benefit from something (e.g., a trust, life-insurance policy, or contract). A primary beneficiary receives proceeds from a trust or insurance policy before any other. if she reported that she had received Medicaid benefits just before her pregnancy or that Medicaid had paid for her prenatal care or delivery. The woman's yes-or-no answer to the statement "Your husband or partner said he did not want you to be pregnant" determined partner intention. We considered a woman to have experienced physical abuse if she reported that her husband or partner, another household member, a relative, a friend or any other person pushed, hit, slapped, kicked or otherwise physically hurt her during the pregnancy. Nonresponse was less than 4% for all variables except breast-feeding (8%) and pregnancy intention. For pregnancy intention, 8% of respondents answered "I don't know" to the question or left it blank. All missing values In statistics, missing values are a common occurrence. Several statistical methods have been developed to deal with this problem. Missing values mean that no data value is stored for the variable in the current observation. were excluded from the analysis. We used information from the birth certificate for maternal age maternal age, n the age of the mother at the period of conception. , marital status marital status, n the legal standing of a person in regard to his or her marriage state. , parity parity or space parity, in physics, quantity that refers to the relationship between an object or process and the image that it can produce in a mirror. and infant birth weight. Low-birth-weight infants Noun 1. low-birth-weight infant - an infant born weighing less than 5.5 pounds (2500 grams) regardless of gestational age; "a low-birth-weight infant is at risk for developing lack of oxygen during labor" low-birth-weight baby were those weighing less than 2,500 g at birth. We performed the analyses using SUDAAN software, which could take into account the complex sampling design and statistical weighting used in PRAMS. (10) We calculated percentages and standard errors to obtain the percentage distributions for each intendedness category by selected characteristics. A chi-square test chi-square test: see statistics. was used to assess differences among intendedness groups. To further examine the relationship between the mistimed and unwanted pregnancy groups and selected characteristics, we calculated unadjusted relative risks, along with 95% confidence intervals confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. . Using similar methods, we also examined whether the mistimed and intended groups differed from one other. RESULTS The majority of births in this analysis--57%--involved intended pregnancies (Table 1). Among the unintended pregnancies, three-quarters were mistimed (32% of all pregnancies) and one-quarter were unwanted (11% of all pregnancies). Descriptive Characteristics When the women were grouped according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the intendedness of their pregnancy, the three groups differed on nearly all variables examined. Among women whose pregnancies were intended, the largest proportion (57%) were 25-34 years of age, and the smallest proportion (6%) were teenagers (Table 2). By contrast, women aged 20-24 and those aged 25-34 represented the largest fractions of the mistimed group (34% and 36%, respectively), and women aged 35 or older the smallest (4%). Women aged 25-34 made up the greatest share of those who reported unwanted pregnancies (37%), and women aged 35 or older the smallest (17%). The proportion of mothers who were teenagers was highest in the mistimed group. Most women with intended pregnancies, but fewer than half of those with mistimed or unwanted pregnancies, were married. The proportion of women who were unmarried was largest in the unwanted pregnancy group. The majority of women with intended pregnancies had more than a high school education; the majority in both other groups had at least a high school education. Black women made up 10% of the intended pregnancy group but higher proportions of both the mistimed and the unwanted groups (26% and 42%, respectively). About half of women in each group had already had 1-2 births. However, whereas the rest of those in the intended and mistimed groups were mainly first-time mothers, the remainder in the unwanted group were evenly divided between women having their first birth and those who had already had at least three. Medicaid beneficiaries constituted a minority of the intended pregnancy group but a majority of the mistimed and the unwanted groups. In each group, a minority of women smoked, received no or delayed prenatal care, were abused, delivered a low-birth-weight infant and had a partner who considered the pregnancy unwanted; however, the proportions were largest among women with unwanted pregnancies. Similarly, no more than half in any group breast-fed, yet the highest proportion of women who did not breast-feed was in the unwanted group. Analyses of Association Women differed significantly in their unadjusted relative risks of unwanted (vs. mistimed) pregnancy and mistimed (vs. intended) pregnancy according to most demographic characteristics, notably age and parity (Table 3). For example, compared with women aged 25-34, women who were teenagers or in their early 20s had a decreased risk of unwanted pregnancy (relative risk, 0.8 for each age-group), but the risk was increased in women aged 35 or older (2.3). In contrast, the risk of mistimed pregnancy was elevated in the two youngest age categories (relative risks, 2.7 and 1.7) but was decreased in the oldest group (0.5). Women who had had 1-2 previous children, or three or more, were at increased risk of reporting unwanted pregnancy (2.1 and 4.0, respectively), but they were at decreased risk of reporting mistimed pregnancy (0.9 for both). Women's marital status, education, race and Medicaid status were also associated with the outcomes of interest, but ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic was not. Among the other variables examined, all but one--drinking in the third trimester--were associated with women's risks of reporting unintended pregnancies. The risks of unwanted and mistimed pregnancies were elevated significantly if the woman had smoked in the third trimester (relative risk, 1.3 for each), had received no prenatal care (2.7 and 1.8) or delayed care (1.4 and 1.8), had not breast-fed (1.3 and 1.4), had been physically abused (1.3 and 1.6), had a partner who had not wanted the pregnancy (1.4 and 2.0) or had a low-birth-weight baby Noun 1. low-birth-weight baby - an infant born weighing less than 5.5 pounds (2500 grams) regardless of gestational age; "a low-birth-weight infant is at risk for developing lack of oxygen during labor" low-birth-weight infant (1.2 and 1.1). DISCUSSION A woman was more likely to report that her pregnancy had been unwanted rather than mistimed if she had certain behavioral risk factors. Women who were at least 35 or parous par·ous adj. Having given birth one or more times. parous having produced offspring. were more likely to report an unwanted rather than mistimed pregnancy. This finding could be expected, because older women and women with children are more likely than younger women and childless women to have achieved their desired family size. (11) However, this relationship has been masked A state of being disabled or cut off. in other analyses when all unintended pregnancies have been considered as a single group. (12) Our findings also show that the majority of pregnancies were intended. Among women reporting an unintended pregnancy, most said that the pregnancy was mistimed rather than unwanted. This result is consistent with NSFG findings. (13) However, the proportion of pregnancies reported as unintended was larger in the 1998 PRAMS (43%) than in the 1995 NSFG (31%). (14) Differences between NSFG and PRAMS survey methods contribute to the difference in the prevalence of unintended pregnancy reported by each survey. For example, the NSFG provides a national estimate, whereas the PRAMS data set used in this study represented 15 states. In addition, pregnancy intention is measured by using different instruments, which could result in women's responding to the intention item in different ways: (15) The NSFG uses a series of questions to define pregnancy intention, whereas PRAMS uses a single item. PRAMS is primarily a mail survey with telephone follow-up, whereas the NSFG is conducted primarily as a face-to-face interview. Meanwhile, survey response rates can vary according to the manner in which the survey is administered; (16) moreover, respondents are generally less likely to answer sensitive questions when they are asked face-to-face. (17) With PRAMS, participants' responses are recorded 2-6 months postpartum postpartum /post·par·tum/ (post-pahr´tum) occurring after childbirth, with reference to the mother. post·par·tum adj. Of or occurring in the period shortly after childbirth. ; however, the NSFG, using a calendar method to assist participants in their recall and reporting, assesses pregnancies over the previous five years. Meanwhile, over time, women may come to view the intendedness of a given pregnancy in an increasingly positive light. (18) Limitations This study has several limitations. The PRAMS survey collects data 2-6 months postpartum, at which point a mother's feelings toward her pregnancy or recall of her feelings at the time that she learned she was pregnant may have changed. (19) In addition, PRAMS collects data on only a subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original. of all pregnancies--those resulting in live births. Thus, we could not assess women with unintended pregnancies ending in abortion, miscarriage miscarriage: see abortion. miscarriage or spontaneous abortion Spontaneous expulsion of an embryo or fetus from the uterus before it can live outside the mother. or stillbirth Stillbirth Definition A stillbirth is defined as the death of a fetus at any time after the twentieth week of pregnancy. Stillbirth is also referred to as intrauterine fetal death (IUFD). , whose characteristics probably differ from those of the women with unintended pregnancies in our analysis. Pregnancy intendedness is complex and difficult to measure. Previous research has shown that the concept may not be meaningful to some women (20) or that women may be ambivalent am·biv·a·lent adj. Exhibiting or feeling ambivalence. am·biv  a·lent·ly adv.Adj. 1. . (21) Studies that have looked at other ways to measure pregnancy intention status, such as by assessing attitudes and happiness, suggest that considering unintendedness in terms of mistimed and unwanted pregnancies may not be the only way to study women's intentions (22) or that this concept may be best suited for estimating unintendedness on a population level hut not necessarily for unraveling the complex array of cultural and social factors that operate on an individual level. (23) In this study, for example, 8% of women did not answer the pregnancy intention question or responded that they did not know. Alternative measures of pregnancy intendedness should be explored in PRAMS and other studies. Additional measures of attitudes and happiness are now available in PRAMS. Since 2000, PRAMS has offered states the option to include standard questions on the woman's attitudes and degree of happiness regarding her recent pregnancy, and on her partner's pregnancy intention. As a result, 10 states have added 1-3 questions on these topics. Finally, we chose not to perform a multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. with adjustment for socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. . Many births in the PRAMS data set are to teenagers, and conventional measures of socioeconomic status, such as level of education completed and income, are inappropriate in this population. (24) Moreover, socioeconomic status would have been more important if we had been examining differences between intended and unintended pregnancies; however, our primary comparison was between unwanted and mistimed pregnancies. Compared with births among women with intended pregnancies, those among women with unwanted or mistimed pregnancies are more likely to involve poor and minority women. Conclusions The use of a single category to represent unintended pregnancy masks apparent differences between women with mistimed pregnancies and those with unwanted pregnancies: According to our analysis, women with behavioral risk factors that could negatively affect their pregnancy outcomes are more likely to report unwanted than mistimed pregnancy. Beyond measurement issues, our findings have practical implications. For example, prenatal care providers, family planning family planning Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. providers and other public health professionals may find this information useful for targeting pregnant women who could benefit from counseling regarding the effects of unhealthy behaviors on their unborn child. Because unintended pregnancy is associated with unfavorable maternal behaviors and unfavorable outcomes for both mother and child, (25) clarifying the difference in risk between mistimed and unwanted pregnancies may help guide decisions regarding direct services to women and to infants. Moreover, further research on alternate ways to measure pregnancy intendedness and on the best ways to prevent or ameliorate a·mel·io·rate tr. & intr.v. a·me·lio·rat·ed, a·me·lio·rat·ing, a·me·lio·rates To make or become better; improve. See Synonyms at improve. [Alteration of meliorate. the risk of unintended pregnancies may lead to the development of programs targeting each group. Finally, this research suggests that studies examining the relationships between pregnancy intention, health behaviors and health outcomes among women with live births should examine mistimed and unwanted pregnancies separately.
TABLE 1. Percentage distribution (and 95% confidence
intervals) of women from 15 U.S. states with a recent live
birth, by pregnancy intention status, Pregnancy Risk
Assessment Monitoring System, 1998
Intention status %
(N=25,027)
Intended 56.9(55.9-57.9)
Unintended 43.1(42.1-44.1)
Mistimed 31.8(30.8-32.8)
Unwanted 11.2 (10.5-11.9)
Total 100.0
Note. Data are from Alabama, Alaska, Arkansas, Colorado, Florida,
Illinois, Louisiana, Maine, New Mexico, New York, North Carolina,
Oklahoma, South Carolina, Washington and West Virginia.
TABLE 2. Percentage distribution (and 95% confidence
intervals) of women who had alive birth, by selected
characteristics, according to pregnancy intention status
Characteristic Intended
(N=13,728)
MATERNAL CHARACTERISTICS
Age *
<20 5.9(5.4-6.4)
20-24 22.0(20.8-23.2)
25-34 56.7(55.2-58.1)
[greater than or equal to] 35 15.5(14.4-16.6)
Marital status *
Married 82.9(81.8-83.9)
1 Other 17.1(16.1-18.2)
Education *
<H.S. 14.1(13.1-15.1)
H.S. 30.9(29.6-32.2)
>H.S. 55.0(53.6-56.4)
Race *
White 86.0(85.1-86.8)
Black 10.4(9.7-11.1)
Native American/
Alaska Native 1.2(1.0-1.4)
Other 2.4(2.0-2.8)
Ethnicity
Hispanic 17.9(16.6-19.2)
Non-Hispanic 82.1(80.8-83.4)
Parity *
0 42.6(41.2-44.0)
1-2 51.2(49.7-52.6)
[greater than or equal to] 3 6.3(5.5-7.0)
Medicaid coverage *
No 72.9(71.7-74.1)
Yes 27.1(25.9-28.3)
MATERNAL BEHAVIORS
Smoked in third trimester *
No 88.8(87.9-89.7)
Yes 11.2(10.3-12.1)
Drank alcohol in third trimester
No 94.8(94.2-95.5)
Yes 5.2(4.5-5.8)
Received prenatal care *
None 0.3(0.2-0.5)
Delayed 13.8(12.8-14.7)
First trimester 85.9(84.9-86.8)
Breast-fed *
No 30.3(29.0-31.6)
Yes 69.7(68.4-71.0)
OTHER
Physical abuse during pregnancy *
No 96.9(96.5-97.4)
Yes 3.1(2.6-3.5)
Partner wanted pregnancy *
No 4.7(4.1-5.3)
Yes 95.3(94.7-95.9)
INFANT OUTCOME
Birth weight *
Low 6.5(6.3-6.8)
Normal 93.5(93.2-93.7)
Total 100.00
Characteristic Mistimed
(N=8,373)
MATERNAL CHARACTERISTICS
Age *
<20 26.2(24.8-27.6)
20-24 33.5(31.7-35.2)
25-34 36.4(34.6-38.1)
[greater than or equal to] 35 3.9(3.2-4.7)
Marital status *
Married 48.9(47.1-50.7)
1 Other 51.1(49.3-52.9)
Education *
<H.S. 25.9(24.3-27.4)
H.S. 38.2(36.4-40.0)
>H.S. 35.9(34.2-37.7)
Race *
White 69.8(68.3-71.3)
Black 26.2(24.9-27.6)
Native American/
Alaska Native 2.0(1.6-2.3)
Other 2.0(1.5-2.5)
Ethnicity
Hispanic 17.2(15.4-19.0)
Non-Hispanic 82.8(81.0-84.6)
Parity *
0 48.9(47.1-50.7)
1-2 45.4(43.6-47.2)
[greater than or equal to] 3 5.7(4.8-6.5)
Medicaid coverage *
No 45.8(44.0-47.6)
Yes 54.2(52.4-56.0)
MATERNAL BEHAVIORS
Smoked in third trimester *
No 83.1(81.7-84.4)
Yes 16.9(15.6-18.3)
Drank alcohol in third trimester
No 95.5(94.6-96.3)
Yes 4.5(3.7-5.4)
Received prenatal care *
None 0.8(0.5-1.0)
Delayed 30.8(292-32.5)
First trimester 68.4(66.7-70.1)
Breast-fed *
No 42.1(40.3-43.8)
Yes 57.9(56.2-59.7)
OTHER
Physical abuse during pregnancy *
No 93.1(92.1-94.0)
Yes 6.9(6.0-7.9)
Partner wanted pregnancy *
No 16.7(15.3-18.1)
Yes 83.3(81.9-84.7)
INFANT OUTCOME
Birth weight *
Low 7.5(7.1-8.0)
Normal 92.5(92.0-92.9)
Total 100.00
Characteristic Unwanted
(N=2,926)
MATERNAL CHARACTERISTICS
Age *
<20 18.6(16.4-20.8)
20-24 27.2(24.6-29.9)
25-34 37.4(34.3-40.4)
[greater than or equal to] 35 16.8(14.4-19.3)
Marital status *
Married 41.4(38.4-44.5)
1 Other 58.6(55.5-61.6)
Education *
<H.S. 30.4(27.0-33.8)
H.S. 38.3(353-41.3)
>H.S. 31.3(28.4-34.2)
Race *
White 54.9(52.0-57.9)
Black 41.5(38.6-44.4)
Native American/
Alaska Native 1.5(1.1-2.0)
Other 2.1(1.1-3.0)
Ethnicity
Hispanic 16.9(13.8-20.0)
Non-Hispanic 83.2(80.1-86.3)
Parity *
0 23.2(20.7-25.6)
1-2 54.8(51.8-57.9)
[greater than or equal to] 3 22.0(19.4-24.6)
Medicaid coverage *
No 38.2(35.2-41.2)
Yes 61.8(58.8-64.8)
MATERNAL BEHAVIORS
Smoked in third trimester *
No 77.3(74.6-80.0)
Yes 22.7(20.0-25.4)
Drank alcohol in third trimester
No 94.3(93.0-95.6)
Yes 5.7(4.4-7.0)
Received prenatal care *
None 3.4(2.3-4.5)
Delayed 39.4(36.3-42.4)
First trimester 57.2(54.1-60.3)
Breast-fed *
No 51.5(48.5-54.6)
Yes 48.5(45.4-51.5)
OTHER
Physical abuse during pregnancy *
No 90.1(88.3-91.9)
Yes 9.9(8.1-11.7)
Partner wanted pregnancy *
No 24.6(22.0-27.3)
Yes 75.4(72.7-78.0)
INFANT OUTCOME
Birth weight *
Low 9.6(8.7-10.5)
Normal 90.4(89.5-91.3)
Total 100.00
* For difference among intended, mistimed and unwanted pregnancy
groups, p<.001.
TABLE 3. Unadjusted relative risks (and 95% confidence
intervals) of unwanted and mistimed pregnancy among
women's recent live births, by selected characteristics
Characteristic Unwanted
(vs. mistimed)
MATERNAL CHARACTERISTICS
Age
<20 0.75(0.65-0.87)
20-24 0.84(0.73-0.96)
25-34 (ref) 1.00
[greater than or equal to] 35 2.27(1.98-2.61)
Marital status
Married (ref) 1.00
Other 1.25(1.12-1.39)
Education
<H.S. 1.25(1.09-1.43)
H.S. 1.11(0.98-1.27)
>H.S.(ref) 1.00
Race
White(ref) 1.00
Black 1.65(1.48-1.83)
Native American/
Alaska Native 0.98(0.74-1.31)
Other 1.24(0.83-1.84)
Ethnicity
Hispanic 0.98(0.81-1.19)
Non-Hispanic (ref) 1.00
Parity
0 (ref) 1.00
1-2 2.08(1.83-2.37)
[greater than or equal to] 3 4.02(3.50-4.62)
Medicaid coverage
No (ref) 1.00
Yes 1.26(1.13-1.41)
MATERNAL BEHAVIORS
Smoked in third trimester
No (ref) 1.00
Yes 1.30(1.15-1.48)
Drank alcohol in third trimester
No (ref) 1.00
Yes 1.19(0.96-1.48)
Received prenatal care
None 2.66(2.19-3.22)
Delayed 1.36(1.22-1.52)
First trimester (ref) 1.00
Breast-fed
No 1.32(1.19-1.47)
Yes (ref) 1.00
OTHER
Physical abuse during pregnancy
No (ref) 1.00
Yes 1.32(1.12-1.55)
Partner wanted pregnancy
No 1.42(1.26-1.60)
Yes (ref) 1.00
INFANT OUTCOME
Birth weight
Low 1.21(1.11-1.32)
Normal (ref) 1.00
Characteristic Mistimed
(vs. intended)
MATERNAL CHARACTERISTICS
Age
<20 2.66(2.50-2.84)
20-24 1.73(1.61-1.86
25-34 (ref) 1.00
[greater than or equal to] 35 0.47(0.39-0.57)
Marital status
Married (ref) 1.00
Other 2.52(2.39-2.67)
Education
<H.S. 1.89(1.76-2.04)
H.S. 1.53(1.43-1.64)
>H.S.(ref) 1.00
Race
White(ref) 1.00
Black 1.87(1.77-1.98)
Native American/
Alaska Native 1.54(1.35-1.76
Other 1.01(0.81-1.25)
Ethnicity
Hispanic 0.97(0.87-1.08)
Non-Hispanic (ref) 1.00
Parity
0 (ref) 1.00
1-2 0.85(0.80-0.90)
[greater than or equal to] 3 0.86(0.75-0.98)
Medicaid coverage
No (ref) 1.00
Yes 2.03(1.92-2.15)
MATERNAL BEHAVIORS
Smoked in third trimester
No (ref) 1.00
Yes 1.34(1.24-1.44)
Drank alcohol in third trimester
No (ref) 1.00
Yes 0.91(0.78-1.07)
Received prenatal care
None 1.83(1.47-2.28)
Delayed 1.81(1.71-1.91)
First trimester (ref) 1.00
Breast-fed
No 1.38(1.30-1.46)
Yes (ref) 1.00
OTHER
Physical abuse during pregnancy
No (ref) 1.00
Yes 1.59(1.44-1.75)
Partner wanted pregnancy
No 2.03(1.91-2.16
Yes (ref) 1.00
INFANT OUTCOME
Birth weight
Low 1.10(1.05-1.16)
Normal (ref) 1.00
Note: ref=reference group.
Acknowledgements The authors thank the members of the PRAMS Working Group: Sandra Anseth, Melissa Baker, Lois Bloebaum, Yasmina Bouraoui, Peggy Brozicevic, Paul Buescher, Diana Cheng, Amy Davis, JoAnn Dotson, Tanya J. Guthrie, Martha Henson, Carol Hobart, Jan Jernell, Lakota Kruse, Linda Lohdefinck, Dick Lorenz, Helen Marshall Helen Marshall was elected Queens Borough President in 2001 succeeding the term-limited Claire Shulman. Prior to being elected Borough President, Marshall served on the New York City Council from 1992 to 2002, an office she vacated due to term limits. , Candace Mulready, Linda Pendleton, Kathy Perham-Hester, Anne Radigan-Garcia, Gina Redford, Ken Rosenberg Theresa Sandidge, Jennifer Severe-Oforah, Alyson Shupe, Sylvia Sievers, Limin Song, Rhonda Stephens, Sam Viner-Brown, Ssu Weng and Joan Wightkin. * Data for New York State do not include New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . Data for New Mexico involve births from July 1997 through December 1998. Weighted response rates for the 15 states ranged from 70% (in New Mexico) to 83% (in Maine and Florida). REFERENCES (1.) Henshaw SK, Unintended pregnancy in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , Family Planning Perspectives, 1998, 30(1):24-29&46; and Beck LF e t al., PRAMS 1999 Surveillance Report, Atlanta: Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ), 2003. (2.) Henshaw SK, 1998, op. cit. (see reference 1). (3.) Ibid.; Beck LF et al., Prevalence of selected maternal behaviors and experiences, Pregnancy Risk Assessment Monitoring System (PRAMS), 1999, Morbidity and Mortality Weekly Report Morbidity and Mortality Weekly Report (MMWR) is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention. The 5 June 1981 issue of the MMWR published the cases of five men in what turned out to be the first report of AIDS. , 2002, 51(SS-2):1-27; and U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS (DHHS DHHS Department of Health & Human Services (US government) DHHS Dana Hills High School (Dana Point, California) DHHS Deaf and Hard of Hearing Services DHHS Deaf and Hard of Hearing Services ), Healthy People 2010, conference ed., Washington, DC: DHHS, 2000. (4.) Adams MM et al., Pregnancy planning and preconception pre·con·cep·tion n. An opinion or conception formed in advance of adequate knowledge or experience, especially a prejudice or bias. Noun 1. counseling, Obstetrics obstetrics (ŏbstĕ`trĭks), branch of medicine concerned with the treatment of women during pregnancy, labor, childbirth (see birth), and the time after childbirth. & Gynecology gynecology (gīn'əkŏl`əjē), branch of medicine specializing in the disorders of the female reproductive system. Modern gynecology deals with menstrual disorders, menopause, infectious disease and maldevelopment of the , 1993, 82(6):955-959; Dye TD et al., Unintended pregnancy and breastfeeding behavior, American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. , 1997, 87(10):1709-1711; Hellerstedt WL et al., Differences in preconceptional and prenatal prenatal /pre·na·tal/ (-na´tal) preceding birth. pre·na·tal adj. Preceding birth. Also called antenatal. prenatal preceding birth. behaviors in women with intended and unintended pregnancies, American Journal of Public Health, 1998, 88(4):663-666;Joyce TJ, Kaestner R and Korenman S, The effect of pregnancy intention on child development, Demography demography (dĭmŏg`rəfē), science of human population. Demography represents a fundamental approach to the understanding of human society. , 2000, 37(1):83-94; and Kost K, Landry DJ and Darroch JE, The effects of pregnancy planning status on birth outcomes and infant care, Family Planning Perspectives, 1998, 30(5):223-230. (5.) Adams MM et al., 1993, op. cit. (see reference 4). (6.) Dye TD et al., 1997, op. cit. (see reference 4). (7.) Kost K, Landry DJ and Darroch JE, 1998, op. cit. (see reference 4). (8.) Pulley L et al., The extent of pregnancy mistiming and its association with maternal characteristics and behaviors and pregnancy outcomes, Perspectives on Sexual and Reproductive Health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene , 2002, 34(4): 206-211. (9.) Gilbert BC et al., The Pregnancy Risk Assessment Monitoring System (PRAMS): methods and 1996 response rates from 11 states, Maternal and Child Health Journal, 1999, 3(4):199-209. (10.) Shah BV, Barnwell BG and Bieler GS, SUDAAN User's Manual: Software for Analysis of Correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. Data, Release 6.40, Research Triangle Park Research Triangle Park, research, business, medical, and educational complex situated in central North Carolina. It has an area of 6,900 acres (2,795 hectares) and is 8 × 2 mi (13 × 3 km) in size. Named for the triangle formed by Duke Univ. , NC: Research Triangle Institute The Research Triangle Institute (RTI) is a non-profit research organization based in the Research Triangle Park (RTP) of North Carolina. RTI is the oldest tenant of this major research park, and the sister organization to the Research Triangle Foundation. , 1995. (11.) Campbell AA and Mosher A mosher is a person who is crossed between goth/punk/skater they have long hair and listen to music like slipknot and metal music. Some people call them headbangers. At certain music shows they have something called a mosh pit, basically its a fight pit with loads of people bashing each other. WD, A history of the measurement of unintended pregnancies and births, Maternal and Child Health Journal, 2000, 4(3): 163-169; and Luker KC, A reminder that human behavior frequently refuses to conform to Verb 1. conform to - satisfy a condition or restriction; "Does this paper meet the requirements for the degree?" fit, meet coordinate - be co-ordinated; "These activities coordinate well" models created by researchers, Family Planning Perspectives, 1999, 31(5):248-249. (12.) Gilbert BC et al., 1999, op. cit. (see reference 9); and Beck LF et al., 2002, op. cit. (see reference 3). (13.) Abma JC et al., Fertility, family planning and women's health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. : new data from the 1995 National Survey of Family Growth, Vital and Health Statistics, 1997, Vol. 23, No. 19. (14.) Henshaw SK, 1998, op. cit. (see reference 1). (15.) Kaufmann RB, Morris L and Spitz spitz Any of several northern dogs, including the chow chow, Pomeranian, and Samoyed, characterized by a dense, long coat, erect pointed ears, and a tail that curves over the back. In the U.S. AM, Comparison of two question sequences for assessing pregnancy intentions, American Journal of Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , 1997, 145(9):810-816 (16.) Bongers IM and Van Oers JA, Mode effects on self-reported alcohol use and problem drinking: mail questionnaires and personal interviewing compared, Journal of Studies on Alcohol, 1998, 59(3):280-285; and Aquilino WS, Telephone versus face-to-face interviewing for household drug use surveys, International Journal of the Addictions, 1992, 27(1):71-91. (17.) Santelli J et al., Adolescent sexual behavior
18. Joyce TJ, Kaestner R and Korenman S, The stability of pregnancy intention and pregnancy-related maternal behaviors, Maternal and Child Health Journal, 2000, 4(3):171-178. (19.) Ibid. (20.) Fischer RC et al., Exploring the concepts of intended, planned and wanted pregnancy, Journal of Family Practice, 1999, 48(2):117-122; and Moos MK et al., Pregnant women's perspectives on intendedness of pregnancy, Women's Health Issues, 1997, 7(6):385-392. (21.) Trussell J, Vaughan B and Stanford J, Are all contraceptive contraceptive /con·tra·cep·tive/ (-sep´tiv) 1. diminishing the likelihood of or preventing conception. 2. an agent that so acts. failures unintended pregnancies? evidence from the 1995 National Survey of Family Growth, Family Planning Perspectives, 1999, 31(5):246-247 & 260. (22.) Sable sable, species of marten, Martes zibellina, found in Siberia, N European Russia, and N Finland. This carnivorous mammal is highly valued for its thick, soft fur, which is dark brown or black, sometimes with white underparts and sometimes flecked with silver. MR et al., Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status, Family Planning Perspectives, 1997, 29(2):76-81; Sable MR and Wilkinson D, Pregnancy intentions, pregnancy attitudes and the use of prenatal care in Missouri, Maternal and Child Health Journal, 1998, 2(3):155-165; Sable MR, Pregnancy intentions may not be a useful measure for research on maternal and child health outcomes, Family Planning Perspectives, 1999, 31(5):249-250; Sable MR and Libbus MK, Pregnancy intention and pregnancy happiness: are they different? Maternal and Child Health Journal, 2000, 4(3):191-196; and Klerman LV, The intendedness of pregnancy: a concept in transition, Maternal and Child Health Journal, 2000,4(3):155-162. (23.) Santelli J et al., The measurement and meaning of unintended pregnancy, Perspectives on Sexual and Reproductive Health, 2003, 35(2):94-101. (24.) Gazmararian JA, Adams MM and Pamuk ER, Associations between measures of socioeconomic status and maternal health behavior, American Journal of Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. , 1996, 12(2):108-115. (25.) Brown SS and Eisenberg LE, eds., The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, Washington, DC: National Academy Press, 1995; Kost K and Forrest JD, Intention status of U.S. births in 1988: differences by mothers' socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. and demographic characteristics, Family Planning Perspectives, 1995, 27(1): 11-17; Hellerstedt WL et al., 1998, op. dr. (see reference 4); Kost K, Landry DJ and Darroch JE, Predicting maternal behaviors during pregnancy: does intention status matter? Family Planning Perspectives, 1998, 30(2):79-88; Dye TD et al., 1997, op. cit (see reference 4); Goodwin MM et al., Pregnancy intendedness and physical abuse around the time of pregnancy: findings from the Pregnancy Risk Assessment Monitoring System, 1996-1997, Maternal and Child Health Journal, 2000, 4(2): 85-92; Hulsey TM, Association between early prenatal care and mother's intention of and desire for the pregnancy, Journal of Obstetric ob·stet·ric or ob·stet·ri·cal adj. Of or relating to the profession of obstetrics or the care of women during and after pregnancy. obstetrical, obstetric pertaining to or emanating from obstetrics. , Gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology. and Neonatal Nursing Neonatal nursing is a specialized nursing practice of caring for newborn infants (neo meaning new, natal meaning birth) up to 28 days subsequent to birth. , 2001, 30(3):275-282; Barber A barber (from the Latin barba, "beard") is someone whose occupation is to cut any type of hair, give shaves, and trim beards. In previous times, barbers also performed surgery and dentistry. JS, Axinn WG and Thornton A, Unwanted childbearing child·bear·ing n. Pregnancy and parturition. child bear ing adj. , health and mother-child relationships, Journal of Health
and Social Behavior In biology, psychology and sociology social behavior is behavior directed towards, or taking place between, members of the same species. Behavior such as predation which involves members of different species is not social. , 1999, 40(3):231-257; Myhrman A et al., Does the
wantedness of a pregnancy predict a child's educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.[1]The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the ? Family Planning Perspectives, 1995, 27(3): 116-119; and Bustan MN and Coker AL, Maternal attitude toward pregnancy and the risk of neonatal death Noun 1. neonatal death - death of a liveborn infant within the first 28 days of life death - the absence of life or state of being dead; "he seemed more content in death than he had ever been in life" , Ameriran Journal of Public Health, 1994, 84(3):411-414. Denise V. D'Angelo is program analyst at Computer Sciences Corp., Atlanta. Brenda Colley Gilbert is team leader, Unintended and Teen Pregnancy Prevention Program, and at the time this article was written, john S. Santelli was chief, Applied Sciences Branch, both in the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta. Roger W. Rochat is research professor of epidemiology, and Joan M. Herold is associate professor of behavioral sciences behavioral sciences, n.pl those sciences devoted to the study of human and animal behavior. and health education, both at the Rollins School of Public Health The Rollins School of Public Health (RSPH) is the public health school of Emory University. Founded in 1990, RSPH has more than 850 students pursuing master's degrees (MPH/MSPH) and over 100 students pursuing doctorate degrees (PhD). , Emory University Emory University (ĕm`ərē), near Atlanta, Ga.; coeducational; United Methodist; chartered as Emory College 1836, opened 1837 at Oxford. It became Emory Univ. in 1915 and in 1919 moved to Atlanta. , Atlanta. DDAngelo@cdc.gov |
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion