Unintended pregnancy risk in an emergency department population

OBJECTIVE: To assess unintended pregnancy risk and associated factors among female urban Baltimore emergency department (ED) attendees. METHODS: A cross-sectional anonymous questionnaire study was completed by 790 women, sufficient to detect a 5% difference of unintended pregnancy risk in the national population and a 10% intersite difference with 80% power. The results were analyzed with chi-square tests, univariate and multivariate logistic regression analyses. RESULTS: Female ED attendees are at greater risk for unintended pregnancy (33.5%), particularly those of lower income (p=.006) and without a primary care provider (p=.003). Unintended pregnancy risk did not vary between sites by any variable except young age despite the fact that sites varied significantly by race, insurance and income measures. CONCLUSION: Women using the ED are at increased risk for unintended pregnancy and are less likely to have access to a regular medical care source; thus, the ED represents a possible contraceptive provision site.     

Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion

BACKGROUND: Most pregnancies ending in therapeutic abortion are assumed to have been unintended. In the developed world, most arise from inconsistent or incorrect contraceptive use. Ambivalence about pregnancy might be associated with less effective contraceptive use. METHODS: Three hundred sixteen women undergoing abortion in Scotland were interviewed about contraceptive use at the time of conception. A modified measure of pregnancy intendedness was used to determine ambivalence. RESULTS: Pregnancy appeared to be clearly unintended for 92% of women. Sixteen percent were not using contraception and had higher intendedness scores (p<.001) than those using a method. Forty-four percent were using contraception inconsistently or incorrectly, almost always condoms or oral contraception, but method choice was not linked to pregnancy intendedness. DISCUSSION: Women who are ambivalent about the desire for pregnancy are less likely to use contraception. The challenge for reducing abortion rates lies in improving contraceptive use among the much larger group of women who do not intend to get pregnant but use contraception imperfectly.     

Contraceptive use and risk of unintended pregnancy in California

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.     

Unintended pregnancy among women in the US military

Background

The study was conducted to examine the extent of unintended pregnancy among female active-duty military personnel in the US Armed Forces.

Study Design

Data consisted of representative data from active-duty women aged 18–44 years (n=3745) from the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. The proportion of women with an unintended pregnancy in the last 12 months, the pregnancy rate and the percentage of all pregnancies in the last 12 months that were unintended were calculated.

Results

An estimated 54% of pregnancies were unintended, based on self-reports. After accounting for likely underreporting for abortion, the adjusted unintended pregnancy rate was 117 per 1000 women. Younger and less educated women had higher rates, as did enlisted women when compared to officers.

Conclusion

Further efforts are needed to reduce unintended pregnancy among women in the military.     

Unintended pregnancy among the urban poor

This article seeks to determine the proportion of pregnancies that are unintended among poor women in New York City, compare the New York City rate to national data, and examine factors associated with unintended pregnancy in this population. Pregnancy testing data collected between June 1, 1998, and June 1, 2001, from field sites operated by the Office of Family Health, New York City Department of Health and Mental Hygiene were analyzed. Pregnancy planning (intended vs. unintended) was examined by age group, race/ethnicity, marital status, frequency of contraceptive use, number of previous pregnancies, drug and alcohol use, and smoking. Odds ratios were calculated to determine if pregnancies were more likely to be unintended among women with certain characteristics. Logistic regression was used to examine independent risk factors for unintended pregnancy. Of the 20,518 women who had a pregnancy test during the study period, 9,406 (45.8%) were pregnant. Of the pregnancies, 82% were unintended. Marital status was the strongest predictor of unintended pregnancy, increasing the risk 2.5-fold for unmarried women. Adolescents and those who drank alcohol were also at increased risk of unintended pregnancy. The extremely high percentage of pregnancies that were unintended among the study population suggests that national unintended pregnancy rates are not representative of what occurs among low-income women in an urban setting. Unintended pregnancy interventions should be tailored for the urban poor and target unmarried, young women.     

Contraceptive nonuse among US women at risk for unplanned pregnancy

BACKGROUND: This study was conducted to assess risk factors for contraceptive nonuse among a nationally representative sample of US women and explored the influence of future pregnancy intentions on contraceptive nonuse. STUDY DESIGN: Using data from the 2002 National Survey of Family Growth (NSFG), we analyzed 12 months of contraceptive behavior among 3687 women at risk for unplanned pregnancy. RESULTS: Compared with contraceptive users, contraceptive nonusers were more likely to be older than 40 years (OR 6.3, 95% CI 2.7-14.7), black (OR 1.8, 95% CI 1.2-2.8), less educated (OR 2.4, 95% CI 1.4-4.0), uninsured (OR 1.6, 95% CI 1.1-2.4), Medicaid recipients (OR 1.9, 95% CI 1.2-2.9) or having infrequent intercourse (OR 3.8, 95% CI 2.7-5.3). We found no significant association between future pregnancy intentions and contraceptive behavior. CONCLUSIONS: While family planning efforts have traditionally focused on disadvantaged women, older women and women who have infrequent sex are also at high risk for nonuse. Future pregnancy intentions, as currently assessed by the NSFG, is not a useful indicator of contraceptive behavior.     

Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it

BACKGROUND: Unintended pregnancies continue to burden many countries in sub-Saharan Africa. Our aim was to estimate the number of unintended pregnancies in the region and model the impact of expanding use of contraceptive implants at the expense of short-term hormonal birth control methods. STUDY DESIGN: For the 42 countries in mainland sub-Saharan Africa, we estimated current levels of unintended pregnancy, prevalence of hormonal contraceptive use and number of unintended pregnancies stemming from early discontinuation and typical method failure rates. Using a decision-analytic model, we estimated the potential impact of more widespread use of the contraceptive implant. RESULTS: Every year in sub-Saharan Africa, approximately 14 million unintended pregnancies occur and a sizeable proportion is due to poor use of short-term hormonal methods. If 20% of the 17.6 million women using oral contraceptives or injectables wanted long-term protection and switched to the contraceptive implant, over 1.8 million unintended pregnancies could be averted over a 5-year period. CONCLUSION: Poor patterns of short-term hormonal contraceptive use (high discontinuation rates and incorrect use) contribute significantly to the problem of unintended pregnancy in sub-Saharan Africa. More availability and widespread use of highly effective methods, such as the contraceptive implant, will improve reproductive health in the region.     

Unintended pregnancy in the United States: incidence and disparities, 2006

Background

The incidence of unintended pregnancy is among the most essential health status indicators in the field of reproductive health. One ongoing goal of the US Department of Health and Human Services is to reduce unintended pregnancy, but the national rate has not been estimated since 2001.

Study Design

We combined data on women's pregnancy intentions from the 2006–2008 and 2002 National Survey of Family Growth with a 2008 national survey of abortion patients and data on births from the National Center for Health Statistics, induced abortions from a national abortion provider census, miscarriages estimated from the National Survey of Family Growth and population data from the US Census Bureau.

Results

Nearly half (49%) of pregnancies were unintended in 2006, up slightly from 2001 (48%). The unintended pregnancy rate increased to 52 per 1000 women aged 15–44 years in 2006 from 50 in 2001. Disparities in unintended pregnancy rates among subgroups persisted and in some cases increased, and women who were 18–24 years old, poor or cohabiting had rates two to three times the national rate. The unintended pregnancy rate declined notably for teens 15–17 years old. The proportion of unintended pregnancies ending in abortion decreased from 47% in 2001 to 43% in 2006, and the unintended birth rate increased from 23 to 25 per 1000 women 15–44 years old.

Conclusions

Since 2001, the United States has not made progress in reducing unintended pregnancy. Rates increased for nearly all groups and remain high overall. Efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women.     

青岛市未婚女性意外妊娠心理和行为研究

目的:了解青岛市未婚女性意外妊娠的心理和行为等情况,为采取积极措施降低未婚意外妊娠的发生率提供科学依据.方法:采用问卷方式对青岛市2012年5～8月因意外妊娠来院进行流、引产或生育的未婚女性进行心理、行为、避孕知识等因素的调查,采用EpiData软件建立数据库,应用SAS软件进行卡方分析和多因素分析.结果:共调查未婚女性1 1 12例,有34.35％的女性认为是被诱惑发生性行为导致意外妊娠,69.06％认为社会性文化开放导致未婚性行为,71.67％未婚女性认为缺乏避孕知识而造成意外妊娠,48.29％女性因未避孕而妊娠,其中73.29％认为不可能妊娠而未采取紧急避孕措施.不同年龄组对未婚性行为的看法无差异.年龄越小,未避孕的比例越高,各年龄组之间差异有统计学意义(P＜0.01).引流产组和生育组对于妊娠的第一感觉和流产危害的认识差异有统计学意义(P＜0.01).不同文化程度各组间避孕知识的知晓情况差异有统计学意义,文化程度越高了解越全面(P＜0.01).多因素广义线性模型分析结果显示现居地(农村→镇街→市区)、贞操观念、是否缺乏紧急避孕知识组间妊娠次数差异有统计学意义.结论:青岛市未婚女性生殖健康和避孕知识欠缺,被诱惑发生性行为情况较严重,应加强性道德、生殖健康、避孕知识的教育,减少未婚意外妊娠的发生.     

中国高校学生吸烟危险因素的Meta分析

目的 探讨影响中国高校学生吸烟的危险因素,为制定预防教育措施提供科学依据.方法 利用Meta分析方法综合分析公开发表的有关我国高校学生吸烟影响因素的17篇文献.结果 我国高校学生吸烟危险因素的单因素分析合并OR值及95％ CI分别为:朋友吸烟3.84(3.09 ～4.77)、教师吸烟2.21(1.60 ～3.07)、父母吸烟1.81(1.43 ～2.30);多因素分析合并OR值及95％ CI分别为:父母吸烟1.66(1.39～1.98)、教师吸烟1.48(1.21 ～1.82)、朋友吸烟2.39(1.96 ～2.91)、专业2.05(1.20 ～3.50)、吸烟态度2.89( 1.85 ～4.54)、每月生活费2.84(2.18 ～3.71)、低年级1.24(1.00～1.54)、同学吸烟1.40(1.02 ～1.91)、母亲文化程度0.34(0.18 ～0.62)、饮酒4.84(3.03～7.72).结论 饮酒、吸烟态度、月生活费、朋友吸烟、专业、父母吸烟、教师吸烟、同学吸烟是我国高校学生吸烟的危险因素.     

某高校学生婚前性行为、意外妊娠的发生及影响因素分析

目的了解大学生的生育健康知识、态度及行为,探索影响大学生发生性行为的因素,使未来的健康教育活动更有针对性。方法抽取北京市某高校1～4年级大学生698名,采用自行设计的问卷对大学生进行高校学生婚前性行为、意外妊娠的发生及影响因素现场调查。结果知晓适宜的流产时间、认为在大学期间可以接受婚前性行为、对待避孕的态度是消极者分别占16．8％、60．5％和29．7％;20．2％的人发生过性行为,在发生性行为的学生中,43．5％的男生使女友妊娠过,37．9％的女生意外妊娠过。Logistic回归结果显示男生（OR=7．302）、高年级（DR=2．076）及中度抑郁的（OR=2．537）学生发生性行为的风险增加。结论被调查人群的生育健康知识不足,大学生群体中性行为及意外妊娠的发生率较高,未来的教育活动应该多关注男生、高年级学生以及学牛的心弹。     

Periodic abstinence in developing countries: an assessment of failure rates and consequences

It is estimated that 27 million couples, representing 2.6% of all couples in the reproductive span, use periodic abstinence (PA). Using data from 15 national surveys in low and middle-income countries, this article assesses characteristics of PA users, knowledge of the fertile period, accidental conceptions while using PA and the reproductive consequences of these conceptions. Current users of PA (predominantly the simple calendar variant) tend to be more educated and urban than users of other methods. The method is preferred by young single women and older married women. The proportion of users with correct knowledge of the timing of ovulation ranges from 8% to 91%, with a median value of 62%. The median 12-month gross failure rate was 24 per 100 episodes. Net of other predictors of failure, correct knowledge of the timing of ovulation was associated with a 12% decrease in failure probabilities. Couples who experienced PA failure were more likely than couples who experienced failure with another method to carry the pregnancy to term. Nevertheless, PA still contributes to one-sixth of all abortions (or miscarriages) following contraceptive failure.     

The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth

BACKGROUND: The study was conducted to characterize the relationship between body mass index (BMI) and unintended pregnancy, contraceptive use patterns, and perceived fertility. METHODS: This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Unintended pregnancy was compared among BMI groups [normal (<25 m/kg(2)), overweight (25-30 m/kg(2)) and obese (>30 m/kg(2))]. Analyses also evaluated the association between demographic, socioeconomic, behavioral and health-related variables and BMI. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. RESULTS: BMI data were available from 6690 nonpregnant women. Of these, 3600 (53.6%) were normal weight, 1643 (25%) were overweight and 1447 (21.4%) were obese. Compared to women with normal BMIs, the risk of unintended pregnancy in the last 5 years did not differ among overweight [adjusted OR 0.95 (95% CI 0.77-1.17)] or obese [adjusted OR 0.87 (95% CI 0.70-1.09)] women. There were no differences in contraceptive use patterns or perceived fertility among BMI groups. CONCLUSION: Data from the 2002 NSFG do not support an association between obesity and unintended pregnancy.     

Unintended pregnancies with the etonogestrel implant (Implanon): a case series from postmarketing experience in Australia

This paper describes a case series of over 200 unintended pregnancies associated with the etonogestrel implant, Implanon. These cases have been reported to the Australian Adverse Drug Reactions Advisory Committee during the first 3 years of marketing in this country. Of 218 cases included, 45 had insufficient data to assess the reason for contraceptive failure and 46 women were determined to have been already pregnant prior to Implanon insertion. Of the remaining 127 cases, the most common reason for unintended pregnancy was failure to insert the implant in 84 women. Other reasons included incorrect timing of insertion (19 cases), expulsion of Implanon (3 cases) and interaction with hepatic enzyme-inducing medicines (8 cases). The remaining 13 cases were classified as product/method failures once other reasons had been excluded. Using the 204,486 Implanon devices subsidized in this period to estimate the population exposed and the 218 pregnancies reported, the approximate failure rate in postmarketing use was 1 in 1000 insertions. These findings (and reports to medical indemnity insurers) have resulted in the development of guidelines and training for doctors inserting Implanon in Australia.     

Reasons for Ineffective Contraceptive Use Antedating Adolescent Pregnancies Part 1: An Indicator of Gaps in Family Planning Services

Purpose Identify new ways to increase the impact of pregnancy prevention interventions on the number of children born to adolescents. Methods The study participants, a racially/ethnically diverse group of 1,568, pregnant 13–18 year olds, reported why they had not used contraception at the time of conception. Their explanations were sorted into categories. The frequency with which each category was endorsed, the stability of these endorsements (Kappa statistic), and differences between adolescents who endorsed each category (stepwise logistic regression) were examined at two points in gestation. Results “Not ready to prevent pregnancy” was the most frequently endorsed category; it was often the only category endorsed. Logistical barriers and misperceptions about the need for contraception were the least frequently endorsed categories. The reasons individual patients gave for not using contraception changed (K ≤ 0.4) during gestation. Yet, adolescents who were not ready to prevent conception consistently differed from those who were; they were more apt to be Hispanic, to live in non-chaotic environments with an adult father of the child rather than their parents, and to have goals compatible with adolescent childbearing. Conclusions The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention from overcoming logistical barriers and misperceptions about the need for contraception, to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence.     

The cost of unintended pregnancy in the United States

INTRODUCTION: Despite the many contraceptive options available in the United States, nearly half (49%) of the 6.4 million pregnancies each year are unintended; these represent a significant cost to the health care system. METHODS: The total number of unintended pregnancies and their outcomes were obtained from the literature. Direct medical costs were estimated for each unintended pregnancy outcome. RESULTS: The direct medical costs of unintended pregnancies were US$5 billion in 2002. Direct medical cost savings due to contraceptive use were US$19 billion. DISCUSSION: Unintended pregnancies are a costly problem in the United States. Contraceptive use can reduce direct and indirect costs; hence, payers may realize cost savings by providing coverage of contraceptive products.     

Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth

Background

Maternal chronic medical disease and unintended pregnancies increase the risk of maternal and infant morbidity and mortality. Little is known regarding the relationship between chronic medical disease status and pregnancy intendedness or contraceptive use.

Study Design

We compared pregnancy intention and postpartum contraception use in women with and without chronic medical disease who experienced a live birth using data from the Florida Pregnancy Risk Assessment Monitoring System 2004–2005.

Results

Women aged ≥20 years with chronic medical disease were more likely to report that the index pregnancy was unintended (odds ratio [OR]=1.56, 95% confidence interval [CI] 1.28–2.03) and reported similar postpartum contraception nonuse (OR=0.85, 95% CI 0.60–1.19) compared to those without chronic medical disease. Women aged <20 years with chronic medical disease were less likely to report that the index pregnancy was unintended (OR=0.50, 95% CI 0.28–0.88) and reported similar postpartum contraception nonuse (OR=0.99, 95% CI 0.54–1.82) compared to those without chronic medical disease.

Conclusions

In our study population, age and chronic medical disease were associated with different risks of pregnancy intention in the index pregnancy. Women with and without chronic disease in both age groups reported similar postpartum contraception use.     

Factors Affecting Abortion Decisions among Young Couples in Nepal

PurposeTo explore, using both survey data and case studies, factors that are associated with abortion decisions among young couples in the context of recently legalized abortion in Nepal.MethodsThis article draws primarily on data collected in detailed case histories of 30 participants selected from a sample of the respondents to a survey of 997 married women aged 15 to 24 years and 499 men aged 15 to 27 years collected in 2003. Bivariate analyses of the survey data are presented in summary form to provide some general contextual background, with the key themes that emerged from analysis of the case histories being described.ResultsAlmost half of the young women in the survey reported that they had ever experienced an unintended pregnancy. A considerable proportion of these couples thought about abortion but the majority of them did not take any action. Some of them had attempted abortion but only few had succeeded. Multiple factors, including socio-cultural beliefs, affect the decision-making phase, making the process dynamic and situation-specific. Husbands and health service providers play a major role in the decision-making process.ConclusionsThe study highlights the need to scale up family planning and abortion services to young couples, and emphasizes the importance of involving men and service providers in public education and advocacy campaigns against unsafe abortion. It also points to the need for wider education in the community about family planning and legal abortion services, as well as for the transparent pricing of services and greater efforts to enhance women’s decision-making capacities and control over their reproductive options.     

Prevalence and correlates of ambivalence towards pregnancy among nonpregnant women

BACKGROUND: Ambivalence towards pregnancy is rarely acknowledged in policy discussions. METHODS: We surveyed 441 nonpregnant women who consecutively presented to two urgent care clinics in California about their current intentions to conceive using a five-point scale. We examined the association between ambivalence towards pregnancy, sociodemographic characteristics and use of contraception. RESULTS: Almost one third of women (29.0%; 95% CI=25-33%) expressed ambivalence about their intentions to become pregnant. In multivariable modeling, being older than 30, being nonwhite and having a personal or religious objection to abortion were significantly associated with ambivalence towards pregnancy. Compared with women who stated they were trying to avoid pregnancy, women who expressed ambivalence were significantly less likely to have used a barrier or hormonal form of contraception at last intercourse (OR=0.36, 95% CI=0.23-0.57) and more likely to use the natural family planning (NFP) method (OR=3.31, 95% CI=1.39-7.90) or withdrawal (OR=1.61, 95% CI=0.98-2.65). CONCLUSION: Ambivalence towards pregnancy is common and is associated with use of less effective contraceptive methods.     

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Background

This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

Study Design

Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

Results

Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

Conclusion

Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.