Marital status and cohabitation during pregnancy: relationship with social conditions, antenatal care and pregnancy outcome in France

Summary. A survey of a representative sample of 5508 births in France in 1981 permitted the study of social characteristics of pregnant women, the medical care they received during their pregnancy and their pregnancy outcome, as a function of their marital status and whether or not they lived with the father of the child. Unmarried women living with the father (n = 412) like unmarried women living alone (n = 171), were more often younger, having their first baby and had a lower educational level than did married women living with the father (n = 4590). However, among the unmarried women, those living alone were in a more unfavourable position than those living with the father; in particular, they were more often less than 20 years old, had the minimum educational level required and were unemployed. Both groups of unmarried women had a higher preterm delivery rate than did married women, even after taking other risk factors into account in a logistic regression. The odds ratios (95% confidence interval) for pre-term delivery among unmarried mothers living without the father was 1.9 (1.0–3.4) and that for the unmarried cohabiting with the father was 1.6 (1.0–2.4). Thus, to fully appreciate the perinatal risks and medical needs during pregnancy, both the marital and cohabitational status of the women should be considered.     

Predictors of Maternal Depression in the First Year Postpartum: Marital Status and Mediating Role of Relationship Quality

Existing literature has documented the associations between marital status and maternal depression within the first year postpartum. Using data that is representative of urban non-marital births in the United States with a large over-sample of non-marital births, we investigate the association of maternal depression with not only marital status but also relationship quality with the father of the baby. Quality is independently associated with maternal depression after controlling for marital status and other variables that have been documented as risk factors for maternal depression. In addition, relationship quality explains away the associations between marital status and maternal depression. After controlling for relationship quality, single women were no more likely to be depressed compared to married or cohabiting women.     

Smoking behaviour among pregnant women prior to antenatal care registration

Changes in smoking behaviour during early pregnancy and factors influencing such changes were studied in an unselected, area-based population. During 1987, all women registered at the antenatal care clinics in Uppsala county. Sweden, received a self-administered questionnaire regarding past and present smoking habits. Thirty-two per cent (n = 1160) were daily smokers at the time of conception. Almost one-fourth of the smokers (n = 263) had quit smoking at the first visit to antenatal care 6-10 weeks later. Using logistic regression analyses, we found that low education, not living with infants's father and whether others smoked at home or at work were factors that were independently associated with increased risks of smoking at time of conception as well as continued smoking in early pregnancy. Continued smoking was also significantly more common among women with previous births, women who started smoking at an early age and women who smoked heavily.     

Psychosocial resources and persistent smoking in early pregnancy--a population study of women in their first pregnancy in Sweden.

STUDY OBJECTIVE: To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. DESIGN: The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks. SETTING: The study was performed in the antenatal clinics in the city of Malmö, Sweden. PARTICIPANTS: The participants were all primigravidas living in the city of Malmö, Sweden, over a one year period, 1991-92. A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n = 404, 46.3%). MAIN RESULTS: At the first antenatal visit (63.6% (n = 257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29.5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2.7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2.2 (1.2, 4.0) and those with a low social participation RR 1.6 (1.0, 2.7), low instrumental support RR 2.6 (1.2, 6.0), low support from the child's father RR 2.1 (1.0, 4.2) and those exposed to job strain RR = 2.3 (1.1, 4.8). The associations were independent of potential confounders such as age, educational level, nationality, cohabiting status, passive smoking, and previous years of smoking. CONCLUSIONS: This study supports the stress hypothesis. Smoking can be one way women handle stress when demands become too great. In order to reduce smoking among pregnant women, maternity centre resources need to be focused more on women with low psychosocial resources who are at highest risk for continued smoking. It is also important to involve actively the woman's partner or other important people in the woman's social network.     

Women''s drinking and drinking problems: patterns from a 1981 national survey

A 1981 national survey of women's drinking interviewed 917 women in the general population, stratified on the basis of screening interviews to include 500 moderate-to-heavy drinkers. The survey found no evidence of any major recent increase in women's drinking, and no evidence of unusually heavy drinking among working wives. Adverse drinking consequences and episodes of extreme drinking were most common among women aged 21-34; women who were unmarried, divorced or separated, or cohabiting; and women with frequent drinkers as spouses or companions. Alcohol-related behavior problems and symptoms of alcohol dependence were closely related to levels of alcohol consumption. Among women averaging one ounce or more of ethanol per day, 45 per cent had driven while intoxicated in the past year, and 36 per cent reported memory lapses while drinking. Women at this consumption level were also more likely to report experiences with depression (61 per cent). Women with extremely high consumption levels were more likely to have histories of obstetrical and gynecological problems. Some women with alcohol-related problems reported periods of temporary abstention, a pattern not studied heretofore.     

Antenatal care: a case of the inverse care law?

Abstract: As part of a review of maternity services this study assessed satisfaction with antenatal care among 1193 women who gave birth in Victoria during two weeks of 1989, except for those who had a stillbirth or whose infant died between the birth and the survey. The survey questionnaire was mailed to women eight to nine months after the birth. The response rate, excluding duplicates, women who gave birth outside the survey period and those whose questionnaires were returned because of a change of address was 71.5 per cent. Women attending public hospital clinics were the least satisfied with antenatal care and those attending private obstetricians were the most satisfied, with general practitioners intermediate. These differences by provider accounted for almost all the differences by sociodemographic factors (age, marital status, family income, being of non-English-speaking background and health insurance status). While the majority of women were happy with their antenatal care, an inverse care law still applied: women whose economic and social circumstances meant they were most likely to need ‘care’ from caregivers were more likely to be limited in their choice of caregiver and to be dissatisfied with the care they received.     

Social inequalities in the association between partner/marital status and health among workers in Spain

The objectives of this study are to examine the association between partner/marital status and several health outcomes among workers and to assess whether it depends on gender and occupational social class. The sample was composed of all workers aged 21-64 years interviewed in the 2006 Spanish National Health Survey (8563 men and 5881 women). Partner/marital status had seven categories: married and living with the spouse (reference category), married and not living with the spouse, cohabiting, single and living with parents, single and not living with parents, separated/divorced and widowed. Four health outcomes were analysed: self-perceived health status, mental health, psychiatric drugs consumption and hypertension. Multiple logistic regression models stratified by sex and social class were fitted. Female manual workers who were cohabiting were more likely to report poor self-perceived health status, poor mental health status, psychiatric medication consumption and hypertension than their married and living with the spouse counterparts. In that group the prevalence of poor health outcomes was even higher when compared with single people. Among male non-manual workers, being married and not living with the spouse was associated with poor self-perceived health status, poor mental health status and hypertension. There were almost no differences in health between being married and the rest of partner/marital status categories for different combinations of gender and social class and, even, some groups of single people reported better health outcomes than people who were married. Our results show no evidence that being married and living with the spouse is unequivocally linked to better health status among Spanish workers. They emphasize the importance of not only considering marital status, but also partner status, as well as the role of gender, social class and the sociocultural context in the analysis of the association between family characteristics and health.     

The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis

CONTEXT: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.     

Marital status and body weight,weight perception,and weight management among U.S. adults

Married individuals often have higher body weights than unmarried individuals, but it is unclear how marital roles affect body weight-related perceptions, desires, and behaviors. This study analyzed cross-sectional data for 4,089 adult men and 3,989 adult women using multinomial logistic regression to examine associations between marital status, perceived body weight, desired body weight, and weight management approach. Controlling for demographics and current weight, married or cohabiting women and divorced or separated women more often perceived themselves as overweight and desired to weigh less than women who had never married. Marital status was unrelated to men's weight perception and desired weight change. Marital status was also generally unrelated to weight management approach, except that divorced or separated women were more likely to have intentionally lost weight within the past year compared to never married women. Additionally, never married men were more likely to be attempting to prevent weight gain than married or cohabiting men and widowed men. Overall, married and formerly married women more often perceived themselves as overweight and desired a lower weight. Men's marital status was generally unassociated with weight-related perceptions, desires, and behaviors. Women's but not men's marital roles appear to influence their perceived and desired weight, suggesting that weight management interventions should be sensitive to both marital status and gender differences.     

Births: preliminary data for 2001.

OBJECTIVES: This report presents preliminary data for 2001 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. METHODS: Data in this report are based on more than 96 percent of births for 2001. The records are weighted to independent control counts of all births received in State vital statistics offices in 2001. Comparisons are made with 2000 final data. RESULTS: The number of births, the crude birth rate, and the fertility rate all declined slightly between 2000 and 2001. The number of births was down by less than 1 percent, the crude birth rate declined 1 percent to 14.5 per 1,000 population, and the fertility rate was down slightly to 67.2 births per 1,000 women aged 15-44 years. Teenagers were less likely to give birth in 2001; the teen birth rate continued to fall, dropping 5 percent between 2000 and 2001 to 45.9 births per 1,000 females aged 15-19 years, another record low. The teen birth rate has fallen 26 percent since 1991. The birth rate for teenagers 15-17 years fell 8 percent, and the rate for teenagers 18-19 years was down 4 percent for 2000-2001. Since 1991 rates have fallen 35 percent for teenagers 15-17 years, and 20 percent for teenagers 18-19 years. Birth rates for women aged 20-24 declined by 2 percent, whereas rates for women 25-44 years increased. Childbearing among women aged 40-54 years was stable. The birth rate for unmarried women decreased modestly to 44.9 births per 1,000 unmarried women 15-44 years in 2001, still remaining below the peak reached in 1994. The number of births to unmarried women was up very slightly, but births to unmarried teens were down. The proportion of women who began prenatal care in the first trimester of pregnancy improved slightly to 83.4 percent, but the rate of low birthweight held at 7.6 percent. The total cesarean delivery rate jumped 7 percent between 2000 and 2001 to 24.4 percent of all births, the highest level ever reported from this data source; the primary rate of cesarean deliveries rose 5 percent, and the rate of vaginal births after previous cesarean delivery tumbled 20 percent.     

WIC participation and pregnancy outcomes: Massachusetts Statewide Evaluation Project.

The effects of WIC prenatal participation were examined using data from the Massachusetts Birth and Death Registry. The birth outcomes of 4,126 pregnant women who participated in the WIC program and gave birth in 1978 were compared to those of 4,126 women individually matched on maternal age, race, parity, education, and marital status who did not participate in WIC. WIC prenatal participants are at greater demographic risk for poor pregnancy outcomes compare to all women in the same community. WIC participation is associated with improved pregnancy outcomes, including, a decrease in low birthweight (LBW) incidence (6.9 per cent vs 8.7 per cent) and neonatal mortality (12 vs 35 deaths), an increase in gestational age (40.0 vs 39.7 weeks), and a reduction in inadequate prenatal care (3.8 per cent vs 7.0 per cent). Stratification by demographic subpopulations indicates that subpopulations at higher risk (teenage, unmarried, and Hispanic origin women) have more enhanced pregnancy outcomes associated with WIC participation. Stratification by duration of participation indicates that increased participation is associated with enhanced pregnancy outcomes. While these findings suggest that birth outcome differences are a function of WIC participation, other factors which might distinguish between the two groups could also serve as the basis for alternative explanations.     

Stage of change is associated with assessment of the health risks of maternal smoking among pregnant women

This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.     

Trends in low birth weight infants and changes in Baltimore's childbearing population, 1972–77

Linked birth and death records provided the population for a study of trends in low birth weight (LBW) rates in Baltimore between 1972 and 1977 and of the effect of changes in the characteristics of the childbearing population on these trends. The impact of shifts in the birth weight distribution on neonatal mortality rates was also investigated. Trends were analyzed for unstandardized LBW rates as well as for rates standardized on the distributions of maternal age, education, gravidity, prior pregnancy losses, and marital status.Between 1972 and 1977, the 1,500 and 2,000 gm rates rose significantly by approximately 1 infant per 1,000 live births per year among whites and 2 infants per 1,000 live births among nonwhites. Despite declines in rates for most weights, the effect of these increases was a rise in neonatal mortality rates for both races, but especially for nonwhites.The population of women delivering in Baltimore in 1977 became slightly older, slightly more educated, and of higher gravidity than in 1972, but these changes had little impact on yearly fluctuations in LBW rates. In contrast, increases in births to unmarried women and to women with at least one prior pregnancy loss were related to rising LBW rates. For both races, standardization on marital status and prior pregnancy losses diminishes the increase in the LBW rate over the study period, especially when standardization is performed simultaneously for both variables. These findings hold within maternal age, education, and gravidity groups. However, the LBW rates for nonwhite teenage mothers and for nonwhite women with 12 years of less education increased significantly over the study period, regardless of standardization.     

Pregnancy, social status and health in Sweden

The variations in reproductive outcome according to marital and social status are of major interest in many countries. It has however been suggested recently in Sweden that socio-economic characteristics do not in general have a substantial effect on reproductive performance. It is noted that women living alone report more general health symptoms than women cohabiting whether or not they are pregnant which appears to contradict previous results. On the other hand pregnant women living alone report more pregnancy related symptoms than pregnant women who are cohabiting. Moreover, in both cases, upper social groups tend to be healthier.     

Live births resulting from unintended pregnancies: is there variation among states? The PRAMS Working Group.

CONTEXT: States need data on live births resulting from unintended pregnancies in order to assess the need for family planning services; however, many states do not collect such data. Some states may use extrapolated rates from other states. METHODS: Pregnancy Risk Assessment Monitoring System (PRAMS) data were assessed to explore the feasibility of extrapolating data on the percentage of live births resulting from unintended pregnancies from states that collect these data to states that do not. Data on women who had live births between 1993 and 1995 were examined for eight states: Alabama, Florida, Georgia, Michigan, New York (excluding New York City), Oklahoma, South Carolina and West Virginia. Logistic regression was used to determine state variation in the odds of delivering a live birth resulting from an unintended pregnancy after adjustment for maternal race, marital status, age, education, previous live birth and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). RESULTS: The percentage of live births resulting from unintended pregnancy ranged from 33% in New York to 49% in Alabama, Georgia and South Carolina. Compared with women in Alabama, women in Oklahoma were more likely to deliver a live birth resulting from an unintended pregnancy (odds ratio of 1.2, confidence interval of 1.1-1.3) and women in New York State were less likely (odds ratio of 0.7, confidence interval of 0.6-0.8) to have such a birth. However, unmarried white women in New York had lower odds of having a live birth resulting from an unintended pregnancy and married black women in Michigan had higher odds of having a live birth resulting from unintended pregnancy than their counterparts in Alabama. Although the percentages varied, in all eight states women who were black, were unmarried, were younger than 20 years of age, had less than 12 years of education or had more than one child had higher percentages of live births resulting from unintended pregnancy than women with other demographic characteristics. CONCLUSIONS: Data on which women have the greatest risk of delivering a live birth resulting from an unintended pregnancy may be extrapolated from one state to another, but the rate of such births may overestimate or underestimate the problem from one state to another.     

Marital status, fatness and obesity.

Marital status is related to morbidity and mortality, with married people healthier and at lower risk of death than those who are unmarried (especially among men). However, the relationship between marital status and obesity is not well established. Role theory suggests through a marital causation model that people in the marital role are more likely to be obese, and through a marital selection model that people in the marital role are less likely to be obese because of stigmatization. The martial causation model was examined using data from the National Survey of Personal Health Practices and Consequences, a cross-sectional national telephone survey of 3025 adults age 20-64 in the United States. Sequential regression analyses revealed that married men were significantly fatter and more likely to be obese than never married or previously married men, even when demographic, social, and physical variables were controlled. By contrast, marital status was not significantly associated with fatness or obesity among women when other variables were controlled. The marital role appears to influence fatness and obesity among men, but not women.     

Why do pregnant women smoke?

This study aimed to record the main reasons given by pregnant women for smoking and to observe how these varied by age, education, marital status, social class and level of tobacco consumption. The study involved 498 smoking mothers who were all new antenatal clinic attenders. Data were collected by self-completed questionnaire containing closed and open response items. The participation rate was 95%. Main reasons given for smoking in pregnancy included those related to mood control (i.e. to relax, calm down, enjoyment, out of boredom) and addiction. Pregnant women were more likely to smoke to control their mood if they were older and smoked less than ten cigarettes per day. They were more likely to give addiction as their reason for smoking if they were older. Pregnant women were also more likely to smoke due to boredom if they were single, especially divorced or separated, from unskilled or semi-skilled occupational groups and if their husband or partner was unemployed. The implications of the findings for health education are discussed.     

Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?

STUDY OBJECTIVES: To describe the utilisation of reproductive health services (family planning, antenatal care, and delivery services) and the socioeconomic determinants for utilisation of health services. DESIGN: This was a cross sectional survey, using a multistage sampling technique. SETTING: Tien Hai district, Thai Binh Province, Vietnam. Altogether 1132 mothers with children under 5 years of age were interviewed about antenatal, delivery, and family planning services utilisation during a five year period (1987-92). MAIN RESULTS: Seventy per cent of the women used contraceptive methods, with the intrauterine device being the most common. The use of the intrauterine device was positively associated with the number of children alive but not with other sociodemographic factors in the mothers. Thirty per cent of the women had attended an antenatal clinic for check ups during their last pregnancy. It was found that mothers with fewer deliveries, higher education, and who were Buddhist or of no religion had utilised antenatal services more frequently than the others. Seventy five per cent of the mothers in this study had been assisted by health professionals at their last delivery. Those mothers with fewer deliveries, higher education, who were Buddhist or had no religion, and had sufficient to eat were more likely to have their births attended by health professionals. CONCLUSIONS: In spite of a relatively high education level in the population and services which are generally available, there was an under utilisation of antenatal and delivery care and there was no equal opportunity for different groups of mothers to use these services. Family planning services were, however, frequently used and were used to the same extent by different groups of mothers. Except for abortion, alternatives to the intrauterine device method were rarely available. If pregnancies are to be protected in an efficient way in rural Vietnam, reproductive health care must be strengthened and efforts should be made to reach the women who are not using these services at present.     

Infant health consequences of childbearing by teenagers and older mothers

The association of childbearing at early and late ages with various adverse outcomes of pregnancy was explored in data collected in the 1980 National Natality and Fetal Mortality Surveys. The characteristics of interest for teenage mothers were marital status at conception and the trimester of pregnancy in which prenatal care was begun. For married mothers aged 30 years and older, the variables considered were employment status and occupation during the year preceding childbirth and smoking status before and during pregnancy. The pregnancy outcome variables analyzed were the same for both groups of mothers: fetal loss, low birth weight, and low 1-minute Apgar scores. Although more than half of all births to teenage mothers were to unmarried women, an additional one-quarter of these births were to women who married between the time of conception and the birth of the child. Generally there was little difference in outcomes for teenage mothers who were married at the time of delivery, regardless of their marital status at the time of conception. Pregnancy outcomes for teenagers who did not marry prior to delivery were considerably less favorable. Nearly 90 percent of women aged 30-34 years who had a first birth in 1980 were employed during the year before delivery, an extraordinarily high labor force participation rate. More than half of these employed mothers were in professional occupations, consistent with their very high levels of educational attainment. Although the analysis is limited by the small numbers of births involved, it appears that professionally employed women generally have the best pregnancy outcomes. When mother's smoking status is taken into account,nonsmokers had more favorable outcomes, with births to professionally employed mothers generally most favored.