Planned,unplanned and in-between: the meaning and context of pregnancy planning for young people

Objective

To understand how young people conceptualize planned, unplanned and “in-between” pregnancies.

Disparities in contraceptive knowledge, attitude and use between Hispanic and non-Hispanic whites

BACKGROUND: Higher rates of unwanted pregnancies and lower rates of contraceptive use have been reported among Hispanic women than among non-Hispanic whites. Despite these differences, it is unclear how these groups differ with respect to various psychosocial factors that are associated with contraceptive decision making, including contraceptive knowledge, attitudes, self-efficacy and social support. METHODS: A total of 443 sexually active, nonpregnant, low-income women (137 non-Hispanic whites, 74 US-born Hispanics and 231 non-US-born Hispanics) were surveyed at two publicly funded clinics. RESULTS: The greatest number of barriers to the effective use of contraception was seen among non-US-born Hispanic women. Fewer differences emerged between US-born Hispanics and whites, although differences continued to exist between the two groups in certain key areas. As compared to non-Hispanic whites, US-born Hispanic women had lower levels of social support for and self-efficacy in contraceptive use, desired larger families, had more religious objections to using birth control and were more those likely to believe that birth control use is the responsibility of women. As compared to whites, both US and non-US-born Hispanic women had significantly lower rates of ever-use of contraceptives that are highly effective in preventing pregnancy or in preventing disease transmission, and higher rates of unintended pregnancies. All associations were independent of known confounders. CONCLUSION: Despite improvements in contraceptive knowledge and attitude, birth control and disease-preventive practices did not improve significantly among Hispanics who were born in the United States. Hispanic women are at higher risk for unintended pregnancy than are non-Hispanic whites, irrespective of their US nativity.     

Geographic Access to Family Planning Facilities and the Risk of Unintended and Teenage Pregnancy

Objectives: This study tested the hypotheses that greater geographic access to family planning facilities is associated with lower rates of unintended and teenage pregnancies. Methods: State Pregnancy Risk Assessment Monitoring System (PRAMS) and natality files in four states were used to locate unintended and teenage births, respectively. Geographic availability was measured by cohort travel time to the nearest family planning facility, the presence of a family planning facility in a ZIP area, and the supply of primary care physicians and obstetric-gynecologists. Results: 83% of the PRAMS cohort and 80% of teenagers lived within 15 min or less of a facility and virtually none lived more than 30 min. Adjusted odds ratios did not demonstrate a statistically significant trend to a higher risk of unintended pregnancies with longer travel time. Similarly there was no association with unintended pregnancy and the presence of a family planning facility within the ZIP area of maternal residence, or with the supply of physicians capable of providing family planning services. Both crude and adjusted relative rates of teenage pregnancies were significantly lower with further distance from family planning sites and with the absence of a facility in the ZIP area of residence. In adjusted models, the supply of obstetricians-gynecologists and primary care physicians was not significantly associated with decreased teen pregnancies. Conclusions: This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.     

Gestational Weight and Dietary Intake During Pregnancy: Perspectives of African American Women

Objectives This investigation explored the participants’ perspective on weight, nutrition, and dietary habits during pregnancy. The data of interest were culled from a larger ethnographic research study designed to gather information and ideas about the socio-cultural, psychological, and behavioral influences on maternal health during pregnancy (N = 63). Methods My study focused on the six participants (including three teenagers) who delivered low birth weight and/or preterm babies and 13 participants aged ≤18 years (teenagers) who delivered normal weight babies. Data were analyzed utilizing qualitative methodology. Results Four of the participants who delivered low birth/weight preterm infants reported weight related concerns during pregnancy. These included: weight loss, lack of weight gain, and exceeding their expected weight gain. Frequently, the nutrition knowledge was based on miseducation, misconceptions, and/or ‘a grain of truth’ i.e. folk beliefs. Support group members had an influential role on participants’ dietary habits during pregnancy. Conclusion The next step appears to be more qualitative work, with health care providers, the Women Infants and Children Program (WIC) nutrition counselors, clinical dietetic professionals, and women who already have children, to explore strategies for improving diet quality as well as address the issue of inadequate and excessive weight gain during pregnancy.     

Unintended Childbearing and Knowledge of Emergency Contraception in a Population-Based Survey of Postpartum Women

Objectives We examined the relationship between unintended childbearing and knowledge of emergency contraception. Methods The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of postpartum women. We analyzed data from the 2001 PRAMS survey using logistic regression to assess the relationship between unintended childbearing and emergency contraception while controlling for maternal characteristics such as age, race/ethnicity, education, marital status, family income, and insurance coverage before pregnancy. Results In 2001, 1,795 women completed the PRAMS survey (78.1% weighted response proportion). Of the women who completed the survey, 38.2% reported that their birth was unintended and 25.3% reported that they did not know about emergency contraception before pregnancy. Unintended childbearing was associated with a lack of knowledge of emergency contraception (OR 1.43, 95% CI 1.00, 2.05) after controlling for marital status and age. Conclusions Women in Oregon who were not aware of emergency contraception before pregnancy were more likely to have had an unintended birth when their marital status and age were taken into account. Unintended birth was more likely among women who were young, unmarried, lower income, and uninsured. Given that emergency contraception is now available over-the-counter in the US to women who are 18 years of age or older, age- and culturally-appropriate public health messages should be developed to expand women’s awareness of, dispel myths around, and encourage appropriate use of emergency contraception as a tool to help prevent unintended pregnancy and birth. An erratum to this article can be found at     

Unplanned Pregnancy in Adolescents: Association with Family Structure,Employed Mother,and Female Friends with Health-Risk Habits and Behaviors

Previous publications have suggested that living in a nonintact family household and socializing with girlfriends who smoke or who consume alcoholic beverages favor the development of health-risk habits and customs in adolescents. However, their relationship with unplanned pregnancy in adolescents has not been determined. We investigated the association between family structure, employed mother, and female friends with health-risk habits and behaviors with unplanned pregnancy in adolescents (n = 3,130). After adjusting for low maternal educational level and low family income, logistic regression analyses showed that having an employed mother and socializing with girlfriends who have health-risk habits or behaviors, rather than living in a nonintact family household, appear to be the most important health-risk factors for unplanned pregnancy in adolescents. It is important for health-care programs for adolescents to be revised and for their strategies be strengthened in order to reach the objectives for which they were created.     

Exposure to Partner,Family, and Community Violence: Gang-Affiliated Latina Women and Risk of Unintended Pregnancy

While teen pregnancy rates appear to be declining in the USA overall, the rate of decline among young Latinas has been less than other ethnic groups. Among the myriad factors associated with elevated pregnancy rates, for Latina girls living in the inner city, exposure to gang and community violence may be a critical context for increased pregnancy risk. This study explores the relationship between gang involvement and reproductive health, and the pathways through which childhood, family, and relationship violence exposure may lead to unintended pregnancy. Interviews of 20 young adult Latinas with known gang involvement in Los Angeles County were audiotaped, transcribed, and coded for key themes related to violence exposure and reproductive health. Limited access to reproductive health care compounded by male partner sexual and pregnancy coercion, as well as physical and sexual violence, emerged in the interviews. Exposures to interparental domestic violence, childhood physical and sexual abuse, and gang violence were prominent and closely associated with unhealthy and abusive intimate relationships. Adverse childhood experiences and exposure to partner, family, and community violence impact the reproductive lives and choices of young Latina women in gangs. These findings may guide targeted pregnancy prevention efforts among urban gang-affiliated Latinas as well as encourage the integration of sexual violence prevention and reproductive health promotion within gang violence intervention programs.     

34例系统性红斑狼疮患者行中期引产术临床分析

目的：分析系统性红斑狼疮（SLE）患者于妊娠中期终止妊娠的原因及引产方式的选择,探讨SLE患者的生育管理和中期引产相关问题。方法：回顾性分析1994年1月—2012年4月收治的34例SLE患者于妊娠中期行中期引产的相关数据。引产原因分为可避免和不可避免2类,可避免中期引产指社会因素和SLE治疗中意外妊娠;不可避免中期引产包括胎儿因素、妊娠期SLE初发和疾病稳定期计划内妊娠后妊娠期SLE复发。结果：可避免中期引产者共15例（占44.1%）,不可避免中期引产者共19例（占55.9%）。引产方式中：12～16周行大钳刮术者3例,行米非司酮加米索前列醇药物引产者2例,17～28周行依沙吖啶羊膜腔内引产者25例,行剖宫取胎术者4例。除1 例钳刮时大出血外,无手术并发症。2组相比妊娠周及引产方式差异无统计学意义,但妊娠期疾病活动者在不可避免组（16/19）显著高于可避免组（6/15）,差异有统计学意义（P＜0.05）。结论：SLE妇女缺乏生育管理,应加强该人群的妊娠前和避孕咨询,以减少可避免的引产手术。此类患者的中期引产系高危手术,术前应全面评估,选择适合的手术方法以确保母亲的安全。     

Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014

Objective

The objective was to examine levels of, correlates of and changes in the use of individual and grouped methods of contraception among US females aged 15–44 from 2008 to 2014.

Pregnancy Intentions,Pregnancy Attitudes,and the Use of Prenatal Care in Missouri

Objectives: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. Methods: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of women's attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. Results: Women's attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. Conclusions: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve women's utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.     

卢湾区社区高危孕妇发生情况和妊娠结局分析

目的了解社区高危孕妇的发生情况和妊娠结局,为有效开展高危孕妇早发现、早诊断、早干预提供依据。方法按照《上海市孕产妇系统保健管理办法》中“高危妊娠评分标准”,对2008-2009年上海市卢湾区全区4个社区卫生服务中心的3167名孕妇中671名（21．19％）高危孕妇,进行高危因素和妊娠结局的分析。结果外来人口的高危孕妇发生率（29．09％）明显高于上海户籍人口（19．61％）,高危因素中以异常妊娠分娩史为主,其中异常妊娠分娩史发生率比较高,高危孕产妇的流产率、低体重儿发生率和早产率明显高于正常的孕产妇。结论在社区卫生服务中心和接产医院建立高危孕妇双向转诊制度,可以提高高危孕妇管理的整体性、连续性及有效性。加强婚前、孕前保健和流动人口的生殖保健指导,可以有效地降低高危孕妇的发生率,预防不良妊娠结局的发生。     

谷胱甘肽联合多烯磷脂酰胆碱对妊娠期肝内胆汁淤积症孕妇皮肤瘙痒症状及妊娠结局的影响

目的 探讨分析谷胱甘肽联合多烯磷脂酰胆碱对妊娠期肝内胆汁淤积症(ICP)孕妇皮肤瘙瘁症状及妊娠结局的影响.方法 选取2016年3月至2020年2月我院收治的ICP孕妇62例,随机平均分为两组.对照组在常规治疗基础上采用多烯磷脂酰胆碱治疗,观察组在对照组基础上采用谷胱甘肽治疗.治疗10 d后,比较两组孕妇的Ribaha评...     

124例妊娠中期子宫动脉血流频谱与不良妊娠结局的相关性分析

目的：分析妊娠中期子宫动脉血流频谱与不良妊娠结局相关性。方法：选取2011年10月-2014年1月间本院收治的妊娠中期孕产妇124例为研究对象进行分析,应用超声检测子宫动脉血流阻力参数RI值、PI值、S/D值,分析不良妊娠结局与子宫动脉血流频谱之间的相关性。结果：124例孕产妇中,正常妊娠97例,不良妊娠结局者27例,比例21.77％;27例不良妊娠结局孕产妇中,7例妊高症（25.92％）,6例妊娠期糖尿病（22.22％）,5例低体重儿（18.51％）;正常孕产妇左侧、右侧、双侧子宫动脉血流阻力参数RI值、PI值、S/D值对比差异无统计学意义（P〉0.05）;妊娠期糖尿病与正常孕妇相比,仅RI较小值、PI较小值对比差异具有统计学意义（P〈0.05）;切迹组与无切迹组不良妊娠结局对比差异无统计学意义。结论：妊娠中期子宫动脉血流阻力参数改变与妊娠期糖尿病密切相关,子宫动脉血流频谱对指示不良妊娠结局有一定价值,具体还需进一步研究探索。     

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.     

吉林省部分地区育龄妇女妊娠期与分娩期卫生保健服务现状调查

目的:了解吉林省孕产妇在妊娠期与分娩期的卫生保健服务状况,探讨进一步改进服务水平的有效途径。方法:采用定量研究方法,选择省内16个县(市、区)计划生育行政部门和服务机构以及相关卫生部门,进行问卷调查,并对调查数据进行整理和统计。结果:调查地区已婚育龄妇女生育率逐年下降,孕产妇的保健情况已逐步得到改善,孕期保健就诊率逐年提高,10年间增幅在20%以上,其间各地孕产妇的妊娠并发症的发生率逐年下降,妊娠合并症主要为贫血和肝炎。近年各地的剖宫产率在逐年增加,家庭分娩仍占有一定比例,个别地区该比例仍居高不下。结论:调查县(市、区)的孕产期保健服务虽已得到改善,但仍存在家庭分娩率高、剖宫产率高和妊娠并发症发生率较高等问题,亟待计生和卫生部门联手,进一步完善服务机制,以提高孕产妇的生殖保健服务水平。     

Implementing changes to hospital services: factors influencing the process and 'results' of reconfiguration

Objectives

Acute hospital reconfiguration is often presented as a problem to be solved by calculations of optimal design, a rational process amenable to influence by open and responsive consultation. We aimed to analyse factors in the process and ‘results’ of hospital reconfiguration in three case study sites in the English NHS.

Methods

In-depth semi-structured interviews were conducted with internal and external stakeholders at each site. Analysis within each case was complemented by cross-case analysis focusing on the relationships between the features of the origins and process of reconfiguration and progress in the implementation of plans.

Findings

We identified a number of inter-related factors operating in the process of implementation which influenced the ‘results’: the drivers for change, the reconfiguration, its content (particularly the extent to which services are withdrawn or made less accessible), the influence of stakeholders, such as local politicians, financial pressures, and the role of the management team.

Conclusions

We argue that the differences in reconfiguration implementation between the three cases reflected the nature of the proposed changes and local politics, rather than the strength of the ‘evidence’ for change. National policy has tended to over-emphasise the importance of consultation using ‘evidence’ and underplays these influencing factors.     

孕期微量元素变化与妊娠不良结局相关性研究

目的:探讨不同孕期微量元素变化及与妊娠不良结局相关性。方法:选择研究组:早期先兆流产组64例,晚期先兆流产组70例,胎膜早破组31例,早产组35例。另选对照组:早孕组72例,中孕组96例,晚孕组126例,未孕组47例,测各组Se、Mn、Fe、Cu、Zn水平。结果:①与未孕组比较,早、中孕组血清Se含量差异无显著意义,晚孕组明显降低。与相应对照组相比,所有研究组血清Se含量均明显降低。②与未孕组比较,早、中孕组血清Mn含量差异无显著意义,晚孕组明显升高。与相应对照组比较,所有研究组血清Mn含量差异无显著意义。③与未孕组比较,早孕组血清Fe水平显著升高,晚孕组血清Fe水平显著减低。与相应对照组比较,早期先兆流产、晚期先兆流产组血清Fe显著降低。④与未孕组比较,早孕组、中孕组、晚孕组血清Cu显著升高。与相应对照组比较,早期先兆流产、晚期先兆流产组血清Cu显著降低。⑤与未孕组比较,早,中,晚孕组血清Zn显著下降。与相应对照组比较,所有研究组血清Zn含量差异无显著意义。结论:硒、铁、铜是关键性微量元素,在围产期严重缺乏可致流产、胎膜早破,孕妇应注意摄入含硒、铁、铜丰富的食物,避免流产的发生,尤其是补充硒更为重要。     

Emergency contraception among university students in Kingston,Jamaica: a survey of knowledge,attitudes, and practices

Emergency contraceptives (ECs) are an important option for young women in Jamaica, where rates of unplanned pregnancy are high. Few previous studies of EC exist in Jamaica. We surveyed a random sample of 205 students living on campus at the University of the West Indies in Kingston, Jamaica, to learn more about students' knowledge and opinions of EC pills (ECPs). General awareness of ECPs was high (84%), although many students were unaware of specific details regarding the method's appropriate use, such as the time frame. Twenty students (10%) had used ECPs themselves or had a partner who had used them. Most had used ECPs for the first time because they lacked contraception or because of contraceptive failure. Following their first use of ECPs, 55% adopted an ongoing method of contraception. Most students felt ECPs were an important option for women in Jamaica; however, some feared ECPs might be overused. Future educational campaigns should provide Jamaican university students with detailed information about this method.     

南京市流动妇女的避孕方法现状及影响因素研究

基于"南京市建邺区流动妇女计划生育/生殖健康状况研究"的问卷调查数据,对流动妇女的避孕方法现状及影响因素进行了分析。研究表明:流动妇女避孕措施的选择依次是宫内节育器(48.0%)、绝育术(32.9%)和避孕套(16.3%);65.4%的流动妇女没听说过紧急避孕;46.0%的流动妇女不知道目前自己使用的避孕方法的副作用。据此提出,应建立流动人口计划生育/生殖健康服务管理和测评体系,以保证基层流动人口的计划生育/生殖健康服务工作落到实处。     

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.