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.     

Pregnancy Intention: How PRAMS Data Can Inform Programs and Policy

Background: In most states, the Pregnancy Risk Assessment Monitoring System (PRAMS) is the only source for state-specific, population-based data on the prevalence of unintended pregnancy among women having a live birth. These data can be used in a variety of ways to inform state policies and programs aimed at the prevention of unintended pregnancy. Objectives: This paper highlights the programmatic and policy development activities undertaken by three states in relation to unintended pregnancy as well as the role that PRAMS data played in those efforts. Results: Georgia, Oklahoma, and Washington have used PRAMS data to gain support for program initiatives directed at unintended pregnancy, to promote policies aimed at either monitoring or reducing unintended pregnancy, and to acquire additional funds for related programs, such as family planning.     

Awareness,Prior Use,and Intent to Use Emergency Contraception Among Montana Women at the Time of Pregnancy Testing

Objectives: To identify factors associated with awareness of emergency contraception (EC), prior use of EC, and intent to use EC in the future among women at the time of pregnancy testing. Methods: A convenience sample of women presenting for pregnancy testing and being found to be pregnant in 38 primary health care facilities completed a self-administered, anonymous questionnaire. Information regarding demography, pregnancy intentions, use of any contraception, awareness of EC, prior use of EC, and intent to use EC in the future was collected. Results: Of the 583 women that completed the questionnaire, 62% were aware of EC, 4% had previously used EC, and 13% considered using EC in the future. Women aware of EC were more likely to be white, have 12 years of education, and report use of birth control prior to the current pregnancy. Younger women, those with <12 years of education, and those not currently living with a partner were more likely to have previously used EC. Women who considered using EC in the future were more likely to be younger, non-white, have <12 years of education, not currently living with a partner, and their usual source of care was a public clinic. Women who considered using EC in the future were also more likely to not want to be pregnant now or ever (21%) compared to women who wanted to be pregnant now or sooner (12%), or with those who were unsure of their current pregnancy (7%). Conclusion: Strategies need to be developed to increase the awareness of EC and determine the factors that would assist in enhancing its utilization.     

Emergency contraception – knowledge and attitudes in a group of Australian university students

Objective: To explore first year Australian university students' knowledge and attitudes about emergency contraception and their understanding of the risk for pregnancy.
Method: A self-report questionnaire was completed by a convenience sample of 627 first year on-campus students from both health and non-health disciplines.
Results: Knowledge about emergency contraception (EC) was generally poor including misunderstanding that it can only be used the 'morning after', as well as where it may be accessed. Its potential use was, however, more highly accepted as a preventative measure after unprotected sexual intercourse than abortion in the event of unplanned pregnancy. Women had better knowledge than men, and on a number of measures there were significant differences between these groups.
Conclusions: Poor knowledge about the timing, accessibility, action and side effects of EC may act as a barrier to its use in the event of unprotected sexual intercourse. Although EC has been available in Australia as a Schedule 3 medication since 2004, its availability from pharmacies is not well known, nor is access from other primary health care providers.
Implications: The lack of knowledge about EC may lead to its underutilisation and underlines the need for future educational strategies about EC as well as the need for health professionals who provide contraceptive services to discuss EC with clients. Health promotion campaigns which are both general as well as gender-specific may improve overall community knowledge about this method of contraception.     

孕期至产后干预对产后意外妊娠影响

目的 分析从孕期至产后开展综合干预对产后避孕知识及意外妊娠的影响。方法 于2011年7月-2012年7月对上海市浦东新区妇幼保健院和普陀区妇婴保健院3542名孕产妇进行干预,按医院分为干预组和对照组,采取结构式问卷进行调查。结果 产后开始避孕时间、产后恢复性生活时间和排卵期计算方法相关知识,对照组回答正确人数分别为364人(45.50%)、622人(77.75%)和374人(46.75%),干预组分别为1905人(69.47%)、2504人(91.32%)和1152人(42.01%);不同避孕方法中,产后意外妊娠103人(3.09%),对照组为35人(4.57%),干预组为68人(2.65%);2组导致产后意外妊娠发生比例最高的分别为口服避孕药和紧急避孕药,其次分别为安全期和体外排精避孕;多因素分析结果显示,干预组产后意外妊娠发生比例较对照组降低45%,文化程度、产后恢复性生活时间与避孕时间的交互作用对产后意外妊娠有影响。结论 以医院为基础的综合干预可有效降低产后意外妊娠发生的可能性。     

产后避孕的昨天、今天与未来

预防产后意外妊娠、减少高危人工流产的发生是生殖健康领域的重要内容。尽管目前产后避孕技术成熟,但推广不足,尚未形成针对高危人群和高危行为有效的产后避孕服务规范。重视产后避孕,有益人类健康。     

Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey

Objective : Mistimed, unexpected or unwanted pregnancies occur in Australia, despite widespread contraception use. The objective was to estimate prevalence and ascertain modifiable social factors for prevention of unintended pregnancy. Methods : National population‐based survey of women and men aged 18–51 years recruited from a random sample of electors on the Australian Electoral Roll in 2013. Data were weighted to reduce non‐response bias. Factors associated with unintended pregnancy were identified in multivariable analyses. Results : Data from 2,235 completed questionnaires were analysed (Women: 69%; Men: 31%). Of those ever pregnant or partner in pregnancy (59%), 40% had experienced an unintended pregnancy. Adjusting for other risks, ever having experienced sexual coercion (AOR, 95%CI=Women 1.948; 1.458–2.601; Men 1.657, 1.014–2.708); socioeconomic disadvantage (AOR, 95%CI=Women 1.808, 1.373, 2.381; Men 1.360, 1.004–1.841), living in a rural area (AOR, 95%CI=Women 1.403, 1.056–1.864; Men 1.583, 1.161–2.159), and for men being born overseas (AOR, 95%CI 1.989, 1.317–3.002) were significantly associated with unintended pregnancy. Conclusions : Experiences of sexual coercion, social disadvantage, rural residence and overseas birth are independently associated with unintended pregnancy in Australia. Implications : Public health policy and health service initiatives should prioritise prevention of sexual coercion, reduction of social inequality and reduction of geographic inequality for those in rural areas.     

Psychometrics of an original measure of barriers to providing family planning information: Implications for social service providers

Social service professionals can face challenges in the course of providing family planning information to their clients. This article reports findings from a study that developed an original 27-item measure, the Reproductive Counseling Obstacle Scale (RCOS) designed to measure such obstacles based conceptually on Bandura’s social cognitive theory (1986). We examine the reliability and factor structure of the RCOS using a sample of licensed social workers (N = 197). A 20-item revised version of the RCOS was derived using principal component factor analysis. Results indicate that barriers to discussing family planning, as measured by the RCOS, appear to be best represented by a two-factor solution, reflecting self-efficacy/interest and perceived professional obligation/moral concerns. Implications for practice and future research are discussed.     

Pregnancy Intention and Pregnancy Happiness: Are They Different?

Objectives: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. Methods: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. Results: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. Conclusions: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.     

产后避孕服务的研究进展

产后近期意外妊娠对育龄妇女的生殖健康影响较大，产后1年内人工流产率高于育龄妇女的平均水平，低文化程度、低经济收入和社会贫困层次的妇女以及未婚青少年是产后近期意外妊娠的高危人群。尽管目前产后避孕技术成熟，但推广不足，尚未形成针对高危人群和高危行为有效的产后避孕服务规范。随着生育高峰的到来，在加强产前、产时安全的同时，预防产后意外妊娠、减少高危人工流产的发生是生殖健康领域的重要内容。     

Fertility control? Middle‐aged Australian women's retrospective reports of their pregnancies

OBJECTIVE: To assess middle-aged Australian women's retrospective reports of how intended and wanted were their pregnancies, and the degree of happiness associated with these pregnancies. METHODS: A self-administered questionnaire was sent to 1000 participants in the Mid-Age cohort of the Australian Longitudinal Study on Women's Health. RESULTS: Responses from 811 women (81%) showed that, although 32% of first pregnancies were unplanned and 29% were unwanted, most women recall being happy with their pregnancies and termination rates were very low. The second pregnancy was the most planned and wanted and associated with the highest levels of happiness. CONCLUSIONS: While the majority of middle-aged women report having been happy to be pregnant, and the majority of pregnancies are described retrospectively as planned and wanted, a significant proportion of pregnancies are unwanted, unplanned or resulting from unintended contraceptive failure. IMPLICATIONS: The data support the continuing need for widely available, affordable and sensitive fertility control services.     

A Pregnant Pause: Rethinking Economic Evaluation in Contraception and Pregnancy

Pregnancy presents a unique challenge to economic evaluation, requiring methods that can account for both maternal and fetal outcomes. The ethical challenges to healthcare presented by pregnancy are well understood, but these have not yet been incorporated into cost-effectiveness approaches. Economic evaluations of pregnancy currently take an ad hoc approach to outcome valuation, opening the door to biased estimates and inconsistent resource allocation. We summarize the limitations of current economic evaluation methods and outline key areas for future work.     

Survey of attitudes regarding natural family planning in an urban Hispanic population

METHODS: We performed a cross-sectional survey of 357 reproductive-aged women, mostly Hispanic (81.8%), presenting for ambulatory and hospital reproductive care in Phoenix, AZ, about their interest in natural family planning (NFP). Participants completed questionnaires, and responses were analyzed to determine predictors of interest in NFP. RESULTS: Sixty-one percent stated that they were likely or very likely to use NFP to avoid pregnancy, and 50% would use NFP to achieve pregnancy. Of factors studied, Hispanic ethnicity, lower level of acculturation, less education and recent use of condoms or withdrawal were independently associated with interest in using NFP to avoid pregnancy. Younger age and desire for future pregnancy were independently predictive of potential NFP use to achieve pregnancy. CONCLUSION: This study suggests that Hispanic women find NFP to be an appealing family planning alternative.     

城乡哺乳期妇女避孕现状比较分析

目的分析比较城乡哺乳期妇女避孕方法的使用情况、获得渠道和选择决定者，以及未避孕原因等。方法利用国家人口和计划生育委员会2001年全国计划生育／生殖健康调查的原始数据，对城乡哺乳期妇女避孕方法的使用现状进行描述性统计分析。结果我国哺乳期妇女的避孕率为78％，城乡哺乳期妇女的避孕率、未避孕原因虽然没有较大差异，但在选择避孕方法、避孕工具获得渠道和选择决定者等方面差异有统计学意义。结论我国妇女对哺乳期避孕的必要性缺乏足够认识，需从多方面加强干预。     

Motivations for Pregnancy Planning Among Mexican Immigrant Women in North Carolina

Objectives: To enhance understanding of 1) Mexican immigrant women's attitudes toward planning their pregnancies and the factors that influence their fertility preferences, and 2) the effect of migration on their pregnancy planning decisions. Methods: Qualitative in-depth interviews were conducted with 11 Mexican immigrant women living in North Carolina. Participants were recruited by means of snowball sampling. Interviews were conducted in Spanish in the women's homes. Interviewing and analysis were conducted iteratively to allow emerging themes and interpretations to be developed and validated in subsequent interviews. Results: The women were strongly motivated to plan their pregnancies. Their primary considerations in pregnancy planning were their ability to give their children a good life and their ability to enjoy their families. Individual personal aspirations did not emerge as an important consideration. Migration intensified the women's felt need to plan their pregnancies. Conclusions: The Mexican immigrant women in this study had a strong familistic orientation. Far from diminishing their interest in planning their pregnancies, however, the high value they placed on family was their primary motivation for pregnancy planning. Migration to the U.S. intensified their felt need to plan their pregnancies. Understanding of the women's motivations for family planning may help health care providers better address the family planning needs of Mexican immigrant women.