The Association Between Body Weight,Unintended Pregnancy Resulting in a Livebirth,and Contraception at the Time of Conception

Objectives: Annually, 3 million pregnancies in the United States are classified as unintended, with many of these unintended pregnancies occurring to women who use some type of contraceptive. Obesity may be affecting the biological effectiveness of contraceptives. We investigated whether there is an association between body weight and unintended pregnancy and whether this association differs by a woman's contraceptive status at the time of conception. Methods: We conducted a case–control study using multistate data from the 1999 Pregnancy Risk Assessment Monitoring System. A total of 18,445 women provided complete information on pregnancy intention, contraceptive use at the time of conception, weight, height, and other covariates. Multivariable logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among contraceptors, overweight and obese women had nearly twice the odds of having an unintended pregnancy as compared to women with normal body mass indices (OR=1.73 [95% CI: 1.20, 2.36] and OR=1.75 [95% CI: 1.21, 2.52], respectively) after adjustment for age, marital status, education, socioeconomic status, Medicaid, race/ethnicity, and parity. No association was found between heavier weight and unintended pregnancy among noncontraceptors. Conclusions: Though the observed associations could be the result of selection bias or unmeasured confounding, the findings suggest that the effect of obesity on unintended pregnancy is limited to contraceptive failure. Prospective studies designed specifically to examine a body weight–contraceptive failure association are needed to determine if heavier women should be advised to use contraceptive methods other than hormonal contraceptives to prevent unintended pregnancy.     

人工流产女性非意愿妊娠现状调查分析

目的了解天津地区人工流产女性非意愿妊娠的现状,减少女性非意愿妊娠和重复流产的发生,维护和促进女性生殖健康。方法采用现况调查的方法,对天津医科大学第二医院计划生育科8 745例要求人工流产的女性进行问卷调查。主要调查内容包括一般人口学特征、人工流产情况以及非意愿妊娠原因等情况。以人工流产次数≥2次的患者为病例组,只有1次人工流产的患者为对照组,进行病例-对照研究。结果 8 745例人工流产患者,其中重复流产者共5 648例,占65.2%;在重复流产者中,≥3次者占全部对象的33.0%。患者意外妊娠原因主要为未避孕(50.1%)和避孕失败(34.4%)。多因素分析显示,年龄大者(OR=2.38,95%CI:2.10~2.69)和有过生育者(OR=1.50,95%CI:1.32~1.70)发生重复流产的风险较高。结论我国育龄妇女人工流产率及重复人工流产率均较高,应进一步开展人工流产后关爱服务,促进高效避孕方法的使用,从而保障女性身心健康。     

Contraceptive failure--results from a study conducted among women with accepted and unaccepted pregnancies in Denmark

Most studies focusing on contraceptive failure in relation to pregnancy have focused on contraceptive failure among women having induced abortions, thereby neglecting those women who, despite contraceptive failure, accept the pregnancy and intend to carry the fetus to term. To get a more complete picture of the problem of contraceptive failure, this study focuses on contraceptive failure among women with diverse pregnancy outcomes.In all, 3520 pregnant women attending Odense University Hospital were included: 373 had induced abortions, 435 had spontaneous abortions, 97 had ectopic pregnancies, and 2614 received antenatal care. The variables studied comprise age, partner relationship, number of births, occupational and economical situation, and contraceptive use.Contraceptive failure, defined as contraceptive use (condom, diaphragm, IUD, oral contraception, or another modern method) at the intercourse where conception most likely occurred, were reported by 315 women, 52% of these women had induced abortions, 10% had spontaneous abortions, 3% had ectopic pregnancies, and 36% received antenatal care. Women aged 15-24 years were more likely to have experienced contraceptive failure in relation to use of condom and oral contraception than women aged 25-34 years. In addition, contraceptive failure was found to be associated with being single, a student, and having given birth twice or more previously. Regarding pregnancy acceptance, being 25-34 years of age was positively associated, whereas being single and a student was negatively associated with pregnancy acceptance.     

Factors associated with contraceptive nonuse among US women ages 35-44 years at risk of unwanted pregnancy

Background

Women ages 35 years and older have the greatest proportion of contraceptive nonuse and unintended pregnancies ending in abortion.

Study Design

We conducted a population-based case-control study among women ages 35-44 years at risk of unwanted pregnancy using the National Survey of Family Growth (NSFG) data to investigate risk factors for contraceptive nonuse.

Results

At last intercourse, 9.8% of women reported not using any contraceptive method. Contraceptive nonusers, as compared to users, were more likely to be ages 40-44 years (OR=2.0, 95% CI 1.1-3.7), foreign-born (OR=4.3, 95% CI 1.9-9.7), black (OR=2.8, 95% CI 1.1-7.0), with household incomes 100-249% of the federal poverty level (FPL) (OR=2.5, 95% CI 1.1-5.8). Women who received contraceptive counseling in the past year had an 80% decreased risk of nonuse (95% CI 0.1-0.5).

Conclusion

Public health strategies to reduce unintended pregnancy, particularly among women ages 35 years and older, should focus on addressing disparities in contraceptive use and promoting contraceptive counseling.     

Factors associated with unintended pregnancy

This research was designed to identify determinants of unintendedpregnancy among women attending family practice or family planning clinics.Survey data were collected from 95 women who were categorized according towhether or not they had experienced an unintended pregnancy. Women reportingunintended pregnancy were younger, reported earlier sexual debut and agreater number of sexual partners than those not having experienced anunintended pregnancy. Those who had avoided unintended pregnancy displayedhigher levels of preventive sexual self-efficacy, had more confidence intheir ability to use contraceptive methods, perceived more negativeconsequences associated with having children in the near future, andbelieved pregnancy among unmarried women to be less acceptable than didwomen who had had unintended pregnancies.     

How contraceptive use patterns differ by pregnancy intention: implications for counseling.

To increase awareness of issues to include in contraceptive counseling-the objectives of this study were to evaluate: 1) how contraceptive use patterns (eg, non-use), level of effectiveness of contraceptive method, and sociodemographic characteristics may be associated with the occurrence of unintended pregnancy; 2) patterns of health care use for women with intended and unintended pregnancy; and 3) the association between contraceptive use patterns and sociodemographic characteristics. In-person interviews were conducted with 279 women enrolled in a Medicaid managed care health plan who had been pregnant in the last 5 years. Self-reported measures of pregnancy intention, contraceptive use, and health care use were collected. The relationships of pregnancy intention with contraceptive use patterns, level of effectiveness of contraceptive method used, and patterns of recent health care use were assessed. Differences in contraceptive use patterns by sociodemographic groups were assessed. Seventy-eight percent of women reported an unintended pregnancy. Non-use of birth control the month before conception was reported by 57% of women with unintended pregnancies and 84% of women with intended pregnancies. Use of birth control of low effectiveness was reported by 20% of women with unintended pregnancies and 8% of women with intended pregnancies. Non-use or use of contraceptive methods of low effectiveness did not differ for women in different sociodemographic groups regardless of pregnancy intention status. A majority of women reported recent health care use. Health care providers should be aware that women who have no intention for pregnancy may not be using an effective contraceptive method NOR have an effective pattern of contraceptive use.     

Pregnancy intention in an urban Australian antenatal population

Objective : To determine the prevalence of unintended pregnancy in women presenting for antenatal care to a large metropolitan hospital in Sydney, Australia, and to investigate health behaviours and demographic factors associated with unintended pregnancy. Methods : From October 2010 to April 2011, a self‐administered questionnaire covering pregnancy intention, contraceptive use and demographic information was given to 1,554 women. A total of 1,218 women (78.4%) completed all questions in the validated pregnancy intention instrument. Results : Two‐thirds of pregnancies (67.6%) were clearly intended, 30.0% were ambivalent and more than 2% experienced an unplanned pregnancy. Those more likely to experience an unintended pregnancy were women under 25 years old (OR 1.86, 95% CI 1.10–3.14), unmarried women (OR 6.08, 95% CI 3.40–10.87) and women of Asian background (OR: 2.45, 95% CI 1.76–3.42). More than one‐third of women (34.6%) did not take any health actions such as stopping smoking before pregnancy. Conclusions : Unintended pregnancies in this population were associated with young age, being unmarried and being of Asian background. This study confirms the idea that many women do not take health actions before pregnancy. Implications : Experts believe that an effective strategy to address unintended pregnancy is to improve access to long‐acting reversible contraceptives, which do not require daily compliance.     

Unintended pregnancy and its risk factors among university students in eastern China

BACKGROUND: The study was conducted to determine the prevalence of unintended pregnancy, induced abortion and contraceptive use, and factors associated with unintended pregnancy among Chinese university students. STUDY DESIGN: A self-administered questionnaire survey with cross-sectional design was administered among students in two universities in Ningbo, China, in November-December 2003. Sociodemographic and behavioral factors associated with unintended pregnancy were identified in both genders using univariate and multivariate analyses. RESULTS: Of sexually active students, 10.6% of male and 11.6% of female students reported their partner or they had a history of pregnancy; 10.0% of male and 11.3% of female students reported their partner or they had a history of induced abortion. The risk factors for unintended pregnancy identified among males by multivariate analysis were older age [odds ratio (OR), 2.12; 95% confidence interval (CI), 1.15-3.88], initiation of sexual activity before high school (OR, 2.45; 95% CI, 1.36-4.44), reported lack of condom use in first sexual activity (OR, 1.71; 95% CI, 1.10-2.64), multiple sexual partners (OR, 1.54; 95% CI, 1.06-2.23), and often used condoms during their lifetime (OR, 1.97; 95% CI, 1.01-3.81). The identified risk factors among females were initiation of sexual activity before high school (OR, 5.12; 95% CI, 1.49-17.68), non-consensual sexual intercourse as first sex (OR, 1.77; 95% CI, 1.08-2.90), multiple partners (OR, 2.75; 95% CI, 1.61-4.71), and sometimes/never (OR, 3.02; 95% CI, 1.16-7.87) or often (OR, 3.92; 95% CI, 1.43-10.73) used condoms during their lifetime. CONCLUSION: The high prevalence of unintended pregnancies and induced abortions in this population indicates a need for better and targeted sex education and family planning services.     

Unintended pregnancy among American women

This research note presents new estimates of the proportion of American women of reproductive age who experience unintended pregnancies, unintended births and abortions. The data are based on tabulations from the 1982 National Survey of Family Growth (NSFG) and the Alan Guttmacher Institute's 1981-1982 national survey of abortion providers. Of 6.1 million women who became pregnant in 1982, 3.7 million gave birth, 1.6 million had abortions and 0.9 million experienced miscarriages. An estimated 37% of all births in the 5 years preceding the 1982 NSFG were unintended. Applying that proportion to 1982 births results in an estimate of 1.3 million unintended births. It can be assumed that all 1.6 million abortions were terminations of unintended pregnancies. Respondents in the 1982 NSFG reported that 40% of the births they had ever had were unintended. 33% of NSFG respondents said that they had had at least 1 unintended birth during their life. Abortions were seriously underreported in the NSFG, as they have been in most other surveys. Only 47% of the abortions that occurred during the period 1977-1981 were reported. The real proportion of women of reproductive age who have ever had an abortion appears to be 21%. 65% of all women aged 40-44 in 1982 had had at least 1 unintended pregnancy, and more than 1/3 of them had had at least 1 abortion. It is probably inappropriate to view these levels as representative of the proportions of today's young women who will ever experience an unintended pregnancy or abortion. Estimates of the proportion of women who will have had abortions by age 45 indicate that 18% of women will have had a 1st abortion by age 20; 41% will have had one by age 30; and 46%, by age 45.     

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.     

Factors associated with effective contraceptive use among a sample of Latina women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.     

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 Use and Abortion Among Women Of Reproductive Age in St. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied, no large-scale research has been conducted on women's use of different contraceptive methods and abortion.
METHODS: A random sample of 1,147 women aged 18–44 completed questionnaires at local women's clinics in St. Petersburg in 2003–2004. Chi-square tests were used to examine differences in selected characteristics among age-groups, and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history.
RESULTS: Among women at risk of unintended pregnancy, six in 10 had used reliable contraceptives (the pill, the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio, 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3–0.5, respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2–3.5), cohabiting (2.9), having high income (1.7), having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a woman's number of births (4.9–5.7).
CONCLUSIONS: Educational programs that promote the consistent use of condoms, especially among young women, and family planning programs that reduce financial barriers to contraceptive use, are critically needed in Russia.     

Lifetime patterns of contraception and their relationship to unintended pregnancies

BACKGROUND: For the past 30 years many effective methods of contraception have been available, yet unintended pregnancy rates still range from 30% to 50% in many populations. We examined patterns of women's contraceptive use throughout their lives and relate them to unintended pregnancy. METHODS: A total of 396 women aged 18 to 50 years chosen by convenience sampling from a family practice residency office were interviewed in a cross-sectional study about their history of using and changing contraception, and whether they believed they became pregnant while using a method of contraception. We analyzed the data for correlations and significance using chi-square and Student t tests. RESULTS: Most women had used both condoms and oral contraceptive pills, and tried an average of 3.54 methods during a lifetime. Two patterns of women's use of contraception emerged that describe 75% of the women. One third of the women--those who indicated a pattern of following their first method with a less effective method--are significantly more likely to have an unintended pregnancy while using contraception (odds ratio=1.4). The other group (50% of the entire sample) used increasingly effective methods and were less likely to have an unintended pregnancy. CONCLUSIONS: Pregnancy is an inherent natural consequence of sexual intercourse, even when using very effective contraceptive methods. By asking a few questions about a woman's history of contraceptive use, physicians may be able to determine those who are more likely to be at risk for an unintended pregnancy.     

U.S. women's one-year contraceptive use patterns, 2004

CONTEXT: Unintended pregnancies occur far too often in the United States, and half occur when couples fail to practice contraception. Improved measures of the continuity of women's contraceptive use, nonuse and switching patterns can help identify ways to reduce unintended pregnancy. METHODS: A nationally representative sample of 1,978 adult women at risk of unintended pregnancy was surveyed by telephone in 2004. Respondents provided detailed information about contraceptive use and periods of stopping or switching methods during the past year. A typology of patterns of contraceptive use was created, classifying women into mutually exclusive categories according to their exposure to pregnancy risk. RESULTS: Twenty-three percent of women at risk of unintended pregnancy were exposed to a high risk of pregnancy because of gaps in contraceptive method use in the year prior to the survey--8% were consistent nonusers, and 15% experienced 1-11 months of nonuse while at risk. More than half of women used a method during each of the previous 12 months-38% used the same method or methods all year, and 24% switched methods. Fifteen percent of women had gaps in contraceptive use when they were not at risk. Women reported a variety of reasons for their gaps in contraceptive use, including method-related difficulties and side effects, infrequent sex and being ambivalent about avoiding pregnancy. CONCLUSIONS: Strategies for reducing gaps in contraceptive use include improved counseling to help women both choose the right method and continue method use, especially when they have periods of infrequent sexual activity or are experiencing method-related side effects or problems.     

Measuring contraceptive use patterns among teenage and adult women

CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.     

Adolescent pregnancy trends and demographics

In the United States today, 9% of women aged 15 to 19 years become pregnant each year: 5% give birth, 3% have induced abortions, and 1% have miscarriages or stillbirths--rates much higher than those in other developed countries. Rates are highest among those who are older, from disadvantaged backgrounds, black or Hispanic, married, have much older male partners, and live in southern states. Teen pregnancies are overwhelmingly unintended, reflecting substantial gaps in contraceptive use, and difficulties using reversible methods effectively. Teen pregnancy, birth, and abortion levels have decreased in recent years, primarily because of more effective contraceptive use (responsible for about 75% of the decline), and because of fewer adolescents having sexual intercourse (about 25%). Much work remains to improve the conditions in which young people grow up, provide them with information and education regarding sexuality and relationships, and improve access to sexual and reproductive health services.     

Knowledge of likely time of ovulation and contraceptive use in unintended pregnancies

This investigation analyzed social and demographic characteristics of women having an unwanted or mistimed pregnancy (unintended pregnancies at the current time) in South America.A sample of 5135 women having had a normal non-malformed live-born infant were interviewed immediately postpartum at 18 hospitals participating in the Latin American Collaborative Study of Congenital Malformations (Spanish acronym: ECLAMC). Half (2568/5135 = 50%) reported that their pregnancies had been unintended, and, of those, 59.3% (1522/2568 = 59.3%) declared that they were trying to avoid conception. The latter group (n = 1522) was the main sample for this study.Patients were asked about their knowledge of when during the menstrual cycle conception is most likely to occur, their biomedical and social characteristics, the type of contraceptive methods used, their opinion of reasons for contraceptive failure, and their reasons for not using contraceptive methods.Women with unintended pregnancies who had not attempted to avoid conception were younger, often primigravid, less educated, and less knowledgeable concerning when during the cycle pregnancy is most likely to occur. Thus, reproductive health policies should be aimed at this target group.     

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.