Pregnancy Intentions and Maternal and Child Health: An Analysis of Longitudinal Data in Oklahoma
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Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Data from the 2004–2008 Oklahoma Pregnancy Risk Assessment Monitoring System survey and The Oklahoma Toddler Survey 2006–2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed <2 years, mistimed ≥2 years, unwanted) and maternal behaviors and child health outcomes up to age two. Propensity score methods were used to control for confounding. Births mistimed by two or more years (OR .58) and unwanted births (OR .33) had significantly lower odds than intended births of having a mother who recognized the pregnancy within the first 8 weeks; they were also about half as likely as intended births to receive early prenatal care, and had significantly higher likelihoods of exposure to cigarette smoke during pregnancy. Breastfeeding was significantly less likely among unwanted births (OR .68); breastfeeding for at least 6 months was significantly less likely among seriously mistimed births (OR .70). We find little association between intention status and early childhood measures. Measured associations of intention status on health behaviors and outcomes were most evident in the prenatal period, limited in the immediate prenatal period, and mostly insignificant by age two. In addition, most of the negative associations between intention status and health outcomes were concentrated among women with births mistimed by two or more years or unwanted births. Surveys should incorporate questions on the extent of mistiming when measuring pregnancy intentions.
KeywordsUnintended pregnancy Pregnancy intentions PRAMS Child health
This study was supported by Grant R40 MC 25692 from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD068433. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Health and Human Services.
- 1.Institute of Medicine. (2011). Clinical preventive services for women: Closing the gaps. Report of the Committee on Preventive Services for Women. Washington, DC: National Academy of Sciences Press.Google Scholar
- 2.U.S. Department of Health and Human Services. (2010). Healthy People 2020 topics & objectives. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=13
- 4.Logan, C., Holcombe, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended childbearing: A white paper. Washington, DC: Child Trends and The National Campaign to Prevent Teen and Unplanned Pregnancy.Google Scholar
- 6.Baydar, N. (1995). Consequences for children of their birth planning status. Family Planning Perspectives, 27(6), 228–34, 245.Google Scholar
- 15.Mosher, W. D., Jones, J., & Abma, J. C. (2012). Intended and unintended births in the United States: 1982–2010. Hyattsville, MD: National Center of Health Statistics.Google Scholar
- 16.Lindberg, L. D., Finer, L. B., & Stokes-Prindle, C. (2008). Refining measures of pregnancy intention: Taking timing into account. In 2008 Annual meetings of the Population Association of America. New Orleans, LA.Google Scholar
- 17.Oklahoma State Department of Health. (2006). PRAMSGRAM: Unintended pregnancy. http://www.ok.gov/health2/documents/PRAMS_Unintended_Pregnancy_06.pdf.pdf
- 18.Oklahoma State Department of Health. (2010). TOTS brief: The Oklahoma Toddler Survey. http://www.ok.gov/health2/documents/Imm_Brief_final_Dec_2010.pdf
- 19.Centers for Disease Control and Prevention. (2009). PRAMS model surveillance protocol, 2009 CATI version. http://www.cdc.gov/prams/PDF/ProtocolFiles/ProtocolZipFile.zip
- 20.Oklahoma State Department of Health. (2012). TOTS 2012 protocol. Unpublished manuscript available upon request at TOTS@health.ok.gov.Google Scholar
- 21.Singh, G., Siahpush, M., & Kogan, M. D. (2010). Disparities in children’s exposure to environmental tobacco smoke in the United States, 2007. Pediatrics, 126(5), 1052.Google Scholar
- 22.Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.Google Scholar
- 27.Guo, S., & Fraser, M. W. (2010). Propensity score analysis: Statistical methods and applications. Los Angeles, CA: Sage.Google Scholar
- 29.Dugoff, E. H., Schuler, M., & Stuart, E. A. (2013). Generalizing observational study results: Applying propensity score methods to complex surveys. Health Services Research, 49(1), 284–303.Google Scholar
- 30.Sonfield, A., & Kost, K. (2013). Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy and infant care: Estimates for 2008. New York: Guttmacher Institute.Google Scholar
- 33.American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice & Long-Acting Reversible Contraception Working Group. (2009). Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstetrics and Gynecology, 114(6), 1434–1438.CrossRefGoogle Scholar
- 41.Guzzo, K. B., & Hayford, S. R. (2014). Revisiting retrospective reporting of first-birth intendedness. Maternal and Child Health Journal. doi: 10.1007/s10995-014-1462-7.
- 44.Edin, K., & Kefalas, M. (2005). Why poor women put motherhood before marriage. Berkeley, CA: University of California Press.Google Scholar