Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy.
Unintended pregnancy Induced abortion Social inequalities Economic inequalities Pregnancy outcome
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We are grateful for the work done by the three REDCB nurses, Montserrat Cunillé, Montserrat Ricart, and Angelina Roig, and more than 200 health professionals in the city of Barcelona who took part in the registry, as well as all the mothers who agreed to be interviewed in-depth so soon after having their baby. We also thank Roser Bosser and Rosa Gispert from the Health Department of the Generalitat de Catalunya and Dave McFarlane for his help in editing the manuscript.
This study was used by Laia Font to obtain a Master’s of Public Health degree.
We have no conflict of interest.
This study was partially funded by Red de Centros de Investigación en Epidemiología y Salud Pública (Network of Research centers of Epidemiology and Public Health) of the Fondo de Investigaciones Sanitarias (CO3/09) and the CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
Agència de Salut Pública de Barcelona. Pregnancy planning. Health in Barcelona 2000. [Planificació de l’embaràs. La salut a Barcelona 2000]. Agència de Salut Pública de Barcelona, 2001:48–51.Google Scholar
Bartlett LA, Berg CJ, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004;103(4):729–737.PubMedGoogle Scholar
Cook RJ, Dickens BM, Horga M. Safe abortion: WHO technical and policy guidance. Int J Gynaecol Obstet. 2004;86(1):79–84.PubMedCrossRefGoogle Scholar
Murthy A, Creinin MD. Pharmacoeconomics of medical abortion: a review of cost in the United States, Europe and Asia. Expert Opin Pharmacother. 2003;4(4):503–513.PubMedCrossRefGoogle Scholar
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part1). J Epidemiol Community Health. 2006;60:7–12.PubMedCrossRefGoogle Scholar
Campbell AA, Mosher WD. A history of the measurement of unintended pregnancies and births. Matern Child Health J. 2000;61(4):163–169.CrossRefGoogle Scholar
Williams LB. Determinants of unintended childbearing among ever-married women in the United States: 1973–1988. Fam Plann Perspect. 1991;23(5):212–215, 221.PubMedCrossRefGoogle Scholar
Kost K, Darroch J. Intention status of U.S. births in 1988: differences by mothers’ socioeconomic and demographic characteristics. Fam Plann Perspect. 1995;27:11–17.PubMedCrossRefGoogle Scholar
Cano-Serral G, Rodríguez-Sanz M, Borrell C, Pérez MM, Salvador J. Socioeconomic inequalities in the provision and uptake of prenatal care. [Desigualdades socioeconómicas en el cuidado y control del embarazo]. Gac Sanit. 2006;20(1)25–30.PubMedCrossRefGoogle Scholar
Salvini S, Schifini S. Induced abortion in Italy: levels, trends and characteristics. Fam Plann Perspect. 1996;28:267–271.CrossRefGoogle Scholar
Addor V, Narring F, Michaud PA. Abortion trends 1990–1999 in a Swiss region and determinants of abortion recurrence. Swiss Med Wkly. 2003;133:219–226.PubMedGoogle Scholar
Uria M, Mosquera C. Legal abortion in Asturias (Spain) after the 1985 law: sociodemographic characteristics of women applying for abortion. Eur J Epidemiol. 1999;15:59–64.PubMedCrossRefGoogle Scholar
Helström L, Zättersröm C, Odlind V. Abortion rate and contraceptive practices in immigrant and Swedish adolescents. J Pediatr Adolesc Gynecol. 2006;19(3):209–213.PubMedCrossRefGoogle Scholar
Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health. 2006;38(2):90–96.PubMedCrossRefGoogle Scholar
Besculides M, Laraque F. Unintended pregnancy among the urban poor. J Urban Health. 2004;81(3):340–348.PubMedGoogle Scholar
Sihvo S, Bajos N, Ducot B, Kaminski M, Cocon Group. Women’s life cycle and abortion decision in unintended pregnancies. J Epidemiol Community Health. 2003;57:601–605.PubMedCrossRefGoogle Scholar
Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol. 1994;170:1485–1489.PubMedGoogle Scholar
Barret G, Peacock J, Victor CR. Are women who have abortions different from those who do not? A secondary analysis of the 1990 national surveys of sexual attitudes and lifestyles. Public Health. 1998;112, 157–163.CrossRefGoogle Scholar
Agència de Salut Pública de Barcelona. La salut a Barcelona 2005. [Health in Barcelona 2005]. Agència de Salut Pública de Barcelona, 2006.Google Scholar
Servei d’informació i estudis. Legal abortion in Catalunya 2004. Induced Abortion Register. [Avortament legal a Catalunya, 2004. Registre d’interrupció voluntària de l’embaràs.] Barcelona: Departament de Salut. Generalitat de Catalunya, 2005.Google Scholar
Associació salut i família. Programa d’atenció a la maternitat a risc: memoria 2004. [Attention to risky maternity: 2004 Report] Barcelona: Associació salut i família, 2005.Google Scholar
Valero C, Nebot M, Villalbi JR. Adolescent pregnancy in Barcelona: its distribution, antecedents and consequences. Gac Sanit. 1994;8(43):155–161.PubMedGoogle Scholar
Instituto Nacional de Estadística. Population Data Referred to 01/01/2004. [Cifras de población referidas al 01/01/2004]. Available at: http://www.ine.es/inebase/cgi/axi.
Hosmer DW, Lemeshow D. Applied Logistic Regression. New York: John Wiley, 1989.Google Scholar
Smith T. Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies. BMJ. 1993;306(6887):1232–1235.PubMedGoogle Scholar
Skouby SO. Contraceptive use and behaviour in the 21st century: a comprehensive study across five European countries. Eur J Contracept Reprod Health Care. 2004;9:57–68.PubMedCrossRefGoogle Scholar
Zeitlin JA, Saurel-Cubizolles MJ, Ancel PY, the EUROPOP Group. Marital status, cohabitation, and the risk of preterm birth in Europe: where births outside marriage are common and uncommon. Paediatr Perinat Epidemiol. 2002;16(2):124–130.PubMedCrossRefGoogle Scholar
Fu H, Darroch JE, Henshaw SK, Kolb E. Measuring the extent of abortion underreporting in the 1995 National Survey of Family Growth. Fam Plann Prespect. 1998;(3):128–133.Google Scholar
Jagannathan R. Relying on surveys to understand abortion behavior: some cautionary evidence. Am J Public Health. 2001;91(11):1825–1831.PubMedCrossRefGoogle Scholar
Skjeldestad FE, Borgan JK, Daltveit AK, Nymoen EH. Induced abortion. Effects of marital status, age and parity on choice of pregnancy termination. Acta Obstet Gynecol Scand. 1994;73(3):255–260.PubMedCrossRefGoogle Scholar
Domingo-Salvany A, Regidor E, Alonso J, Alvarez-Dardet C. [Proposal for a social class measure. Working Group of the Spanish Society of Epidemiology and the Spanish Society of Family and Community Medicine]. Aten Primaria. 2000;25(5):350–363.Google Scholar
Mason KO. The Status of Women: A Review of Its Relationships to Fertility and Mortality. The Rockefeller Foundation, New York; 1984.Google Scholar
Bachrach CA, Newcomer S. Intended pregnancies and unintended pregnancies: distinct categories or opposite ends of a continuum? Fam Plann Perspect. 1999;31(5):251–252.PubMedCrossRefGoogle Scholar
Moos MK, Petersen R, Meadows K, Melvin CL, Spitz AM. Pregnant women’s perspectives on intendedness of pregnancy. Women’s Health Issues. 1997;7(6):385–392.PubMedCrossRefGoogle Scholar
American Academy of Pediatrics. Committee on adolescence. Emergency contraception. Pediatrics. 2005;116(4):1026–1035.CrossRefGoogle Scholar
Jackson R, Schwarz E, Freedman L, Darney P. Knowledge and willingness to use emergency contraception among low-income post-partum women. Contraception. 2000;61:351–357.PubMedCrossRefGoogle Scholar