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The Consequences of Unintended Pregnancy for Maternal and Child Health in Rural India: Evidence from Prospective Data

Maternal and Child Health Journal volume 17, pages 493–500 (2013)Cite this article

Abstract

To investigate the relationship between pregnancy intendedness and utilization of recommended prenatal care for mothers and vaccinations for children against six vaccine preventable diseases in rural India using a prospective dataset. To examine the association between pregnancy intention and neonatal and infant mortality in rural India. The study is based upon a prospective follow-up survey of a cohort selected from the National Family Health Survey 1998–1999, carried out in 2002–2003 in rural areas of four Indian states of Bihar, Jharkhand, Maharashtra and Tamil Nadu. Data for 2108 births for which pregnancy intendedness was assessed prospectively was analyzed using bivariate analysis, logistic regressions and discrete-time survival analysis. Mothers reporting unwanted births were 2.32 (95 % CI: 1.54–3.48) times as likely as mothers reporting wanted births to receive inadequate prenatal care. Moreover, unwanted births were 1.38 (95 % CI: 1.01–1.87) times as likely as wanted births to receive inadequate childhood vaccinations. Likewise, births that were identified as mistimed/unwanted had 83 % higher risk of neonatal mortality compared to wanted births. The association between pregnancy intendedness and infant mortality was only marginally significant. This is the first study of its kind which has investigated the relationship between prospectively assessed pregnancy intendedness and early childhood mortality in rural India. The study provides additional and more conclusive evidence that unwanted births are disadvantaged in terms of maternal and child health outcomes. Findings argue for enhanced focus on family planning to reduce the high prevalence of unintended pregnancy in rural India.

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References

  1. Gipson, J. D., Koenig, M., & Hindin, M. J. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of literature. Studies in Family Planning, 39, 18–38.

    PubMed  Article  Google Scholar 

  2. IIPS. (2007). National Family Health Survey (NFHS-3), 2005-06: India. Mumbai: International Institute for Population Sciences and ORC Macro.

  3. Blanc, A. K. (1982). Unwanted fertility in Latin America and the Carribbean. International Family Planning Perspectives, 8, 156–162.

    Article  Google Scholar 

  4. Bongaarts, J. (1990). The measurement of wanted fertility. Population and Development Review, 16, 487–506.

    Article  Google Scholar 

  5. Bongaarts, J. (1997). The proximate determinants of unwanted childbearing in the developing world. Paper presented in the Annual Meeting of the Population Association of America. Washington, DC.

  6. Brown, S. S., & Eisenberg, L. (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, DC: National Academies Press.

    Google Scholar 

  7. Lightbourn, R. E. (1985). Individual preferences and fertility behaviour. In J. Cleland & J. Hobcraft (Eds.), Reproductive change in developing countries: insights from the World Fertility Survey. Oxford: Oxford University Press.

    Google Scholar 

  8. UnitedNations. (1987). Fertility behaviour in the context of development: Evidence from the World Fertility Survey. New York: Department of International Economics and Social Affairs, United Nations.

    Google Scholar 

  9. Westoff, C. (1981). Unwanted fertility in six developing countries. International Family Planning Perspectives, 7, 43–52.

    Article  Google Scholar 

  10. Bitto, A., Gray, R. H., Simpson, J. L., et al. (1997). Adverse outcomes of planned and unplanned pregnancies among users of natural family plannning: A prospective study. American Journal of Public Health, 87, 338–343.

    PubMed  Article  CAS  Google Scholar 

  11. Delgado-Rodriguez, M., Gomez-Olmedo, M., Bueno-Cavanillas, A., & Galvez-Vargas, R. (1997). Unplanned pregnancy as a major determinant in inadequate use of prenatal care. Preventive Medicine, 26, 834–838.

    PubMed  Article  CAS  Google Scholar 

  12. Husley, T. M., Laken, M., Miller, V., & Ager, J. (2000). The influence of attitudes about unintended pregnancy on use of prenatal and postpartum care. Journal of Perinatology, 20, 513–519.

    Article  Google Scholar 

  13. Joyce, T., Kaestner, R., & Korenman, S. (2000). The stability of pregnancy intentions and pregnancy-related maternal behaviours. Maternal and Child Health Journal, 4, 171–178.

    PubMed  Article  CAS  Google Scholar 

  14. Korenman, S., Kaestner, R., & Joyce, T. (2002). Consequences for infants of parental disagreement in pregnancy intention. Perspectives on Sexual and Reproductive Health, 34, 198–205.

    PubMed  Article  Google Scholar 

  15. Kost, K., Landry, D. J., & Darroch, J. E. (1998). Predicting maternal behaviours during pregnancy: Does intention status matter? Family Planning Perspectives, 30, 79–88.

    PubMed  Article  CAS  Google Scholar 

  16. Marsiglio, W., & Mott, F. L. (1988). Does wanting to become pregnant with a first child affect subsequent maternal behaviours and infant birth weight. Journal of Marriage and the Family, 50, 1023–1036.

    Article  Google Scholar 

  17. Pagnini, D. L., & Reichman, N. E. (2000). Psychosocial factors and the timing of prenatal care among women in New Jersey’s HealthStart program. Family Planning Perspectives, 32, 56–64.

    PubMed  Article  CAS  Google Scholar 

  18. Sable, M. R., Stockbauer, J. W., Schramm, W. F., & Land, G. H. (1990). Differentiating the barriers to adequate prenatal care in Missouri, 1987-88. Public Health Reports, 105, 549–555.

    PubMed  CAS  Google Scholar 

  19. Sangi-Haghpeykar, H., Mehta, M., Posner, S., & Poindexter, A. N. (2005). Parental influences on the timing of prenatal care among Hispanics. Maternal and Child Health Journal, 9, 159–163.

    PubMed  Article  Google Scholar 

  20. Tsui, A. O., McDonald-Mosley, R., & Burke, A. E. (2010). Family planning and burden of unintended pregnancies. Epidemiologic Reviews, 32, 152–174.

    PubMed  Article  Google Scholar 

  21. Weller, R. H., Eberstein, I. W., & Bailey, M. (1987). Pregnancy wantedness and maternal behaviour during pregnancy. Demography, 24, 407–412.

    PubMed  Article  CAS  Google Scholar 

  22. Eggleston, E. (2000). Unintended pregnancy and women’s use of prenatal care in Ecuador. Social Science and Medicine, 51, 1011–1018.

    PubMed  Article  CAS  Google Scholar 

  23. Magadi, M. A., Madise, N. J., & Rodrigues, R. N. (2000). Frequency and timing of antenatal care in Kenya: Explaining the variations between women of different communities. Social Science and Medicine, 51, 551–561.

    PubMed  Article  CAS  Google Scholar 

  24. Gage, A. J. (1998). Premarital childbearing, unwanted fertility and maternity care in Kenya and Namibia. Population Studies, 52, 21–34.

    Article  Google Scholar 

  25. Marston, C., & Cleland, J. (2003). Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies, 57, 77–93.

    PubMed  Article  Google Scholar 

  26. Ni, H., & Rossignol, A. M. (1994). Maternal deaths among women with pregnancies outside of family planning in Sichuan, China. Epidemiology, 5, 490–494.

    PubMed  CAS  Google Scholar 

  27. Singh, A., Chalasani, S., Koenig, M., & Mahapatra, B. (2012). The consequences of unintended fertility for maternal and child health in India. Population Studies (Forthcoming).

  28. Montgomery, M. R., Lloyd, C. B., Hewett, P. C., & Heuveline, P. (1997). The consequences of imperfect fertility control for children’s survival, health and schooling. Calverton: Macro International.

    Google Scholar 

  29. Montgomery, M. R., Zhao, J., & Hossain, M. B. (1997). Unintended fertility and investments in children’s human capital: The Bangladesh case. Paper presented in the Annual Conference of the Population Association of America. Washington, DC.

  30. Chalasani, S., Casterline, J. B., & Koenig, M. A. (2007). Consequences of unwanted childbearing: A study of child outcomes in Bangladesh. Paper presented in the Annual Conference of the Population Association of America. New York.

  31. Koenig, M., Acharya, R., Singh, S., & Roy, T. K. (2006). Do current measurement approaches underestimate levels of unwanted childbearing? Evidence from rural India. Population Studies, 60, 243–256.

    PubMed  Article  Google Scholar 

  32. Koenig, M., Stephenson, R., Acharya, R., Barrick, L., Ahmed, S., & Hiddin, M. J. (2010). Domestic violence and early childhood mortality in rural India: Evidence from prospective data. International Journal of Epidemiology, 39, 825–833.

    PubMed  Article  Google Scholar 

  33. IIPS, & JHSPH. (2005). Quality of care in Indian family planning programme and reproductive behaviour of women in four Indian states: A follow-up study of NFHS-2. Mumbai: International Institute for Population Sciences.

    Google Scholar 

  34. Stephenson, R., Koenig, M., Acharya, R., & Roy, T. K. (2008). Domestic violence, contraceptive use and unwanted pregnancy in rural India. Studies in Family Planning, 39, 177–186.

    PubMed  Article  Google Scholar 

  35. WHO. (2006). Provision of effective antenatal care: integrated management of pregnancy and childbirth (IMPAC). Geneva, Switzerland: Standards for maternal and neonatal care (1.6), Department of making Pregnancy Safer.

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Authors and Affiliations

  1. Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, 400 088, India

    Abhishek Singh

  2. Indira Gandhi Institute of Development Research, Mumbai, 400 065, India

    Ashish Singh

  3. HIV and AIDS Program, Population Council, 142, Golf links, New Delhi, 110003, India

    Bidhubhusan Mahapatra

Authors
  1. Abhishek Singh
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  2. Ashish Singh
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  3. Bidhubhusan Mahapatra
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Correspondence to Abhishek Singh.

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Singh, A., Singh, A. & Mahapatra, B. The Consequences of Unintended Pregnancy for Maternal and Child Health in Rural India: Evidence from Prospective Data. Matern Child Health J 17, 493–500 (2013). https://doi.org/10.1007/s10995-012-1023-x

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  • DOI: https://doi.org/10.1007/s10995-012-1023-x

Keywords

  • Pregnancy intendedness
  • Prospective data
  • Recommended prenatal care for mothers
  • Recommended set of vaccinations for children
  • Neonatal and infant mortality
  • Rural India