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The Sensitivity of Measures of Unwanted and Unintended Pregnancy Using Retrospective and Prospective Reporting: Evidence from Malawi

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Abstract

A thorough understanding of the health implications of unwanted and unintended pregnancies is constrained by our ability to accurately identify them. Commonly used techniques for measuring such pregnancies are subject to two main sources of error: the ex post revision of preferences after a pregnancy and the difficulty of identifying preferences at the time of conception. This study examines the implications of retrospective and prospective measurement approaches, which are vulnerable to different sources of error, on estimates of unwanted and unintended pregnancies. We use eight waves of closely-spaced panel data from young women in southern Malawi to generate estimates of unwanted and unintended pregnancies based on fertility preferences measured at various points in time. We then compare estimates using traditional retrospective and prospective approaches to estimates obtained when fertility preferences are measured prospectively within months of conception. The 1,062 young Malawian women in the sample frequently changed their fertility preferences. The retrospective measures slightly underestimated unwanted and unintended pregnancies compared to the time-varying prospective approach; in contrast the fixed prospective measures overestimated them. Nonetheless, most estimates were similar in aggregate, suggesting that frequent changes in fertility preferences need not lead to dramatically different estimates of unwanted and unintended pregnancy. Greater disagreement among measures emerged when classifying individual pregnancies. Carefully designed retrospective measures are not necessarily more problematic for measuring unintended and unwanted fertility than are more expensive fixed prospective ones.

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Notes

  1. See Gipson et al. [9] for a detailed review of this literature and its limitations.

  2. Although it could be used to measure unwanted pregnancy using a pregnancy history, we are not aware of any studies (beside the present one) that have used a pregnancy history in this way.

  3. Tsogolo la Thanzi is a research project designed by Jenny Trinitapoli and Sara Yeatman and funded by grant (R01-HD058366) from the National Institute of Child Health and Human Development.

  4. The question in Chichewa, nanga mimbayi mumayifuna, translates to “did you want this pregnancy?” Although not explicitly describing timing, responses to the question suggest that respondents interpreted it that way. Nonetheless, the wording remains a limitation of the measure.

  5. Thirty-six of the 48 missing cases were due to women missing pregnancy questionnaires. The additional 12 were due to “don't know” or “no preference/whenever” responses to questions on the desired timing of next child. We conducted a sensitivity analysis in which we classified “don’t know” responses as a desire to delay and “no preference/whenever” responses as a desire to have a child soon (<2 years). Neither our estimates nor the differences between estimates changed significantly.

  6. If we assume conceptions occur midway between survey waves on average, the gap would be 2 months.

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Acknowledgments

An earlier version of this article was presented at the 2013 IUSSP International Population Conference in Busan, Republic of Korea. The data used in this study and the time afforded to the authors for this research were supported by grants from the National Institute of Child Health and Human Development (R01-HD058366; R01-HD077873). For valuable feedback on earlier drafts, we are grateful to Ilene Speizer, John Casterline and the journal’s reviewers; any errors are our own. The research was made possible by the Tsogolo la Thanzi team, particularly Abdallah Chilungo, Sydney Lungu, Hazel Namadingo, and Jenny Trinitapoli.

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Authors and Affiliations

  1. Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA

    Sara Yeatman

  2. Department of Sociology, Purdue University, West Lafayette, IN, USA

    Christie Sennott

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  1. Sara Yeatman
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Correspondence to Sara Yeatman.

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Yeatman, S., Sennott, C. The Sensitivity of Measures of Unwanted and Unintended Pregnancy Using Retrospective and Prospective Reporting: Evidence from Malawi. Matern Child Health J 19, 1593–1600 (2015). https://doi.org/10.1007/s10995-015-1669-2

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