Joan M. Herold

Differences Between Mistimed and Unwanted Pregnancies Among Women Who Have Live Births

CONTEXT Mistimed and unwanted pregnancies that result in live births are commonly considered together as unintended pregnancies, but they may have different precursors and outcomes. METHODS Data from 15 states participating in the 1998 Pregnancy Risk Assessment Monitoring System were used to calculate the prevalence of intended, mistimed and unwanted conceptions, by selected variables. Associations between unintendedness and womens behaviors and experiences before, during and after the pregnancy were assessed through unadjusted relative risks. RESULTS The distribution of intended, mistimed and unwanted pregnancies differed on nearly every variable examined; risky behaviors and adverse experiences were more common among women with mistimed than intended pregnancies and were most common among those whose pregnancies were unwanted. The likelihood of having an unwanted rather than mistimed pregnancy was elevated for women 35 or older (relative risk, 2.3) and was reduced for those younger than 25 (0.8); the pattern was reversed for the likelihood of mistimed rather than intended pregnancy (0.5 vs. 1.7-2.7). Parous women had an increased risk of an unwanted pregnancy (2.1-4.0) but a decreased risk of a mistimed one (0.9). Women who smoked in the third trimester, received delayed or no prenatal care, did not breast-feed, were physically abused during pregnancy, said their partner had not wanted a pregnancy or had a low-birth-weight infant had an increased risk of unintended pregnancy; the size of the increase depended on whether the pregnancy was unwanted or mistimed. CONCLUSION Clarifying the difference in risk between mistimed and unwanted pregnancies may help guide decisions regarding services to women and infants.

Premarital sexual activity and contraceptive use in Santiago Chile.

The Santiago Young Adult Reproductive Health Survey was conducted in 1988 to examine the sexual behavior of and contraceptive use among young adults in Chile. The survey was based on multistage household probability samples of 865 women and 800 men aged 15-24 who were living in Santiago in 1988. Findings show that 35 percent of females and 65 percent of males had had premarital intercourse. Among those who had done so, the median age at first experience was 18.4 years for women and 16.4 years for men. Only 20 percent of females and 19 percent of males used contraceptives at first premarital intercourse. Use of contraceptives increased with age at the time of that event. Fertility data reveal that 70 percent of first births were premaritally conceived, and more than one-third of these were born prior to union. The high rates of premarital and unintended pregnancy among young women and the low prevalence of effective contraceptive use indicate a need for greater emphasis on sex education and family planning services directed at adolescents and unmarried young adults in Santiago.

Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe

BackgroundTo determine differences among persons who provided blood specimens for HIV testing compared with those who did not among those interviewed for the population-based Zimbabwe Young Adult Survey (YAS).MethodsChi-square analysis of weighted data to compare demographic and behavioral data of persons interviewed who provided specimens for anonymous testing with those who did not. Prevalence estimation to determine the impact if persons not providing specimens had higher prevalence rates than those who did.ResultsComparing those who provided specimens with those who did not, there was no significant difference by age, residence, education, marital status, perceived risk, sexual experience or number of sex partners for women. A significant difference by sexual experience was found for men. Prevalence estimates did not change substantially when prevalence was assumed to be two times higher for persons not providing specimens.ConclusionWhen comparing persons who provided specimens for HIV testing with those who did not, few significant differences were found. If those who did not provide specimens had prevalence rates twice that of those who did, overall prevalence would not be substantially affected. Refusal to provide blood specimens does not appear to have contributed to an underestimation of HIV prevalence.

Contraceptive use and the need for family planning in Puerto Rico.

In 1982, 69 percent of Puerto Rican women in union were practicing contraception. Forty-five percent relied on contraceptive sterilization (40 percent, female, and five percent, male), eight percent were using the pill, four percent each, the IUD and the condom, five percent relied on rhythm, and three percent were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for childspacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54 percent), whereas pill use is highest among those aged 15-24 (approximately 23 percent). Overall, eight percent of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from nine percent among those aged 30-39 to 22 percent among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible family planning services, especially for young women, and those whose childbearing is incomplete.

Contraceptive sterilization in Puerto Rico

For twenty years Puerto Rico has had the world’s highest prevalence of sterilization. From the 1982 Puerto Rico Fertility and Family Planning Assessment we examine whether the probability of obtaining sterilization is changing and what impact sterilization has on fertility, finding that the use of contraceptive sterilization has not declined and will probably continue to increase in Puerto Rico. Nonuse rather than temporary methods of contraception is the second most likely circumstance after sterilization. We also find that sterilization has reduced the total marital fertility rate by over 33 percent, thus having a significant effect on reducing the rate of natural increase; by all indications, it will have a greater effect in the future.