Marjorie R. Sable

Pregnancy intentions may not be a useful measure for research on maternal and child health outcomes.

The findings of three researchers about pregnancy intendedness as a measure for understanding maternal and child health outcomes were evaluated. Studies have linked unintended pregnancy to some behaviors and to negative birth weight. Several issues undermine the validity of intendedness as it is presently measured, such as recall bias implicit in retrospective queries about intention; and pregnancy intention as a complex concept. Moreover, discrepancies between the stated and actual contraceptive practice of women also complicated the issue of intention status. Also, the issue of mistimed versus unwanted pregnancy presented another problem. Thus, intendedness may be too complex to quantify and measure accurately.

Pregnancy Intention and Pregnancy Happiness: Are They Different?

Objectives: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. Methods: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. Results: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. Conclusions: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.

Beliefs Concerning Contraceptive Acquisition and Use Among Low-Income Women

Despite the availability of a wide variety of safe and effective contraceptives, unintended pregnancy remains a problem of considerable social and public health concern. This qualitative, descriptive investigation was based on Ajzens Theory of Planned Behavior. The study examined attitudinal and normative beliefs, as well as perceived control factors that may affect a womans intention to acquire and use specific contraceptive methods. The study sample consisted of 42 low-income women of reproductive potential. In face-to-face, audiotaped interviews, open-ended questions were used to elicit salient beliefs that affected these womens decision making about contraceptive acquisition and use. Respondents named embarrassment as a factor influencing condom acquisition and use; concerns about potential risks and side effects were a major deterrent to use of hormonal contraceptives. Implications for practitioners and public policy are suggested.

Pregnancy Intentions, Pregnancy Attitudes, and the Use of Prenatal Care in Missouri

Objectives: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. Methods: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of womens attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. Results: Womens attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. Conclusions: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve womens utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.

Domestic Violence Among AFDC Recipients: Implications for Welfare-to-Work Programs

This article reports on a 1996 prevalence study of domestic violence and other partne and family-related problems among 404 female aid to families with dependent children (AFDC) recipients in the Kansas City, Missouri, metropolitan area. Almost one third of the women had been abused sometime in their lives, and 10% had been abused in the past year. The women stated that abuse or lack of support reduced their ability to work, but not as often as did lack of child care and transportation. Thus, domestic violence may affect womens success in finding and keeping jobs.

Hispanic Immigrant Women Talk About Family Planning

In an effort to discover what can improve family planning services for recently immigrated Hispanic women and to foster cultural competence among health care providers in this arena, the authors conducted four focus groups of recently immigrated Hispanic women in a medium-sized Midwestern community. The focus group discussions covered such topics as health care, knowledge of birth control, domestic life, and economic issues in the United States. The participants demonstrated knowledge of and support for the concept of family planning and specific birth control methods. They also identified issues that challenge the use of birth control at the individual, family, system, and cultural levels.

The Influence of Patriarchal Behavior on Birth Control Access and Use Among Recent Hispanic Immigrants

It is commonly assumed that Hispanic immigrants in the United States subscribe to a patriarchal ideology that keeps women subordinated to men, often through violence and exploitative reproductive behaviors. If this assumption is true, we might expect to find that in the Hispanic culture patriarchal males control decision-making about access to and use of birth control. Structured interviews of 100 Hispanic men and 100 Hispanic women who were recent immigrants to a Midwest community were conducted to examine this assumption. Results did not support this assumption among this study population. We found no patriarchal ideology supporting women’s subordination to men, violence as a mechanism of control, reproduction as a way of exploitation, or cultural influences discouraging access to and use of birth control in the Hispanic community. Rather, these immigrants revealed adequate knowledge of birth control use and positive perceptions of gender equality. Gaining a better understanding of the limited influence of patriarchal ideology on the use of birth control and family planning services among this Hispanic community may inform the development of family planning services tailored for new Hispanic immigrants.

The role of pregnancy intention in HIV prevention in South Africa: a proposed model for policy and practice.

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural, behavioural, environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore, understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy, prevention of transmission of HIV, protection of the infant, and protection of the mother.

Gender and Contraception: A Proposed Conceptual Model for Research and Practice

Unintended pregnancy and birth, frequently due to contraceptive non-use or misuse, continue to be important public health problems. A large body of literature has examined womens characteristics related to contraceptive use. However, much of what is known about men and contraception has been obtained or extrapolated from interviews with women. In this paper, we first present an overview of unintended pregnancy and the link with contraception. We explore gender considerations in contraceptive decision-making and discuss the literature of mens role in contraceptive attitudes and practices both in the developing countries and in the United States. Because individuals who make contraceptive decisions are actually part of couples, we examine the recent literature on couple communication and the role of partner influence on contraceptive practice. Finally, we propose a conceptual model that can be used for studying gender differences regarding factors that influence contraceptive use. The model is comprised of a variety of factors influencing contraceptive use that include; (1) knowledge of contraceptive methods, use, and effectiveness; (2) structural/access, institutional, and financial factors that may present barriers to contraceptive acquisition and use; and (3) socio-cultural factors. These sociocultural factors include: (a) attitude (beliefs, values, perceived risk of pregnancy, cognitive assessment/acceptability of pregnancy, masculinity ideology, self-esteem, and self-efficacy); (b) the influence of significant others, including partners, peers, and family; and (c) sociodemographic factors including age, ethnicity, marital status, education, and income. This model should be useful in identifying gender differences in knowledge, attitudes, and practices about contraception and pregnancy so that efforts to reduce unintended pregnancy can effectively target both women and men.

Integrating HIV prevention, STD, and family planning services. The need for integrated government funding and services.

This letter responds to an editorial by Zena Stein on the need for integrating family planning (FP) programs with efforts to prevent and control sexually transmitted diseases and HIV infections. In the US the government funds its FP program in a categorical manner which keeps it discrete from maternal and child health services delivered to the same population. Integration of services such as the Special Supplemental Nutrition Program for Women Infants and Children; prenatal care; FP; sexually transmitted diseases prevention and control; and child immunization would benefit women and children. People in need of services must be located wherever they are in order that they may benefit from primary prevention efforts targeting reproductive and sexual health as well as child health.