Do Pregnancy Intentions Matter? A Research Note Revisiting Relationships Among Pregnancy, Birth, and Maternal Outcomes

Abstract

The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause adverse maternal and child outcomes is limited. In this research note, we examine these relationships using recent large-scale data and inverse propensity weights estimated from generalized boosted models. We find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth—both of which are consistent with prior research. In an addition to the literature, we show that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.

Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes

“…Studies were mostly conducted in North America, with additional studies in Europe and Asia. Most studies were based on analysis of more than 1000 observations, and 12 studies were based on more than 10 000 observations from population-based data sources . Examples include the California Maternal and Infant Health Assessment, UK Millennium Cohort Study, and the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing maternal and infant health surveillance system in the US .…”

“…Most studies were based on analysis of more than 1000 observations, and 12 studies were based on more than 10 000 observations from population-based data sources . Examples include the California Maternal and Infant Health Assessment, UK Millennium Cohort Study, and the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing maternal and infant health surveillance system in the US . Participants in studies using population-based data sources reflected the age, racial and ethnic, and sociodemographic characteristics of the community, while smaller studies focused on specific populations.…”

“…Studies determined pregnancy intention by maternal self-report using measures from the PRAMS or measures modeled on the PRAMS; direct questions; and other approaches . Studies used various terms to elicit pregnancy intention from participants including whether the pregnancy was intended, wanted, planned, or mistimed.…”

“…Twenty-three studies reported adjusted estimates of the association between unintended pregnancy and maternal depression including 15 studies of depression during pregnancy (7 cohort and 8 cross-sectional studies) and 10 studies of depression post partum (4 cohort and 6 cross-sectional studies) (Table 1). For prenatal depression, 12 studies collected depression measures during pregnancy and 3 collected measures post partum .…”

Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy

“…25 These results reiterate that laws limiting abortion to early pregnancy eliminate abortion access and are a threat to personal and public health. 4 , 26 , 27 Most people do not recognize they are pregnant before 6 weeks’ gestation 28 ; thus, a law like HB481 creates widespread challenges to accessing abortion and increases the likelihood that people have to carry pregnancies against their wishes. 29 While Georgia was once a major point of abortion access in the Southeast, people across the region will likely need to travel further—potentially hundreds of miles—to reach care, due to HB481.…”