Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study

Abstract

Background An estimated 40% of pregnancies globally are unintended. Measurement of pregnancy intention in low- and middle-income countries relies heavily on surveys, notably Demographic and Health Surveys (DHS), yet few studies have evaluated survey questions. We examined questions for measuring pregnancy intention, which are already in the DHS, and additional questions and investigated associations with maternity care utilisation and adverse pregnancy outcomes. Methods The EN-INDEPTH study surveyed 69,176 women of reproductive age in five Health and Demographic Surveillance System sites in Ghana, Guinea-Bissau, Ethiopia, Uganda and Bangladesh (2017–2018). We investigated responses to survey questions regarding pregnancy intention in two ways: (i) pregnancy-specific intention and (ii) desired-versus-actual family size. We assessed data completeness for each and level of agreement between the two questions, and with future fertility desire. We analysed associations between pregnancy intention and number and timing of antenatal care visits, place of delivery, and stillbirth, neonatal death and low birthweight. Results Missing data were <2% in all questions. Responses to pregnancy-specific questions were more consistent with future fertility desire than desired-versus-actual family size responses. Using the pregnancy-specific questions, 7.4% of women who reported their last pregnancy as unwanted reported wanting more children in the future, compared with 45.1% of women in the corresponding desired family size category. Women reporting unintended pregnancies were less likely to attend 4+ antenatal care visits (aOR 0.73, 95% CI 0.64–0.83), have their first visit during the first trimester (aOR 0.71, 95% CI 0.63–0.79), and report stillbirths (aOR 0.57, 95% CI 0.44–0.73) or neonatal deaths (aOR 0.79, 95% CI 0.64–0.96), compared with women reporting intended pregnancies. We found no associations for desired-versus-actual family size intention. Conclusions We found the pregnancy-specific intention questions to be a much more reliable assessment of pregnancy intention than the desired-versus-actual family size questions, despite a reluctance to report pregnancies as unwanted rather than mistimed. The additional questions were useful and may complement current DHS questions, although these are not the only possibilities. As women with unintended pregnancies were more likely to miss timely and frequent antenatal care, implementation research is required to improve coverage and quality of care for those women.

Feasibility of continuous distal body temperature for passive, early pregnancy detection

“…The cost of delayed pregnancy awareness is great: adoption of appropriate pregnancy habits is delayed [ 4 , 5 ] in the earliest, most fragile developmental window [ 6 – 9 ]. Moreover, unplanned pregnancy occurs at a rate of ~50% [ 10 – 13 ], and is associated with higher likelihood of adverse exposures [ 4 , 5 , 14 , 15 ], increased maternal morbidity and mortality [ 16 , 17 ], preterm birth and low childhood weight [ 18 – 21 ], elevated risk of birth defects [ 22 , 23 ], and poorer maternal psychological health [ 24 , 25 ]. As the effective window for emergency contraception is ~120 h at most [ 26 – 29 ], and as access to pregnancy testing and safe abortion access continues to be limited around the world [ 16 , 30 ], delayed confirmation poses considerable risks to pregnant individuals [ 16 , 17 ].…”

A partner‐specific critique of mistimed and unwanted fertility: Results from an analysis of the 2017–2019 United States National Survey of Family Growth

“…This may explain why large minorities of women with recent unwanted births report wanting more children in the future both in our data and across contexts. 15 Indeed, a recent study using NSFG data found teenagers to have the highest proportion of births categorized as unwanted, 32 and researchers using earlier rounds of the same study were puzzled as to why so many teenagers reported unwanted rather than mistimed births. 1,16 Researchers working in sub-Saharan Africa have expressed similar confusion.…”

“…[12][13][14] Other research has revealed that many women who report a birth as unwanted (by indicating that a particular pregnancy came when they did not want more children; see Table 1) also report wanting more children in the future. 3,15,16 Still others have shown that desired fertility with a particular partner is closely related to pregnancy intentionality. 17,18 The United States (US) National Fertility Survey introduced the concept of a mistimed birth in 1965.…”

Measures of Pregnancy Intention: Why Use Them and What Do They Tell Us?

“…As previously mentioned, a prospective understanding of pregnancy intention can inform who needs which kind of advice and can empower individuals or couples to formulate and achieve their reproductive intentions. 2 52 Such assessment allows the health care worker to provide contraception information or preconception care which may prevent unintended pregnancy, or enable people to optimize their health prior to pregnancy. 53 Several pilot studies regarding One Key Question have shown feasibility and acceptability and formal studies are underway to assess the impact of this tool on reproductive health.…”