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

Yeatman, Sara; Sennott, Christie

doi:10.1007/s10995-015-1669-2

Cited by 20 publications

(26 citation statements)

References 27 publications

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“…Our finding that changes in intentionality from prospective to short‐term retrospective assessment differed by pregnancy outcome also represents an important new contribution to the literature and builds on work conducted in other settings . To date, no U.S. study examining changes in intentionality from prospective to retrospective assessment has included participants who had an abortion or experienced a miscarriage.…”

Section: Discussionsupporting

confidence: 56%

“…As a result, prospective assessment is financially and practically infeasible in many contexts. Further, such an approach has its own set of limitations: An individual's attitudes toward pregnancy are not static and may change over time in response to other life circumstances . Some revision in prospective intention over time is to be expected, especially if the circumstances of a person's life related to partnership, finances or health status have shifted to make them feel more (or less) prepared to raise a child .…”

mentioning

confidence: 99%

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Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women

Ralph¹,

Foster²,

Rocca³

2020

Perspect Sexual Reproductive

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CONTEXT Measurement of pregnancy intentions typically relies on retrospective reporting, an approach that may misrepresent the extent of unintended pregnancy. However, the degree of possible misreporting is unclear, as little research has compared prospective and retrospective reports of intention for the same pregnancies. METHODS Longitudinal data collected between 2010 and 2015 on 174 pregnancies were used to analyze the magnitude and direction of changes in intendedness (intended, ambivalent or unintended) between prospective and retrospective measurements of intendedness using versions of the London Measure of Unplanned Pregnancy (LMUP). Changes were assessed both continuously and categorically. Differences in the degree of change—by pregnancy outcome and participant characteristics—were examined using mixed‐effects linear and logistic regression models. RESULTS Over two and one‐half years of follow‐up, 143 participants reported 174 pregnancies. Approximately half showed changes in intention between the prospective and retrospective assessments, with 38% of participants reporting increased intendedness and 10% decreased intendedness. Reported intendedness increased more among those who gave birth (mean change in continuous LMUP score, 2.2) than among those who obtained an abortion (0.7), as well as among individuals with a college degree (4.1) than among those with a high school diploma (1.2). Participants who reported recent depression or anxiety symptoms showed more stable intentions (0.02) than those who did not (2.1). CONCLUSIONS Retrospective measurement of pregnancy intentions may underestimate the frequency of unintended pregnancy, with such underestimation being greater among certain subgroups. Estimates based on retrospective reports thus may produce inaccurate impressions of intentionality. Further efforts to refine the measurement of pregnancy preferences are needed.

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Section: Discussionsupporting

confidence: 56%

mentioning

confidence: 99%

Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women

Ralph¹,

Foster²,

Rocca³

2020

Perspect Sexual Reproductive

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“…Such prospective research is significantly hampered by the lack of a validated prospective measure of pregnancy intention. However, one recent study in Malawi compared seven different prospective and retrospective ways of measuring pregnancy intention [41]. When compared with each other they found that retrospective measures tended to overestimate levels of intended pregnancy and that prospective measures tended to underestimate intended pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

Hall

Barrett

Phiri³

et al. 2016

PLoS ONE

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BackgroundIn 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies.Methods4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies.Results44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father’s age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner’s age and mother’s education level. The effect of mother’s education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies.ConclusionA simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This ...

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“…Many studies were conducted using retrospective data collection once the pregnancy had occurred, when women might be hesitant to label their pregnancy as ‘unintended’ or ‘unwanted’ 18. So far, no reliable data are available about prevalence in the Gaza Strip.…”

Section: Discussionmentioning

confidence: 99%

Causes and consequences of unintended pregnancies in the Gaza Strip: a qualitative study

Böttcher

Abu-El-Noor

2019

BMJ Sex Reprod Health

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BackgroundLittle is known about unintended pregnancies in the Gaza Strip. This study explored causes and consequences of unintended pregnancies among women in the Gaza Strip.MethodsThis was a qualitative study, and included 21 women who had experienced unintended pregnancies previously. Data collection took place in three focus groups of 5–12 participants, which were facilitated by one female researcher. Structured questions on reasons for, causes and impact of unintended pregnancies were answered by all participants. Sessions were audiotaped and responses were transcribed and read by all the researchers to extract themes.ResultsThe mean age of participants was 34.2±6.0 years, parity was 2.7±0.6 and 16 participants (76.2%) had benefitted from secondary level education or above.Five main themes were identified: (1) economic hardship was the main reason for pregnancies to be unwanted; (2) high pressure was exerted on women for male babies, exposing women to gender-based violence; (3) advanced maternal age was perceived as a social stigma; (4) complete lack of support for women facing unintended pregnancy led to self-management of terminations including attempts of unsafe methods; and (5) changes of methods and incorrect use leading to contraceptive failure was the most frequent cause.ConclusionsUnintended pregnancies in the Gaza Strip are a common cause of distress for women. The most effective way of preventing unintended pregnancies remains access to reliable contraception. However, a service designated to support women facing unintended pregnancies is needed in the Gaza Strip. Local policymakers have to address this when planning healthcare services.

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

Cited by 20 publications

References 27 publications

Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women

Comparing Prospective and Retrospective Reports of Pregnancy Intention in a Longitudinal Cohort of U.S. Women

Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

Causes and consequences of unintended pregnancies in the Gaza Strip: a qualitative study

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