MINNEAPOLIS – Data from a surveillance system in Maryland show that the burden of unintended pregnancy remains large, with multiple potential risks for both mothers and infants, according to Dr. Diana Cheng of the Maryland Department of Health and Mental Hygiene, Baltimore.
The Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) was established by the Centers for Disease Control and Prevention with the goal of obtaining information about maternal behaviors and experiences that may be associated with adverse pregnancy outcomes.
Between 2001 and 2005, a random sample of 7,381 mothers completed the PRAMS survey from 2 to 6 months after delivery.
The survey included the following question: Thinking back to just before you got pregnant, how did you feel about becoming pregnant?
Available answers were “I wanted to be pregnant sooner,” “I wanted to be pregnant later,” “I wanted to be pregnant then,” or “I didn't want to be pregnant then or at any time in the future.”
Pregnancies were classified as intended if the mothers had wanted them then or sooner and as unintended if they said they wanted them later or not at all.
Analysis of the survey responses determined that 58% of the pregnancies were intended, while 42% were unintended, Dr. Cheng reported at the annual meeting of the Association of Reproductive Health Professionals.
Among women with intended pregnancies, 16% said they wanted their pregnancy sooner and 42% said they wanted their pregnancy then.
Among women with unintended pregnancies, 31% said they wanted their pregnancies later and 11% said they didn't want to be pregnant then or ever.
“We also looked at maternal behaviors and risk factors, and the group whose pregnancies were unwanted really fared much worse,” Dr. Cheng said. A total of 86% of the mothers whose pregnancies were unwanted did not take folic acid daily, 44% initiated prenatal care after the first trimester, and about 24% smoked during pregnancy.
Post partum, 37% did not breast-feed, 30% smoked, 27% reported depression, and 50% did not place their babies on their backs to sleep.
Moreover, 11% of women in this group reported a history of physical abuse.
In contrast, significantly lower percentages of women with intended pregnancies reported unhealthy behaviors. For example, among mothers in this group, 87% initiated prenatal care during the first trimester, 81% breast-fed, and 69% placed their babies on their backs for sleep.
A total of 10% of babies born to mothers whose pregnancies were unwanted were low birth weight, as were 7% of babies born to mothers whose pregnancies were intended.
The survey also found that 43% of the women were using birth control at the time they became pregnant.
“Discouragingly, the fact that this many women were using birth control and became pregnant anyway suggests inconsistent or improper use of contraceptives,” Dr. Cheng noted.
Among the women who did not use birth control, most said they did not think they could get pregnant at that time. Other reasons for failure to use contraceptives included cost and difficulties in obtaining birth control supplies, she noted.
Improving women's access to education about contraception will help couples better plan pregnancies and increase the rates of intended pregnancies, and counseling, particularly with the inclusion of the partner, can help clarify common misconceptions about birth control, she said.
Unwanted and mistimed births remain a huge educational challenge and opportunity for family planning organizations and specialists, Dr. Cheng concluded.