Can LARC Fulfill Its Potential to Reduce U.S. Women’s Unintended Pregnancy Risk? Examining Women’s Contraception and Childbearing in the Year Before Initiating LARC

Long-acting reversible contraceptives (LARCs) have received increased attention in recent decades for their potential to reduce the high level of unintended pregnancy. We know little about women’s contraceptive use and (unintended) childbearing prior to LARC initiation, even though it provides vital context to considering the extent to which increased LARC use could be expected to reduce the U.S. unintended pregnancy rate. Data from 849 women who initiated LARC in the 2–3 years prior to the 2006–2015 cycles of the National Survey of Family Growth were analyzed to describe U.S. women’s contraceptive use and (unintended) childbearing in the year before initiating LARC. Results show that more than half of women (55.4%) who initiated LARC did so within a year of giving birth, with 47.3% of these births resulting from an unintended pregnancy. Among women without a recent birth, 5.0% had last relied on sterilization, 54.7% had last used a moderately-effective method, 34.7% had last used a less-effective method, and 5.6% had not used contraception in the year prior to initiating LARC. These findings advance understanding of the extent to which increased LARC use could be expected to reduce the unintended pregnancy rate. Women initiating LARC after a recent birth are selective of those at high risk of unintended pregnancy. In contrast, the majority of LARC initiators without a recent birth last relied on a moderately-effective method or sterilization—a pattern that could reduce LARC’s impact on the unintended pregnancy rate.

     

Family planning and deforestation: evidence from the Ecuadorian Amazon

Despite an abundant literature exploring the relationship between population growth and forest cover change, comparatively little research has examined the forest cover impacts of family planning use—a key determinant of population growth rates in many developing countries. Using data from a panel survey of farms in the Northern Ecuadorian Amazon, this paper explores whether family planning use affects changes in forest cover. After controlling for household life cycle effects, family planning use among female heads of farm households did not have an independent effect on deforestation, reforestation, or net forest loss between 1990 and 2008. Rather, shorter-term drivers of forest change tend to be associated with household life cycles and shifts in production and consumption. However, family planning will continue to improve development and health outcomes for women by reducing unwanted fertility and may offer longer-term environmental benefits.     

Unintended pregnancy and intimate partner violence around pregnancy in a population-based study

BackgroundIntimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. However, the relationship between IPV and women's ability to control their fertility has not been adequately explored.AimTo investigate the association between unintended pregnancy and emotional or physical violence perpetrated by partners around pregnancy.MethodsA population-based study was undertaken, recruiting women (n = 779) at the hospital obstetric departments and gathering social and family data. IPV was diagnosed by using the Index of Spouse Abuse (ISA). Data were gathered by trained midwives in 15 public hospitals in southern Spain and multivariate logistic regression analysis was performed.FindingsThe pregnancy was reported to be unintended by 118 (15.1%) of the study population. Unintended pregnancy was significantly associated with: physical and/or emotional IPV around pregnancy, age, marital status, cohabitation, educational level, and employment status. After adjusting for socio-demographic characteristics, emotional IPV around pregnancy was significantly associated with an unintended pregnancy (AOR = 2.5; 95% CI = 1.5–4.3). Being in a non-committed relationship was a risk factor (AOR = 3.5; 95% CI = 1.8–6.1) and being in employment a protective factor (AOR = 0.4; 95% CI = 0.2–0.8) for an unintended pregnancy.ConclusionWomen who report an unintended pregnancy may be experiencing emotional IPV. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. A better understanding of the relationship between unintended pregnancy and violence can aid midwives about potential reproductive health risk factors associated with abuse.     

"Are they still having sex?" STI's and unintended pregnancy among mid-life women

Research has shown that women remain sexually active throughout mid-life and into the post-menopausal years. Recent data reveal that significant numbers of STIs (sexually transmitted infections) and unintended pregnancies occur among mid-life women. Data on STI prevalence indicate several STIs have relatively high rates among women over age 30, including HIV and HSV-2. Racial/ethnic disparities in STI prevalence between mid-life African American, Hispanic, and Caucasian women have also been noted. Data from the 1995 National Survey of Family Growth reveal 51% of pregnancies among women 40 and older are unintended. Both STIs and unintended pregnancy can result in serious health consequences for mid-life women. STIs can result in pelvic inflammatory disease and ectopic pregnancy. Unintended pregnancy can result in increased morbidity and mortality to the woman and the fetus. Mid-life women are also highly likely to go through relationship transitions (e.g., separation, divorce) and the subsequent initiation of new sexual relationships. As a result, these women are at elevated risk of STIs and unintended pregnancy. Despite these realities, there is a lack of programs addressing these two health issues among mid-life women and the unique life circumstances of women at this stage of life. The authors assert there is a compelling need for interventions to reduce STIs and unintended pregnancy in this population of women, review the literature regarding STIs and unintended pregnancy in mid-life women, identify gaps in current resources, and make recommendations for health care practice and future research.     

Pathways to a Stable Union? Pregnancy and Childbearing Among Cohabiting and Married Couples

This study analyzes the stability of cohabiting and marital unions following a first birth. But unlike previous research, it compares the subsequent trajectories of unions that began with a pregnancy to those in which conceptions came after coresidence. The U.S. data from the 2006–2010 and 2011–2013 cross-sectional files of the National Survey of Family Growth indicate that roughly 1-in-5 first births were associated with rapid transitions from conception into either cohabitation or marriage. Moving in together following a pregnancy—especially an unintended one—is unlikely to lead to marital success or union stability. Compared with marital unions, dissolution rates following birth were particularly high for couples who entered a cohabiting union following conception. Only a small minority of these couples married (i.e., less than one-third), and these marriages experienced high dissolution rates. The results also suggest that the most committed cohabiting couples got married after finding themselves pregnant, leaving behind the most dissolution-prone cohabiting couples. The American family system is being transformed by newly emerging patterns of fertility among cohabiting couples.     

Midlife Women Online: Evaluation of an Internet-Based Program to Prevent Unintended Pregnancy & STIs

Background: Midlife women are an underserved population in the areas of unintended pregnancy and STI prevention yet remain at risk for both health conditions. Methods: A randomized controlled trial of an Internet-based multimedia program to reduce risk of unintended pregnancy and STIs among midlife women was conducted with 164 women ages 40–55 years of age. Results: Women in the treatment condition compared to the control condition reported significant gains in attitudes, self-efficacy, and behavioral intentions at posttest. Conclusion: Interventions specifically targeted to midlife women can impact constructs known to reduce risk. Implications for future research and intervention development are presented.     

Economic aspects of Singapore's selective family planning policy

In the mid 1980s Singapore instituted a selective family planning policy which encouraged poorly educated women to prevent pregnancy while university graduates were discouraged from using family planning. The intent of this policy was to restructure the population and the economy into a more skill-intensive industrial society and to produce effective leaders for the future governing of the country. Monetary incentives were offered to both groups of women for their compliance with the policy, including grants to poor women agreeing to undergo steriliaztion. This study undertakes a cost benefit analysis of this family planning policy, taking into account parameters of economic growth, marginal value product of labor, and the consumption levels. Results of this analysis suggest that society may benefit more by prevention the birth of a potential university student than by preventing the birth of a potential primary school graduate. However, this study does not take into account the value of educated citizens in technical advancement which would raise the productivity of the uskilled workers in the country, nor some of the real economic conditions in Singapore such as the virtually unlimited availability of labor from other Asian countries (who come without dependents and are expatriated when they become unproductive). Training cost and the timing of benefits are critical to the outcome of this analysis. It is shown that, under some reasonable conditions, the selective family planning policy might not be economically warranted.     

On the validity of retrospective assessments of pregnancy intention

Information on pregnancy intention is often gathered retrospectively (after the birth of a child). This article investigates whether the retrospective assessment of pregnancy intention leads to biased estimates of the extent or consequences of unintended fertility. Comparisons are made between pregnancy intentions ascertained during pregnancy and after birth using data from the National Longitudinal Survey of Youth. To address the bias caused by selective recognition or acknowledgment of pregnancy, we used the longitudinal feature of the data to determine actual pregnancy status at the time of interviews, which, in turn, was used as an instrumental variable for the retrospective (versus prospective) reporting of pregnancy intention. After correction for selective pregnancy recognition, we found no evidence that the retrospective assessment of pregnancy intention produces misleading estimates of either the number or the consequences of unintended births. This finding is supported by additional analyses of a small subsample of women for whom information on pregnancy intention was collected both during pregnancy and after birth.     

The effect of pregnancy intention on child development

In this paper, we use data from the National Longitudinal Survey of Youth to investigate the empirical link between unintended pregnancy and child health and development. An important contribution of our study is the use of information on siblings to control for unmeasured factors that may confound estimates of the effect of pregnancy intentions on infant and child outcomes. Results from our study indicate that unwanted pregnancy is associated with prenatal and postpartum maternal behaviors that adversely affect infant and child health, but that unwanted pregnancy has little association with birth weight and child cognitive outcomes. Estimates of the association between unwanted pregnancy and maternal behaviors were greatly reduced after controls for unmeasured family background were included in the model. Our results also indicate that there are no significant differences in maternal behaviors or child outcomes between mistimed and wanted pregnancies.     

The unintended effects of cash transfers on fertility: evidence from the Safe Motherhood Scheme in India

India launched the Safe Motherhood Scheme (Janani Suraksha Yojana or JSY) in 2005 in response to persistently high maternal and child mortality rates. JSY provides a cash incentive to socioeconomically disadvantaged women for childbirth at health facilities. This study explores some unintended consequences of JSY. Using data from two large household surveys, we examine a policy variation that exploits the differential incentive structure under JSY across states and population subgroups. We find that JSY may have resulted in a 2.5–3.5 percentage point rise in the probability of childbirth or pregnancy over a 3-year period in states already experiencing high population growth.     

Effect of Pregnancy Intention on Child Well-Being and Development: Combining Retrospective Reports of Attitude and Contraceptive use

Prior research has documented a relationship between unintended pregnancy and negative consequences for infants and children. Much of this research is based on retrospective reports of intention, but this method has been critiqued as subject to biases in recall and reporting. Non-retrospective measures have also been employed, but these are less widely available and tend to be hindered by limited samples. Using the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up, a composite measure of reported pregnancy intention and birth control use is constructed to attempt to overcome some limitations of the use of retrospective reports of intention. This composite measure is compared to more conventional measures through analyses predicting the effects of pregnancy intention on child health, activity, and development. Across the different constructions of the pregnancy intention measure, children from unintended pregnancies have poorer outcomes. They are more likely to have less than excellent health, undesirable activity levels, and below median scores on a development assessment. The composite measure predicts similarly to the more conventional measures of intention, but provides an additional dimension that helps address some of the concerns about bias in retrospective reporting, while maintaining the benefit of application in existing large and representative samples. Researchers and policy makers need to continue their concern about the effects of unintended pregnancies, and need widely available measures to understand determinants, consequences, and prevention strategies.     

Lowering Social Security's Duration-of-Marriage Requirement: Distributional Effects for Future Female Retirees

A number of alternatives to Social Security's auxiliary benefit system have been proposed in the context of changes in American family and work patterns. This article focuses on one modification therein—lowering the 10-year duration-of-marriage requirement for divorced spouses. Using a powerful microsimulation model (MINT), we examine the distributional effects of extending spouse and survivor benefit eligibility to 5- and 7-year marriages ending in divorce among female retirees in 2030, a population largely comprised of baby boomers. Results show that the options would increase benefits for a small share of female retirees, around 2 to 4%, and would not affect the vast majority of low-income divorced older women. However, of those affected, the options would substantially increase benefits and lower incidence of poverty and near poor. Low-income divorced retirees with marriages between 5 and 9 years in length and a deceased former spouse face the greatest potential gains.     

Environmental Effects on Family Size Preferences and Subsequent Reproductive Behavior in Nepal

This study investigates the relationship between environmental degradation and men and womens family size preferences and subsequent reproductive behaviors in Nepal. We draw on unique environmental data at the local level, household and individual-level survey data and individuals reproductive behavior over a 3 year time period in Western Chitwan Valley, Nepal. Results from Ordinary Least Squares (OLS) and logistic regression models show that poorer environmental quality and greater reliance on publicly owned natural resources are associated with higher family size preferences and higher rates of pregnancy. The analyses provide support for the vicious circle argument that environmental degradation can lead to rising population growth via positive effects on fertility. As environmental conditions decline and when households rely on public lands for natural resources, men and women desire larger family sizes and women are more likely to get pregnant in the near future.     

Population growth rates in perfect contraceptive populations

Eventually, world population must cease to grow. In many countries attempts are made to decrease population growth by providing family planning services to all who want to prevent pregnancies. In this paper we use the concept ‘perfect contraceptive population’,¹ — a population in which no unwanted births occur — to derive estimates of the maximum contribution that prevention of unwanted births might make toward attaining a zero rate of natural increase in population.     

A computer model of family building based on expected values

A computerized probability model of family building is described. Called FERMOD, the model is designed to follow the changing distribution of children ever born and birth intervals of a large homogeneous population as it moves through the reproductive period. Use of the model presupposes assumptions about such factors as risks of fetal wastage, lengths of pregnancy, and postdelivery amenorrhea conditional to outcome of pregnancy, length of reproductive period, fecundability, desired family size, preferred birth spacing!, and effectiveness of contraception. Use of FERMOD is illustrated in a limited application to United States fertility. Relations to other models are briefly discussed.     

Policy review: thoughts on addressing population and climate change in a just and ethical manner

Many believe that linking population growth to the issue of climate change will help to place family planning back into the political realm as an urgent matter of national and environmental security. Others worry, however, that focusing on the environmental impacts of demographic change places at risk the hard-fought and long-developed global consensus that individual rights and empowerment are what matters most in fostering sustainable development and stabilizing population growth. This paper focuses on United States population policy. It presents a brief historical background and summarizes the state of scientific evidence regarding the impacts of population growth on climate change. It then analyzes some of the underlying ethical issues involved in advancing an advocacy argument around increasing family planning as a way to slow population growth and mitigating climate change. Finally, it recommends a way in which advocates can frame the connections between population growth and climate change in a just and ethical manner.     

Medicaid,motherhood, and the challenges of having a healthy pregnancy amidst changing social networks

BackgroundAfrican American women with low income face various challenges to having a healthy pregnancy. Unplanned pregnancies often amplify those challenges and negatively impact women’s ability to get the care that she needs. Research has shown that social networks can improve pregnancy outcomes by helping women cope with and address the problems that they face. However, there is little research on how unintended pregnancy impacts the medical and social support that African American women receive.AimThis research explored how unintended pregnancies impact women’s social networks and the type of support that they need throughout the pregnancy.Design and sampleThis ethnographic study included 20 African American women who used pregnancy services at a health department in the United States. Fourteen women were enrolled in the study during their first or second trimester and were interviewed upon enrollment, in their third trimester, and within one month of giving birth. An additional six women were enrolled and interviewed within one month of giving birth.ResultsAfrican American women’s needs and social support networks change throughout their pregnancy. When medical providers primarily offer pregnancy information and referrals to social service agencies during the first trimester, problems that women have later in the pregnancy are not properly addressed.ConclusionSocial support needs to be accessed at multiple times during the pregnancy. Pregnancy resources should be provided throughout the pregnancy, recognizing that social support and personal struggles evolve during the pregnancy.     

Family policy in 1990-1994

The nature and goals of family policy in Poland are discussed in the larger context of social policy and economic change, which reflects the transition to a market economy. The aim of family policy is to bring about a proper system of relationships between state and family, which allows for the performance of basic functions related to child rearing and satisfaction of basic needs. The roles of both governmental and nongovernmental organizations are considered important, although not actualized, in the implementation of family policy. Family policy involves laws regulating the conditions of welfare benefits in terms of prerequisites, amount of financial grants, services, and allowances such as food, clothing, or fuel. Financial resources may be received directly or indirectly by families. During 1990-94 major changes in family policy came about due to the transition to a market economy and were applied to social security benefits, work benefits, disability pensions, and health insurance. Changes were made in education, health care, and housing. A comprehensive model was never developed, in which negative effects of changes could be improved upon. Changes put greater emphasis on state and territorial governments to provide social welfare benefits, including social security benefits. Social welfare benefits were set at the lowest level of social security benefits. Economic changes have led to greater unemployment, housing difficulties, inflation, lower quality services, and a decline in the standard of living and security. The Central Statistical Office determined that over 56% of families in 1993 were affected by poverty conditions, which reduced expenditures on food and other needs. The proportion of the population recognized as poor increased during 1990-93 from 16.6% to 22.5% among workers, from 9.7% to 17.3% among farm tenants, from 23.9% to 36.6% among the self-employed, and from 30.4% to 40.6% among the aged and disabled. World Bank estimates showed that 15% of the total population were identified as poor. During this period, however, old-age pensions and the lowest salaries increased. The author concludes that policies must use general concepts that are comprehensive and that current economic trends should increase family income.     

Changing Australia’s Age Pension Qualification Age: Modelling Differential Effects by Race

Increasing the age at which people are eligible for the age pension is one mechanism by which governments of developed nations are attempting to manage increasing costs associated with population ageing. In Australia, there are a number of groups within the population who may be affected in unintended ways by increasing the eligibility age to 70 years by the year 2035, as was proposed in the 2014 Federal Budget. Most notably, Aboriginal and Torres Strait Islander (Indigenous) Australians currently with an average at birth life expectancy of 69.1 years for males and 73.7 years for females, nearly 11 years less than non-Indigenous Australians, may be the most affected. This study explores the consequences of the proposed future amendments to the age pension eligibility age, using projections of the likely age structures of future populations to estimate expected years of life remaining after reaching pension age. Despite projected improvements for Indigenous life expectancies, increasing the pension eligibility age under the schedule proposed in the policy would significantly reduce the expected years in post pension age, thus countering some of the anticipated benefits flowing from expected future life expectancy increases. However, if the eligibility age were to be increased more gradually, Indigenous Australians would be afforded a greater opportunity to access age pension benefits, whilst still reducing the length of time the non-Indigenous population is eligible to access the age pension, thus fulfilling policy objectives to manage increasing costs associated with population ageing.     

Quality of care in Peru: measuring its impact. Field report

A report published in 1995 by the Population Council described the impact of the quality of family planning services on the incidence of unplanned pregnancy in Peru. This report followed a 1994 study that assessed the impact of quality on contraceptive usage by linking data from Peru's 1991-92 Demographic and Health Survey (DHS) and a 1992 Peru Situational Analysis study of the status of family planning (FP) services at 3000 individual service delivery points. The 1995 study added data from a follow-up survey of a sample of the DHS respondents. The 1994 study used an innovative quality of care index that measured the quality of FP services available in a geographic area to women with partners living nearby. This index was then assigned to every woman in the area and correlated with her use of modern contraceptives. The analysis revealed that availability of high-quality FP services greatly increased the number of women using modern contraception. The 1995 study analyzed the impact of quality of care on rates of unintended pregnancy and found that the percentage of unwanted births was significantly higher in areas with low-quality FP services. The researchers note that these results only hint at a relationship between quality of care and reproductive behavior and that the findings should be interpreted conservatively. However, the studies support the importance of investing in quality FP care.