Measuring Unintended Pregnancy in 2000-2001 Hawai`i PRAMS Data

Limin Song, M.P.H., C.H.E.S.Cheryl B. Prince, Ph.D., M.P.H.Nighat Quadri, M.S., M.P.H.

Traditional question

Thinking back to just before you got pregnant with your new baby, how did you feel about becoming pregnant?

• I wanted to be pregnant sooner• I wanted to be pregnant later• I wanted to be pregnant then• I didn’t want to be pregnant then or at any time in the

future

Traditional Definition

sooner + then = intended

later + never =unintended

Filter Question

When you got pregnant with your new baby, were you trying to become pregnant?

(No/Yes)

Question?

Exclude ‘TRYING’ women from unintended group?

Purpose

• To compare data on intendedness using both questions vs. only traditional question

• To determine the best measurement tool of pregnancy intendedness for the State of Hawai`i.

Hawai`i PRAMS

• Native Hawaiian/Part Hawaiian women

• Women living in rural areas outside of Honolulu

Honolulu

Methods

• Analyzed demographic characteristics of Hawai`i PRAMS mothers delivering in 2000-2001

• Compared statistics between traditional unintended pregnancy definition and definition using both questions

Results

Sample size 6,251

Respondents 5,009 (80%)

Estimated live births 33,991

(Weighted population size)

Characteristics Percent

Age <20

20-24

25-34

>34

10.3

24.9

48.0

16.8

Education <12 years

12 years

>12 years

9.5

41.4

49.0

Marital Status

Married

Not married

67.7

32.3

Results

Characteristics Percent

Race/Ethnicity Chinese & Japanese

Filipino

Hawaiian/Pt Hawaiian

Other Asian & Pac. I.

Other Nonwhite

White

16.2

20.7

27.0

9.4

4.1

22.5

Residence Urban Honolulu

Rural Oahu

Neighbor Islands

50.2

23.7

26.1

Income <$10,000

$10,000-30,000

$30,001-50,000

>$50,000

14.4

31.9

25.0

28.7

Results

Results

I wanted to be pregnant:

Trying to get pregnant

Yes No

Sooner 29.49% 6.41%

Later 4.99% 61.16%

Then 64.68% 16.83%

Didn’t want 0.84% 15.59%

Results

Unintended pregnancy

Intended pregnancy

Use one question

(traditional)44.3% 55.7%

Use both questions

41.6% 58.4%

• Unintended Pregnancy Rate Among Seventeen States:

33.7% -------------- 52.0%

(Utah) (Louisiana)

1999 PRAMS Surveillance Report

Extending the Study

Other Measurements:

• Wanted

• Mistimed

• Unwanted

• Ambivalent

Commonly Used Definition

I wanted to be pregnant:

Sooner + then = wanted

Later = mistimed

Never = unwanted

Two additional questions

When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant? (yes/no)

What were your or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant? (one option is ‘I didn’t mind if I got pregnant’)

Our Results

• Wanted – 50.29%• Mistimed – 28.53%

• Ambivalent – 12.88%• Unwanted – 8.29%

Unclassified - 0.02% (1)

How did we get these numbers?

• Use information from all four questions

• Include women with some missing values

Conclusions

• The intention to become pregnant is a difficult concept to measure precisely.

• Discussing with the family planning program staff for further decision.

Limitation

Since stillbirths are not included in the PRAMS data set, measuring the prevalence of pregnancy intendedness using PRAMS data will never be 100% accurate.

Public Health Benefits

• Development of a stable and reliable measurement tool

• Directing scarce resources to focus on populations at risk.

Acknowledgements

• Ms. Marisa Martin, Family Health Service Division, former Hawai`i PRAMS Data Manager

• George Lin and Caryn Tottori, Office of Health Status Monitoring

• Hawai`i PRAMS team

• Dr. Nedra Whitehead, Division of Reproductive Health, CDC

Keep Marching…

2004-2005

sooner + using BC = mistimed, otherwise sooner=wanted later + (trying or didn’t mind) =ambivalent, otherwise later=mistimed then + using BC = ambivalent, otherwise then=wanted never + (trying or didn’t mind) = ambivalent, otherwise never=unwanted

missing feel + trying = wanted missing feel + (not or missing try) + using BC = unwanted missing feel + (not or missing try) + (not using or missing BC) + mind =unwanted missing feel +(not or missing try) + (not using or missing BC) + didn’t mind = wanted missing feel + not trying + not using BC + missing mind = ambivalent all missing = unclassified

How did we get these numbers?