Elsevier

Social Science & Medicine

Volume 51, Issue 7, 1 October 2000, Pages 1011-1018
Social Science & Medicine

Unintended pregnancy and women’s use of prenatal care in Ecuador

https://doi.org/10.1016/S0277-9536(00)00010-1Get rights and content

Abstract

This paper assesses the relationship between unintended pregnancy — both unwanted and mistimed — and several dimensions of use of prenatal care among women in Ecuador, where the level of unintended pregnancy has risen considerably in recent years. Data were collected from a nationally representative sample of 3988 women interviewed in the 1994 Demographic and Maternal–Child Health Survey. Multivariate logistic regression was used to assess jointly the effect of pregnancy intention status (unwanted, mistimed, planned) on three aspects of prenatal care use while controlling for potential confounders. Women with unwanted pregnancies were 32% less likely than women with planned pregnancies to seek out prenatal care. Women with unwanted pregnancies were also 25% less likely to initiate care in the first trimester and 29% less likely to receive at least an adequate number of visits. Mistimed pregnancy was not associated with receiving care, timely initiation of care or receiving an adequate number of visits.

Introduction

Both researchers and health care providers have argued that it is important to prevent unintended pregnancies because of their negative effects on the health of women and infants. It is posited that women with planned pregnancies, compared to those with unintended pregnancies, are likely to be better prepared, emotionally and financially, for the demands of pregnancy and childbearing and more likely to take better care of themselves and the developing fetus during pregnancy. For example, women with unintended pregnancies may be less likely to seek prenatal care than women with planned pregnancies (Institute of Medicine, 1995). The effect of unintended pregnancy on prenatal care use is of concern because, while the benefits of routine prenatal care for all women are currently under debate, some elements of prenatal care have been associated with positive pregnancy outcomes. These include folic acid and iron supplementation, detection and treatment of tuberculosis and malaria, tetanus immunization, detection and care of pre-eclampsia, and screening for and treatment of syphilis (Fiscella, 1995, WHO, 1994, Rooney, 1992, Institute of Medicine, 1988, Bergsjo and Villar, 1997, Villar and Bergsjo, 1997, Villar et al., 1993, Kogan et al., 1998).

Most studies of the relationship between pregnancy intention status and prenatal care use have been conducted in the United States. In an extensive literature search for rigorously conducted scientific studies, the only located U.S. study that examined the separate impacts of unwanted (woman did not want any more children), mistimed (unintended, but woman desired a child at some point in the future) and planned pregnancy found that both women with unwanted pregnancies and women with mistimed pregnancies were less likely than those with planned pregnancies to initiate prenatal care in the first 8 weeks of pregnancy. However, pregnancy intention status was not associated with receiving the recommended number of prenatal care visits (Kost, Landry & Forrest, 1998).

Other U.S. studies measured pregnancy intention status in only two categories and were conducted among nonrepresentative samples of women. A study of married women and another of women aged 18–26 experiencing their first births found that women with planned pregnancies were slightly more likely than women with unintended pregnancies (unwanted and mistimed) to initiate prenatal care in the first trimester (Marsiglio and Mott, 1988, Weller et al., 1987). A study conducted in the state of Missouri found that women who felt “unhappy” when they discovered they were pregnant were 40% less likely to receive adequate prenatal care than women who were happy to be pregnant. Adequate prenatal care was defined in terms of both timely initiation of care (in the first 4 months of pregnancy) and number of visits (eight or more for a pregnancy over 36 weeks) (Sable, Stockbauer, Schramm & Land, 1990).

Only two identified studies of the relationship between pregnancy intention status and use of prenatal care focused on women in developing countries. An analysis of Demographic and Health Survey data from Kenya and Namibia found that, in Kenya, both women with unwanted pregnancies and those with mistimed pregnancies had significantly fewer prenatal care visits than women with planned births. In Namibia, however, pregnancy intention status was not associated with the number of prenatal visits. Intention status was not associated with initiating care in the first trimester in either Kenya or Namibia (Gage, 1996). A study in Peru found that women with unwanted pregnancies were less likely than those with wanted pregnancies (defined as planned or mistimed) to have received at least one prenatal care visit. This study did not distinguish between planned and mistimed pregnancy; nor did it explore dimensions of prenatal care use other than use or nonuse (Tam, 1991).

This paper assesses the relationship between unintended pregnancy — both unwanted and mistimed — and several dimensions of use of prenatal care among women in Ecuador. The consequences of unintended pregnancy are of particular concern in Ecuador because levels of unintended pregnancy have risen markedly in recent years. Between 1989 and 1994, the proportion of pregnancies reported as unwanted rose from 6.7 to 19.3%, and the proportion that were mistimed rose from 5.8 to 16.3% (CEPAR, 1995). In contrast, levels of unintended pregnancy decreased during the same time period in every other Latin American country but Paraguay (Bongaarts, 1997).

Section snippets

Data and methods

Data for this study were drawn from the 1994 Ecuador Demographic and Maternal–Child Health Survey, hereafter referred to by its Spanish-language acronymn, ENDEMAIN (Encuesta Demográfica y de Salud Materna e Infantil). The ENDEMAIN was a three-stage cluster design sample survey of women aged 15–49 years. Twenty thousand households were randomly selected for interview, and 71.8% had at least one woman of reproductive age (15–49). Interviewers completed 13,582 interviews, achieving a 96.4%

Pregnancy intention status and background characteristics

Table 1 presents women’s pregnancy intention status and background characteristics. Approximately 20% of women reported that their last pregnancies were unwanted, and 18% said their pregnancies were mistimed. Most (73%) of the women in the study were between 20 and 34 years old. Prior to their most recent pregnancies, just over half the women had one to three previous births, 31% were nulliparous, and 16% had given birth to four or more children. Approximately 20% were from homes of low SES,

Discussion

This study found that the intention status of Ecuadoran women’s pregnancies was associated with three aspects of prenatal care use. Similar to findings from earlier studies (Kost et al., 1998, Gage, 1996, Tam, 1991, Sable et al., 1990), women with unwanted pregnancies were significantly less likely to receive prenatal care than women with planned pregnancies. Women with unwanted pregnancies were also less likely to initiate care in the first trimester and receive an adequate number of visits.

Acknowledgements

The author wishes to thank Amy Ong Tsui, Milton Kotelchuck, Judith Fortney, Sandra Martin, Trude Bennett and Patricia Bailey for their advice and review of this manuscript. In addition, the author would like to acknowledge the generous assistance of the Center for Population Studies and Responsible Parenthood (Centro de Estudios de Población y Paternidad Responsable — CEPAR) and the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC) in making the ENDEMAIN data

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