Fertility intentions and child health in India: Women's use of health services, breastfeeding, and official birth documentation following an unwanted birth.

This study examines the relationship between women's prospective fertility intentions and child health, measured via access to healthcare facilities for children and postpartum maternal behaviors that are indicative of future child health. We analyze two waves of nationally representative data (2005 and 2012) from the India Human Development Survey (IHDS). The analytic sample includes 3,442 non-pregnant, currently married women aged 18-40 in 2005 who participated in both rounds of the IHDS, and had at least one birth between 2005 and 2012. We investigate the influence of women's prospective fertility intentions on access to benefits from the Integrated Child Development Services (ICDS), indicators of breastfeeding as recommended by the World Health Organization, and official documentation of births via birth certificates or registration. We find that 58 percent of births among women in the sample were labeled as unwanted. We use an adaptation of propensity score matching-the inverse-probability-weighted regression adjustment (IPWRA) estimator-and show that, after accounting for maternal and household characteristics that are known to be associated with maternal and child health, children who resulted from unwanted births were less likely to obtain any benefits or immunizations from the ICDS, to be breastfed within one hour of birth, and to have an official birth certificate. Results from this study have direct policy significance given the evidence that women's fertility intentions can have negative implications for child health and wellbeing in the short and longer term.

Correlates of Unwanted Births in Bangladesh: A Study through Path Analysis.

BACKGROUND: Unwanted birth is an important public health concern due to its negative association with adverse outcomes of mothers and children as well as socioeconomic development of a country. Although a number of studies have been investigated the determinants of unwanted births through logistic regression analysis, an extensive assessment using path model is lacking. In the current study, we applied path analysis to know the important covariates for unwanted births in Bangladesh. METHODS: The study used data extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. It considered sub-sample consisted of 7,972 women who had given most recent births five years preceding the date of interview or who were currently pregnant at survey time. Correlation analysis was used to find out the significant association with unwanted births. This study provided the factors affecting unwanted births in Bangladesh. The path model was used to determine the direct, indirect and total effects of socio-demographic factors on unwanted births. RESULTS: The result exhibited that more than one-tenth of the recent births were unwanted in Bangladesh. The differentials of unwanted births were women's age, education, age at marriage, religion, socioeconomic status, exposure of mass-media and use of family planning. In correlation analysis, it showed that unwanted births were positively correlated with women age and place of residence and these relationships were significant. On the contrary, unwanted births were inversely significantly correlated with education and social status. The total effects of endogenous variables such as women age, place of residence and use of family planning methods had favorable effect on unwanted births. CONCLUSION: Policymakers and program planners need to design programs and services carefully to reduce unwanted births in Bangladesh, especially, service should focus on helping those groups of women who were identified in the analysis as being at increased risks of unwanted births- older women, illiterate, low socioeconomic status, early age at marriage and rural poor susceptible women.

Child Wanted and When? Fertility Intentions, Wantedness, and Child Survival in Rural Northern Ghana.

Panel survey data collected in rural northern Ghana asked women about the "wantedness" status of their children. Parous women were asked whether they wanted more children, while those who had never had a child were asked whether they wanted to have children in the future; those who said that they did not want to have any more children in the future were asked whether they wanted to become pregnant when they last became pregnant and, if so, whether they wanted to become pregnant at the time, or would have preferred to be pregnant earlier or later. This article analyzes longitudinal responses to these questions over a 10-year period. Birth and survival histories of subsequently born children linked to preference data permit investigation of the question: are "wanted" children more likely to survive than "unwanted" children? Hazard models are estimated to determine whether children born to women who indicated that they did not want to have a child at the time they did, or did not want any more children in the future, have a higher risk of mortality relative to children who were reported wanted at the time of pregnancy. Results show no significant differences in adjusted mortality risks between children who were reported to be wanted and those reported to be unwanted.

Desired Fertility and Number of Children Born Across Time and Space.

Economists have often argued that high fertility rates are mainly driven by women's demand for children (and not by family planning efforts) with low levels of unwanted fertility across countries (and hence with little room for family planning efforts to reduce population growth). We study the relationship between wanted fertility and number of children born in a panel of 200 country-years controlling for country fixed effects and global time trends. In general, we find a close relationship between wanted and actual fertility, with one desired child leading to one additional birth. However, our results also indicate that in the last 20 years, the level of unwanted births has stayed at 2 across African countries but has, on average, decreased from 1 to close to 0 in other developing countries. Hence, women in African countries are less able to translate child preferences into birth outcomes than women in other developing countries, and forces other than fertility demand have been important for previous fertility declines in many developing countries. Family planning efforts only partially explain the observed temporal and spatial differences in achieving desired fertility levels.

Medicaid family planning waivers in 3 States: did they reduce unwanted births?

Effects of Medicaid family planning waivers on unintended births and contraceptive use postpartum were examined in Illinois, New York, and Oregon using the Pregnancy Risk Assessment Monitoring System. Estimates for women who would be Medicaid eligible "if" pregnant in the waiver states and states without expansions were derived using a difference-in-differences approach. Waivers in New York and Illinois were associated with almost a 5.0 percentage point reduction in unwanted births among adults and with a 7 to 8.0 percentage point reduction, among youth less than 21 years of age. Oregon's waiver was associated with an almost 13 percentage point reduction in unintended, mostly mistimed, births. No statistically significant effects were found on contraceptive use.

Unintended births among adult immigrant and U.S.-born Mexican women in the Los Angeles Mommy and Baby (LAMB) survey.

BACKGROUND: Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized. METHODS: Data are from vital statistics and the 2005 Los Angeles Mommy and Baby (LAMB) survey, a population-based study of women delivering a live birth in Los Angeles County, California (n = 1,214). Multivariable logistic regression assessed the relation of unintended birth with acculturation variables adjusting for background and psychosocial characteristics. Multinomial models assessed these relations for women with an unintended birth who did and did not use contraception. FINDINGS: Forty-one percent of women reported an unintended birth. Being a long-term immigrant and U.S.-born were positively associated with unintended birth compared with shorter term immigrants, but the adjusted relation was significant only for U.S.-born women (odds ratio [OR], 2.01; 95% CI, 1.19-3.39). Women reporting an unintended birth were younger, unmarried, and higher parity. If using contraception, the odds of unintended birth were increased for cohabiting women, those with high education, and those with greater stress during pregnancy. When not using contraception and reporting an unintended birth, women also have no usual place for health care, have depressive symptoms during pregnancy, and are dissatisfied with partner support. CONCLUSIONS: Women's background and psychosocial characteristics were central to explaining unintended birth among immigrant women but less so for U.S.-born Mexican mothers. Interventions to improve birth intentions should not only target effective contraception, but also important social determinants.

Parental pregnancy wantedness and child social-emotional development.

To examine how maternal and paternal pregnancy wantedness and couple concordance regarding pregnancy wantedness predict children's social-emotional development in kindergarten. We used data from nationally representative US sample from the Early Childhood Longitudinal Study Birth Cohort. Exposures of interest were maternal and paternal pregnancy wantedness, and couple concordance regarding pregnancy wantedness. Children's social-emotional development was evaluated by the child's kindergarten teacher using an adapted version of the Preschool and Kindergarten Behavior Scales. We examined bivariate associations between pregnancy wantedness and key socio-demographic variables in relation to children's social-emotional development. Multiple linear regression was used to assess the relationship between each pregnancy wantedness predictor and children's social-emotional development scores. Items related to child concentration and attention appeared to be the components driving almost all the associations with social-emotional development. Maternal report of unwanted pregnancy, resident father's report of mistimed pregnancy, and discordance of parental pregnancy wantedness (specifically when the mother wanted but the father did not want the pregnancy) predicted lower children's social-emotional development scores. Results suggest that maternal unwanted pregnancy and couple discordance in pregnancy wantedness were associated with poorer social-emotional development, especially in the area of concentration and attention, in kindergarten.

The impact of legalized abortion on child health outcomes and abandonment. Evidence from Romania.

We use household survey data and a unique census of institutionalized children to analyze the impact of abortion legalization in Romania. We exploit the lift of the abortion ban in December 1989, when communist dictator Ceausescu and his regime were removed from power, to understand its impact on children's health at birth and during early childhood and whether the lift of the ban had an immediate impact on child abandonment. We find insignificant estimates for health at birth outcomes and anthropometric z-scores at age 4 and 5, except for the probability of low birth weight which is slightly higher for children born after abortion became legal. Additionally, our findings suggest that the lift of the ban had decreased the number of abandoned children.

Unintended pregnancy and taxpayer spending.

CONTEXT: Nearly half of all pregnancies in the United States are unintended. These pregnancies likely represent a substantial cost to taxpayers, but national-level estimates of these public costs have been lacking. METHODS: Taxpayer spending on unintended pregnancy is measured by multiplying estimates of the 2001 incidence of publicly financed unintended pregnancy outcomes (abortions, fetal losses, births and need for infant medical care) by average per-incident costs. Public savings that would result from preventing unintended pregnancies are estimated by assuming that the prevention of an unwanted pregnancy would save the full cost of financing the pregnancy, while the prevention of a mistimed pregnancy would save the cost of financing the pregnancy today minus the present value of the cost of financing the pregnancy when it eventually occurs. RESULTS: Lower-bound, mean and upper-bound estimates of the annual cost of unintended pregnancy are, respectively, $9.6 billion, $11.3 billion and $12.6 billion. Corresponding estimates of the savings that would accrue to taxpayers by preventing unintended pregnancies are $4.7 billion, $5.6 billion and $6.2 billion. The mean estimate of the taxpayer cost per publicly subsidized unintended pregnancy is $9,000; the prevention of such a pregnancy would save taxpayers about half that amount. CONCLUSIONS: The prevention of unintended pregnancy represents an important opportunity for the public to reap substantial savings, especially given the current fiscal climate. The enactment or expansion of cost-effective policies to prevent unintended pregnancies is therefore a timely and sensible strategy.

The public costs of births resulting from unintended pregnancies: national and state-level estimates.

CONTEXT: Births resulting from unintended pregnancies are associated with substantial maternity and infant care costs to the federal and state governments; these costs have never been estimated at the national and state levels. METHODS: The proportions of births paid for by public insurance programs in 2006 were estimated, by pregnancy intention status, using data from the Pregnancy Risk Assessment Monitoring System and similar state surveys, or were predicted by multivariate linear regression. Public costs were calculated using state-level estimates of the number of births, by intention status, and of the cost of a publicly funded birth. RESULTS: In 2006, 64% of births resulting from unintended pregnancies were publicly funded, compared with 48% of all births and 35% of births resulting from intended pregnancies. The proportion of births resulting from unintended pregnancies that were publicly funded varied by state, from 42% to 81%. Of the 2.0 million publicly funded births, 51% resulted from unintended pregnancies, accounting for $11.1 billion in costs-half of the total public expenditures on births. In seven states, the costs for births from unintended pregnancies exceeded a half billion dollars. CONCLUSIONS: Public insurance programs are central in assisting American families in affording pregnancy and childbirth; however, they pay for a disproportionately high number of births resulting from unintended pregnancy. The resulting budgetary impact warrants increased public efforts to reduce unintended pregnancy.

Unintended births: patterns by race and ethnicity and relationship type.

CONTEXT: Childbearing intentions vary by race and ethnicity and by relationship type. However, few studies have examined whether they differ by race and ethnicity within relationship type. METHODS: Data from the Early Childhood Longitudinal Study were used to examine the childbearing intentions of 9,100 mothers of a cohort of children born in 2001. Multivariate and multinomial regression analyses were conducted to examine whether relationship type (married, cohabiting or neither) helps explain racial and ethnic differences in childbearing intentions and whether associations between race and ethnicity and childbearing intentions vary by relationship type. RESULTS: Blacks were more likely than whites to have had an unintended birth (odds ratio, 2.5); the relationship held among married (2.6), but not unmarried, mothers. For most relationship types, black mothers had higher relative risks than whites of having had an unwanted birth, rather than an intended or a mistimed one. Asian married mothers were more likely than their white counterparts to have had an unwanted, rather than intended, birth (1.9). The odds of an unintended birth were lower among foreign-born Hispanic cohabiting women than among white cohabiting women (0.6), a finding driven by the lower risk of unwanted than of other births among foreign-born Hispanics (0.3­0.5). Few differences were apparent between native-born Hispanics and white mothers. CONCLUSIONS: Racial and ethnic differences in childbearing intentions are frequently contingent on relationship context. Differences between whites and blacks are largely attributable to married women. Assessment of childbearing intendedness among Hispanics should take nativity into account.

Filicide and fatal abuse in Japan, 1994-2005: temporal trends and regional distribution.

To describe the recent filicide features in Japan, data were collected from newspaper databases between 1994 and 2005 and compared with several official statistics. From this dataset, 933 cases and 1084 victims under age 15 were identified. Fatal abuse cases were most prevalent (309 cases, or 33.1%), followed by filicide-suicide cases (303, or 32.5%) and unwanted child cases (225, or 24.1%). Infants under the age of one were most at risk (filicide rate: 2.72 per 100,000 for the same aged infants). Annual filicide numbers showed an upward trend between 1994 and 2001 and the average filicide rate per year was 0.42 per 100,000 for children under age 15. Both the number of cases over the period and the filicide rate per year by prefecture ranged widely. Furthermore, the annual filicide rates over the period were strongly correlated with both suicide rates and unemployment rates for the general population (r=.884 and .926, respectively; p<.001 for both). The measure of filicide per region and the predominating category in a prefecture provides direction for filicide prevention. Result suggests that recent socioeconomic situations have a significant effect on not only filicide-suicide but also the overall filicide rate in Japan.

Misclassification bias and the estimated effect of parental involvement laws on adolescents' reproductive outcomes.

OBJECTIVES: We evaluated the presence of misclassification bias in the estimated effect of parental involvement laws on minors' reproductive outcomes when subjection to such laws was measured by age at the time of pregnancy resolution. METHODS: Using data from abortion and birth certificates, we evaluated the effect of Texas's parental notification law on the abortion, birth, and pregnancy rates of adolescents aged 17 years compared with those aged 18 years on the basis of age at the time of pregnancy resolution and age at conception. RESULTS: On the basis of age at the time of the abortion or birth, the law was associated with a fall of 26%, 7%, and 11% in the abortion, birth, and pregnancy rates, respectively, of 17- relative to 18-year-olds. Based on age at the time of conception, the abortion rate fell 15%, the birth rate rose 2%, and the pregnancy rate remained unchanged. CONCLUSIONS: Previous studies of parental involvement laws should be interpreted with caution because their methodological limitations have resulted in an overestimation of the fall in abortions and underestimation of the rise in births, possibly leading to the erroneous conclusion that pregnancies decline in response to such laws.

The number of illegally abandoned and legally surrendered newborns in the state of Texas, estimated from news stories, 1996-2006.

In 1999, Texas was the first of 47 states to pass a Safe Haven law allowing for the anonymous surrender of unwanted newborns at designated locations. However, state agencies do not systematically collect data on the number of illegally abandoned infants and infants legally surrendered under the law. Using the LexisNexis database of Texas newspapers, this study estimated the number of illegally abandoned and legally surrendered newborns younger than age 60 days in Texas, 1996 to 2006 and describes their demographic characteristics. Of 93 infants (53% male) identified during the study period, 82 were illegally abandoned (70% found alive) and 11 were legally surrendered. On average, 7.5 (range: 4-16) infants were illegally abandoned each year, with the greatest number found in 1999. Infants continued to be illegally abandoned following passage of the Safe Haven law. A statewide surveillance system should be implemented to evaluate this important public health problem.

On the politics and practice of Muslim fertility: comparative evidence from West Africa.

Recent popular works have represented Muslim fertility as dangerously high, both a cause and consequence of religious fundamentalism. This article uses comparative, statistical methods to show that this representation is empirically wrong, at least in West Africa. Although religion strongly inflects reproductive practice, its effects are not constant across different communities. In West African countries with Muslim majorities, Muslim fertility is lower than that of their non-Muslim conationals; in countries where Muslims are in the minority, their apparently higher reproductive rates converge to those of the majority when levels of education and urban residence are taken into account. A similar pattern holds for infant mortality. By contrast, in all seven countries, Muslim women are more likely to report that their most recent child was wanted. The article concludes with a discussion of the relationship between autonomy and fertility desires.

[Unwanted children after birth: frequency measurement and trends analysis]. / Hijo no deseado después del parto: medición de frecuencia y análisis de tendencia.

BACKGROUND: A significant proportion of pregnancies occurring in Metropolitan Santiago are unplanned and unwanted. It is reasonable to postulate that the frequency of unwanted children must be high. AIM: To measure the frequency of unwanted children in newborns of a public hospital of Santiago. MATERIAL AND METHODS: In a period of fourteen months a score assigning survey to detect unwanted children was applied, after birth, to 741 women delivering at San Juan de Dios Hospital in Metropolitan Santiago. Women whose newborns were hospitalized or had congenital malformations were excluded from the survey. RESULTS: Forty children (5.4%) scored as unwanted while 52 (7%) qualified as being in a doubtful situation. When compared to desired children, unwanted infants had a lower frequency of suitable pregnancy controls (p < 0.0002) and a higher incidence of mothers declaring bad relations with children's father (p < 0.0002). A trend towards higher frequency of single mothers (p: 0.044) was observed. A lower frequency of first born children (p: 0.017) and a higher frequency of children born in the fourth place, was observed among unwanted newborns (p < 0.002). CONCLUSIONS: In the last 15 years, previous studies, carried out with similar methodologies, have showed a comparable frequency of unwanted children. These condition seems to be associated with poor pregnancy control, high birth order and bad relations with the child's father.

Hijo no deseado después del parto: medición de frecuencia y análisis de tendencia / Frequency of unwanted children after birth

Background: A significant proportion of pregnancies occurring in Metropolitan Santiago are unplanned and unwanted. It is reasonable to postulate that the frequency of unwanted children must be high. Aim: To measure the frequency of unwanted children in newborns of a public hospital of Santiago. Material and methods: In a period of fourteen months a score assigning survey to detect unwanted children was applied, after birth, to 741 women delivering at San Juan de Dios Hospital in Metropolitan Santiago. Women whose newborns were hospitalized or had congenital malformations were excluded from the survey. Results: Forty children (5.4 percent) scored as unwanted while 52 (7 percent) qualified as being in a doubtful situation. When compared to desired children, unwanted infants had a lower frequency of suitable pregnancy controls (p <0.0002) and a higher incidence of mothers declaring bad relations with children's father (p <0.0002). A trend towards higher frequency of single mothers (p: 0.044) was observed. A lower frequency of first born children (p: 0.017) and a higher frequency of children born in the fourth place, was observed among unwanted newborns (p <0.002). Conclusions: In the last 15 years, previous studies, carried out with similar methodologies, have showed a comparable frequency of unwanted children. These condition seems to be associated with poor pregnancy control, high birth order and bad relations with the child's father

Did abortion legalization reduce the number of unwanted children? Evidence from adoptions.

CONTEXT: The legalization of abortion in the United States led to well-known changes in reproductive behavior, but its effect on adoptions has not been investigated. METHODS: Variation across states in the timing and extent of abortion legalization is used to identify the effects of changes in the legal status of abortion on adoption rates from 1961 to 1975. These effects are estimated in regression analyses that control for states' economic, demographic and political characteristics, as well as for health care availability within states. RESULTS: The rate of adoptions of children born to white women declined by 34-37% in states that repealed restrictive abortion laws before Roe v. Wade. The effect was concentrated among adoptions by petitioners not related to the child. Legal reforms resulting in small increases in access, such as in cases of rape and incest, were associated with a 15-18% decline in adoptions of children born to nonwhite women; however, this decline may have been due to other changes in the policy environment for such adoptions. Rates of adoption of children born to white women appear to have declined after Roe v. Wade, but this association is not statistically significant. CONCLUSIONS: The estimated effect of abortion legalization on adoption rates is sizable and can account for much of the decline in adoptions, particularly of children born to white women, during the early 1970s. These findings support previous studies' conclusions that abortion legalization led to a reduction in the number of "unwanted" children; such a reduction may have improved average infant health and children's living conditions.

The long-term impact of parents' childbearing decisions on children's self-esteem.

We examine the long-term impact of parents' childbearing decisions on children's self-esteem. We focus on subjective aspects of the home environment in the creation of children's internalized sense of self-worth. Unique 23-year family panel data combining measures of mothers' childbearing, mothers' childbearing intentions, and children's self-esteem allow us to examine the overall links between parents' childbearing and children's self-esteem. The results demonstrate that parents' childbearing intentions can have a significant long-term impact on their children's self-esteem. Children who were unintended by their mothers have significantly lower self-esteem 23 years later. Our findings indicate that giving birth to an unintended child can have a long-term negative impact on subjective aspects of the child's well-being, at least in terms of self-esteem. Unintended childbearing has received an increasing amount of research attention in recent years.