Unintended and unwanted pregnancy in St. Lucia.

Among 200 mothers interviewed in St. Lucia, 82.5% described their pregnancy as unintended and 44% as unwanted; 80% of women having an intended pregnancy and 94.6% having an unintended pregnancy were unmarried and 18.5% were teenagers. Mothers of unintended pregnancies were significantly younger, were of significantly higher parity and had begun sexual relations at a significantly earlier age than mothers of intended pregnancies; and, unlike mothers of planned pregnancies, their desired interpregnancy interval was significantly longer than the actual interval. These results and the sporadic and ineffective use of contraception in St. Lucia emphasize the need for improvements in fertility regulation in that country.

PIP: Between June 13 and July 30, 1993, in St. Lucia, 200 mothers who had just delivered at Victoria Hospital were interviewed so researchers could examine unintended and unwanted pregnancies and their socioeconomic and demographic determinants. 165 pregnancies (82.5%) were unplanned. Unmarried women comprised 96.4% of women having an unintended pregnancy and 80% of those having an intended pregnancy. 18.5% of all pregnancies occurred to teenagers. Women who had completed an unplanned pregnancy were younger than those who had completed a planned pregnancy (20 years, 21.2% vs. 5.7%; p 0.01). Mothers of unintended pregnancies had a significantly higher parity than those of intended pregnancies (parity =or 4, 16.7% vs. 0; p 0.005). The actual interpregnancy interval among mothers of unintended pregnancies was much shorter than the desired interval (p 0.005). Women with unintended pregnancies were significantly younger at age of first intercourse than women with intended pregnancies (p 0.005). 88 of the unintended pregnancies (53.3%) (44% of all pregnancies) were unwanted pregnancies. Among unintended pregnancies, mothers who wanted their pregnancy were more likely than those who did not want their pregnancy to have had at least some post-primary school education (p 0.01) and have a high personal income (p 0.001). 87.9% did not use a consistent family planning method around the time of conception. 28% of women with unintended pregnancies had never used a contraceptive method. The leading reason for not using contraception effectively were carelessness (about 40%) and fear of side effects (26%). These findings suggest the need for a policy aimed to reduce the incidence of unintended pregnancy in St. Lucia. The policy should include counseling on use of contraceptives and the risks associated with unintended and unwanted pregnancy.

Pregnant again? Psychosocial predictors of short-interval repeat pregnancy among adolescent mothers in Mexico City.

Which adolescent mothers are most likely to become pregnant soon after their first delivery? This study identifies and explores selected background, pregnancy, and postpartum predictors of short-interval repeat pregnancy among urban Mexican adolescents who were single when they conceived their first pregnancy. Of 137 adolescents followed until their second postpartum year, 26 had short-interval repeat pregnancies. These pregnancies were most likely to occur if the teenager was married or in consensual union by 5 months postpartum, was not using an IUD, and had a mother who had been an adolescent mother. Being married or in consensual union postpartum was, in turn, predicted by positive reactions of the adolescent and her partner during the first pregnancy. Nonuse of IUD was more likely if the adolescent had left school prior to pregnancy, did not receive support from her partner during the first pregnancy, and had not obtained an IUD before hospital discharge after first delivery. Adolescents whose mothers had been teen mothers came from more disadvantaged families.

[The critical period in natural fertility]. / El periodo crítico de la fertilidad natural.

In order to learn the natural expectancy period of first pregnancy as well as the influences of some biosocial variables, a clinical-retrospective study was performed within 1120 gravida I women. All of them attended the major institutes of health care in Mexico City (IMSS, ISSSTE, SS and DDF). Data were obtained by means of predetermined questions from subjects after the first postpartum hours. None of them had previously used any contraceptive method. Results showed age at the first pregnancy: 21.6 +/- 3.8 (years); gestational interval 22.1 +/- 19.9 (months) and a 67% achievement rate the following twelve months of sexual activity. Eutocia was seen in 54% of these population and significant linear correlation was attained between age of the patient and the gestational interval. It seems that this is the first information regarding the fertility critical period within our society.

PIP: The interval between first intercourse and pregnancy and the influence on it of various biosocial variables were studied in 1120 women who gave birth in maternity centers in Mexico City belonging to the Mexican Institute of Social Security (IMSS), the Institute of Social Security Services for State Workers (ISSSTE), the Secretariat of Health (SS), and the Medical Services of the Department of the Federal District (DDF). Women who had used contraceptives or who had a history of infertility or of endocrine or metabolic diseases were excluded. Data were obtained by means of questionnaires administered postpartum. The average age of the women was 22 + or - 4 years. 60% were married and 40% single. 41% were housewives and 59% were employed. 2% were illiterate, 22% had primary educations, 48% had secondary educations, and 8% were professionals. The average age at menarche varied from 12 to 13 years. Average age at first intercourse was 20 + or - 4 for the IMSS, 22 + or - 4 for the ISSSTE, 18 + or - 3 for the SS, and 17 + or - 2 for the DDF subsamples. The average age at first pregnancy was 21.6 + or - 2.8 years, and the average gestational interval was 22.1 + or - 19.9 months. But 67.5% of the total sample became pregnant in the 12 months following first intercourse, as did 82.9% of the SS and 86.3% of the DDF subsamples. The interval between first intercourse and first pregnancy was 8 years or more for 1-2% of the sample in each institution. 36% of women in the IMSS group, 73% in the SS and DDF groups, and 77% in the ISSSTE group had normal vaginal deliveries. 18% in the ISSSTE, 21% in the SS and DDF, and 51% in the IMSS groups had Cesarean deliveries.

Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals.

In many regions of the world, women breastfeed one child while pregnant with the next. Among rural Guatemalan women participating in a nutrition-supplementation trial, lactation overlapped with pregnancy in 253 of 504 (50.2%) of the pregnancies. For cases where overlap occurred, 41.4% continued to breast-feed into the second trimester and 3.2%, in the third trimester. The maternal and fetal responses to the energetic stresses of overlap and of the duration of the recuperative (nonpregnant, nonlactating) interval were assessed. Overlap resulted in increased supplement intake. Short recuperative periods (less than 6 mo) resulted in increased supplement intake and reduced maternal fat stores. The energetic stresses of overlap and short recuperative periods did not significantly affect fetal growth. The mother appears to buffer the energetic stress, protecting fetal growth. This research demonstrates that evidence of depletion of maternal nutrient stores caused by a demanding reproductive history is found when reproductive stress is characterized adequately.

Subsequent pregnancies: who has them and who wants them? Observations from an urban center in southern Brazil.

Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort child's birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income.

PIP: Researchers followed 5914 children born in 1982 in Pelotas, an urban center in southern Brazil, and interviewed the mothers about subsequent pregnancies between 35-52 months of the cohort child's age to gather data on these pregnancies. 39% of the mothers had at least 1 pregnancy after the cohort child. 78% of them had =or+ 1 child while the remainder had at least 1 abortion. Additional pregnancies occurred more often among lower income women (p.001). In addition, as age and years of schooling rose, the number of subsequent pregnancies fell (p =or- .001). If the cohort child was the 3rd child, the mother was less likely to have a subsequent pregnancy, but the odds ratio fell up to the 3rd child then increased (p.001). This U shaped trend was especially pronounced after adjusting for other factors. A possible explanation for this trend could be due to desired family size and access to sterilization. Other than women who had undergone sterilization, women who delivered their cohort child by cesarean section were least likely to have a subsequent birth, even after adjusting age, income, parity, and education (p.001). This may be due to fear of surgery or these women followed medical advice. The percentage of women who did not want the subsequent pregnancy fell as income, education, and age climbed (p.001). Moreover it increased with parity, especially among richer women. In fact, women of high parity and high income were more likely to have experienced an unwanted subsequent pregnancy than those of high parity and moderate and low income (p.01).

The effects of birth spacing on child and maternal health.

Child and maternal mortality and morbidity are examined in relation to the interval between pregnancies. Most data available pertain to child mortality. Very little reliable information links child morbidity or maternal health detriments to short birth spacing. The evidence on child mortality suggests that very short intervals (conceptions less than six months after a birth) are detrimental to survival of the second child, but these results must be viewed in light of the methodological difficulties of studies of this subject. Policy implications of the data are perhaps less clear than is sometimes assumed.

PIP: The health effects of birth spacing remain relatively obscure despite frequent exhortation to space pregnancies in order to improve maternal and child health. Most studies have not controlled for very important confounding factors. More needs to be known about the relationship of birth interval to child health apart from maternal age and parity. It is important to control for socioeconomic effects and prior child deaths because these factors are so closely associated with differentials in health risks. For example, the raw data of Fedrick and Adelstein's work suggested a birth interval effect on survival, with higher risks at the longest intervals; correction for age and socioeconomic class completely eliminated an effect except in the very shortest interval. We do not yet know which months of postneonatal mortality are most affected by short birth interval, nor understand whether the effects are more likely due to prematurity and/or low birth weight, or to nutritional status and child care at the commencement of weaning. More needs to be known about the mechanism of excess risk for siblings born into families with a prior early child death. Also in many societies where birth interval effects on mortality have been demonstrated, the distribution of births is already relatively favorable. A very small percentage of children are subject to the risks of the shortest intervals, and a great majority of births already occur with greater than 24-month spacing. Perhaps where traditional lactation practices help avoid the worst hazards of short intervals, emphasis on delaying the 1st birth and/or making available the means for women to limit their fertility may have as much impact on health as birth spacing alone. Birth intervals may be most measurable in situations where general infant and child mortality patterns are already high. Finally, we do not know how to measure the health effects of high fertility or short intervals on mothers or their effects on healthy women of low parity and their children.