TY - JOUR
T1 - Pregnancy intention data completeness, quality and utility in population-based surveys
T2 - EN-INDEPTH study
AU - the Every Newborn-INDEPTH Study Collaborative Group
AU - Yargawa, Judith
AU - Machiyama, Kazuyo
AU - Ponce Hardy, Victoria
AU - Enuameh, Yeetey
AU - Galiwango, Edward
AU - Gelaye, Kassahun
AU - Mahmud, Kaiser
AU - Thysen, Sanne M.
AU - Kadengye, Damazo T.
AU - Gordeev, Vladimir Sergeevich
AU - Blencowe, Hannah
AU - Lawn, Joy E.
AU - Baschieri, Angela
AU - Cleland, John
AU - Byass, Peter
AU - Waiswa, Peter
AU - Blencowe, Hannah
AU - Yargawa, Judith
AU - Akuze, Joseph
AU - Fisker, Ane B.
AU - Martins, Justiniano S.D.
AU - Rodrigues, Amabelia
AU - Thysen, Sanne M.
AU - Biks, Gashaw Andargie
AU - Abebe, Solomon Mokonnen
AU - Ayele, Tadesse Awoke
AU - Bisetegn, Telake Azale
AU - Delele, Tadess Guadu
AU - Gelaye, Kassahun Alemu
AU - Geremew, Bisrat Misganaw
AU - Gezie, Lemma Derseh
AU - Melese, Tesfahun
AU - Mengistu, Mezgebu Yitayal
AU - Tesega, Adane Kebede
AU - Yitayew, Temesgen Azmeraw
AU - Kasasa, Simon
AU - Galigawango, Edward
AU - Gyezaho, Collins
AU - Kaija, Judith
AU - Kajungu, Dan
AU - Nareeba, Tryphena
AU - Natukwatsa, Davis
AU - Tusubira, Valerie
AU - Enuameh, Yeetey A.K.
AU - Asante, Kwaku P.
AU - Dzabeng, Francis
AU - Etego, Seeba Amenga
AU - Manu, Alexander A.
AU - Manu, Grace
AU - Nettey, Obed Ernest
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/2
Y1 - 2021/2
N2 - Background: An estimated 40% of pregnancies globally are unintended. Measurement of pregnancy intention in low- and middle-income countries relies heavily on surveys, notably Demographic and Health Surveys (DHS), yet few studies have evaluated survey questions. We examined questions for measuring pregnancy intention, which are already in the DHS, and additional questions and investigated associations with maternity care utilisation and adverse pregnancy outcomes. Methods: The EN-INDEPTH study surveyed 69,176 women of reproductive age in five Health and Demographic Surveillance System sites in Ghana, Guinea-Bissau, Ethiopia, Uganda and Bangladesh (2017–2018). We investigated responses to survey questions regarding pregnancy intention in two ways: (i) pregnancy-specific intention and (ii) desired-versus-actual family size. We assessed data completeness for each and level of agreement between the two questions, and with future fertility desire. We analysed associations between pregnancy intention and number and timing of antenatal care visits, place of delivery, and stillbirth, neonatal death and low birthweight. Results: Missing data were <2% in all questions. Responses to pregnancy-specific questions were more consistent with future fertility desire than desired-versus-actual family size responses. Using the pregnancy-specific questions, 7.4% of women who reported their last pregnancy as unwanted reported wanting more children in the future, compared with 45.1% of women in the corresponding desired family size category. Women reporting unintended pregnancies were less likely to attend 4+ antenatal care visits (aOR 0.73, 95% CI 0.64–0.83), have their first visit during the first trimester (aOR 0.71, 95% CI 0.63–0.79), and report stillbirths (aOR 0.57, 95% CI 0.44–0.73) or neonatal deaths (aOR 0.79, 95% CI 0.64–0.96), compared with women reporting intended pregnancies. We found no associations for desired-versus-actual family size intention. Conclusions: We found the pregnancy-specific intention questions to be a much more reliable assessment of pregnancy intention than the desired-versus-actual family size questions, despite a reluctance to report pregnancies as unwanted rather than mistimed. The additional questions were useful and may complement current DHS questions, although these are not the only possibilities. As women with unintended pregnancies were more likely to miss timely and frequent antenatal care, implementation research is required to improve coverage and quality of care for those women.
AB - Background: An estimated 40% of pregnancies globally are unintended. Measurement of pregnancy intention in low- and middle-income countries relies heavily on surveys, notably Demographic and Health Surveys (DHS), yet few studies have evaluated survey questions. We examined questions for measuring pregnancy intention, which are already in the DHS, and additional questions and investigated associations with maternity care utilisation and adverse pregnancy outcomes. Methods: The EN-INDEPTH study surveyed 69,176 women of reproductive age in five Health and Demographic Surveillance System sites in Ghana, Guinea-Bissau, Ethiopia, Uganda and Bangladesh (2017–2018). We investigated responses to survey questions regarding pregnancy intention in two ways: (i) pregnancy-specific intention and (ii) desired-versus-actual family size. We assessed data completeness for each and level of agreement between the two questions, and with future fertility desire. We analysed associations between pregnancy intention and number and timing of antenatal care visits, place of delivery, and stillbirth, neonatal death and low birthweight. Results: Missing data were <2% in all questions. Responses to pregnancy-specific questions were more consistent with future fertility desire than desired-versus-actual family size responses. Using the pregnancy-specific questions, 7.4% of women who reported their last pregnancy as unwanted reported wanting more children in the future, compared with 45.1% of women in the corresponding desired family size category. Women reporting unintended pregnancies were less likely to attend 4+ antenatal care visits (aOR 0.73, 95% CI 0.64–0.83), have their first visit during the first trimester (aOR 0.71, 95% CI 0.63–0.79), and report stillbirths (aOR 0.57, 95% CI 0.44–0.73) or neonatal deaths (aOR 0.79, 95% CI 0.64–0.96), compared with women reporting intended pregnancies. We found no associations for desired-versus-actual family size intention. Conclusions: We found the pregnancy-specific intention questions to be a much more reliable assessment of pregnancy intention than the desired-versus-actual family size questions, despite a reluctance to report pregnancies as unwanted rather than mistimed. The additional questions were useful and may complement current DHS questions, although these are not the only possibilities. As women with unintended pregnancies were more likely to miss timely and frequent antenatal care, implementation research is required to improve coverage and quality of care for those women.
KW - Assessment
KW - Desired family size
KW - Fertility
KW - Low birthweight
KW - Measurement
KW - Neonatal mortality
KW - Pregnancy intention
KW - Retrospective reporting
KW - Stillbirth
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85100765528&partnerID=8YFLogxK
U2 - 10.1186/s12963-020-00227-y
DO - 10.1186/s12963-020-00227-y
M3 - Article
C2 - 33557851
AN - SCOPUS:85100765528
SN - 1478-7954
VL - 19
JO - Population Health Metrics
JF - Population Health Metrics
M1 - 6
ER -