Unintended birth

Over 14 million adolescents in the world annually give birth and nearly 800.000 adolescents in the United States become pregnant each year. This paper considers concepts of teen pregnancy including risks to the mother as well as offspring, the adolescent father, issues related to abortion, and concepts of prevention of unwanted pregnancy in youth. Adolescent pregnancy is a global phenomenon affecting all societies and cultures

Objectives. To examine abortion utilization in Ohio from 2010 to 2018, a period when more than 15 abortion-related laws became effective. Methods. We evaluated changes in abortion rates and ratios examining gestation, geographic distribution, and abortion method in Ohio from 2010 to 2018. We used data from Ohio’s Office of Vital Statistics, the Centers for Disease Control and Prevention’s Abortion Surveillance Reports, the American Community Survey, and Ohio’s Public Health Data Warehouse. Results. During 2010 through 2018, abortion rates declined similarly in Ohio, the Midwest, and the United States. In Ohio, the proportion of early first trimester abortions decreased; the proportion of abortions increased in nearly every later gestation category. Abortion ratios decreased sharply in most rural counties. When clinics closed, abortion ratios dropped in nearby counties. Conclusions. More Ohioans had abortions later in the first trimester, compared with national patterns, suggesting d...

What is the best way to ask survey respondents about the number of children they have? Arnaud RégnieR-LoiLieR compares the number of children reported by the people who completed the three waves of the Étude des relations familiales et intergénérationnelles (ERFI), the French version of the European Generations and Gender Survey. While there was no single question in the first two waves about the number of children born or adopted, this figure was determined by a succession of questions about the number of children alive or deceased, resident or non-resident in the household. This procedure introduced errors which are measured in this article by a further question contained in the third wave which asked respondents to give their total number of children. It shows that some respondents tend not to report non-resident children. The article draws survey designers' and users' attention to these collection biases and highlights the value of including a question about the total number of children. (1) The name of the survey was changed in French because of the vagueness of the word "gender", which was considered by respondents in the test surveys to be too scientific and uninformative. * Institut national d'études démographiques, Paris.

What is the best way to ask survey respondents about the number of children they have? Arnaud RégnieR-LoiLieR compares the number of children reported by the people who completed the three waves of the Étude des relations familiales et intergénérationnelles (ERFI), the French version of the European Generations and Gender Survey. While there was no single question in the first two waves about the number of children born or adopted, this figure was determined by a succession of questions about the number of children alive or deceased, resident or non-resident in the household. This procedure introduced errors which are measured in this article by a further question contained in the third wave which asked respondents to give their total number of children. It shows that some respondents tend not to report non-resident children. The article draws survey designers' and users' attention to these collection biases and highlights the value of including a question about the total number of children. (1) The name of the survey was changed in French because of the vagueness of the word "gender", which was considered by respondents in the test surveys to be too scientific and uninformative. * Institut national d'études démographiques, Paris.

higher odds of reporting an unintended pregnancy than their counterparts, as did women in the Navy (OR 1.51, 95% CI 1.19-1.91) and Marine Corps (OR 2.38, 95% CI 1.92-2.95) compared with women in the Air Force. Unintended pregnancy rates did not differ between women who were deployed in the prior 12 months and nondeployed women. Additionally, 9.8% of women who were deployed for 11-12 months in 2011 reported an unintended pregnancy in the prior year, suggesting that their pregnancies occurred during deployment. Conclusions: Unintended pregnancy remains higher in the military, including during deployment, compared with the general U.S. population, although it may be beginning to decline. All branches need to address the issue in a comprehensive manner including evidence-based provision of contraception and education among service members.

BackgroundThe purpose of this study was to examine women's knowledge of female reproduction—anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy.MethodsA survey was completed by 125 women of childbearing age as part of a larger “Women's Health Promotion Program.” Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13.ResultsThe women in the study were ages 18–51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one‐third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keep...

BackgroundThe purpose of this study was to examine women's knowledge of female reproduction—anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy.MethodsA survey was completed by 125 women of childbearing age as part of a larger “Women's Health Promotion Program.” Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13.ResultsThe women in the study were ages 18–51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one‐third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keep...

Despite the focus on adolescents, most unintended pregnancies occur in adults. The objective of this study was to identify reasons why adult women have unprotected intercourse when they do not desire pregnancy. We held 4 focus groups to explore reasons for unprotected intercourse. Participants were adult women aged 18 to 39 who were unmarried, fertile, not currently pregnant, not desiring pregnancy, and who had recently had intercourse without using effective contraception. Sessions were audiotaped and transcripts were analyzed thematically. Women gave 146 reasons for unprotected intercourse. Four major categories emerged: method‐related, user‐related, partner‐related, and cost/access‐related reasons. The reasons for unprotected intercourse were numerous, but could be organized into a logical framework. The results suggest that multidimensional interventions may be needed to effectively reduce the rate of unintended pregnancy.

Objectives: This study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy. Methods: As part of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey, women with a recent unintended viable pregnancy were asked after the birth why they had not used birth control. Results: Of 7856 respondents, 33% felt they could not get pregnant at the time of conception, 30% did not really mind if they got pregnant, 22% stated their partner did not want to use contraception, 16% cited side effects, 10% felt they or their partner were sterile, 10% cited access problems and 18% selected bother.Q Latent class analysis showed seven patterns of response, each identifying strongly with a single reason. Conclusions: Almost half of women with viable unintended pregnancies ending in a birth felt they could not/would not get pregnant at the time of conception. Most women identified with a single reason for having unprotected intercourse.

To illustrate trends in unintended pregnancy over a 5-year period and to describe variations in desire for pregnancy at conception in relation to maternal age, race/ethnicity, income, and education. Study Design and Methods: Data were collected as part of the Iowa Barriers to Prenatal Care Project, a large, multiyear study of new mothers. A brief questionnaire eliciting maternal experiences and behaviors during pregnancy was administered to new mothers in all Iowa hospitals providing maternity care following the birth of their baby. Sample sizes ranged from 16,714 to 19,421 over the 5 years included in this analysis (1997 to 2001), and response rates ranged from 44% to 53%. Results: The study sample closely matched the overall statewide profile of women in this age group. In each of the 5 years, about one third of the mothers giving birth indicated that they did not intend to become pregnant at that time, and another 4% to 5% indicated that they did not want to be pregnant at that time or in the future. There were no substantive variations across years. Maternal age, race/ethnicity, income, and education were significantly related to intendedness of pregnancy. Clinical Implications: The findings underscore the continuing challenge of unintended pregnancy, despite recent national attention to this issue. All women of childbearing age should be considered at risk for unintended pregnancy. Additional work is needed to examine reasons, attitudes, and behaviors associated with unintended pregnancies and to determine the relative predictive strength of key demographic variables to improve interventions aimed at decreasing unintended pregnancy rates.

Objectives-Better understanding of the impact of unintended childbearing on infant and early childhood health is needed for public health practice and policy. Methods-Data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) survey and The Oklahoma Toddler Survey (TOTS) from 2006-2010 were used to examine associations between a four category measure of pregnancy intentions (intended, mistimed<2 years, mistimed>=2 years, unwanted) and maternal behaviors and child health outcomes up to age two. Propensity score methods were used to control for confounding. Results-Births mistimed by two or more years (OR =.58) and unwanted births (OR=.33) had significantly lower odds than intended births of having a mother who recognized the pregnancy within the first 8 weeks; they were also about half as likely as intended births to receive early prenatal care, and had significantly higher likelihoods of exposure to cigarette smoke during pregnancy. Breastfeeding was significantly less likely among unwanted births (OR=.68); breastfeeding for at least six months was significantly less likely among seriously mistimed births (OR=.70). We find little association between intention status and early childhood measures. Conclusions-Measured associations of intention status on health behaviors and outcomes were most evident in the prenatal period, limited in the immediate prenatal period, and mostly insignificant by age two. In addition, most of the negative associations between intention status and health outcomes were concentrated among women with births mistimed by 2 or more years or unwanted births. Surveys should incorporate questions on the extent of mistiming when measuring pregnancy intentions.

pregnancy, while black women were nearly three times as likely as white women to do so.11 The dimensions of the problem have long been known as a result of analyses that combined national-level data on pregnancy intentions from the National Survey of Family Growth (NSFG) with national data on births and abortion incidence. However, such estimates have not been calcu-lated for each state. Because teenage pregnancy rates,12 abortion incidence rates and access to family planning ser-vices13 all vary widely by state, rates of unintended preg-nancy may vary as well, among both teenagers and adults. State-level data on unintended pregnancy rates would be highly useful to researchers, service providers, advocates and policymakers. For example, absent such rates, it is impossible to assess whether decreases in state abortion

Background: The purpose of this study was to examine women's knowledge of female reproduction-anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy. Methods: A survey was completed by 125 women of childbearing age as part of a larger "Women's Health Promotion Program". Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13. Results: The women in the study were ages 18 to 51 years, 52% were Hispanic, 36% African American and 12% White. Over 70% had a household income of less than $20,000, 58.4% were not married, 83.2% were not trying to get pregnant at the time, and 37.6% had sexual intercourse that may have put them at risk for pregnancy in the last one month. Less than a third knew about the reproductive hormones. Over 80% knew their reproductive anatomy, 68.8% were not keeping any log to track their menstrual flow, 53.6% did not know when their next menstruation would be and 50% did not know the average number of days for a regular menstrual cycle. Many did not know what ovulation is (47%), the ovulation timing (67%), the number of eggs released from an ovary each month (79%), and how long an egg or sperm could live in a woman's body (62%). Conclusions: Reproductive knowledge should be assessed during preconception visits and women should be taught comprehensive reproductive education-not just selected topics-to be adequately equipped to make informed reproductive decisions.

Background Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs). Methods Using Louisiana pregnancy risk assessment monitoring system, 2000-2003, a secondary crosssectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design. Results In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23-2.53). Furthermore, the association between husbands/partners' who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02-1.69); while among Black women, neither parent's pregnancy intention were associated with mild or severe PPDs. Conclusions This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.

Recent studies indicate that older women are more likely to consume alcohol during pregnancy, but subgroups at highest risk within the context of maternal age have not been identified. This study identifies subgroups at risk for alcohol use during pregnancy among three age categories using classification and regression trees (CART) analysis.Using the 2002–2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records of U.S. women), logistic regression and classification trees were constructed separately for age groups, ≤24, 25–29, and ≥30 years.Overall, 6.5% of women reported drinking alcohol during the last trimester of pregnancy. Alcohol consumption by age group was: 3.7% for ≤24, 5.7% for 25–29, and 10.1% for ≥30 years of age. Women ≤24 years were at greater risk of consuming alcohol if they also smoked (5.8%). Among nonsmokers, higher levels of education and being Hispanic were associated with a 35% increase in alcohol use. Distinct high-risk subgroups emerge...

Family has been shown to be one of the most relevant socio-demographic factors in understanding health differences among individuals in Western countries. The difference in survival between the married and not married population was stated by William Farr as early as the 19th Century (Farr 1885). However, although the health advantages of those who live with a partner were already well known, the interest in this factor has increased among scholars in the past three decades. This increase has run parallel to two interrelated changes in traditional patterns which are contributing to reshape current European societies: diversification of family forms and the subsequent acceptance of the new forms among individuals; and the increase of female empowerment due to a progressive reduction of the gender gap. The diversification of family forms has led to a more complex scenario that extends beyond merely comparing married and not-married individuals. At the same time, the traditional gender roles that men and women used to play within the context of the families in the past have also been modified. This family diversification and the process of gender balancing has not occurred with the same intensity and timing in all European countries. It has been stated that both processes have spread from the North and West to the South and East of the Continent (Surkyn and Lesthaeghe 2004). With these changes, family as a social determinant of health has become an ever more important factor of health, one which is rooted at the meso-level and extends beyond individual characteristics at the micro-level. Indeed, when one thinks about family, one figures a context where individuals provide

The purpose of this study was to recognise the barriers to unprotected intercourse in adult married women who were not keen for pregnancy. Focus Group discussion in groups of 8-10 women were held among women attending OPD of Obstetrics and Gynaecology Department of SCB Medical College, Cuttack. We interviewed 1840 adult married women out of which 1000 (54%) did not adopt any contraceptive measure. These women were included in Focus Group Discussion over a period of 6 months, aged between 18 to 45 years who were not desirous of pregnancy, to explore the possible reasons for unprotected intercourse. Women were grouped on the basis of the following characteristics: Age, Parity status, literacy, Place of residence-Rural/Urban, Religion and Socio-economic status (using Modified Kuppuswamy score). Women on an average gave 5 reasons for non-adherence to contraception. The reasons were further categorised at Personal, Interpersonal and Social levels. Common personal reasons cited were fear ...

CONTEXT-Little is known about low-income women's and teenagers' experiences accessing publicly funded family planning services, particularly after policy changes are made that affect the cost of and access to such services. METHODS-Eleven focus groups were conducted with 92 adult women and 15 teenagers in nine Texas metropolitan areas in July-October 2012, a year after legislation that reduced access to subsidized family planning was enacted. Participants were recruited through organizations that serve low-income populations. At least two researchers independently coded the transcripts of the discussions and identified main themes. RESULTS-Although most women were not aware of the legislative changes, they reported that in the past year, they had had to pay more for previously free or low-cost services, use less effective contraceptive methods or forgo care. They also indicated that accessing affordable family planning services had long been difficult, that applying and qualifying for programs was a challenge and that obtaining family planning care was harder than obtaining pregnancy-related care. As a result of an inadequate reproductive health safety net, women experienced unplanned pregnancies and were unable to access screening services and follow-up care. Teenagers experienced an additional barrier, the need to obtain parental consent. Some women preferred to receive family planning services from specialized providers, while others preferred more comprehensive care. CONCLUSION-Women in Texas have long faced challenges in obtaining subsidized family planning services. Legislation that reduced access to family planning services for low-income women and teenagers appears to have added to those challenges. Publicly funded family planning programs in the United States provide poor and lowincome women essential access to subsidized contraceptives and other preventive reproductive health services, such as screening for cervical cancer and STDs. Federal guidelines recommend that these programs provide a broad range of contraceptive methods and that women receive evidence-based information to help them choose the most

Restrictions on Medicaid Funding for Abortions: A Literature Review n The Hyde Amendment bans the use of federal Medicaid funds for abortions except in cases of life endangerment, rape or incest. In addition, as of 2008, 32 states and the District of Columbia had prohibited the use of their state Medicaid funds for abortions except in the limited cases allowed under the Amendment. • A literature search identified 38 studies of the impact of these laws on a range of outcomes. • Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable. • Medicaid restrictions lead to a reduction in the proportion of teenage pregnancies that end in abortion, but the long-term effect on the birthrate is less clear. • Such restrictions appear to delay some women having abortions by 2-3 weeks and Medicaideligible women having first-trimester abortions by a few days on average; the net impact on second-trimester procedures is unclear. • Studies have found little evidence that lack of Medicaid funding has resulted in illegal abortions, although one death was directly related to the restrictions and two were indirectly related. • Studies of the impact of Medicaid restrictions on other outcomes-sexual behavior, prematurity, low birth weight, fatal injuries to children, late or no prenatal care, suicide and number of abortion providers-suffer from methodological limitations and are inconclusive, although there is some evidence of adverse effects on child health. • The additional public cost of prenatal care, delivery services and welfare totals 4-5 times the amount saved by not paying for Medicaid abortions. • Many studies were limited by the weakness of data sources and inability to control for unmeasured factors that influence trends in abortion rates and birthrates. Although short-term impacts of Medicaid restrictions have been demonstrated, the long-term impact is less clear and difficult to measure.

Objective: To devise a score allowing a better measure of the role of social vulnerability (SV) in a woman's attitude toward abortion. Study design: Consecutive sampling and semi-structured personal interviewing of 2641 women requesting legal termination of pregnancy from 1994 to 2001 in the county of Roanne, France. Results: SV was estimated from each woman's situation with reference to work, family composition, marital status, health insurance status and characteristics of neighbourhood of residence. It was correlated with the income and home ownership situation. With a high SV level taken as reference, the relative risks (RR) of severe, moderate, and low SVP, respectively,

This paper uses data on the distribution of abortions by weeks of gestation to examine the relationship between abortion restrictions and the timing of abortions. State-level data from 1974 to 1997 indicate that adoption of parental involvement laws for minors or enforcement of mandatory waiting periods is positively associated with the post-first trimester percentage of abortions. However, autocorrelation-corrected specifications indicate that enforced parental involvement laws increase the share of later-term abortions by lowering the first trimester abortion rate rather than by delaying abortions. Medicaid funding restrictions generally do not have a significant effect on the timing of abortions in our results.

This paper considers whether state Medicaid abortion funding restrictions affect the likelihood of getting pregnant, having an abortion, and bearing a child. Aggregate, state-level data and microdata from the National Longitudinal Survey of Youth (NLSY) are applied in the empirical work. Changes in laws resulting from Supreme Court decisions create a natural experiment which is utilized to examine fertility behavior. Multivariate models controlling for state and, in the NLSY, personal characteristics are also estimated using alternative fIxed effect specifIcations. We fInd that Medicaid funding restrictions are associated with a reduction in both the number of abortions and pregnancies, resulting in either no change or a reduction in births.

This report presents findings from a further analysis study undertaken as part of the follow-up to the 2002 Jordan Demographic and Health Survey. ORC Macro provided technical assistance for the project. Funding was provided by the U.S. Agency for International Development (USAID) through its Mission in Jordan. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID. This report is part of the MEASURE DHS+ program, which is designed to collect, analyse, and disseminate data on fertility, family planning, and maternal and child health. Additional information about the 2002 Jordan DHS survey may be obtained from the

Objective: To evaluate the effect of question wording on national estimates of pregnancy intentions. Design: Data drawn from a national probability survey. Setting: The FECOND study in France in 2010. Patient(s): Five thousand two hundred and seventy-two women and 3,373 men who reported 11,603 pregnancies. Intervention(s): Participants randomly assigned to answer 1 of 2 questions on whether they had planned or wanted each of their pregnancies. Main Outcomes Measure(s): Generalized estimated equation regression models used to test for differences in pregnancy intentions by question wording. Result(s): The use of different wording yielded a 6% point difference in estimates: 33.5% pregnancies were ''unplanned,'' and 27.4% were ''unwanted.'' The addition of information on reasons for not using contraception at the time of conception lead to significant recoding, which resulted in a significant reduction in the wording effect: 23.7% (95% CI 22.4-25.0) of pregnancies were unplanned, and 21.2% (95% CI 19.9-22.5) were unwanted. Results from the multivariate analysis confirm the greater chance of reporting an unplanned as compared with an unwanted pregnancy (relative risk 1.25 [95% CI 1.17-1.33]), even after recoding (relative risk 1.15 [95% CI 1.06-1.24]). Conclusion(s): This study shows the strong effect of question wording on estimates of pregnancy intentions. The results also support the value of adding information on reasons for nonuse of contraception when assessing pregnancy intentions.

To explore initial pregnancy intentions and postmiscarriage family planning needs and counseling preferences of women experiencing spontaneous abortion. We conducted semistructured qualitative interviews with women who recently experienced spontaneous abortion to explore their feelings about conception, pregnancy, and miscarriage; their future family planning goals; and contraceptive counseling preferences. Two trained coders utilized an inductive, iterative approach to code transcripts and identify themes using Atlas.ti software to organize the analysis. We interviewed 26 women reporting varied intentions in their recent pregnancies: 54% were trying to conceive, 27% were not trying but not preventing, and 19% were attempting to avoid pregnancy. Participants reported a range of feelings about the pregnancy diagnoses and eventual miscarriages with some relatively unemotional (&quot;a little disappointed…suffering for two months for nothing&quot;) and others feeling devastated by thei...

In this article, we conduct a comprehensive analysis of the effect of parental involvement (PI) laws on the incidence of abortions to minors in the United States. We contribute to the extant literature in several ways. First, we explore differences in estimates of the effect of PI laws across time that may result from changes in contraception, the composition of pregnant minors, abortion access in nearby states, and differences in how these laws are enforced. We find that PI laws enacted before the mid-1990s are associated with a 15% to 20% reduction in abortions to minors, but PI laws enacted after this time are not associated with declines in abortions to minors. Second, we assess the role of out-of-state travel by minors and find that it is not a significant factor moderating the effect of PI laws. Third, we use a synthetic control approach to explore state-level heterogeneity in the effect of PI laws and find large differences in the effect of PI laws on abortions to minors by s...

This survey of abortion patients is AGI's third in a series, and uses a design and questionnaire similar to those for the two earlier studies, which were conducted in 1987 6 and 1994-1995.* 7 Data Collection The facilities in the survey were selected from all hospitals, clinics and physicians' offices where abortions were performed in 1996, according to information from AGI's 1997 Abortion Provider Survey. Facilities were stratified by provider type (hospital or nonhospital) and 1996 caseload,

This report was prepared by Kathryn Kost, Isaac Maddow-Zimet and Shivani Kochhar, and edited by Lisa Melhadoall of the Guttmacher Institute. Guttmacher colleagues Megan Kavanaugh and Rebecca Wind provided comments on drafts, as did members of the PRAMS Working Group and staff from California's Maternal and Infant Health Assessment team. We relied greatly on the work of staff of the PRAMS Working Group and the CDC PRAMS Team at the Applied Sciences Branch, Division of Reproductive Health of the Centers for Disease Control and Prevention, who collected, compiled and published much of the surveillance data used in this report. We also gratefully acknowledge staff of state health departments throughout the United States, who provided tabulations of state-level data upon request. Without their cooperation, expertise and dedicated work, the estimates provided in this report would not be possible.

To identify risk factors associated with contraceptive nonuse among obese women. Methods: We performed a case control study of sexually active, obese women (body mass index > 30), aged 20 to 44 years, at risk of unintended pregnancy using the 2006-2010 National Survey of Family Growth. We defined cases as contraceptive nonusers and controls as users of any contraceptive method. We assessed demographic, reproductive, behavioral, and health services factors associated with nonuse using generalized linear models with a log-link function to estimate relative risks and 95% confidence intervals (CI). Results: Of 1,359 obese respondents at risk of unintended pregnancy, 21.4% were nonusers (n=292). In our multivariable model, nonusers users compared to users were more likely to be between the ages 35 to 39 years (aRR 1.65, 95%CI 1.05-2.59), non-Hispanic black (aRR 1.43, 95%CI 1.03-2.00), single (1.44, 95%CI 1.04-2.00), parous with 1 prior birth (aRR 1.52, 95%CI 1.07-2.15) or 2 births (aRR 1.57, 95%CI 1.10-2.23); to have infrequent sex (aRR 1.67, 95%CI 1.27-2.22); and to perceive difficulty becoming pregnant (aRR 1.89, > 95%CI 1.42-2.53). Obese nonusers did not differ significantly from users in socioeconomic indicators. Compared to users, nonusers were less likely to have discussed contraception with a health care provider (OR 0.45, 95%CI 0.31-0.65). Conclusions: Efforts to decrease contraceptive nonuse among obese women should focus on older, non-Hispanic black, single, parous women across all socioeconomic strata. Increasing contraceptive counseling by providers may improve contraceptive uptake, especially among obese women who have infrequent sex and who perceive difficulty becoming pregnant.

 Consent and confidentiality are core components of adolescent health care  Legal and ethical precedents support autonomous adolescent decisionmaking  Nurses must understand complex confidentiality and mandatory reporting regulations in their setting  EMR and billing systems can improve or compromise confidentiality, and nurses should be aware of their own system's capabilities and safeguards  Title X funding may be the only source of confidential reproductive care in some states Synopsis: Adolescent access to reproductive health services, mental health services and treatment for drug and alcohol use depends on the teen's rights to consent and confidentiality in the State in which they live. This article reviews the history, current practices and potential challenges to confidentiality, including Title X funding, questions about brain development and ability to make autonomous choices, and meaningful use practices in electronic records. Resources are provided for professional position statements and individual state regulations.

Each year, 750,000 to 850,000 teenage women in the United States experience pregnancy. 1,2 Moreover, 74 to 95 percent of these pregnancies are unintended. 3,4 In 1999, the most recent year for which data are available, over 148,000 teenage pregnancies ended in abortion. 5 Around the world, women of reproductive age have some 50 million abortions, 20 million under unsafe conditions that result in high rates of injury and death. 6 In the United States, legal abortion is a very safe procedure. 5 Yet, U.S. adolescents' access to legal abortion is increasingly restricted.

Partial financial support for this research was provided by grant #R01HD082133 from the National Institutes of Health. We thank Isaac Maddow-Zimet from the Guttmacher Institute for help understanding the construction of the resident teen abortion rates and Caitlin Myers for comments on the manuscript and for sharing her data on teen abortion rates and knowledge of parental involvement laws. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

Objective: Later second-trimester abortion (gestational age ≥ 19 weeks) is higher risk, more expensive and more difficult to access than abortion earlier in pregnancy. We sought to enumerate barriers to care described by women seeking abortion in the latter half of the second trimester. We also assessed the accuracy of later second-trimester abortion patients' perceptions of their pregnancies' gestational ages. Study Design: A retrospective analysis of data from 232 women served by a referral program for women seeking abortion care between 19 and 24 weeks of gestational age was performed. Data collected included demographics, pregnancy history, gestational age by ultrasound, perceived gestational age, barriers to abortion care experienced and time lapsed from pregnancy recognition to presentation for care. Results: Difficulty deciding whether to terminate (44.8%), financial barriers to care (22.0%) and the patient having recently realized she was pregnant (21.6%) were the most common delaying barriers cited. Nearly half (46.6%) of women underestimated their own gestational ages by greater than 4 weeks. Risk factors for experiencing at least 3 months time lapsed from pregnancy recognition to program referral included difficulty deciding whether to terminate [odds ratio (OR) 4.08, 95% confidence interval (CI) 2.51-8.70] and nonwhite race/ethnicity (OR 2.04, 95% CI 1.16-3.57). Conclusions: Women seeking abortion care in the latter half of the second trimester encounter many of the same barriers previously identified among other abortion patient populations. Because many risk factors for delayed presentation for care are not amenable to intervention, abortion must remain available later in the second trimester. Implications: Women presenting for abortion in the later second trimester are delayed by structural and individual-level barriers, and many substantially underestimate their own gestational age. Removing financial barriers may help reduce abortion delay; however, many risk factors are nonmodifiable, underscoring the need to ensure access to later second-trimester abortion.

Results: A total of 115 (46.1%) participants met criteria for moderateto-severe depressive symptoms. Multivariate analyses revealed that participants who reported depressive symptoms were more likely than those who did not to be African American (versus Hispanic: adjusted odds ratio [AOR] ¼ 2.17; 95% Confidence Interval [CI] ¼ 1.14-4.16; p ¼ .019), and to report limited contact with the father of the baby (AOR ¼ 2.18; 95% CI ¼ 1.16-4.13; p ¼ .016), prior verbal abuse (AOR ¼ 2.23; 95% CI ¼ 1.11-4.47; p ¼ .023), and physical or sexual abuse (AOR ¼ 1.84; 95% CI ¼ 1.04-3.28; p ¼ .038). Depressed adolescents also experienced higher levels of family criticism (AOR ¼ 1.67; 95% CI ¼ 1.07-2.60; p ¼ .025) and lower levels of general support (AOR ¼ 1.81; 95% CI ¼ 1.24-2.64; p ¼ .002). The Hosmer and Lemenshow Goodness of Fit Test ¼ 8.370(8), p ¼ .398, indicating an acceptable fit to the data. Conclusions: The results of the study indicated that pregnant adolescents are confronted with many environmental challenges that affect their mental health and well-being. Interventions that incorporate partners and families to address the multiple needs of this priority population are sorely needed.

Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Despite the many differences that exist between Italy, Bulgaria, and Germany, the three countries are among those with the lowest fertility rates in Europe. However, they differ in the level of public support for families and the role of informal supportive networks in daily life. Italy and Bulgaria, on the one hand, share very low levels of public support. In both countries, consequently, informal supportive networks base...

The study of fertility intentions has gained importance in the literature during the last decades. Nevertheless, research focussing on their realisation is still scarce due to limited availability of longitudinal data. Although a bulk of existing studies demonstrated regional variation and rural-urban differences in fertility, respective differences in the realisation of fertility intentions have not been addressed in prior research. We address this shortcoming by analysing the realisation of short-term fertility intentions in Vienna and Budapest as opposed to the remaining parts of Austria and Hungary, using two waves of the Generations and Gender Survey (GGS). Results clearly demonstrate that those two capitals are different: Although short-term childbearing intentions are very similar in capitals and other parts of the countries, probabilities of realisation are lower in capitals. These differences in realisation are at least partly explained by individual characteristics of inhabitants. There are, however, also factors that affect realisation differently in metropolitan than in less populated regions.

An extensive literature documents the determinants of adolescent contraceptive behavior. Critical factors associated with contraceptive use include social and demographic characteristics (e.g., age, race and income), family-related characteristics (e.g., parental education and closeness with parents) and individual characteristics (e.g., cognitive ability, educational achievement and expectations, self-esteem, age at first sex, history of pregnancy and attitudes toward contraception). 7 The impact of religiosity on contraceptive use is less clear, and the literature

Objectives. I examined the effect of imposing a requirement for parental consent before minors can receive medical contraceptives. Methods. Birth and abortions among teens, relative to adults, in a suburban Illinois county that imposed a parental consent requirement in 1998 were compared with births and abortions in nearby counties during the period 1997–2000. Results. The relative proportion of births to women under age 19 years in the county rose significantly compared with nearby counties, whereas the relative proportion of abortions to women under age 20 years declined insignificantly, with a relative increase in the proportion of pregnancies (births and abortions) to young women in the county. Conclusions. Imposing a parental consent requirement for contraceptives, but not abortions, appears to raise the frequency of pregnancies and births among young women.

Since the landmark ruling of Roe v. Wade, some restrictions to abortion access have been upheld as constitutional by the Supreme Court of the United States. This paper focuses on the ways in which mandatory parental involvement laws and funding restrictions, such as the Hyde and Vitter Amendments, disproportionately limit access for specific women. For example, mandatory parental involvement laws specifically target young women, and the Vitter Amendment solely targets Native American women. By centering the analysis on citizenship, it is possible to examine the complex relationship between the state and women’s bodies, while simultaneously underscoring the fact that not all women are treated equally under the law. Consideration of both pregnant teens’ and Native women’s restricted access to abortion services reveals how the reproductive rights of specific women are targeted under the current political climate, as well as the material impacts that result from the constricted access t...

This article examines the characteristics of women and men who got a child despite declaring no such wish up to three years before the pregnancy. We compare these unintended or sooner-than-intended parents with those who got a child as intended and those who, in line with their intentions, did not increase their family size. Using the first and second wave of the Generations and Gender Survey for six low-fertility countries (Austria, Bulgaria, France, Hungary, Italy and Poland) we conduct bivariate analysis and (multinomial) logit models. Our results show that not realising negative fertility intentions is linked more to a particular stage in one's life course and finding a new partner than to a disadvantaged socio-economic status. Thus, most of the unintended or sooner-than-intended births are probably neither unintended nor sooner-than-intended, but are a result of change in one's life circumstances between the time of measuring the fertility intentions and their realisation.

economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.

From the beginning of 2000s there is fertility growth in Russia, which was partly accelerated by the family policy instruments introduced from 2007 and aimed at increasing the number of second and subsequent births. Previous research shows that the number of second and third births has increased from 2007. At the same time, age of entering motherhood is continuously increasing, although at a lower speed comparing to Western and CEEs countries. In this study we analyze how fertility outcomes are related to the previous time-dependent parity-progression fertility intentions using the data of three waves of Russian Generations and Gender Surveys (2004, 2007 and 2011). Micro level analysis allows us understanding better not only the proportion of planned or unintended births, as well as not realized intentions, but also the individual characteristics associated with each fertility outcome. Our findings show that realization of the first births has at least not changed from 2007 to 2011 ...

Objectives: Spontaneous abortion (SAB) affects over 1 million US women each year, yet little is known about the intendedness of these pregnancies. We examined prevalence and correlates of unintended and unwanted pregnancies ending in SAB. Study design: We used nationally-representative cross-sectional data of US women aged 15-44 from the 2011-2013 National Survey of Family Growth to examine pregnancies ending in SAB. We used modified Poisson regression models to evaluate associations between demographic and pregnancy characteristics with unintended and unwanted pregnancy. Results: Among 1351 pregnancies ending in SAB, 44.5% were unintended (i.e. unwanted or occurring sooner than desired). Younger women with SAB were more likely to report unintended pregnancies than women 30-44 years, and women 15-19 years reported unintended pregnancy most often [adjusted relative risk (aRR) = 3.0; 95% confidence interval (CI): 2.2-4.1]. Unintended pregnancy was two times more likely among unmarried than married women [never married: aRR=2.2; 95% CI: 1.7-2.7; previously married: aRR=2.2; 95% CI: 1.7-3.0]. Other factors associated with unintended pregnancy were multiparity compared to nulliparity [aRR=2.6; 95% CI: 1.7-4.1 for ≥3 children; aRR=1.8; 95% CI: 1.3-2.5 for 2 children] and inter-pregnancy interval ≤12 months compared to >12 months [aRR=1.4; 95% CI: 1.2-1.7]. We found similar associations with unwanted pregnancies ending in SAB (15.3% of pregnancies). Neither race/ethnicity nor ☆ Clinical Trial Registration: not applicable.