Abstract
ObjectivesUnintended (mistimed or unwanted) pregnancies occur frequently in the United States and have negative effects. When designing prevention programs and intervention strategies for the provision of comprehensive birth control methods, it is necessary to identify (1) populations at high risk of unintended pregnancy, and (2) geographic areas with a concentration of need.MethodsTo estimate the proportion and incidence of unintended births and pregnancies for regions in Missouri, two machine-learning prediction models were developed using data from the National Survey of Family Growth and the Missouri Pregnancy Risk Assessment Monitoring System. Each model was applied to Missouri birth certificate data from 2014 to 2016 to estimate the number of unintended births and pregnancies across regions in Missouri. Population sizes from the American Community Survey were incorporated to estimate the incidence of unintended births and pregnancies.ResultsAbout 24,500 (34.0%) of the live births in Missouri each year were estimated to have resulted from unintended pregnancies: about 25 per 1,000 women (ages 15 to 45) annually. Further, 40,000 pregnancies (39.7%) were unintended each year: about 41 per 1,000 women annually. Unintended pregnancy was concentrated in Missouri’s largest urban areas, and annual incidence varied substantially across regions.ConclusionsOur proposed methodology was feasible to implement. Random forest modeling identified factors in the data that best predicted unintended birth and pregnancy and outperformed other approaches. Maternal age, marital status, health insurance status, parity, and month that prenatal care began predict unintended pregnancy among women with a recent live birth. Using this approach to estimate the rates of unintended births and pregnancies across regions within Missouri revealed substantial within-state variation in the proportion and incidence of unintended pregnancy. States and other agencies could use this study’s results or methods to better target interventions to reduce unintended pregnancy or address other public health needs.
Highlights
The ability to freely decide and successfully plan the number, spacing, and timing of pregnancies is a fundamental human right, as first recognized by the 1968 International Convention on Human Rights and supported by multiple organizations thereafter, including the United Nations Sustainable Development Goals [1, 2]
Missouri Vital Records data, containing personally identifiable information on all births in the state of Missouri, can be made available from the Missouri Department of Health and Senior Services, Bureau of Vital Records for researchers who meet the criteria for access to confidential data
We were granted permission from the Missouri Department of Health and Senior Services to use the Missouri vital records data underlying the results presented in the study per our data use agreement and Internal Review Board application #1357
Summary
The ability to freely decide and successfully plan the number, spacing, and timing of pregnancies is a fundamental human right, as first recognized by the 1968 International Convention on Human Rights and supported by multiple organizations thereafter, including the United Nations Sustainable Development Goals [1, 2]. Rates of unintended pregnancies vary substantially across the United States with some areas, notably states in the New England region, exhibiting as few as 36 unintended pregnancies per 1,000 women ages 15 to 44, while areas in parts of the Southern and Western United States experience more than 60 unintended pregnancies per 1,000 women ages 15 to 44 [6]. Such variation is not surprising given the differences in sociodemographics, policies, and health care access across states. This variation does, suggest the need for state level programming tailored to the context of each state, which in turn requires further understanding of sub-state trends to support such decision-making around where, how, and to whom to roll out programming focused on reducing unintended pregnancy
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