Abstract
ObjectivesRetrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention.MethodsWe compared the test–retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher’s exact tests, and calculated odds ratios to estimate effect size.ResultsThe DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51–0.66); the DHS had moderate reliability (0.56–0.58). The LMUP’s stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p = 0.033), number of children (p = 0.048) and postnatal depression (p < 0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy.Conclusions for PracticeThe LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.
Highlights
Unplanned pregnancies are of societal interest for a number of reasons, including assessing unmet need for family planning, understanding population level fertility and service requirements, women’s empowerment and agency and the achievement of sexual and reproductive health rights (Joyce et al 2000; Yeatman and Sennott 2015)
Given that retrospective measures of pregnancy intention are used for planning and evaluation purposes at national and international levels, it is vital that we investigate their reliability i.e. to what extent they are affected by the passage of time, women’s characteristics and outcome of pregnancy
This paper aims to: assess the reliability of the London Measure of Unplanned Pregnancy (LMUP) from pregnancy to 1 year postnatally; assess the reliability of the Demographic and Health Surveys (DHS) from 1 to 12 months postnatally; and investigate whether maternal characteristics or pregnancy outcome are associated with the stability of pregnancy intention as reported by either LMUP or DHS in the first six postnatal months
Summary
Unplanned pregnancies are of societal interest for a number of reasons, including assessing unmet need for family planning, understanding population level fertility and service requirements, women’s empowerment and agency and the achievement of sexual and reproductive health rights (Joyce et al 2000; Yeatman and Sennott 2015). Maternal and Child Health Journal (2019) 23:1177–1186 adverse maternal, perinatal and child health outcomes, such as low birth weight, pre-term birth, maternal depression and child development (Gipson et al 2008; Tsui et al 2010; Shah et al 2011; Fisher et al 2012; Hall et al 2017) They are of interest because of the significant personal, emotional, financial, physical, psychological and social costs for women and their families (Gipson et al 2008), and because of the missed opportunities for preconception care and the prevention of unplanned pregnancy (Hall et al 2016; Stephenson et al 2018). A similar approach is taken by the National Survey of Family Growth (NSFG) and other surveys in the USA
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