Pregnancy Intention and Antenatal Care Use in Two Rural North Indian States

Abstract

Many studies have shown strong effects of pregnancy intention on antenatal care (ANC) behaviour in developed countries, but studies from developing settings have shown mixed results. Few investigators have utilized a prospective measure of pregnancy intention. This paper will analyze the association of pregnancy intention and the utilization of antenatal services in two states in northern India, using a prospective measure of whether a future pregnancy would be wanted or unwanted. A prospective cohort study was conducted between 1998 and 2003 in Jharkhand and Bihar, India, of 2028 women with one or two pregnancies resulting in the live births of singleton infants during the study period. Antenatal care utilization was not found to be significantly associated with prospective pregnancy intention (OR=1.18 [95% CI 0.91, 1.52]). Among women who received ANC (N = 701), initiation of care was not delayed in unwanted pregnancies. Significant differences existed between the numbers of women who reported their pregnancy unwanted retrospectively compared with prospectively. These differences were not associated with the utilization of antenatal care services or timing of care initiation. The exception to these findings were women who consistently reported their pregnancies unwanted both before and after conception, who were twice as likely to delay ANC initiation as women with consistently wanted pregnancies. Demographic characteristics of reproductive-age women, such as age and parity, seem to predict more closely the use of ANC services than pregnancy intention in Bihar and Jharkhand. Delayed ANC initiation may be significantly associated with unwanted pregnancy, but only when pregnancies were most decisively identified as unwanted.