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Assessing the prevalence and predictors of unintended pregnancy: evidence from recent reproductive health surveys in El Salvador.
Marion W. Carter
According to conventional measures, unintended pregnancies are common throughout developing countries, including the Central American region. For example, in 1998, Salvadoran women reported that 35% of live births in the preceding 5 years were either mistimed or unwanted; 38% of Ecuadoran women reported the same in 2001. The prevalence of unintended pregnancies is an important reproductive health indicator for most governments and other reproductive health organizations, because the intendedness of pregnancy is a consistent predictor of various reproductive and maternal-child health outcomes (e.g. delayed prenatal care).
Data on unintended pregnancy for countries in the Central American region typically come from periodic national reproductive and maternal-child health surveys. Prevalence estimates often are based on a single question asked of women, about recent pregnancies that ended in a live birth: "When you became pregnant that time, did you want to be pregnant then, did you want to wait more time, or did you not want the pregnancy at all?"1 While straightforward and valuable in some ways, this method of measuring unintended pregnancies has weaknesses (Santelli et al. 2002, Stanford et al. 2000, Joyce, Kaestner, Korenman 2000, Trussell, Vaughan, Stanford 1999). For example, qualitative and survey research has shown that the intendedness of pregnancy is multidimensional, variable over time, and affected by women's partners. Such results raise questions about the conventional understanding of pregnancy intention and its causes and consequences.
One outcome of such developments is that many major US health surveys (e.g. PRAMS, NSFG) now collect multiple measures of pregnancy intention. However, to date few reproductive health surveys fielded in developing countries have included these innovations. A key exception is the recent (2003) national male reproductive health survey conducted in El Salvador. In that survey, a series of 5 questions on pregnancy intention was included, in addition to the traditional measure.
I propose to use those data, as well as data from the companion female reproductive health survey (where that series of questions was not included), to analyze pregnancy intention in El Salvador. The main objectives are to:
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Compare the prevalence of unintended pregnancies between the male and female surveys. How different are the two groups' estimates?
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Calculate and compare the prevalence of unintended pregnancy, using various measures afforded by the additional questions. How much does the prevalence estimate change when pregnancy intention is defined in other ways?
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Examine the determinants of unintended pregnancy. How consistent are the determinants across different ways of measuring unintended pregnancy? How consistent are they between the male and female
samples?
While the results are most applicable to the Salvadoran context, the aim is to stimulate broader discussion about pregnancy intention in general and its measurement.
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