Maternal Pregnancy Intention and Developmental Outcomes in Brazilian Preschool-Aged Children

Do women with a previous unintended birth subsequently experience missed opportunities for postpartum family planning counseling? A multilevel mixed effects analysis

Client-provider communication about family planning (FP) remains an important strategy for preventing unintended pregnancy. Yet, the literature lacks empirical studies examining whether and how women's intendedness of a recent pregnancy may impact subsequent receipt of FP counseling. We investigated whether the intendedness of a recent pregnancy is associated with subsequent missed opportunities (MOs) for FP counseling, taking into account compositional and contextual factors. We performed a secondary analysis using pooled data from the 2016, 2017 and 2018 Performance Monitoring and Accountability 2020 cross-sectional surveys conducted in Nigeria, adjusting for complex design effects. Weighted multilevel logistic regression modeling was used to examine the relationships between pregnancy intention and MOs, overall and at the health facility, using two-level random intercept models. In the analytic sample of women within 24 months postpartum (N = 6479), nearly 60% experienced MOs for FP counseling overall and even 45% of those who visited a health facility visit in the past 12 months (N = 4194) experienced MOs. In the multivariable models adjusted for individual-/household- and community-level factors, women whose recent birth was either mistimed or unwanted were just as likely to have MOs for FP counseling as their counterparts whose pregnancy was intended (p > 0.05). Factors independently associated with a MOs include individual/household level factors such as level of education, exposure to FP media, household wealth index and contextual-level variables (geographic region). While evidence that pregnancy intendedness is associated with MOs for FP counseling remains inconclusive, efforts to mitigate these MOs requires prioritizing women's prior pregnancy intentions as well as equipping healthcare providers with the capacity need to provide high-quality client-centered FP counseling, particularly for women whose recent birth was unintended.

Pregnancy Desirability and Motivational Readiness for Postpartum Contraceptive Use: Findings from Population-Based Surveys in Eight Sub-Saharan African Countries

This study examined the associations between pregnancy intention and motivational readiness for postpartum contraceptive use. Data for this cross-sectional analysis were derived from nationally representative surveys of the Performance Monitoring and Accountability 2020 (PMA2020) project conducted in eight sub-Saharan African countries. Participants included 9488 nonpregnant women of reproductive age (15-49 years) who had given birth in the last 2 years. Weighted multinomial logistic regression analyses were performed to estimate the odds ratios (OR) and their corresponding 95% confidence intervals (CIs) of the associations of motivational readiness for contraceptive adoption categorized as precontemplation, contemplation, and post-action with pregnancy intention. After adjusting for confounding factors, the findings revealed that women in Côte d'Ivoire and Nigeria who had mistimed pregnancies had significantly higher odds of being in the contemplation vs. precontemplation stage compared to those who had intended pregnancies. Similarly, women who had unwanted pregnancies in Ethiopia were also more likely to be in the contemplation stage. Furthermore, significant differences were observed for women in Burkina Faso, Côte d'Ivoire, and Nigeria regarding the association between mistimed pregnancies and being in the post-action stage. For women who had unwanted pregnancies, this association was significant only in Nigeria. Additionally, the odds of being in the contemplation stage, compared to the post-action stage, for women who had unwanted pregnancies were significantly higher in Ethiopia and Nigeria. These results indicate that recent unintended pregnancies in specific sub-Saharan African countries may motivate women to take action to prevent future unintended pregnancies. The findings underscore the importance of tailored and context-specific approaches in family-planning programs based on the stage of motivational readiness.

Association between pregnancy planning or intention and early child development: A systematic scoping review

The Sustainable Development Goals have a specific target to "ensure that all girls and boys have access to quality early childhood development" by 2030. There is sparse literature regarding the impact of pregnancy intention (wantedness and timing) or planning on child development. We aimed to summarize the evidence measuring the association between unintended or unplanned pregnancy and child development for children aged 3 to 5. We included studies that compared developmental outcomes of children from unwanted, unplanned, or mistimed pregnancies to those of children from wanted or planned pregnancies. In April 2022, we searched Ovid MEDLINE (from 1946), EMBASE (from 1974), and SCOPUS (from inception) without language restrictions. One reviewer tabulated data on country and year of study, population, sample and sampling method, age of participants, exposure, date of exposure retrieval, developmental outcome(s), assessment (direct or through third parties), statistical methods (including covariate selection methods), and effect estimates into bespoken data tables. Our scoping review identified 12 published studies reporting on 8 "cohorts" (range: 1963-2016) with information on approximately 39,000 children born mostly in developed countries. Overall, unwanted/unplanned pregnancies seemed to be associated with poorer child development when compared with wanted/planned pregnancies. Mistimed or delayed pregnancies correlated with weaker effects in the same direction. We concluded that achieving the target for SDG 4, related to child development, might entail policies that create environments supportive of wanted conception and access to safe abortion.

Are Social Vulnerability and Family Social Support Associated with Children's Psychiatric Symptoms?

Social influence can shape early childhood at different levels. We explored the association between social vulnerability and lifetime caregiver alcohol use with children's psychiatric symptoms. Multivariable logistic regression assessed the association between child psychiatric symptoms and social vulnerability among 1275 preschool child-caregiver pairs with lifetime caregiver alcohol used as a control variable. Of the children, 15.78% (95% CI 15.17-16.42) had internalizing symptoms, 2.49% (95% CI 2.19-2.83) had externalizing symptoms, and 9.36% (95% CI 8.88-9.86) had internalizing/externalizing symptoms. High social vulnerability was positively correlated with internalizing (aRRR 1.54; 95% CI 1.41-1.68) and internalizing/externalizing symptoms (aRRR 1.77; 95% CI 1.58-2.00). Low family support was strongly associated with internalizing/externalizing symptoms (aRRR 2.60; 95% CI 2.20-3.10). Lifetime caregiver alcohol use was positively correlated with all three psychiatric symptoms (aRRR 1.33; 95% CI 1.18-1.51; aRRR 1.13; 95% CI 1.06-1.59; and aRRR 1.26; 95% CI 1.12-1.42). Their association with children's mental health outcomes calls for social policy changes at the macrosystem level.