‘Unintended’ pregnancies are either ‘unwanted’ or ‘mistimed’ (coming sooner than desired). What does this mean for a child’s health? Researchers from the University of London tackle this question using demographic and health survey results from Bolivia, Egypt, Kenya, Peru and the Philippines.

As countries go through the fertility transition, desired family sizes may fall at a rate that outstrips the ability of couples to control their fertility. This increases the risk of unwanted pregnancies. Does this have an impact on children’s health? Researchers looked at the effects of the ‘unwantedness’ of a pregnancy on:

• uptake of antenatal care
• delivery under medical supervision
• vaccination status
• children’s growth.

They found that:

• numbers of unwanted births range from 10 per cent in Kenya to 37 per cent in Peru. They rise sharply with the size of the family
• The level of mistimed births varies from 10 per cent in Egypt to 30 per cent in Kenya. Within families, it is strongly related to the time since the last pregnancy
• After adjusting for factors such as mother’s education, household wealth, birth order and urban/rural location, wantedness is not consistently related to the probability of a supervised delivery, vaccination status or child growth.
• Inadequate antenatal care is the only outcome that is related to wantedness across the five countries.
• However, in Peru, which has the highest level of unwanted pregnancies (37 per cent), there are significant differences between wanted and unwanted pregnancies for all four outcomes.

The researchers warn that ‘wantedness’ is difficult to define accurately. It may differ before and after conception. It may also vary among various family members responsible for childcare. And its intensity may depend on the number of children a family already has. In fact, they conclude that birth order has a stronger and more widespread influence on health than wantedness.

So parents in most developing countries probably do not discriminate against pregnancies and children who are unwelcome at the time of conception. Instead, children born into large families are at a disadvantage compared with first and second children in terms of antenatal and maternity care. The researchers advocate public sector provision of contraceptive services and information to facilitate and accelerate the reduction in numbers of births per woman.

Source(s):
‘Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries’, Population Studies 57(1): 77-93, by C. Marston and J. Cleland, 2003

id21 Research Highlight: 20 August 2003

Further Information:
Cicely Marston
Department of Social Science and Medicine
Primary Care and Population Health Sciences
Faculty of Medicine
Imperial College
Third Floor, Reynolds Building
St Dunstan's Road
London
W6 8RP
UK

Tel: +44 (0)20 7594 0786
Contact the contributor: c.marston@imperial.ac.uk

London School of Hygiene and Tropical Medicine, UK

John Cleland
London School of Hygiene and Tropical Medicine
51 Bedford Square
London
WC1B 3DP
UK

Tel: +44 (0)20 7299 4621
Fax: +44 (0)20 7299 4637
Contact the contributor: John.Cleland@lshtm.ac.uk

Faculty of Medicine, Imperial College, London

Other related links:
'Gloomy prospects – effects of postnatal depression on infants’ development'

'Unwelcome surprise – preventing unplanned births in Kenya'

'Is pregnancy good for your health? Evidence from Senegal'

See id21's collection of links relevant to maternal and child health.