Pregnancy Intentions' Relationship with Infant, Pregnancy, Maternal, and early Childhood Outcomes: Evidence from Births in Alaska, Missouri, and Oklahoma

Hobby, Erica, Nicholas Mark, Alison Gemmill, & Sarah K. Cowan

Published in Perspectives on Sexual and Reproductive Health 55, 2023

Much of reproductive health care policy in the United States focuses on enabling women to have intended pregnancies. Investigating whether the association between pregnancy intention and adverse outcomes for mothers and children in the immediate and longer term is due to intention or a mother's demographics provides valuable context for policy makers aiming to improve maternal and child outcomes. We investigated relationships between pregnancy intention and pregnancy, infant, early childhood, and maternal outcomes using data from the Pregnancy Risk Assessment Monitoring System survey, conducted 2-8 months after the child's birth, and follow-up surveys from three states (Alaska, Missouri, and Oklahoma), administered at age 2-3 years old. We used logistic regressions with inverse propensity weights to measure associations, accounting for potential confounding factors. After inverse propensity weighting, pregnancy intention was associated with adverse maternal pregnancy behaviors but not most infant outcomes. Mothers who reported an unwanted pregnancy were associated with increased odds of the child receiving a developmental delay diagnosis. Among those who did not report depression prior to pregnancy, mothers with unwanted pregnancies were more likely to experience persistent depression, and mothers with pregnancies mistimed by two or more years had a higher likelihood of experiencing depression postpartum or in the follow up period. Our findings suggest that pregnancy intention is less consequential for maternal and child well-being than socio-economic disadvantage, suggesting that re-orienting policy toward social conditions and reproductive autonomy will serve better individual and population health.

Category: Pregnancy

Do Pregnancy Intentions Matter? Revisiting Relationships With Pregnancy, Birth, and Maternal Outcomes

Mark, Nicholas* & Sarah K. Cowan

Published in Demography, 2021

Preventing unplanned or unintended pregnancies continues to be a cornerstone of American reproductive health policy and infrastructure, but the evidence that these pregnancies cause adverse maternal and child outcomes is limited. We test these relationships on recent large-scale data using inverse propensity weights estimated from generalized boosted models. Consistent with prior research, we find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth. In an addition to the literature, we find evidence that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.

Category: Pregnancy

Examining the Effects of a Universal Cash Transfer on Fertility

Cowan, Sarah K. & Kiara Wyndham Douds*

Published in Social Forces, 2022

Childbearing is at once deeply personal and shaped by social structure. It is also a site of profound inequality in the United States. Income inequality is an upstream cause of childbearing inequality, yet the evidence of the effect of income on reproduction is inconclusive. Previously, scholars primarily examined the introduction of means-tested relief to families with children. This limits analysis to families in poverty and provides insight only into the presence or absence of a policy. We analyze the Alaska Permanent Fund Dividend, which has provided all Alaskan residents with a substantial annual cash payment since 1982. The amount of the payment varies annually and is exogenous to individual Alaskans’ behavior and the state’s economy. We examine the effect of the cash transfers on fertility and abortion among a large and diverse population that has received varying amounts of money over time. We find the payments increase short-term fertility rates 1 and 2 years after disbursement, particularly among socioeconomically disadvantaged populations. Standardized to the 2010 household size distribution, two average payments relative to two minimum payments would result in a predicted fertility rate increase from 80.03 to 86.53 per 1,000 women age 15–44. The effect is largest for first births. The payments have no effect on the abortion rate. These results indicate the additional income removes economic constraints to reproductive health and autonomy and reduces reproductive inequality.

This research was covered in New York Times and KCBS.

Category: Cash Transfers, Pregnancy

Low perceived susceptibility to pregnancy as a reason for contraceptive nonuse among women with unintended births

Gemmill, Alison & Sarah K. Cowan

Published in Demographic Research 44 (2021)

Background: While low perceived susceptibility (PS) to pregnancy is a common risk factor for having sex without contraception among women susceptible to unintended pregnancy, little research has examined the correlates of low PS, and none have investigated whether low PS predisposes women to later pregnancy discovery and prenatal care initiation among women with unintended births.

Methods: We use data from the 2004‒2011 Pregnancy Risk Assessment Monitoring System and limit our sample to women in the United States with unintended births who were not using contraception at the time of the index pregnancy (n = 55,940). Women were classified as having low PS if they indicated they could not get pregnant at the time the index pregnancy occurred or they or their partner were sterile. We use logistic regression to identify correlates of low PS and determine whether low PS is associated with timing of pregnancy recognition and prenatal care initiation.

Results: Over one-third of women with unintended births cited low PS as a reason for contraceptive nonuse. Maternal age and disadvantage are correlated with low PS. Among women with unintended births, those with low PS had lower odds of early pregnancy recognition (adjOR = 0.88; 95% CI: 0.82, 0.94) and prenatal care initiation (adjOR = 0.86; 95% CI: 0.79, 0.94) compared to those who did not hold these beliefs.

Contribution: Although research remains focused on other barriers to contraceptive use, low perceived susceptibility to pregnancy is critical to understanding the high rates of unintended pregnancies and births in the United States and may affect prenatal health.

This research is the winner of the Editor’s Choice Designation from Demographic Research.

Category: Pregnancy

* indicates student co-author