Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
LIMIN SONG: Hello, Hi, everybody. First, I want to acknowledge the team members for the study--oh, I go too early--Dr. *Cheryl Prince who is a profound professional and a personal mentor. Also, co-worker (inaudible). And the traditional question that has been used in PRAMS to measure pregnancy intendancy--has been thinking back to just before you got pregnant with the new baby, how did you feel about becoming pregnant? And the answers could be, “I wanted to be pregnant sooner,” or, “later,” or, “then,” or, “I didn’t want to be pregnant then or anytime in the future.” And traditional definition of pregnancy intendancy has been the (inaudible), sooner, and (inaudible) together be defined as intended pregnancy and answer of later and never be defined as unintended pregnancy. And in the year of 2000, a future question was added to the questionnaire as a future question to the contraceptive two questions. And this question is, “When you got pregnant with your new baby, were you trying to become pregnant?” Answer could be “yes” or “no.” Since Hawaii PRAMS started to collect data in year of 2000, and when we started to analyze our data on the subject--so we were thinking, looking at this actual question, trying--and we were thinking people who answered to the first traditional question later or never, but they also answered they were trying to get pregnant and to the second question, should that group of women be excluded in the unintended group of women?
So our purpose to do this study is try and to compare a data on intendedness using both question versus only the traditional question, and also to determine the (inaudible) of pregnancy intendedness for the state of Hawaii. For Hawaii PRAMS (inaudible) than native Hawaiian and part Hawaiian women also we’re sampling women living in rural areas outside of Honolulu. And for people who are not familiar with Hawaii, here’s a map to help. As you can see, we have six main islands and Honolulu as a state capital located on Oahu. The method we used and we analyzed the demographic characteristics of Hawaii PRAMS mothers delivering in 2000 and 2001. We also compared the statistics between traditional and intended pregnancy definition and definition using both questions.
So here are the results. Our sample size is 6,251 people and among those, 5,009 women gave us a response rate of 80%, and this sample represents 33,991 women. When I look at the age of this group of women, almost half of the percent--they age between 25 to 34. When I look at the education, almost half of the women had more than high school education, and that the majority of the women are married. The biggest two ethnicity groups are part Hawaiian was at 27% and the white women was 22.5%, and half of the women live in urban Honolulu, the rest of them live in rural and neighbor islands. When I look at the income, about 31.9--that’s the biggest group--percent of women falls into $10,000 to $30,000 a year. We want to show you--compare these two questions (inaudible) traditional question, “When you got pregnant, how did you feel?” and as answer could be “sooner, later, than” and “didn’t want to” and also the second question, “Were you trying to get pregnant?”
So we put these two questions together. As you can see, women who said later but they also said trying to get pregnant is about 5%, and that women who said they didn’t want to get pregnant, yet they said they were trying to get pregnant, that’s about 1%. So those two groups of the women are the women we pull out of the unintended and put in the intended group, so compare the traditional way to manage your unintended pregnancy. The number come out is 44.3%. When we use both questions, the number is 41.6%. When we look at the surveillance report in 1999, the unintended pregnancy rate is ranged from 33.7% in Utah to 52% in Louisiana, and by using both the traditional method and using the methodology of using both questions make Hawaii’s result fall into this range. When we look at this subject further, we were thinking to extend our study by using another set of measurements. We used the concept of wanted, mis-timed, unwanted, and ambivalent. And when this set of measurements are used, the commonly used definition is also go back to where it refers to a traditional question, “When you got pregnant, how did you feel?” And answers sooner and then put together, they are defined normally as wanted and later be defined as mis-timed, and they were defined as unwanted.
When we look at the two contraceptive questions that follow those two questions, we think it makes more sense to consider these two questions also when we measure pregnancy intendancy because these two questions do give us information that are related to the subject. And the two questions are, “When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant?” “Yes” or “no.” Another question is, “What were your or your husband or partner’s reasons for not doing anything to keep from getting pregnant?” And one option to this question can be, “I didn’t mind if I got pregnant.” Here are the results. Wanted has 50%, mis-timed 28.5%, ambivalent is 12.8%, and unwanted is 8.29%, and there is one person we cannot classify because of the other four questions all the (inaudible) are missing for this person. And how did we get this number? As mentioned before, we used the information from all the four questions, and also what we did, we included women with some missing values to the first two especially.
Our conclusions are the intention to become pregnant is a very difficult concept to measure precisely. We learn that through experience. And we’re going to discuss with our family planning staff in the state for further decision on how we can best use PRAMS data on this subject. And the limitation for the study is since the still birth are not included in the PRAMS data set measuring the prevalence of pregnancy intendedness using PRAMS data will never be 100% accurate. And there are some public health benefits to this study is it can lead to development of the stable and the reliable measurement too for this state, and also can help with programs who direct scarce resources to focus on populations at risk only. I’d like to acknowledge people who were helpful to make this study possible and Hawaii PRAMS is a relative new PRAMS state still, and we just keep marching. Just wanted to show you this as our new PRAM survey cover for the Phase V. Thank you.