Clinical Studies
Association Between Early Prenatal Care and Mother’s Intention of and Desire for the Pregnancy

https://doi.org/10.1111/j.1552-6909.2001.tb01545.xGet rights and content

Objective

To examine the associations between having planned to become pregnant and valuing an unintended pregnancy with seeking early prenatal care.

Design

This historical cohort study, using data from the National Survey of Family Growth (NSFG), Cycle V (1995), examined separately the associations of having a planned pregnancy (timing of pregnancy) and valuing an unintended pregnancy (feelings about the pregnancy) with timing of initiation of prenatal care.

Participants

The NSFG was based on a national probability sample of women ages 15 to 44 (N = 1,989).

Design

Outcome Measure: Timing of initiation of prenatal care (early or late/no). Early prenatal care was defined as care sought within the first 13 weeks of pregnancy. It was hypothesized that unwanted and unintended pregnancies were predictors of late or no prenatal care.

Results

In agreement with previous research using logistic regression, unwanted pregnancy was found to be a predictor of late/no prenatal care. Black ethnicity also was found to be a predictor of late/no prenatal care.

Conclusions

Interventions that are sensitive to culture and involve patient education regarding family planning are needed. JOGNN, 30, 275–282; 2001.

Section snippets

Methodology

This study used a nonconcurrent prospective (historical cohort) design using NSFG, 1995 (Abma et al., 1997) data to examine unintended pregnancy and unwanted pregnancy as predictors of timing of initiation of prenatal care. The national survey contains data collected by trained interviewers in face-to-face interviews with the respondents. In 2% of the cases, telephone interviews were conducted because the respondent refused to have the interviewer come into her home or to meet at a neutral

Statistical Analysis

Initially, chi-square analyses were conducted to identify independent associations between sociodemographic characteristics, employment status, previous pregnancy outcome, planned pregnancy, and desire for the pregnancy with timing of initiation of prenatal care. This was achieved using a dichotomous variable of early versus late/no prenatal care as the outcome variable. Second, independent associations of sociodemographic characteristics, employment status, prenatal care, and previous

Results

The majority of the study sample were white women (70%), with at least 12 years of education (77%), at or above the poverty level (70%), married (66%), had been pregnant once or twice before (55%), and between the ages of 20 and 35 (79%). Sociodemographic characteristics associated with late or no initiation of prenatal care included age less than 20 years, black ethnicity, single marital status, income below poverty level, and less than 12 years of education. Both unwanted pregnancy and

Study Limitations

This study was limited by the use of the timing of pregnancy question used in the NSFG survey, which this study found was an inadequate measure of planned pregnancy and of desire for the pregnancy. By using existing data, the researcher was restricted to the questionnaire design that was used to compile the data. Another potential confounder was accessibility, including reimbursement resources. It was not possible to examine access to prenatal care; however, some areas of the country may have

Conclusions

Understanding why women initiate late or no prenatal care is complex. Many risk factors for late or no prenatal care have been identified and seem to be interrelated. The ages of women who initiate late or no prenatal care and those who initiate early prenatal care differ significantly. Teenagers are most likely to initiate late/no prenatal care. This finding concurs with previous studies (Chisholm, 1989, Curry, 1990, Essex et al., 1992, McCaw-Binns et al., 1995, Petitti et al., 1990, Poland,

Clinical Implications

Because indifference is a strong predictor of late or no initiation of prenatal care, strategies to have an impact on the value of pregnancy are necessary. Interventions that target family planning and patient education are underscored. The fact that black ethnicity was a predictor of late or no prenatal care, in addition to unwanted pregnancy, indicates the importance of an increased sensitivity to cultural/ethnic differences in views about pregnancy. One suggestion for the racial disparity in

Research Implications

Future research focusing on minorities’ perceptions of treatment within the health care system is needed to provide a baseline of perceptions, underscore the problem, and evaluate and monitor efforts to diminish differential treatment. In addition, studies examining racial differences in unwanted pregnancy will be helpful in understanding differences in attitudes toward pregnancy and prenatal care. Future studies should examine differences in specific cultures within the broad definition of

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