In the past decade, an accumulation of research findings has consistently demonstrated that women's behaviors during their pregnancies can strongly affect the health of their infants at birth. In turn, birth outcomes such as low birth weight or premature delivery have strong negative effects on infant health and survival. The proposed study will seek to determine whether and how the planning status of a birth affects maternal behaviors and infant health outcomes. Our overall strategy is both to investigate the effects of planning status within an analysis of other determinants of maternal behaviors and infant outcomes and to explore the advantages of an integrated model that includes a comprehensive set of measures which play a role in birth outcomes and infant health. The statistical analysis will proceed in four stages, corresponding to four primary hypotheses and to four sets of dependent variables - women's behaviors and the care they obtain during pregnancy, birth characteristics, infant care and infant health. Each stage consists of a number of multivariate analyses, one for each dependent variable included in that stage. The primary hypotheses to be tested in each stage are: (I) during their pregnancy, women carrying unintended pregnancies to term make less use of prenatal care services and conform less to recommended personal practices than women with intended births; (II) through the effects of women's behaviors on pregnancy outcome, unintended births are associated with lower birth weight, shorter gestation and a longer duration of post-delivery hospitalization than intended births; (III) women who have unintended births are less likely to perform infant care practices after the child is born; and (IV) as a result of less attention to infant care, unintended births are more likely to be associated with poor infant health than intended births. Two additional hypotheses will be tested in all four stages of the analysis: (1) unwanted births are more strongly associated with poor prenatal and infant care and with negative birth and infant health outcomes than are mistimed births, and (2) the effects of planning status on women's behaviors during and after pregnancy differ among demographic subgroups of women. The study will make use of two recent nationally representative surveys of women and their births - the 1988 National Maternal and Infant Health Survey (NMIHS) and the 1988 National Survey of Family Growth (NSFG) - which, though similar in the data they contain, differ in some important ways. Parallel analyses of both data sets will have the important advantage of allowing for corroboration of findings. Alternatively, analyses from the two data sources may disagree, but the availability of separate yet similar analyses within one study framework will allow for an evaluation of the stability of the size and direction of the relationships found.
| Kost, K; Forrest, J D (1995) Intention status of U.S. births in 1988: differences by mothers' socioeconomic and demographic characteristics. Fam Plann Perspect 27:11-7 |
