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Rapid repeat pregnancy among women seeking pregnancy termination: a descriptive study
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ABSTRACTS / Contraception 92 (2015) 359–414
P101 Understanding pregnancy intention and contraceptive decision making among Native Hawaiians: focus groups with women and men Elia J University of Hawai‘i John A. Burns School of Medicine, Honolulu, HI, USA Soon R, Beckwith N, Uemoto M, Kaneshiro B, De ver Dye T Objectives: Native Hawaiians report the highest rates of unintended pregnancy in Hawaii. We aimed to qualitatively describe factors related to pregnancy planning among this population. Methods: Eight focus groups were conducted among native Hawaiian adults, organized by gender and age, as part of a community-engaged research project. A vignette of a native Hawaiian couple in their late teens was used to discuss their relationship, attitudes toward pregnancy and unplanned pregnancy decision making. Audio-recordings were transcribed and analyzed through content analysis. Results: Of 52 participants, 30 (57.7%) were women, median age group was 41–45 years and 24 (46.2%) were rural. Three-quarters (76.7%) of women and 59.1% of men reported experiencing an unplanned pregnancy. Ideal circumstances before childbearing and future aspirations were consistently identified as motivations to avoid pregnancy; however, participants also discussed intergenerational and social norms affecting earlier childbearing. Unintended pregnancy was considered more common and accepted among native Hawaiians than among others. Family structure and collectivist culture influenced pregnancy decision making among this group. Perceived responsibility to “own up” to one's actions and strong family support were cited as reasons to encourage women to continue an unplanned pregnancy. The Hawaiian cultural practice of hānai (informal adoption) was mentioned because it allows a baby to stay within the family. While some prochoice voices emerged, abortion was generally viewed as an uncommon, undesirable “last resort” in the native Hawaiian community. Outcomes: While native Hawaiians value educational and career goals, other community values make unplanned pregnancy less burdensome and more acceptable, which may lessen motivations to avoid pregnancy. http://dx.doi.org/10.1016/j.contraception.2015.06.151
P102
Outcomes: Use of postnatal services is low compared with antenatal care service use. More attention should also be focused on the quality of postnatal services. http://dx.doi.org/10.1016/j.contraception.2015.06.152
P103 Rapid repeat pregnancy among women seeking pregnancy termination: a descriptive study Liu T Baystate Medical Center, Springfield, MA, USA White K Objectives: Rapid repeat pregnancy is often unintended but has not been previously studied in the context of abortion. Methods: We conducted a cross-sectional study of women seeking termination at a single clinic, whose current pregnancy began less than 18 months after another pregnancy. We performed descriptive analyses of demographic characteristics, relationship characteristics and healthcare experiences. Results: The 125 participants presented after a birth (48%), abortion (48%) or miscarriage (3%). The median interpregnancy interval was 6 months (IQR 3.5–10). Most participants were young, (median age 25.5; range, 17–45), White (78%), employed (58%) and had no religious affiliation (66%). Most had future educational goals (91%). Many smoked tobacco (38%) or marijuana (15%). Most participants had had at least one birth (87%; median parity two; range, 0–5) and at least one abortion (71%). Most (94%) had a regular sexual partner, who was neutral or supportive of her decision to terminate (61%). Only 6.5% of participants reported resuming sexual activity sooner than they had wanted. Most had a primary care physician (77%) and regular gynecologic care (66%).While 98% had used contraceptives and 76% had used a method after their last pregnancy; only 39% were using contraceptives when they became pregnant this time. Many participants (41%) did not know when their fertility returned, and many (41%) did not go to a postpregnancy follow-up appointment. Outcomes: Rapid repeat pregnancy may be related to lack of information about postpregnancy fertility and to contraceptive nonuse. Future studies should assess contraceptive counseling during pregnancy and specific barriers to postpregnancy contraceptive access. http://dx.doi.org/10.1016/j.contraception.2015.06.153
Utilization of postnatal care services and knowledge of postpartum danger signs among women attending selected health facilities in Ibadan, Nigeria Alere M University of Ibadan, Department of Preventive Medicine and Primary Care, Ibadan, Oyo, Nigeria Owoaje E, Ige O Objectives: This study was designed to assess awareness of postpartum danger signs and utilization of postnatal care services among women utilizing the infant welfare clinics of selected primary health care facilities in Ibadan, Nigeria. Methods: A cross-sectional study of 400 women who had a delivery in the past year was conducted between May and June 2011. A semistructured questionnaire was used to collect data on social and demographic characteristics, awareness of postpartum danger signs and utilization of postnatal care services. Chi-square test was used to determine associations between categorical variables. Results: Most (71.8%) respondents had received antenatal care at least once during pregnancy, 76.8% delivered in hospitals and 12.3% were assisted by a traditional birth attendant. Some 58% reported being informed of postpartum danger signs by health workers. Known danger signs ranged from weakness (44.5%) to foul-smelling vaginal discharge (18%). Sixteen percent of the respondents experienced complications after delivery, most commonly postpartum hemorrhage (53.2%). Many (65.8%) of those who had complications experienced them within a week of delivery. Most (76.7%) sought formal health care, while 23.3% sought traditional care. The prevalence of postnatal service use was 38.3%, while postpartum complications were more common among those who delivered at home and were assisted by traditional birth attendants (39.3%) than among those who delivered in hospitals (29.2%), pb.05.
P104 The role of older siblings in the sexual and reproductive health of Mexican-origin young women Coleman-Minahan K University of Colorado Denver, Denver, CO, USA Scandlyn J Objectives: This study examined the influence of older siblings on the reproductive health of Mexican-origin young women. Methods: Reproductive health outcomes among Mexican-origin adolescents were examined using data from life history interviews conducted in 2014 with 21 first- and second-generation Mexican-origin women, aged 27–39, in Denver. Qualitative results were then tested using quantitative data from 1638 Mexican-origin participants from the National Longitudinal Study of Adolescent Health, Waves I–IV. The qualitative participants are currently the same ages as the Add Health participants. Results: Qualitative data suggested four ways older siblings protected younger siblings from risky sexual behaviors: older siblings, especially sisters, were often responsible for caring for their younger siblings; sibling relationships were close and supportive; older siblings provided advice, such as encouraging contraceptive use; and younger siblings learned from their older siblings' experiences. The hypothesis that older siblings are protective in Mexican-origin families was tested using Add Health data. Results demonstrated that having an older sibling in the home decreased the hazard of sexual initiation by 14% (HR, 0.86, p=.092), doubled the odds of
ABSTRACTS / Contraception 92 (2015) 359–414
P101 Understanding pregnancy intention and contraceptive decision making among Native Hawaiians: focus groups with women and men Elia J University of Hawai‘i John A. Burns School of Medicine, Honolulu, HI, USA Soon R, Beckwith N, Uemoto M, Kaneshiro B, De ver Dye T Objectives: Native Hawaiians report the highest rates of unintended pregnancy in Hawaii. We aimed to qualitatively describe factors related to pregnancy planning among this population. Methods: Eight focus groups were conducted among native Hawaiian adults, organized by gender and age, as part of a community-engaged research project. A vignette of a native Hawaiian couple in their late teens was used to discuss their relationship, attitudes toward pregnancy and unplanned pregnancy decision making. Audio-recordings were transcribed and analyzed through content analysis. Results: Of 52 participants, 30 (57.7%) were women, median age group was 41–45 years and 24 (46.2%) were rural. Three-quarters (76.7%) of women and 59.1% of men reported experiencing an unplanned pregnancy. Ideal circumstances before childbearing and future aspirations were consistently identified as motivations to avoid pregnancy; however, participants also discussed intergenerational and social norms affecting earlier childbearing. Unintended pregnancy was considered more common and accepted among native Hawaiians than among others. Family structure and collectivist culture influenced pregnancy decision making among this group. Perceived responsibility to “own up” to one's actions and strong family support were cited as reasons to encourage women to continue an unplanned pregnancy. The Hawaiian cultural practice of hānai (informal adoption) was mentioned because it allows a baby to stay within the family. While some prochoice voices emerged, abortion was generally viewed as an uncommon, undesirable “last resort” in the native Hawaiian community. Outcomes: While native Hawaiians value educational and career goals, other community values make unplanned pregnancy less burdensome and more acceptable, which may lessen motivations to avoid pregnancy. http://dx.doi.org/10.1016/j.contraception.2015.06.151
P102
Outcomes: Use of postnatal services is low compared with antenatal care service use. More attention should also be focused on the quality of postnatal services. http://dx.doi.org/10.1016/j.contraception.2015.06.152
P103 Rapid repeat pregnancy among women seeking pregnancy termination: a descriptive study Liu T Baystate Medical Center, Springfield, MA, USA White K Objectives: Rapid repeat pregnancy is often unintended but has not been previously studied in the context of abortion. Methods: We conducted a cross-sectional study of women seeking termination at a single clinic, whose current pregnancy began less than 18 months after another pregnancy. We performed descriptive analyses of demographic characteristics, relationship characteristics and healthcare experiences. Results: The 125 participants presented after a birth (48%), abortion (48%) or miscarriage (3%). The median interpregnancy interval was 6 months (IQR 3.5–10). Most participants were young, (median age 25.5; range, 17–45), White (78%), employed (58%) and had no religious affiliation (66%). Most had future educational goals (91%). Many smoked tobacco (38%) or marijuana (15%). Most participants had had at least one birth (87%; median parity two; range, 0–5) and at least one abortion (71%). Most (94%) had a regular sexual partner, who was neutral or supportive of her decision to terminate (61%). Only 6.5% of participants reported resuming sexual activity sooner than they had wanted. Most had a primary care physician (77%) and regular gynecologic care (66%).While 98% had used contraceptives and 76% had used a method after their last pregnancy; only 39% were using contraceptives when they became pregnant this time. Many participants (41%) did not know when their fertility returned, and many (41%) did not go to a postpregnancy follow-up appointment. Outcomes: Rapid repeat pregnancy may be related to lack of information about postpregnancy fertility and to contraceptive nonuse. Future studies should assess contraceptive counseling during pregnancy and specific barriers to postpregnancy contraceptive access. http://dx.doi.org/10.1016/j.contraception.2015.06.153
Utilization of postnatal care services and knowledge of postpartum danger signs among women attending selected health facilities in Ibadan, Nigeria Alere M University of Ibadan, Department of Preventive Medicine and Primary Care, Ibadan, Oyo, Nigeria Owoaje E, Ige O Objectives: This study was designed to assess awareness of postpartum danger signs and utilization of postnatal care services among women utilizing the infant welfare clinics of selected primary health care facilities in Ibadan, Nigeria. Methods: A cross-sectional study of 400 women who had a delivery in the past year was conducted between May and June 2011. A semistructured questionnaire was used to collect data on social and demographic characteristics, awareness of postpartum danger signs and utilization of postnatal care services. Chi-square test was used to determine associations between categorical variables. Results: Most (71.8%) respondents had received antenatal care at least once during pregnancy, 76.8% delivered in hospitals and 12.3% were assisted by a traditional birth attendant. Some 58% reported being informed of postpartum danger signs by health workers. Known danger signs ranged from weakness (44.5%) to foul-smelling vaginal discharge (18%). Sixteen percent of the respondents experienced complications after delivery, most commonly postpartum hemorrhage (53.2%). Many (65.8%) of those who had complications experienced them within a week of delivery. Most (76.7%) sought formal health care, while 23.3% sought traditional care. The prevalence of postnatal service use was 38.3%, while postpartum complications were more common among those who delivered at home and were assisted by traditional birth attendants (39.3%) than among those who delivered in hospitals (29.2%), pb.05.
P104 The role of older siblings in the sexual and reproductive health of Mexican-origin young women Coleman-Minahan K University of Colorado Denver, Denver, CO, USA Scandlyn J Objectives: This study examined the influence of older siblings on the reproductive health of Mexican-origin young women. Methods: Reproductive health outcomes among Mexican-origin adolescents were examined using data from life history interviews conducted in 2014 with 21 first- and second-generation Mexican-origin women, aged 27–39, in Denver. Qualitative results were then tested using quantitative data from 1638 Mexican-origin participants from the National Longitudinal Study of Adolescent Health, Waves I–IV. The qualitative participants are currently the same ages as the Add Health participants. Results: Qualitative data suggested four ways older siblings protected younger siblings from risky sexual behaviors: older siblings, especially sisters, were often responsible for caring for their younger siblings; sibling relationships were close and supportive; older siblings provided advice, such as encouraging contraceptive use; and younger siblings learned from their older siblings' experiences. The hypothesis that older siblings are protective in Mexican-origin families was tested using Add Health data. Results demonstrated that having an older sibling in the home decreased the hazard of sexual initiation by 14% (HR, 0.86, p=.092), doubled the odds of