Who is having intended births:Analysis of two adolescent birth cohorts (2000-2001 and 2010-2011)

Isia Rech Nzikou Pembe and Ann Dozier, RN PhD University of Rochester

Department of Public Health Sciences

I. Background

III. Methods

IV. Results

V. Conclusions

VI. Implications

VII. Limitations Wanted to

be pregnant sooner

Wanted to be

pregnant then

IntendedWanted to

be pregnant

later

Did not want to be pregnant then or in

future

Unintended

Data Source: Birth registry of all live hospital births in a 9 county region of Upstate New York [one urban; 8 rural]. Data collected post-birth: maternal interviews, prenatal/hospital recordsCohorts: births in 2000-2001 (00/01) and 2010-2011 (10/11)Inclusion Criteria: mothers 12-19 years of age; no prior live birthExclusion Criteria: No response to pregnancy intention questionAfter applying exclusion criteria: 2000/01 cohort: 3069 births 2252 births (73.4%)2010/11 cohort: 2369 births 1614 births (68.1%)

Dependent Variable: Intention classified as :

Compare 2 cohorts of adolescent mothers with live births by pregnancy intention to determine:• changes in incidence of intended births • characteristics of those with intended births• differences by intention status within the two cohorts

US adolescent pregnancy and birth rates declined since 1990s but remain among the highest in the developed world • ~18% of all US pregnancies to adolescents are

intended or ambivalent. Some adolescents actively plan their pregnancies and intend to give birth• Perception about benefits of childbearing• Uncertain effectiveness of pregnancy prevention

interventions for these adolescents

Notable Results from Table 1:28.3% fewer births to adolescents over the 10 year period Compared to 00/01 the 10/11 cohort had fewer mothers who were: • Age (12-17); High School graduates; Early

prenatal care (1st Trimester)• 10% more adolescents with intended births

had a paternity acknowledgementNotable Results from Table 2:About 5% fewer intended births over the 10 year period; Significant relationship with birth intention(p< 0.10) included in regression model:

2000/01 Cohort 2010/11 Cohort

AgeRace – BlackForeign Born

Prior Pregnancies (no live birth)

Medicaid Funded BirthCounty of Birth – Urban

Smoker Pre-PregnancyPaternity AcknowledgementFather Hispanic

2000/01 Cohort 2010/11 Cohort

GREATER LIKELIHOOD OF INTENDED BIRTH

Age (18-19)Prior Pregnancies (no live birth)

Race – BlackHispanicMedicaid Funded

Paternity Acknowledgement

LESS LIKELIHOOD OF INTENDED BIRTH

Mother US Born

Notable Results from Table 3:Variables with statistically significant relationship to birth intention (p<.05):

• Pregnancy intent was asked in the immediate postpartum period - could bias responses • Secondary data analysis limited to available data (e.g. missing some personal factors,

contraceptive use) and missing/incomplete data (e.g. paternal age/education)• Results could be unique to the region in which the study was conducted.

Acknowledgments: Joseph Duckett, Information Analyst University of Rochester, Department of Public Health Sciences

• As with US trends, adolescent births declined; Intended births also declined

• Those ages 18-19 and those with Paternity Acknowledgement most likely to have intended births

• Maternal education level and birth intention not related

II. Purpose

• Partner influence and perceived partner desire for pregnancy may contribute to intended pregnancies

• Adolescents intending pregnancies might not grasp the full extent of what it means to become parents and often times are under the impression that having a baby will create a stable family unit

• Black race and Hispanic ethnicity were significant factors in the earlier but not the later cohort• Prior pregnancy (or pregnancies) increased the risk for subsequent pregnancy (especially if the first pregnancy did not turn out as planned)

aOnly hospital births. bVariable is missing <10% of its data in the 2000 to 2001 cohort; cVariable is missing <10% of its data in the 2010 to 2011 cohort. dBirth certificate data from a 9 county region with one primarily urban county. eVariable not collected in the 2000-2001 cohort.fResults in BOLD indicate significant differences ( ≥10% ) amongst both cohorts.

Table 3. Binary Logistic Regression Models Intended Births to Adolescent Mothers ≤ 19 Years Old (only variables with significant bivariate relationships)

2000/01 Cohort 2010/11 CohortOR [95% CI] OR [95% CI]

Maternal Characteristics [ref]Age 18-19 [12-17] 1.56 [1.25-1.94] 2.30 [1.66-3.20]Black Race [No] 1.40 [1.09-1.80] 0.87 [0.64-1.19]Hispanic [No] 1.47 [1.03-2.10] 1.24 [0.87-1.75]≥ High School Education [<High School] 0.81 [0.64-1.01] 0.80 [0.62-1.04]Country of Birth - USA [Foreign Born] 0.59 [0.39-0.89] 0.51 [0.28-0.93] Prenatal History & Birth Variables [ref]Pre-pregnancy Smoker [Non – Smoker]b 1.00 [0.81-1.24] 1.15 [0.89-1.49]Prior Pregnancies - ≥ 1 [0] 1.36 [1.08-1.71] 1.57 [1.18-2.11]Medicaid Funded Birth [Other] 1.38 [1.12-1.68] 1.03 [0.80-1.32]County of Birth – Urban [No]c 1.08 [0.86-1.36] 0.92 [0.69-1.21]Paternity Acknowledgement. [No] 0.98 [0.82-1.19] 1.82 [1.39-2.37]

Table 1. Characteristics of births from two Upstate New York birth cohorts to adolescent mothers ≤ 19

Table 2. Bivariate Analyses of Birth Intention and Parental Characteristics for two birth cohorts of mothers ≤ 19 (%)

2000/01 2010/11 2000/01 Births (%) 2010/11 Births (%)

Births = 2252 n (%)

Births = 1614n (%)

UnintendedBirths

n = 1578

Intended Births

n = 674

UnintendedBirths

n = 1214

IntendedBirths

n = 400

Maternal CharacteristicsAge

12-17 39.9 27.0 42.1 35.0 30.7 15.7

18-1960.1 73.0 57.9 65.0 69.3 84.3

Black Race 29.7 33.8 27.9 33.8 35.7 28.0Hispanic 11.1 14.6 9.4 15.3 13.8 17.3Education – No HS grad 65.5 51.9 64.6 67.8 53.0 48.5Foreign Born − Yes 6.3 3.0 4.9 9.8 2.4 5.0

Mother’s Prenatal History & Birth VariablesSmoker Pre-pregnancy b 30.5 31.0 30.8 29.9 29.6 35.3Pre-Preg. BMI − Nmlc 62.5 63.0 62.5 62.5 62.6 64.3Prior Pregnancies − Yes 18.8 17.2 17.0 23.0 15.0 23.7Began care 1st Trimester 65.2 55.6 65.8 63.8 54.9 59.0Income Proxies Prenatal WIC 72.4 77.6 71.9 73.6 77.7 77.3 Medicaid Funded Birth 60.2 66.7 57.1 67.5 66.6 66.8County of Birth − Urband 60.5 63.0 58.6 65.1 64.0 60.0

Father’s CharacteristicsPaternity Acknow. −Yes 54.3 64.4 55.0 52.7 60.7 75.5Hispanice -- 46.3 -- -- 51.5 30.7bVariable is missing <10% of its data in the 2000 to 2001 cohort; cVariable is missing <10% of its data in the 2010 to 2011 cohort. dBirth certificate data from a 9 county region with one primarily urban county. eVariable not collected in the 2000-2001 cohort.fResults in BOLD indicate significant differences ( ≥10% ) amongst both cohorts or if BOLD only significant in one cohort