Prediction of Unwanted Pregnancies Using Logistic Regression, Probit Regression & Discriminant Analysis

BACKGROUND:

Unwanted pregnancy not intended by at least one of the parents has undesirable consequences for the family and the society. In the present study, three classification models were used and compared to predict unwanted pregnancies in an urban population.

METHODS:

In this cross-sectional study, 887 pregnant mothers referring to health centers in Khorramabad, Iran, in 2012 were selected by the stratified and cluster sampling; relevant variables were measured and for prediction of unwanted pregnancy, logistic regression, discriminant analysis, and probit regression models and SPSS software version 21 were used. To compare these models, indicators such as sensitivity, specificity, the area under the ROC curve, and the percentage of correct predictions were used.

RESULTS:

The prevalence of unwanted pregnancies was 25.3%. The logistic and probit regression models indicated that parity and pregnancy spacing, contraceptive methods, household income and number of living male children were related to unwanted pregnancy. The performance of the models based on the area under the ROC curve was 0.735, 0.733, and 0.680 for logistic regression, probit regression, and linear discriminant analysis, respectively.

CONCLUSION:

Given the relatively high prevalence of unwanted pregnancies in Khorramabad, it seems necessary to revise family planning programs. Despite the similar accuracy of the models, if the researcher is interested in the interpretability of the results, the use of the logistic regression model is recommended.

The frequency distribution of all pregnancies and unwanted pregnancies among women referred to the health centers in Khorramabad in 2012

Variable	Category	Total pregnancies*	Unwanted pregnancies *	p **
Mother's age (years)	< 20 20-34 ≥ 35	7.1 (63) 82.4 (730) 10.5 (94)	20.6 (13) 23.0 (168) 45.7 (43)	<0.001
Husband's age (years)	< 25 25-39 ≥ 40	9.4 (84) 78.7 (698) 11.9 (106)	16.7 (14) 25.0 (174) 32.1 (34)	0.050
Age difference between husband and wife (years)	< 0 0-4 5-9 ≥10	(71) (369) (335) (107)	18.3 (13) 24.4 (90) 26.6 (89) 28.0 (30)	0.439
The number of living male children	0 1 ≥ 2	68.9 (592) 24.0 (206) 7.1 (61)	18.8 (111) 34.0 (70) 67.2 (41)	<0.001
The number of living female children	0 1 ≥ 2	70.3 (604) 23.2 (199) 6.5 (56)	21.2 (128) 34.7 (69) 44.6 (25)	0.003
Parity	1 2 ≥3	47.1 (417) 35.7 (317) 17.2 (153)	15.8 (66) 22.4 (71) 56.9 (87>)	<0.001
Pregnancy spacing (years)	First pregnancy <2 2 - 4 ≥ 4	48.3 (417) 7.2 (62) 9.6 (83) 34.9 (301)	15.8 (66) 51.6 (32) 42.2 (35) 29.6 (89)	<0.001
Mother’s educational attainment	Illiterate high school diploma or lower University degree	2.8 (25) 77.4 (686) 19.8 (176)	60.0 (15) 24.8 (170) 22.2 (39)	<0.001
Husband’s educational attainment	Illiterate high school diploma or lower University degree	2.7 (24) 73.6 (653) 23.7 (210)	58.3 (14) 24.3 (159) 24.3 (51)	0.005
Mother’s occupation	Housewife Employee Self-employed	91.0 (807) 6.9 (61) 2.1 (19)	25.4 (205) 21.3 (13) 31.6 (6)	0.664
Husband’s occupation	Unemployed Worker Employee Self-employed	2.8 (25) 16.0 (142) 29.8 (267) 51.3 (454)	36.0 (9) 29.6 (42) 22.7 (60) 24.9 (113)	0.264
Monthly household income (Rials)	<7.5 million 7.5 million-9.9 million ≥10 million	23.2 (206) 51.3 (455) 25.5 (226)	32.5 (67) 20.9 (95) 27.4 (62)	0.004
Contraceptive method	None Natural/Traditional Condoms Oral Contraceptive Pills Other	15.3 (136) 37.4 (332) 13.2 (117) 26.0 (231) 8.0 (71)	16.2 (22) 21.4 (71) 29.1 (34) 34.6 (80) 23.9 (17)	<0.001
Ownership status of the residence	Personal Parent’s Rented	27.0 (237) 25.5 (224) 47.6 (418)	26.2 (62) 24.1 (54) 25.6 (107)	0.860
The substructure of the residence (m2)	< 100 100-199 ≥200	34.4 (302) 53.8 (473) 11.8 (104)	28.1 (85) 24.3 (115) 22.1 (23)	0.338
Ownership of a personal vehicle	Yes No	42.2 (373) 57.8 (511)	23.1 (86) 26.4 (135)	0.149

*: The numbers in each cell indicates % (frequency).

**: The statistical test used is chi-square.

Full article at:   http://goo.gl/azTrPz

By:  Ebrahimzadeh F1, Hajizadeh E2, Vahabi N3, Almasian M4, Bakhteyar K5.

• 1Biostatistics Instructor, Department of Statistics and Epidemiology, Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, & PhD Candidate in Biostatistics, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. farzadebrahimzadeh2012@gmail.com , ebrahimzadeh@modares.ac.ir.
• 2Associate Professor, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. hajizadeh@modares.ac.ir.
• 3PhD Candidate in Biostatistics, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. nasim.vahabi@modares.ac.ir.
• 4English Language Instructor, Department of the English Language, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran. almasian2@gmail.com.
• 5Midwifery Instructor, Department of Public Health, Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran. k_bakhteyar@yahoo.com. 

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A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists

Background

The oral contraceptive pill (OCP) remains the most popular form of prescription contraception in many countries, despite adherence difficulties for many. Uptake of long acting reversible contraceptives (LARCs), which are less reliant on user adherence, remains low. The aim of this study was to explore the experiences of, and attitudes towards, prescription contraception amongst samples of contraception users, general practitioners (GPs) and pharmacists.

Methodology and Findings

We conducted a qualitative study using semi-structured interviews with 18 contraception users, 18 GPs and 9 pharmacists. The study took place in Galway, Republic of Ireland between June and September 2014. Thematic analysis was used to analyse the data. Overall, contraception users were more familiar with the OCP, and all the women interviewed began their prescription contraception journey using this method. All participants identified episodes of poor adherence throughout the reproductive life course. The identified barriers for use of LARCs were lack of information, misconceptions, lack of access and high cost. In contrast, GPs believed that adherence to the OCP was good and stated they were more likely to prescribe the OCP than other methods, as they were most familiar with this option. Barriers to prescribing LARCSs were time, cost to practice, training and deskilling. Pharmacists also believed that adherence to the OCP was generally good and that their role was limited to dispensing medication and providing information when asked.

Discussion and Conclusion

There are contrasting perspectives between contraception service providers and contraceptive users. Training for healthcare providers is required to support informed contraceptive choice and adherence. It is necessary to address the practice barriers of cost and lack of time, to promote better communication around adherence issues and prescription contraception options. There is a need for more easily-accessible public health information to promote awareness on all methods of prescription contraception.

Full article at:  http://goo.gl/W57XxN

By:  

Leigh-Ann Sweeney, Gerard J. Molloy, Molly Byrne

School of Psychology, National University of Ireland, Galway, Republic of Ireland

Leigh-Ann Sweeney, Gerard J. Molloy, Molly Byrne

Whitaker Institute for Innovation and Societal Change, National University of Ireland, Galway, Republic of Ireland

Andrew W. Murphy

Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Republic of Ireland

Karen Morgan

Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland

Karen Morgan

Perdana University Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia

Carmel M. Hughes

School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom

Roger Ingham

Centre for Sexual Health Research, University of Southampton, Southampton, United Kingdom

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Level, Trend & Correlates of Mistimed & Unwanted Pregnancies among Currently Pregnant Ever Married Women in India

Unintended pregnancy accounts for more than 40% of the total pregnancies worldwide. An Unintended pregnancy can have serious implications on women and their families. With more than one-fourth of the children in India born out of unintended pregnancies such pregnancies are considered to be one of the major public health concerns today. 

The present study is aimed at determining major predictors of unintended pregnancy among currently pregnant ever-married women in India. The present study has used National Family Health Survey (NFHS) data, conducted by the International Institute for Population Sciences (IIPS), Mumbai, to show the trend, pattern and determinants of mistimed and unwanted pregnancies. Bivariate and multinomial logistic regression model have been used with the help of Stata 13 software. 

The results show that the likelihood of a mistimed pregnancy is more prevalent among young women whereas the prevalence of unwanted pregnancy is observed more among the women aged 35 years or more. The results also show that the risk of experiencing mistimed pregnancy decreases if the woman belongs to 'other' castes and has higher education. The likelihood of unwanted pregnancy decreases among married women aged 18 years and above, those women having higher education, some autonomy and access to any mode of mass communication. 

Knowledge of these predictors of mistimed and unwanted pregnancy will be helpful in identifying the most vulnerable group and prioritize the intervention strategies of the reproductive health programmes for the population in need.

Below:  Trend of pregnancy intention among currently pregnant married women

Full article at:  http://goo.gl/TCAeuR

By:  Dutta M1, Shekhar C1, Prashad L2.

• 1Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
• 2School of Social Sciences, Tata Institute of Social Sciences, Mumbai, India. 

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Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy

INTRODUCTION:

The safety of abortion in the United States has been documented extensively. In the context of unwanted pregnancy, however, there are few data comparing the health consequences of having an abortion versus carrying an unwanted pregnancy to term.

METHODS:

We examine and compare the self-reported physical health consequences after birth and abortion among participants of the Turnaway Study, which recruited women seeking abortions at 30 clinics across the United States. We also investigate and report maternal mortality among all women enrolled in the study.

RESULTS:

In our study sample, women who gave birth reported potentially life-threatening complications, such as eclampsia and postpartum hemorrhage, whereas those having abortions did not. Women who gave birth reported the need to limit physical activity for a period of time three times longer than that reported by women who received abortions. Among all women enrolled in the Turnaway Study, one maternal death was identified-one woman who had been denied an abortion died from a condition that confers a higher risk of death among pregnant women.

CONCLUSION:

These results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after unwanted pregnancy.

Table 2Reported Side Effects and Health Problems by Study Group (N = 868)

Variable	Turnaways (n = 143)	Near Limits (n = 452)	First Trimesters (n = 253)	pValue††
Limitations on physical activity, n (%)
Limitations on physical activity reported in days (mean, SD)	10.1 (11.69)∗	2.9 (2.6)	3.2 (3.6)	<.001
Side effects or health problems, n (%)
Any reported side effects/health problems, n (%)	16 (11.2)	55 (12.2)	28 (10.3)	.84
Potentially life-threatening condition reported, n (%)	9 (6.3)∗	5 (1.1)	1 (0.4)	<.001
Side effect/health problem reported, n (%)
Abdominal cramping	0 (0)	12 (3)	6 (2)
Abnormal bleeding	2 (1)	10 (2)	6 (2)
Nausea/vomiting/gastrointestinal upset	0 (0)	3 (1)	8 (3)
Pain	0 (0)	16 (4)	9 (3)
Preeclampsia‡‡	3 (2)	1 (0.5)	0 (0)
Infection‡‡	1 (1)	3 (1)	1 (0.5)
Dizziness	0 (0)	3 (1)	2 (1)
Weakness or fatigue	0 (0)	4 (1)	3 (1)
Breast changes	0 (0)	4 (1)	1 (0.5)
Low blood pressure	1 (1)	1 (0.5)	0 (0)
Normal/light bleeding	0 (0)	2 (0.5)	3 (1)
Anemia	1 (1)	0 (0)	0 (0)
Blood transfusion‡‡	2 (1)	0 (0)	0 (0)
Bruises secondary to procedure/equipment	0 (0)	3 (1)	0 (0)
Disrupted caesarean wound‡‡	1 (1)	0 (0)	0 (0)
Eclampsia/seizure‡‡	1 (1)	0 (0)	0 (0)
Edema	0 (0)	4 (1)	0 (0)
Fever	0 (0)	4 (1)	0 (0)
Fractured pelvis	1 (1)	0 (0)	0 (0)
Headache	0 (0)	2 (0.5)	1 (0.5)
Hypokalemia	1 (1)	0 (0)	0 (0)
Postpartum hemorrhage‡‡	1 (1)	0 (0)	0 (0)
Retained placenta‡‡	1 (1)	0 (0)	0 (0)
Allergic reaction to anesthesia‡‡	0 (0)	1 (0.5)	0 (0)
Hemorrhoids	0 (0)	1 (0.5)	0 (0)

∗p < .05 for comparisons between near limits and other study groups.

†Uncorrected p-value is based on multiple comparisons with “near limits” as the reference group.

‡Denotes a potentially life-threatening condition.

Full article at:  http://goo.gl/R8tOQY

By:  Gerdts C1, Dobkin L2, Foster DG2, Schwarz EB3.

• 1Ibis Reproductive Health, Oakland, California. Electronic address: cgerdts@ibisreproductivehealth.org.
• 2Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
• 3Department of Medicine, University of California, Davis, Sacramento, California. 

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Factors Associated with Early Resumption of Sexual Intercourse among Postnatal Women in Uganda

Background

Despite being a key component to be addressed during postnatal period, sexuality has long been a subject of secrecy and taboo in Africa. Resumption of sexual intercourse after giving birth has been shown to reduce extramarital affairs and consequently reduce risk of sexually transmitted infections like HIV/AIDS. Consequences of early resumption of sexual intercourse include unwanted pregnancy, genital trauma and puerperal infection. The objective of the study was to assess prevalence and factors associated with early resumption of sexual intercourse among postnatal mothers attending postnatal clinic at a National referral Hospital in Uganda.

Methodology

A cross-sectional study that employed an interviewer-administered questionnaire was conducted among 374 women who delivered six months prior to conducting the study. The independent variables included socio-demographic characteristics of the participant, socio-demographic characteristics of the spouse, perceived cultural norms, medical history, mode of delivery, and postpartum complications. The dependent variable was timing of resumption of sexual intercourse after childbirth (before or after six weeks postpartum). Data were analysed using SPSS version 16.0.

Results

The study showed that 105 participants (21.6 %) had resumed sexual intercourse before 6 weeks after childbirth. The participants’ education level, occupation, and parity; education level of the spouse, age of baby and use of family planning were the factors associated with early resumption of sexual intercourse after child birth (before six weeks postpartum) (p < 0.05).

Conclusion

Many women resumed sexual intercourse after six weeks. Women with high income, low parity, who ever-used contraception or had a spouse with high education level were more likely to have early resumption of sexual intercourse.

Full article at:  http://goo.gl/QyG4vY

By:  Alice C. Alum¹, Irene B. Kizza², Charles P. Osingada¹, Godfrey Katende² and Dan K. Kaye^3*

¹Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda

²Adult Health and Critical Care Department, College of Nursing, Sultan Qaboos University, Alkhod, Muscat, PC 123, Oman

³Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

 

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Prevalence of Sexual Coercion & Its Association with Unwanted Pregnancies among Young Pregnant Females in Kampala, Uganda: A Facility Based Cross-Sectional Study

Sexual coercion is associated with sexually transmitted infections and unwanted pregnancies with consequential unsafe abortions and increased maternal morbidity and mortality. Current literature focuses mainly on its risk factors but less on its resultant deleterious health effects. We conducted a study to determine the prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant women.

In a cross-sectional study, four hundred and sixteen (416) consenting pregnant females aged 15–24 years attending antenatal clinics in Lubaga division Kampala district in Uganda were enrolled using systematic sampling. Quantitative and qualitative data on sexual coercion were collected by female interviewers.

Adjusted Prevalence Proportion Ratios (Adj. PPRs) of unwanted pregnancy and associated 95 % confidence intervals were estimated by generalized linear models with log link function and Poisson family distribution using robust variance estimator. Quantitative data were analyzed using Stata version 10.0, while qualitative data were analyzed using manifest content analysis.

Prevalence of sexual coercion was 24% and was higher among those who had non consensual sexual debut (29.0%) compared with those who had consensual sexual debut (22.6%). The prevalence of unwanted pregnancy was 18.3 % and was higher among participants who had been sexually coerced relative to their counterparts. History of sexual coercion in the past 12 months and non consensual sexual debut were associated with unwanted pregnancy [adj.PPR = 2.23, 95 % CI: (1.49-3.32)] and 1.72, 95 % CI: (1.16- 2.54)] respectively. Qualitative results indicated that different forms/contexts of sexual coercion, such as deception, transactional sex and physical force influenced unwanted pregnancies.

This study highlights that a quarter of our participants in our quantitative study had experienced sexual coercion in the past twelve months and nearly a third of these, had history of non consensual sexual debut. Unwanted pregnancy was higher among the sexually coerced and those who had non consensual sexual debut.

Sexual coercion among pregnant women aged 15–24 years in Kampala, Uganda is high and is significantly associated with unwanted pregnancy. Comprehensive sex education targeting young people (<25 years), along with availability and access to youth friendly centers may be useful in addressing sexual coercion and its negative outcomes.

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By: Suzan Tusiime^1*, Geofrey Musinguzi¹, Benjamin Tinkitina¹, Norah Mwebaza², Rose Kisa¹,Ronald Anguzu¹ and Noah Kiwanuka¹

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