Consequences of Unwanted Childbearing for Women and Children

描述（由申请人提供）：假设不想要的生育对儿童和父母的健康、社会和经济产生重大不利影响，这是投资计划生育项目的主要理由。虽然支持这些主张的文献很多，但其中大部分工作存在严重的方法论局限性，特别是对低收入非西方社会的研究。计量意外怀孕的工作因一些严重的方法挑战而复杂化;其中最重要的是生育合理化问题，即受访者可能不愿意回顾性地将受孕时不想要的生育描述为不想要的生育，而是将其修改为想要的或时机不当的生育。拟议项目的重点是与非意愿生育有关的潜在健康后果-即母亲表示不想要更多孩子。通过分析印度四个邦（比哈尔邦、贾坎德、马哈拉施特拉邦和泰米尔纳德邦）农村出生的大量样本，研究将通过查明意外生育对孕产妇和儿童健康结果的影响，大大丰富文献。这项研究的一个显著优势是使用了一种前瞻性的出生不受欢迎的衡量标准，这将克服以往研究所面临的许多偏见。具体而言，该研究将审查意外生育对围产期、新生儿、新生儿后期和1-2年死亡率的影响，对产前护理的时机和利用情况的影响，对幼儿免疫接种的影响，以及对产妇抑郁症和心理健康的影响。分析使用的数据来自两个来源：1998-99年印度全国家庭健康调查（NFHS-2）和2002-03年的后续调查，其中6 303名妇女从四个国家谁被列入NFHS-2重新采访了关于出生和健康结果在干预四年期间。一个多层次的建模方法将被用来确定出生需求和随后的儿童和孕产妇健康结果之间的关联。这项研究将作出重要的实质性贡献，以了解不想要的生育对不利的儿童和孕产妇健康在资源匮乏的环境中的作用，以及在规划中了解有效的计划生育方案可以改善儿童健康和孕产妇福祉的潜在贡献。 公共卫生相关性：使用来自印度4个邦的育龄妇女的两个横断面样本，本研究将研究怀孕不想要与孕产妇，儿童和心理健康结果之间的关联。对于母亲，分析将审查怀孕意外在形成怀孕期间获得护理和心理健康结果方面的作用;对于儿童，分析将审查怀孕意外，早期婴儿死亡率和接受免疫接种之间的关联。

DESCRIPTION (provided by applicant): Unwanted childbearing has been hypothesized to have significant detrimental health, social and economic consequences for children and parents, and represents a primary justification for investment in family planning programs. While the literature supporting these claims is large, much of this work has serious methodological limitations, especially the research on low-income non-Western societies. The measurement of unintended pregnancy is complicated by a number of serious methodological challenges; foremost among these is the issue of birth rationalization, whereby respondents may be reluctant to retrospectively describe births which were unwanted at the time of conception as unwanted, and instead revise them to have been either wanted or mistimed. The proposed project focuses on the potential health consequences associated with unwanted childbearing-- children who were born to mothers who stated that they did not want more children. Through the analysis of large rural samples of births from four states in India (Bihar, Jharkhand, Maharashtra and Tamil Nadu), the research will add substantially to the literature through the identification of the effects of unwanted births on maternal and child health outcomes. A significant advantage of the proposed research is the use of a prospective measure of birth unwantedness, which will surmount many of the biases faced by previous studies. Specifically, the study will examine the effects of unwanted childbearing on perinatal, neonatal, post-neonatal, and 1-2 year mortality, on the timing and utilization of prenatal care, on early childhood immunization and on maternal depression and mental health. The analysis uses data from two sources; the 1998-99 Indian National Family Health Survey (NFHS-2) and from a 2002-03 follow-up survey, in which 6303 women from four states who were included in the NFHS-2 were re-interviewed regarding births and health outcomes during the intervening four year period. A multi-level modeling approach will be employed to identify associations between birth wantedness and subsequent child and maternal health outcomes. The study will make important substantive contributions to understanding the contributing role of unwanted childbearing to adverse child and maternal health in resource-poor settings, as well as programmatically in understanding the potential contributions which effective family planning programs can make to improving child health and maternal well-being. PUBLIC HEALTH RELEVANCE: Using two cross-sectional samples of women of reproductive age from 4 states of India, this research will examine associations between pregnancy unwantedness and maternal, child and mental health outcomes. For the mother, the analysis will examine the role of pregnancy unwantedness in shaping access to care during pregnancy and mental health outcomes; for the child, the analysis will examine associations between pregnancy unwantedness, early infant mortality and receipt of immunizations.