Consequences of Unwanted Childbearing for Women and Children

描述（由申请人提供）：假设意外生育对儿童和父母的健康、社会和经济有重大危害，这是投资计划生育项目的主要理由。虽然支持这些说法的文献很多，但其中许多工作在方法上存在严重的局限性，特别是对低收入非西方社会的研究。意外怀孕的测量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描述在受孕时不想要的出生为不想要的，而是将其修改为想要的或不合时宜的。拟议的项目侧重于与意外生育有关的潜在健康后果，即那些声称不想要更多孩子的母亲所生的孩子。通过对来自印度四个邦（比哈尔邦、贾坎德邦、马哈拉施特拉邦和泰米尔纳德邦）的大量农村出生样本的分析，该研究将通过确定意外生育对孕产妇和儿童健康结果的影响，大大补充文献。这项研究的一个显著优势是使用了一种对出生不想要的前瞻性测量，这将克服以往研究面临的许多偏见。具体而言，该研究将调查意外生育对围产期、新生儿、新生儿后期和1-2岁死亡率、产前护理的时机和利用、幼儿免疫接种以及产妇抑郁和心理健康的影响。该分析使用了两个来源的数据；1998-99年印度全国家庭健康调查（NFHS-2）和2002-03年的后续调查，其中来自四个州的6303名妇女被纳入NFHS-2，在这四年期间就分娩和健康结果重新接受了采访。将采用多层次建模方法来确定生育意愿与随后的儿童和孕产妇健康结果之间的关联。这项研究将对了解在资源贫乏环境中意外生育对不利的儿童和孕产妇健康的促进作用作出重要的实质性贡献，并在方案上了解有效的计划生育方案对改善儿童健康和孕产妇福祉可能作出的贡献。

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.