Consequences of Unwanted Childbearing for Women and Children

描述(由申请人提供)：不想要的生育被认为会对儿童和父母的健康、社会和经济造成严重的不利影响，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，但这些工作中的大部分都有严重的方法局限性，特别是对低收入非西方社会的研究。意外怀孕的衡量因一些严重的方法挑战而变得复杂；其中最重要的是生育合理化问题，根据这一问题，答复者可能不愿回顾地将怀孕时不想要的婴儿描述为不想要的婴儿，而是将其修改为想要的或错误的时间。拟议的项目侧重于与不想要孩子有关的潜在健康后果--不想要孩子的母亲说他们不想要更多孩子的母亲所生的孩子。通过对印度四个邦(比哈尔邦、恰尔肯德邦、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，这项研究将通过确定意外出生对孕产妇和儿童健康结果的影响，大大增加文献的内容。这项拟议的研究的一个显著优势是使用了一种对出生时不受欢迎的前瞻性衡量标准，这将克服之前研究面临的许多偏见。具体地说，这项研究将考察意外生育对围产期、新生儿、新生儿后和1-2年死亡率的影响，对产前护理的时机和利用的影响，对儿童早期免疫的影响，以及对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：1998-1999年印度国家家庭健康调查(NFHS-2)和2002-03年的后续调查，其中来自四个邦的6303名妇女被纳入NFHS-2，就其间四年期间的生育和健康结果进行了重新访谈。将采用多层次建模方法来确定生育意愿和随后的儿童和孕产妇健康结果之间的联系。这项研究将对了解不想要的生育在资源匮乏的环境中对儿童和产妇健康不利的贡献，以及从方案上理解有效的计划生育方案对改善儿童健康和产妇福祉的潜在贡献做出重要的实质性贡献。 公共卫生相关性：利用来自印度4个邦的两个育龄妇女横断面样本，这项研究将检查怀孕不受欢迎与孕产妇、儿童和心理健康结果之间的关系。对于母亲，分析将审查怀孕意外在形成怀孕期间获得护理的机会和心理健康结果方面的作用；对于孩子，分析将检查怀孕意外、婴儿早期死亡率和接受免疫接种之间的关系。

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.