Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

Background: In 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies. Methods: 4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies. Results: 44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father’s age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner’s age and mother’s education level. The effect of mother’s education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies. Conclusion: A simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This information can be used to target family planning services to those most at risk of unplanned pregnancies, particularly women with a history of depression or who are experiencing intimate partner violence

The correlates of natural method use in Moldova: is natural method use associated with poverty and isolation?

Natural method use is often associated with high levels of unwanted births and induced abortions. This study investigates the correlates of natural method use in Moldova, a country with one of the highest proportions of natural contraceptive users in Europe. We hypothesize that economic and spatial disadvantage increase the reliance on natural methods whereas exposure to FP programs decreases the probability of natural method use. The analysis considers a sub-sample of 5860 sexually-active women from the 2005 Demographic and Health Survey. Results from multilevel multinomial models, controlling for relevant characteristics and data structure, show that economic disadvantage increases the probability of natural method use; but the overall effect is small. Higher FP media exposure reduces natural method use; however this effect attenuates with age. We conclude that FP efforts directed towards the poorest may have limited impact, but interventions targeted at older women could reduce the burden of unwanted pregnancies

Prevalence and Predictors of Unintended Births in Low and Middle-Income Countries: A Pooled Analysis of 27 Nationally Representative Surveys

Introduction Rates of unintended births (UIBs) are disproportionately high in low- and middle-income countries (LMICs) where the capacity to provide care to unexpected mothers and their offspring is often lagging. To decrease the prevalence of UIBs and their negative impacts on children, women, families, communities, and health systems of developing nations, global health stakeholders must understand the characteristics of a woman\u27s life in these regions that increase her risk for UIBs. This project identified and analyzed predictors of UIBs in Sub-Saharan Africa (SSA) and South-East Asia among all women of reproductive age. It built on findings from previous studies while also testing novel determinants in predictive models. The overall goal was to add to the conceptual understanding of sociodemographic, interpersonal, and family dynamic situations that predispose a woman to UIBs while factoring out overly specific regional influences. This can guide future research and inform public health practice in regions where comprehensive and context-specific studies on UIBs have not yet been done. Methods Nationally representative Demographic and Health Survey datasets from 27 LMICs across Africa and South-East Asia were appended. Weighted prevalence and 95% confidence intervals (CIs) were calculated while a Rao-Scott design-adjusted Chi-square test with second-order correction estimated bivariate associations between predictors and UIBs. Multivariate logistic regression models were used to predict odds of UIBs across three blocks of predictor variables. The first block produced unadjusted odds ratios by treating country of residence as the only predictor. The second block added sociodemographic and sexual and reproductive health (SRH) variables, while the third added variables about the woman\u27s partner, family power dynamics, and intimate partner violence. The regression analyses produced adjusted odds ratios (AORs), accompanying 95% CIs, and p-values for each predictor. Results The final sample (n=380,577) had an UIB prevalence of 19.4% (CI = 19.2 – 19.6). Model 3 showed the highest odds of UIBs among women from Lesotho (AOR = 11.13, CI = 8.54 – 14.51), as compared to all other countries; Africa (AOR = 2.62, CI = 2.09 – 3.29) as opposed to South-East Asia; and fragile regions (AOR = 1.44, CI = 1.30 – 1.59) compared to non-fragile regions. Also with the highest odds of UIBs were women aged 15-20 years (AOR = 1.65, CI = 1.40 – 1.94); women who were never married (AOR = 1.82, CI = 1.61 – 2.05), compared to those currently and formerly married; those with a primary education (AOR = 1.59, CI = 1.18 – 2.16); women with a parity of nine or more (AOR = 5.54, CI = 4.37 – 7.03), compared to women with parities of Conclusions Although not statistically significant, relatively low odds of UIBs were observed in women with low SES, no education, without knowledge of modern contraceptives, and whose partners had no education. These findings may indicate that decreased levels of empowerment lead to a lack of FP or women feeling unable to classify births as unintended. Governments and donors associated with Lesotho, Malawi, Namibia, and South Africa are encouraged to increase efforts towards FP outreach and the prevention of UIBs. Stakeholders must pay special attention to UIBs in fragile settings and SSA since these regions had significantly higher odds of UIBs compared to non- fragile regions and South-East Asia, respectively. Women 20 years of age and younger; women not currently married; women married at age nine or younger; women with high parity; women who have their healthcare choices made for them by a family member; and women who had sex forced on them are at significantly higher risk of UIBs. Therefore, SRH practitioners are urged to focus FP programming on these subgroups of women when comprehensive and context-specific studies from which they can inform their practice are not available. Lastly, since several of the sociodemographic and SRH associations with UIBs observed in Model 2 lost statistical significance after adding partner and interpersonal covariates in Model 3, it is important for researchers and survey implementers to take indicators reflective of family dynamics into account in subsequent analyses on UIBs

Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007

<p>Abstract</p> <p>Background</p> <p>Antenatal care aims to prevent maternal and perinatal mortality and morbidity. In Indonesia, at least four antenatal visits are recommended during pregnancy. However, this service has been underutilized. This study aimed to examine factors associated with underutilization of antenatal care services in Indonesia.</p> <p>Methods</p> <p>We used data from Indonesia Demographic and Health Survey (IDHS) 2002/2003 and 2007. Information of 26,591 singleton live-born infants of the mothers' most recent birth within five years preceding each survey was examined. Twenty-three potential risk factors were identified and categorized into four main groups, external environment, predisposing, enabling, and need factors. Logistic regression models were used to examine the association between all potential risk factors and underutilization of antenatal services. The Population Attributable Risk (PAR) was calculated for selected significant factors associated with the outcome.</p> <p>Results</p> <p>Factors strongly associated with underutilization of antenatal care services were infants from rural areas and from outer Java-Bali region, infants from low household wealth index and with low maternal education level, and high birth rank infants with short birth interval of less than two years. Other associated factors identified included mothers reporting distance to health facilities as a major problem, mothers less exposed to mass media, and mothers reporting no obstetric complications during pregnancy. The PAR showed that 55% of the total risks for underutilization of antenatal care services were attributable to the combined low household wealth index and low maternal education level.</p> <p>Conclusions</p> <p>Strategies to increase the accessibility and availability of health care services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with low education are vital to increase their awareness about the importance of antenatal services.</p

Pathways of the determinants of unfavourable birth outcomes in Kenya

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries in Kenya, using graphical loglinear chain models. The results show that a number of factors which do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning, and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various socio- demographic or reproductive factors and birth outcomes

인도네시아 여성들의 의도치 않은 임신 경험과 여성 임파워먼트의 연관성

학위논문(석사) -- 서울대학교대학원 : 보건대학원 보건학과(보건정책관리학전공), 2021.8. 김선영.Often defined as mistimed or unwanted pregnancy, unintended pregnancy causes numerous negative health impacts on women as well as children. It is evident that its negative impacts extend to not only social and economic dimension but also to health dimension within the society. Thus, decreasing the prevalence of unintended pregnancy is imperative in public health. The global society already recognized it as urgent issue and called for addressing this problem. In the Global Strategy for Women’s and Children’s Health, the United Nations(UN) has set the global goals to decrease the prevalence of unintended pregnancy which is known as one of the main causes of death for millions of girls and women suffering from unsafe abortions and severe complications related to pregnancy and childbirth. Due to the cooperation on global level, it has been reported that the number of unintended pregnancies worldwide has decreased by approximately 18% in 2015-2019 compared to 1990-1994. However, East Asia and Southeast Asia marked the lowest rate of decrease in unintended pregnancy by only 4%. Among the countries in East Asia and Southeast Asia region, women in Indonesia suffered unwanted pregnancy the most. Meanwhile, it has been widely discussed that women’s empowerment is also contributed to development. Also, empowering women has been regarded as one of the 21st century agendas in global health. When it comes to its terminology, women’s empowerment tends to be used interchangeably with women’s autonomy or women’s decision-making power. However, women’s empowerment should be distinguished from the concepts of autonomy or decision-making power in that it implies process-a dynamic aspect. To be specific, empowerment can be defined as a process which a person who had been denied of the ability to make strategic life choices among recognized alternatives is able to obtain such ability. Research on women’s empowerment is insufficient in public health, nonetheless, empowering women plays pivotal role in producing various social benefits including improving community health. The quantitative indicators of women’s empowerment through utilizing secondary data are limited and lack scholarly consensus in the academia today. Amongst commonly replaced indicators as proxy measures are decision-making power in households and attitude towards domestic violence. These indicators were proposed by the Demographic and Health Survey Program (DHS) to measure women’s degree of empowerment. Driven from the above narratives of women’s health and its relation to empowerment, this study constructed four domains to measure women’s empowerment quantitatively, which are decision-making power in households, attitude towards domestic violence, negotiation of sexual relations and decision-making power on respondents’ health. The latter two indicators were included after a thorough review of existing literature. The data used in this study was generated from IDHS (Indonesia Demographic and Health Survey) in 2017. For analysis, 14,118 out of 49,627 respondents are selected. The dependent variable is the experience of unintended pregnancy, which encompasses mistimed or unwanted pregnancy, in the last five years. The independent variables were as follow: women’s empowerment, parity, types of contraceptives, contraceptive discontinuation, respondents’ age at first birth, heard of family planning, husband/partners’ educational level, current age, wealth index, place of residence, occupation, province, respondents’ educational level. In this research, Stata/SE 14.2 was used for statistical analysis, and two models were presented: a model without women’s empowerment variables (Model 1) and a model with women’s empowerment variables (Model 2). Chi-squared test was performed to determine whether each independent variable had a significant association with unintended pregnancy. Multiple logistic analysis was also conducted to yield adjusted odds ratio (AOR). The result showed that 16.6% of Indonesian women became pregnant unintentionally within the last 5 years. Among the four domains that measure women’s empowerment, only the variable of decision-making power on respondents’ health was statistically significant. Specifically, the women who reported difficulties in deciding their own health had 1.14 times higher odds of undergoing unintended pregnancy than women who did not report difficulties. Moreover, in a subgroup analysis, among respondents who use modern contraceptive, women who report difficulties in accessing health services had 1.42 times higher odds of experiencing unintended pregnancy compared to women who did not report such difficulties. On the other hand, the other three domains, attitude towards domestic violence, decision-making power in household and negotiation of sexual relations, were not statistically significant. These statistically insignificant results can be explained with problematic aggregation or weighting, along with a potentially unperceived fundamental drawback in the study design. Due to the nature of the DHS, the indexes for measuring empowered status of women could not be interpreted variously in accordance with different context of culture, society and country. A qualitative study conducted in Yogyakarta, Indonesia discovered that women’s decisions for family planning were not only influenced by the sexual negotiations that occurred within their marital relations, but also unexpectedly by the internalization of the surrounding society and peer women’s norms of idealistic womanhood, such as having a child immediately within marriage and having at least one child from each gender. The qualitative research emphasized the significance of the women’s surrounding social environments and their norms and contexts to affect women’s reproductive plans and health, beyond the logistical conversations that occur between their spouses. Results of this study suggest that approaching prevention of unintended pregnancy among Indonesian women should consider various societal and economic perspectives and sectors. Acknowledging the higher odds of unintended pregnancy by women who report difficulties accessing health services, policy makers and public health practitioners should consider addressing various infrastructural, physical, and psychological barriers that limit access to health services for Indonesian women. Despite the outcome of only one domain of women’s empowerment to be statistically significant in relation to the experience of unintended pregnancy, statistically insignificant outcomes of the other three domains should be interpreted with caution. Such statistical insignificance does not confirm that women’s empowerment initiatives have no implications towards decreasing the prevalence of unintended pregnancy among Indonesian women. Although this study did not capture the entirety of the multi-dimensional and dynamic aspects of women’s empowerment, its findings provide several implications. Further studies are required to determine whether the interventions for empowering women to prevent unintended pregnancy are more effective than other forms of interventions. As the current scholarly scope and tools on measuring women’s empowerment quantitatively are limiting, revision on current tools and development of new indexes are essential. To elaborate in further depths on the effects of women’s empowerment on women’s health, additional qualitative and mixed method approaches should be accompanied.의도치 않은 임신은 한 개인의 신체, 심리적 불건강을 야기할 뿐만 아니라, 그 부정적 영향이 한 국가의 사회 및 경제, 한 국가의 보건의료체계에 까지도 확장된다는 측면에서 공중 보건학적으로 중요한 문제이다. UN을 비롯한 세계 여러 국가들은 2016년에 여성과 어린이의 건강을 위한 전세계적 전략(Global Strategy for Women’s and Children’s Health)을 발표하며, 2030년까지 임신과 출산으로 인한 합병증 및 안전하지 않은 임신 중단으로 인해 사망하는 여성을 살리기 위해 의도치 않은 임신을 예방하겠다는 목표를 세우기도 하였다. 국제사회의 노력의 결과로 전세계적으로 의도치 않은 임신은 1990년-1994년 대비 2015년-2019년에 약 18%정도 감소했다고 보고되었다. 하지만, 동아시아 및 동남아시아 지역의 감소율은 4%였으며, 이는 전세계에서 가장 낮은 수치였다. 이 지역에 속하는 국가들 중 인도네시아의 여성들은 원치 않은 임신을 가장 많이 겪고 있는 것으로 나타났다. 한편, 전세계적으로 여성들의 역량을 강화하고 권익을 신장하는 것(women’s empowerment)이 경제 발전과 개발에 도움이 된다는 것이 증명되었으며, 국제보건 영역에 있어서 21세기 아젠다로 꼽히기도 하였다. 여성 임파워먼트(women’s empowerment)는 여성의 자율성(women’s autonomy)이나 의사결정권(women’s decision-making power)과 혼용되어 사용되는 경향이 있지만, 임파워먼트는 역량이 박탈된 상태였던 여성이 역량을 획득하는 ‘과정’이라는 동적인 의미를 함축하고 있다는 점에서, 자율성이나 의사결정권과 같은 정적인 개념과는 구분된다. 이렇듯 여성 임파워먼트가 중요하게 여겨지고 있음에도 불구하고, 보건학 분야에서 여성 임파워먼트를 주제로한 연구는 부족한 실정이다. 이런 문제의식을 바탕으로 기존의 연구들을 고찰했을 때, 양적 연구에서 여성 임파워먼트의 대리지표를 구성함에 있어 학자들간 일치된 합의나 일관된 경향성은 확인할 수 없었다. 하지만, 가장 많이 쓰이는 지표로는 ‘가정 내 의사결정권’과 ‘가정 폭력을 정당화하는 태도’ 가 있었으며, 해당 지표들은 인구보건조사 프로그램(Demographic and Health Survey Program, DHS)에서 여성 임파워먼트 측정을 위해 제안한 지표들이다. 따라서, 본 연구에서는 여성 임파워먼트를 나타내는 대리 지표를 총 4가지 세부 영역으로 구성하였다. DHS에서 제안한 지표인 ‘가정 내 의사결정권’과 ‘가정 폭력을 정당화하는 태도’ 외에, 기존 문헌 고찰을 통해 파악한 ‘성 관련 주제에 대한 협상력’ 및 ‘응답자의 건강과 관련된 의사결정권’을 여성 임파워먼트 대리 지표로 삼았다. 분석 시 활용한 자료는 2017년 인도네시아 DHS 자료로, 연구 대상 선정 기준에 따라 전체 표본인 49,627명 중 14,118명을 분석 대상으로 선정하였다. 종속 변수는 의도치 않은 임신 경험 여부로, 회상 편향 (recall bias)을 통제하기 위해 5년 이내에 임신을 경험한 여성 중 전혀 원하지 않았던 임신을 경험했거나, 시기가 맞지 않은 임신 (mistimed pregnancy)을 경험했을 경우 의도치 않은 임신을 경험한 것으로 정의하였다. 독립변수로는 여성 임파워먼트, 출산력, 피임도구 종류, 피임도구 사용 중단 경험 여부, 첫 출산 연령, 가족 계획 메시지 청취 경험 여부, 인구사회학적 변수(현재 연령, 거주 지역, 거주 형태, 응답자 및 남편의 교육 수준, 직업, 재산 수준)가 사용되었다. 통계 분석은 Stata/SE 14.2를 활용하였으며, 여성 임파워먼트 변수가 들어가지 않은 모형 (모형 1`)과 들어간 모형 (모형 2)을 각각 제시하였다. 카이 제곱 검정을 통해 각 독립변수가 종속변수와 유의한 관련성이 있는지 확인하였고, 이후 로지스틱 회귀 분석을 통해 유의한 조정된 오즈비를 산출하였다. 분석 결과, 인도네시아 여성들 중 16.6%가 최근 5년 이내에 의도치 않은 임신을 경험한 것으로 나타났다. 여성 임파워먼트를 구성하는 4개의 세부영역 중 ‘응답자의 건강과 관련된 의사결정권’ 영역만 p-값이 0.05 이하에서 통계적으로 유의한 관계를 갖는 것으로 나타났다. 구체적으로, 건강과 관련된 의사 결정에 문제가 없다고 응답한 여성들에 비해 의사 결정에 문제가 있다고 응답한 여성들이 의도치 않은 임신을 경험할 오즈가 1.14배로 높았으며, 이는 통계적으로도 유의하였다. 구체적으로, 하위집단 분석을 통해 현대식 피임도구(Modern contraceptive methods)를 사용하는 여성들에게서만 ‘응답자의 건강과 관련된 의사결정권’과 의도치 않은 임신 경험이 통계적으로 유의한 관계를 갖는 것으로 드러났다. 반면에, 피임도구를 사용하지 않는다고 응답한 집단과 전통적 피임도구(Traditional contraceptive methods)를 사용하는 집단, 장기간 및 불가역적 피임도구 (Long-acting and permanent methods, LAPMs)를 사용하는 집단에서는 ‘응답자의 건강과 관련된 의사결정권’ 영역이 의도치 않은 임신을 경험할 오즈에 통계적으로 유의한 영향을 미치지 않았다. 한편, 여성 임파워먼트 변수의 4개 영역 중 ‘가정 내 의사결정권’, ‘가정 폭력을 정당화하는 태도’ 및 ‘성 관련 주제에 대한 협상력’ 변수는 의도치 않은 임신과 통계적으로 유의한 연관성을 갖고 있지 않았다. DHS에서 제안한 ‘가정 내 의사결정권’과 ‘가정 폭력을 정당화하는 태도’가 유의하지 않은 이유는 각 영역을 하나의 지표화 하는 과정 혹은 가중치의 부재 때문일 가능성이 있다. 특히 ‘가정 내 의사결정권’이 Kabeer가 정의한 “전략적 삶의 선택”을 반영하는지 검토할 필요가 있다. 혹은 본질적으로 각 영역이 갖는 의미가 서로 다른 국가, 사회, 문화적 맥락에 따라 다르게 해석될 여지가 강하기 때문에, 해당 지표에 문제가 있다는 학자들의 지적과 궤를 같이 한 것이라 볼 수도 있을 것이다. ‘성 관련 주제에 대한 협상력’ 영역이 유의하지 않은 이유는 인도네시아를 대상으로 한 질적 연구로부터 시사점을 얻을 수 있었다. 해당 연구에 따르면, 성 관련 주제를 남편/파트너와 상의하고 협상한다고 하더라도 여성들이 사회 및 사회적 규범(결혼 직후 임신을 해야 한다는 풍조, 자녀는 각기 다른 성별로 한 명씩은 반드시 있어야 한다는 풍조 등)과 상호작용하며, 결론적으로는 여성의 성적 자기 결정권을 억압하는 형태로 발현되었을 가능성이 있다는 것이다. 즉, 남편/파트너와 성 관련 주제에 대한 실제적 협상보다는 사회적 재구성을 거친 여성의 재생산 목표가 더 크게 작용한다고 해석해볼 수 있을 것이다. 본 연구결과를 바탕으로 한 상기 고찰은 인도네시아 여성들의 의도치 않은 임신을 예방하기 위해서 다양한 각도에서의 접근이 필요할 수 있다는 점을 시사한다. 특히, 필요한 보건의료서비스를 받는 것에 문제가 있다고 응답한 여성들이 그렇지 않은 여성들에 비해서 의도치 않은 임신을 경험할 오즈가 높게 나타났기 때문에, 인도네시아 여성들의 보건의료서비스 접근에 대한 물리적 및 심리적 장벽을 해소하는 것이 필요한 것으로 여겨진다. 또한, 피임도구 사용 중단을 경험한 여성이 의도치 않은 임신을 경험할 오즈가 통계적으로 유의하게 높았기 때문에 여성들이 피임도구 사용을 중단하는 원인을 구체적으로 파악할 필요가 있다. 더 나아가, 인도네시아 사회에서 사회적 규범이나 분위기가 여성들의 재생산 계획과 건강에 영향을 미치고 있다는 점을 고려하여 보건학적 중재를 설계해야 한다. 본 연구에서는 여성 임파워먼트의 세부 영역 4개 중 1개의 영역만이 유의하게 의도치 않은 임신에 영향을 미친다고 나타났지만, 이 결과만을 통해 인도네시아의 의도치 않은 임신 문제를 해결하기 위한 여성 임파워먼트가 의미를 갖지 않는다고 단정짓기는 어렵다. 다양한 연구들이 여성 임파워먼트가 사회적으로 여러 관련 분야에서 편익들을 산출할 수 있다는 실증적 근거들을 제시하고 있다. 이런 맥락에서, 본 연구는 인도네시아 사회에서 여성 임파워먼트와 의도치 않은 임신간의 관련성을 탐구했다는 의의를 갖는다. 하지만 의도치 않은 임신을 예방하기 위해 여성들의 역량을 강화하고 권익을 신장(임파워먼트)하는 중재의 효과성을 확인하기 위해서는 추가적인 연구가 필요할 것으로 여겨진다. 많은 학자들이 지적했듯, 기존의 여성 임파워먼트를 양적으로 측정하는 도구에 대한 수정과 개발이 요구되며, 여성들의 사회적 상호작용과 임파워먼트의 역동적, 다층적 및 다차원적 특성을 고려하기 위해서는 추가적인 혼합연구 및 질적연구가 병행되는 것이 필요하다.Chapter 1. Introduction 1 1.1. Background 1 1.2. Purpose of Study 3 1.3. Hypothesis 4 Chapter 2. Literature Review 5 2.1. Literature Review 5 2.1.1. The main variable: Women's empowerment 5 2.1.2. The outcome variable: Unintended pregnancy 8 2.1.3. The effect of women's empowerment on woman-centered health outcomes 10 2.2. Theoretical Framework 12 Chapter 3. Methods 13 3.1. Data Sources and Study Sample 13 3.2. Study Design 15 3.3. Variables 16 3.4. Ethical Considerations 27 Chapter 4. Results 28 Chapter 5. Discussion 50 Chapter 6. Conclusion 58 Abstract in Korean 61 Bibliography 66 Appendix 74석

What are the relationships between the degree of pregnancy intention and key maternal and neonatal health outcomes in the Mchinji district of Malawi?

Background Every year 85 million women experience an unintended pregnancy. Unintended pregnancies may pose increased risks to mother and baby but the evidence is scarce and methodologically limited. This research aims to fill the gap in our knowledge about the pattern of pregnancy intention and the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country. Methods I validated the London Measure of Unplanned Pregnancy (LMUP) in the Chichewa language and used it to assess the degree of pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi. Pregnancy outcome was ascertained after the neonatal period. I analysed these data to examine the determinants of pregnancy intention and the relationships between pregnancy intention and pregnancy outcomes using multivariate hierarchical regressions. I conducted focus group discussions on postpartum family planning (PPFP). Results The Chichewa LMUP is valid in Malawi and shows a similar pattern of pregnancy intention to the UK. Young, unmarried women having their first child, older, married women who have completed their family or who have recently given birth and women who have experienced depression or intimate partner violence are at increased risk of unintended pregnancies. The more unplanned a woman’s pregnancy is, the less likely she is to access adequate care. More planned pregnancies have a lower risk of postnatal depression and possibly stillbirth; there was no significant relationship between pregnancy intention and miscarriage, low birthweight or neonatal death. Conclusion To prevent unintended pregnancies, at-risk women should be targeted by family planning services. These services, particularly PPFP, need strengthening. Including the LMUP in routine antenatal care would identify women who are at risk of inadequate care uptake, stillbirth and postnatal depression. During pregnancy these women should be given additional support to mitigate these risks. They should be followed-up postnatally to detect depression and prevent future unintended pregnancies through PPFP

What has reproductive health decision-making capacity got to do with unintended pregnancy? Evidence from the 2014 Ghana Demographic and Health Survey.

INTRODUCTION: Women's reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana. MATERIALS AND METHODS: We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. RESULTS: We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51-0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25-29 years [AOR = 0.29; CI = 0.13-0.63], 30-34 years [AOR = 0.18; CI = 0.08-0.45], and 35-39 years [AOR = 0.26; CI = 0.10-0.68] being less likely to experience unintended pregnancy compared to those aged 15-19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12-3.84]. CONCLUSION: This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15-19 years, those with primary education, Traditionalists and unmarried women

Mapping Research Trends on Illegal Abortion Behavior: A Bibliometric Study

Research on the topic of illegal abortion is quite a concern, but more discussed macro in a legal point of view and health policy. Micro-analysis with a similar topic has been conducted on a limited basis with the background of the issue of illegality which cannot prevent abortion behavior. This study aims to analyze the scientific literature to find general trends and analyze indicators related to the topic of behavior from illegal abortion practices around the world. This paper uses a bibliometric methodology, utilizing data taken from the Scopus database from 1968 to 2021, and visualizing the data using the VOSviewer. 310 papers from different nations were uncovered in the investigation. When the study's findings are compared to the total number of citations and related publications, it becomes clear that the United States and the United Kingdom continue to dominate research on illegal abortion activity. The great majority of articles on this topic are mostly in the social science sector. By identifying keywords, it can be seen that the majority of research topics continue to center on large-scale issues including abortion, contraception, and unsafe abortion. This study enables us to define unlawful abortion in an individual setting as the behavior a person engages in when deciding to abort a pregnancy, regardless of whether it is carried out by themself, another person, medical professional, health workers, health facilities, or by other parties that deviate from the abortion laws that are in effect in the nation. This study offers crucial conclusions and suggestions for future thematic research opportunities that are sustainable. &nbsp