Determinants of unintended pregnancy among women in Ecuador

International Family Planning Perspectives, Mar 1999 by Eggleston, Elizabeth

Context: Although bivariate survey data have demonstrated that the proportion of unintended pregnancies is increasing in Ecuador, the determinants of unwanted and mistimed pregnancy have yet to be identified.

Methods: A multinomial logistic regression analysis of the predictors of unintended pregnancy (unwanted and mistimed) was conducted using a subsample of women who were interviewed for the 1994 Demographic and Maternal-Child Health Survey for Ecuador. The study sample consisted of 4,534 women whose most recent pregnancy occurred between January 1992 and August 1994.

Results: The multivariate analysis indicated that several explanatory variables significantly influenced the likelihood that a woman would classify her most recent pregnancy as unwanted or mistimed. Among variables that independently raised the likelihood of unintended pregnancy were residence in the Sierra (or highlands) region, residence in a major metropolitan area, the number of previous births and use of a contraceptive method before the most recent pregnancy. In contrast, variables that significantly lowered that probability included residence in rural areas, living in a high-income household and giving birth at a relatively older age (i.e., 30-49 years). Conclusions: Services should focus on helping those groups of women who were identified in the analysis as being at increased risk of unintended pregnancy-high-parity women, women in the Sierra region and those in the metropolitan areas of Quito and Guayaquil. International Family Planning Perspectives, 1999, 25(1):27-33

Unintended pregnancy is an important public health concern in both the developing and developed world because of its association with adverse social and health outcomes, for both mothers and children. These include the higher likelihood of unsafe abortion, of late initiation and underutilization of prenatal care, and of low birth weight.1 The level of unintended pregnancy also can serve as an indicator of the state of women's reproductive health, and of the degree of autonomy women have in determining whether and when to bear children. It is important to identify factors associated with unintended pregnancy, to enable policymakers and program planners to design legislation and services specifically for the women who are most likely to experience this problem.

This article examines the determinants of unintended pregnancy in the Andean country of Ecuador, where fertility has declined markedly over the past two decades. For example, the total fertility rate fell steadily from 5.4 lifetime births per woman in 1975 to 3.8 in 1984-1989, and stood at 3.6 births as of 1989-1994.2 To a large degree, this decrease in fertility reflects the increased availability and use of modem contraceptive methods: Prevalence among married women of reproductive age grew from 34% in 1979 to 53% in 1989, and reached 57% in 1994.3

Despite the decrease in overall fertility and the increase in contraceptive prevalence, however, many women in Ecuador, where induced abortion is illegal, still experience unintended pregnancies. In fact, while the level of unintended pregnancy has fallen in every other Latin American country but Paraguay, it has risen markedly in Ecuador in recent years.4

For example, in Ecuador's 1994 Encuesta Demografica y de Salud Materna e Infantil, or ENDEMAIN (Demographic and Maternal-Child Health Survey), 36% of women in union reported that their most recent pregnancy (in the five years before the survey) was unintended5-19% who said their pregnancy had been unwanted (because they had not wanted any more children at the time of the pregnancy) and 16% who said the pregnancy was mistimed (because it occurred earlier than desired). Comparable proportions in the 1989 ENDEMAIN were 7% unwanted and 6% mistimed, respectively. 6

Background

While research has identified a number of predictors of unwanted and mistimed pregnancy, the majority of these multivariate analyses have been conducted in the United States, rather than in Latin America. Moreover, in both regions, unwanted pregnancy has been examined more often than has mistimed pregnancy. The available information on unintended pregnancy in Latin America is based largely on data collected in the Demographic and Health Surveys (DHS) series. While these data are nationally representative, the survey reports contain bivariate data only.

Nonetheless, these surveys collected data on pregnancy intention status, regardless of outcome, and many of the characteristics identified in the bivariate data as determinants of unwanted pregnancy are consistent with results of multivariate analyses conducted with U.S. data. These analyses have shown that U.S. women who experienced an unwanted birth were more likely than those who did not to be unmarried, to be older (in their 30s), to have already had several children or to have not graduated from high school? The association between poverty and unwanted childbearing among U.S. women is less clear, however, as conflicting studies have indicated both a statistically significant association and the lack of one.8