Search

Purpose : Using Schlossberg's Transition Theory, this study explored the lived experiences of pregnant adolescents and adolescent mothers coping strategies during their transition to motherhood. Methods : Based on a phenomenological perspective, this qualitative study used in-depth interviews (IDIs) and focus group discussions (FGDs) to answer the research aim. The process of data gathering included 8 FGDs and 12 IDIs held with adolescent mothers and pregnant adolescents. Audio recordings were transcribed and imported into MAXQDA 2018 for analysis. Results : Applying the interpretative phenomenologial analysis (IPA), four key themes emerged. This included: news of pregnancy; adolescent motherhood; social support and coping strategies. The findings display female adolescents' expressions of some of the negative aspects of motherhood they have been confronted with that have affected their lives. The dominant societal challenges posited by the adolescents included coping with economic and financial constraints, opting for unsafe abortion to reduce stigma associated with unplanned pregnancy, and managing the extra responsibility of taking care of the baby and the challenge of going back to school after delivery. Conclusion : There is the need to build social capital among community members regarding their support to improve the psychosocial well-being of adolescents during early motherhood.

Background: Adolescent pregnancy and motherhood has been a controversial and much disputed subject within the field of public health. Early childbearing is not only characterized as a physical body experience but also embodies the experiences and perceptions of the social norms, discourses, conflict and moral judgement. There is an increasing concern that the psychosocial challenges facing adolescent mothers remains in the background since research in this field has mainly focused on the medical and physical complications of early childbearing. The aim of this qualitative study was to explore adolescent pregnancy and motherhood in order to understand this phenomenon from the perspective of adolescent mothers and to gain insight into their future aspirations., Methods: This descriptive qualitative study was based on data from four focus group discussions with adolescent mothers utilising healthcare services at a district hospital in Ugu district, KwaZulu Natal, South Africa. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis., Results: Some adolescent mothers' partners were in denial and rejected them and the child while others' partners were happy and supported them during their pregnancy. Families' reactions to the pregnancies ranged between anger and disappointment to abandonment, the silent treatment, and acceptance and forgiveness. The psychological issues experienced by some of the adolescent mothers included suicidal ideation, guilt, loneliness, anxiety, and stress. They also experienced financial constraints, difficulty in returning to school, and stigmatisation in society. The participants envisioned completing their education, focusing on their dream careers, and contributing positively to society., Conclusion: Experiences of adolescent pregnancy and parenting are multifaceted and the healthcare needs of pregnant and parenting adolescents extend beyond information and knowledge. A multidisciplinary approach is required in the care of adolescent mothers. A key policy priority should encompass the collaboration of different professionals from various healthcare sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes as steps to securing a better future for them.

Introduction: the impact of prenatal maternal affectivity on infant development is poorly documented in Africa. The purpose of our study is to determine the relationship between mother feelings about pregnancy and childbirth, infant´s behavior and development., Methods: one hundred and twenty mothers aged 28,4 years (± 12,18 years) with their babies aged 38,70 months (± 19,19) were enrolled in a cross-sectional study based on an interview and questionnaire on maternal affectivity, mother-child relationship, infant´s behavior and psychosocial development. Maternal depression was assessed by Edinburgh (EPDS), Goldberg Depression and anxiety scales and DSM-IV (MINI) criteria. Chi-square and Mann-Whitney were used to describe the relationship between maternal affectivity and infant's behavior and health., Results: unintended pregnancy and fear of childbirth were associated with high anxiety and depression scores. Negative feelings about pregnancy were associated with the lack of social support by the child´s father (0.0110), stress when women were pregnant with a frustrated child (p=0.046), difficult consolability (p<0.001), poor baby's health (p=0.010), infant non-affiliative behavior (p=0.034) and depression identified by using EPDS (p=0.028). Fear of childbirth was associated with delayed or absent responses to infant´s signals (p=0.002) and stress if they were carrying a frustrated baby (p=0.020)., Conclusion: negative feelings during pregnancy are predictive of maternal depression, mother-child relationship disorders, infant´s health and development., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Daniel Okitundu Luwa E-Andjafono et al.)

Background: With the high rates of unintended pregnancy and associated maternal morbidity and mortality in the United States, particularly among poor and minority women, it is imperative that all individuals have information about and access to long-acting reversible contraception (LARC) methods in the immediate postpartum period., Objective: The creation of a framework to provide guidance, address barriers, and dispel myths associated with the implementation of an immediate postpartum LARC program., Methods: A multistep approach to develop a framework to guide planning and implementation of an immediate postpartum LARC program. A literature review, telephone and e-mail interviews with clinical experts involved with successful implementation of immediate postpartum LARC programs, development of a list of interdisciplinary specialists, and steps required to initiate a change in current practice., Results: The provision of a framework to guide the planning and implementation of an immediate postpartum LARC program to streamline the process while addressing perceived barriers and myths., Conclusions: Addressing the lack of knowledge about LARCs, financial concerns, and absence of a standardized framework related to planning and implementation of this complex process will hopefully begin the process of making effective and reliable contraception available., Implications for Nursing: The use of a standardized framework to guide the implementation of an immediate postpartum LARC program provides the potential for easier access to LARC methods in this critical time period., (© Copyright 2020 Springer Publishing Company, LLC.)

Aim: To explore young mothers' experience of rapid repeat pregnancy., Background: Despite a reduction in teenage pregnancies in England over the last two decades, the number of repeat pregnancies remains high, accounting for around 25% of teenage pregnancies. There is a lack of qualitative evidence of teenage perspectives making planning appropriate interventions challenging., Design: Exploratory design., Methods: Six young women were purposively sampled from a Family Nurse Partnership programme in the South London. Semi-structured interviews conducted in spring 2017 elicited experiences of repeat pregnancy., Findings: Each repeat pregnancy was unplanned and accounted for by participants' rejection of Long Acting Reversible Contraceptives and inconsistent use of non- Long Acting Reversible Contraceptives. Misinformation about Long Acting Reversible Contraceptives contributed to their rejection and staff delivery of contraceptive advice was influential. Motherhood was initially prioritised over other life goals to make sense of second pregnancy. Discharge from the Family Nurse Partnership may lead to fractured service contacts. Peer support and health professional contact through social media were proposed as "stepping stones" out of the service., Conclusions: Practice developments working in partnership with young mothers to reduce the risk of a repeat teenage pregnancy are highlighted. Further research is recommended., Impact: Understanding the experiences of teenage mothers who are at risk of rapid repeat pregnancy can assist nurses to provide preventative care and support. Structured advice through social media platforms can provide "stepping stones" that bridge gaps in provision as young mothers transition through services. Further research and development into the role of social media and contraceptive counselling are necessary., (© 2019 John Wiley & Sons Ltd.)

Background: Pregnancy, whether intended or unintended, is associated with internalizing symptoms among women; for some, these symptoms cause impairment and develop into an internalizing disorder (ID). With the growing diversity of the US population, there is a need to understand how pregnancy relates to IDs among minorities. This study examines the association between unintended pregnancy and lifetime and 12-month history of IDs among Latina and Asian mothers., Methods: Data come from the National Latino and Asian American Study (NLAAS), a nationally representative sample of Latino and Asian adults. Pregnancy intention was self-reported. ID history was assessed with the CIDI (DSM-IV). Logistic regression was used to examine the association between pregnancy intention and likelihood of lifetime and 12-month IDs., Results: Among 1915 mothers, 24.1% and 14.7% met criteria for a lifetime and 12-month ID, respectively. Relative to those who only reported intended pregnancies, Asian mothers reporting an unintended pregnancy had the highest odds of lifetime (Odds ratio (OR): 2.51, 95% Confidence Interval (CI): 1.55-4.08) and 12-month IDs (OR: 5.73, 95% CI: 2.67-12.29). Latina mothers reporting unintended pregnancies also had higher odds of lifetime (OR: 1.96, 95% CI: 1.41-2.72) and 12-month IDs (OR: 1.70, 95% CI: 1.12-2.59). Socioeconomic status had no significant modifying effect., Limitations: Cross-sectional data and retrospective recall and social desirability could misclassify pregnancy intention., Conclusions: Unintended pregnancy is associated with higher odds of IDs among mothers. Findings underscore the complex relationship between unintended pregnancy and maternal mental health., (Published by Elsevier B.V.)

Aim: To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers., Method: An institutional cross-sectional study was employed from March to April 2017., Setting: Two primary health centres and one referral hospital in northwestern Ethiopia., Participants: A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included., Outcome Measure: Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance., Results: The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours., Conclusion: Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Postpartum depression has increased significantly worldwide, but in the central Peruvian mountain, there are no studies that address this problem., Objectives: To identify and to establish risk factors for postpartum depression in mothers whose children are hospitalized in pediatrics/neonatology units in Huancayo., Methods: This is a case-control study. Medical records of mothers whose children were hospitalized in pediatrics/neonatology units during 2017 were included. The cases were defined as patients who “had symptoms of postpartum depression." This variable was crossed with other variables using logistical regression, odds ratio were obtained, their confidence intervals were set to 95%, and the p values were calculated., Results: Sixty-one medical records of mothers with postpartum depression (cases) and 61 medical records of mothers without postpartum depression (control) were evaluated. In the multivariate analysis, the unemployed mothers had a bigger chance of postpartum depression (p < 0.001), as well as single mothers (p < 0.001), and those with an unplanned pregnancy (p = 0.003). Conversely, mothers who reported having serious problems with their partner had a smaller chance of postpartum depression (p = 0.003)., Conclusions: Different factors were found to be related to postpartum depression: marital situation, relationship with their partners, work conditions, and having an unplanned pregnancy.

Background: Female sex workers (FSW) have a greater HIV burden compared to other reproductive-aged women and experience high incidence of pregnancies. However, there are limited data on mother-to-child transmission of HIV in the context of sex work. This study assessed the uptake of prevention of mother-to-child transmission (PMTCT) services to understand the vertical HIV transmission risks among FSW in South Africa., Methods: FSW ≥18 years were recruited into a cross-sectional study using respondent-driven sampling (RDS) between October 2014-April 2015 in Port Elizabeth, South Africa. An interviewer-administered questionnaire captured information on demographics, reproductive health histories, and HIV care, including engagement in PMTCT care and ART. HIV and pregnancy testing were biologically assessed. This analysis characterizes FSW engagement in HIV prevention and treatment cascades of the four prongs of PMTCT., Results: Overall, 410 FSW were enrolled. The RDS-weighted HIV prevalence was 61.5% (95% bootstrapped confidence interval 54.1-68.0). A comprehensive assessment of the four PMTCT prongs showed gaps in cascades for each of the prongs. In Prongs 1 and 2, gaps of 42% in consistent condom use with clients among HIV-negative FSW and 43% in long-term high efficacy contraceptive method use among HIV-positive FSW were observed. The analyses for prongs three and four pertained to 192 women with children < 5 years; 101/192 knew their HIV diagnosis prior to the study, of whom 85% (86/101) had their children tested for HIV after birth, but only 36% (31/86) of those who breastfed retested their children post-breastfeeding. A substantial proportion (35%, 42/120) of all HIV-positive women with children < 5 years of age were HIV-negative at their last delivery and seroconverted after delivery. Less than half (45%) of mothers with children < 5 years (45/101) were on ART and 12% (12/101) reported at least one child under five living with HIV., Conclusion: These findings show significant gaps in engagement in the PMTCT cascades for FSW, evidenced by sub-optimal uptake of HIV prevention and treatment in the peri/post-natal periods and insufficient prevention of unintended pregnancies among FSW living with HIV. These gaps result in elevated risks for vertical transmission among FSW and the need for PMTCT services within FSW programs.

Introduction Unintended pregnancy during the postpartum period is common. The aim of this study was to describe contraceptive use among postpartum women and assess whether family planning counseling offered by health care providers during well-baby clinic visits increased use of modern contraceptive methods at 6 months following delivery. Methods Data comes from a cohort of women enrolled in a breastfeeding promotion trial in Kinshasa, Democratic Republic of Congo who reported being sexually active at 24-weeks post-partum. Modern contraceptive methods included intrauterine devices, injectables, implants, and contraception pills. Logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) for the impact of nurse counseling on use of modern birth control methods. Results Of 522 participants who reported being sexually active, 251 (48.0%) reported doing at least one thing to avoid pregnancy and were included in this analysis. Of these 251, 14.3% were using a modern contraceptive method, despite availability at the clinic. Discussion with a nurse about family planning was associated with increased odds of using modern birth control relative to other methods (OR 4.0, 95% CI 1.9, 8.6). Discussion Discussion of family planning with a nurse increased the odds of using a modern contraceptive among postpartum women. Integration of family planning counseling into postpartum services offers a potential avenue to increase modern contraceptive use among women with access.

Aim: Primiparous women with unplanned pregnancies experience greater levels of anxiety that reduce their ability to perform their maternal role., Methods: This clinical trial was conducted in 2014 on 67 primiparous women with unplanned pregnancies visiting the health centers of Mashhad, Iran, who were randomly divided into an intervention and a control group. The intervention group received maternal role training based on Mercer's Maternal Role Attainment Theory, and the control group received the routine pregnancy care. Maternal identity was measured before training and 4 weeks and 4 months after delivery., Results: Four months after delivery, 28 women (80%) in the intervention group and 18 women (56%) in the control group successfully formed a maternal identity (P = 0.036)., Conclusion: A maternal role training program given based on Mercer's theory facilitates the formation of maternal identity in primiparous women with unplanned pregnancies., (© 2018 Japan Society of Obstetrics and Gynecology.)

Background: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk., Methods: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling., Results: Among pregnant women, the study found that 21.3%(95%CI:15.7-28.3) had anxiety and 23.8% (95%CI:17.8-31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7-22.1) had anxiety and 15.2% (95%CI:12.4-18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression., Conclusions: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing.

This study investigates the short-term impact on the quantity and quality of births of an abortion reform in Uruguay that legalised termination of pregnancy until the 12 th week of pregnancy in the short run. We employ a differences-in-differences approach, comprehensive administrative records of births, and a novel identification strategy based on the planned or unplanned nature of pregnancies that came to term. Our results suggest that this policy change has led to an 8% decline in the number of births from unplanned pregnancies, driven by the group of mothers aged between 20 and 34 years old who have secondary education. This decline has triggered an increase in the average quality of births in terms of more intensive prenatal control care and a lower probability of births among single mothers. Furthermore, we document a positive selection process of births because of the reform, as adequate prenatal control care and Apgar scores rose among the affected demographic group., (Copyright © 2018 John Wiley & Sons, Ltd.)

Women experiencing homelessness report higher rates of reproductive health-related traumas, including unplanned pregnancy, miscarriage, and abortion than their non-homeless peers. Using phenomenological hermeneutic methods, we sought to understand the reproductive health histories of women currently experiencing homelessness (N = 20, 25-61 years old, Mage = 38.33, SDage = 9.33) analyzing data collected between June 2014 and July 2015 in north central Texas. Three key themes highlight the essence of the women's experiences: (1) unexpected pregnancy-pregnancy just happened, (2) loss of reproductive health rights-I was broken, and (3) resilience-giving back and looking forward to good things. Many of the women became mothers through unexpected pregnancies, and overnight found that their lives were transformed irrevocably. Often unexpected pregnancy was the result or cause of a lack of ownership over their reproductive health and led to prolonged health-related traumas. Over time, though, many of the women whom we interviewed re-expressed resilience through social support, housing assistance, and a sense of giving back to society. Results indicate that reproductive health care providers require training to identify the relationship among unexpected pregnancy, reproductive health-related traumas, and housing insecurity. Providers can help preserve women's reproductive health rights through education and empowerment.

Background: Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART)., Method: Data are from the Rakai Community Cohort Study (RCCS) - a cohort of communities with 10,000-12,000 adults, ages 15-49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years., Results: The prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65-3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002]., Discussion: HIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.

Purpose: The purpose of this study was to summarize birth mothers' descriptions of unplanned pregnancy experienced in their twenties and how open adoption influenced their lives., Study Design and Methods: Naturalistic inquiry was used with purposive sampling from one agency and telephone interviews of women who experienced unplanned pregnancy in their twenties and relinquishment through open adoption. Recorded, transcribed, and deidentified interviews were analyzed for qualitative themes., Results: Fifteen participants judiciously weighed the open adoption decision. Over half parented other children prior to placement. Most knew they could not have parented this child due to life stressors. Placement was a hard decision, but ongoing contact with birth child and adoptive family was valued. Open adoption processes made them stronger by being happy that their child experienced family life with greater opportunities than birth mothers could offer at the time. Summarized themes used the acronym COMMITTED: C-care deeply about what is best for the child, O-ongoing open adoption: good and hard, M-meeting together regularly, M-moving on in personal growth, accomplishments, and milestones, I-independence from previous stressors or crises, T-transitions, T-therapeutic support, E-emotions, D-depression giving way to deepened strength and personal direction., Clinical Implications: Open adoption is reinforced as a positive resolution of unintended pregnancy for birth mothers in their twenties.

Background: The 10-item Birth Satisfaction Scale-Revised (BSS-R) is being increasingly used internationally. The use of the measure and the concept has gathered traction in the United States following the development of a US version of the tool. A limitation of previous studies of the measurement characteristics of the BSS-R is modest sample size. Unplanned pregnancy is recognised as being associated with a range of negative birth outcomes, but the relationship to birth satisfaction has received little attention, despite the importance of birth satisfaction to a range of postnatal outcomes., Aim: The current investigation sought to evaluate the measurement characteristics of the BSS-R in a large postpartum sample., Methods: Multiple Groups Confirmatory Factor Analysis (MGCFA) was used to evaluate a series of measurement and structural models of the BSS-R to evaluate fundamental invariance characteristics using planned/unplanned pregnancy status to differentiate groups., Findings: Complete data from N=2116 women revealed that the US version of the BSS-R offers an excellent fit to data and demonstrates full measurement and structural invariance. Little difference was observed between women on the basis of planned/unplanned pregnancy stratification on measures of birth satisfaction., Discussion: The established relationship between unplanned pregnancy and negative perinatal outcomes was not found to extend to birth satisfaction in the current study. The BSS-R demonstrated exemplary measurement and structural invariance characteristics., Conclusion: The current study strongly supports the use of the US version of the BSS-R to compare birth satisfaction across different groups of women with theoretical and measurement confidence., (Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Research into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support., Methods: Data for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as "planned", "unplanned/happy", "unplanned/ambivalent" and "unplanned/unhappy". PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects., Results: In total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned)., Conclusions: A third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.

Objectives: Births to less educated women are more likely to be classified as unintended than other births. We question a common interpretation that this association reflects a lack of contraceptive knowledge or self-efficacy among less educated women. We theorize that differences in early life educational advantages structure pregnancy desires and the salience and opportunity costs of precise fertility timing. We hypothesize that net of covariates indicative of early educational disadvantage, mothers with less education are not more likely to report births as unintended compared with mothers who have attained higher levels of education before becoming mothers., Methods: Using multivariate regression, we analyze a sample of women in the National Longitudinal Survey of Youth (1979) who had their first births by 1994. We test whether an index measure of educational advantage in youth predicts unintended first birth., Results: Unadjusted results confirm well-documented associations between educational disadvantage and greater likelihood of unintended pregnancy. However, once covariates are controlled, those with high educational advantage in youth are more likely to report their first birth as mistimed (relative risk ratio, 1.57)., Discussion: Educational advantage captures expectations about how much education a young woman will obtain before giving birth and is a structural dynamic that precedes proximate factors related to family planning access and behaviors., Conclusions: These findings highlight the need to incorporate structural factors that condition perceptions of pregnancy intention in the study of unintended pregnancy and to critically reevaluate the conceptualization and interpretation of pregnancy intention measures., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Background: Postpartum depression (PPD) affects women from different cultures around the world. No previous studies have investigated PPD among women in Palestine. Fertility rates in Palestine are among the highest in the world, hence even low rates of PPD could have considerable national impact. The aim of this study was to determine the prevalence of, and risk factors for, PPD among Palestinian mothers., Methods: 101 mothers were recruited during the registration of their child's birth (within 1 week) at the Bethlehem branch of the Ministry of Interior. Participants were assessed via a face to face interview, and were followed up 1 week, 2 weeks, 6 weeks, 3 months, and 6 months later by telephone interview. Interviews included the Arabic Edinburgh Postnatal Depression Scale (EPDS), with PPD indicated by depressive symptoms (EPDS score ≥11) at ≥2 follow-up time points. Pearson's correlation was calculated between repeated EPDS scores, and multivariable logistic regression was used to investigate risk factors for PPD., Results: The prevalence of depressive symptoms was fairly constant (14-19%) over the follow-up period. Most depressive symptoms developed within 1 month of delivery; mothers with depressive symptoms at 3 months postpartum were highly likely to still have symptoms at 6 months. 27.7% (28/101) of women met our criteria for PPD. High parity (odds ratio (OR) 4.52 (95% CI 0.90, 22.8) parity 3+ versus primiparous), unplanned pregnancy (OR 2.44 (0.99, 6.01)) and sex of child not being the one desired (OR 5.07 (1.12, 22.9)) were associated with PPD, but these associations were attenuated in multivariable analysis., Conclusions: The prevalence of PPD in Palestine appears to be higher than in high income countries, but similar to the prevalence in other Middle Eastern countries. High parity and unplanned pregnancy were identified as risk factors for PPD, suggesting that fully meeting the need for family planning could reduce the incidence of PPD in the Palestinian population.

Objective: to gain a deeper understanding of Thai teenage parents' perspectives, experiences and reasoning about becoming and being a teenage parent from a gender perspective., Design: an exploratory design using grounded theory methodology. Semi-structured interviews were used to collect data. An interview guide was developed, a pilot study was undertaken, and interviews were performed on two different occasions: once during the second trimester of pregnancy and again when the infant was 5-6 months old., Setting: a province in the western part of Thailand., Participants: the selection of a heterogeneous group of teenage parents-to-be continued until saturation was reached, as describe by Glaser and Strauss (1967), in all n=50. Inclusion criteria for participants were that they were heterosexual couples, under 20 years of age, cohabiting, and expecting their first child., Findings: the core category 'struggling with motherhood and coping with fatherhood' comprises descriptions of the process from when the teenagers first learned about the pregnancy until the child was six months old. The teenagers had failed to use contraceptives which led to an unintended parenthood. Their parenthood became a turning point as the teenagers started to change their behaviours and lifestyle during pregnancy, and adapted their relationships to partner and family. Family commitments was a facilitator, through support given by their families. Finally, becoming a parent describes ways of dealing with the parental role, by engaging in parental activities and reestablishing goals in life. Most of the teenage parents reproduced traditional gender roles by being a caring mother or a breadwinning father respectively., Key Conclusions: 'struggling with motherhood and coping with fatherhood' referred to the parents' stories about how they struggled and coped with life changes and their parental role when they became unintentionally pregnant, accepted their parenting, and finally became parents. After becoming parents, the main concerns of most of the teenage parents were being a caring mother and a breadwinning father., Implications for Practice: this study contributes a deeper understanding of Thai teenage parents' experiences of becoming and being a parent and might improve health care professionals' adaptation of care for teentranatanage parents and inspire them to tailor their care specifically to teenager's needs from early pregnancy to parenthood., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence., Methods: A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives., Results: The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers' triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence., Conclusions: Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence., Trial Registration: PROSPERO CRD42012003168.

The postpartum period is a window of risk for psychological disturbances and particularly for depressive symptoms. This study explored the relationships between postpartum depression and prepartum depressive symptoms, marital adjustment, support from family, previous depressive symptomology, and pregnancy planning. A total of 128 women who were receiving prenatal care at a state hospital in Istanbul, Turkey, and who were in the last trimester of their pregnancy participated in the first phase of the study. Of these, eighty-seven women also participated in the second phase, during the 3-6 month postpartum period. The results indicated that depressed mood in the last trimester of pregnancy, family support, care and support from spouse, previous depression history, and unplanned pregnancy were significant risk factors for postpartum depressive symptoms; significant differences were found for study variables as a function of women's scores on the Edinburgh Postnatal Depression Scale in pregnancy and in the postpartum period. The recommendation is made to use screening tools, like the Edinburgh Postnatal Depression Scale, in the course of routine prenatal care, and to refer women with Edinburgh Postnatal Depression Scale scores above the cutoff score for further clinical examination.

Background: A negative birth experience has been shown to have a significant impact on the well-being and future choices of mothers. The objective of this study was to assess the prevalence of, and identify the risk factors associated with a negative birth experience for women in Canada., Methods: The study was based on secondary data analysis of the Maternity Experiences Survey (MES), a Canadian population database administered to 6,421 Canadian women in 2006. The examined outcome - negative birth experience - was derived from mothers' self-report of overall labour and birth experience. Independent variables were maternal demographics, health characteristics, pregnancy-related characteristics, and birth characteristics. Multivariable logistic regression analysis was performed to determine the significant predictors of negative birth experience. Adjusted Odds Ratios (AOR) and 95 % Confidence Intervals (CI) are reported., Results: Negative birth experience was reported among 9.3 % of women. The main significant predictors of a negative birth experience included older age (AOR 2.29, 95 % CI, 1.03-5.07), violence experienced in the past two years (AOR, 1.62, 95 % CI, 1.21-2.18), poor self-perceived health (adjusted OR, 1.95, 95 % CI, 1.36-2.80), prenatal classes attended (adjusted OR, 1.36, 95 % CI, 1.06-1.76), unintended pregnancy (adjusted OR, 1.30, 95 % CI, 1.03-1.63), caesarean birth (AOR, 1.65, 95 % CI, 1.32-2.06), and neonate admission to intensive care (AOR, 1.40, 95 % CI, 1.08-1.82)., Conclusion: Significant predictors of a negative labour and birth experience were identified through this study, a first in the Canadian context. These findings suggest future research directions and provide a basis for the design and evaluation of maternal health policy and prevention programs.

Background: According to United Nation Children's Fund, it has been estimated that worldwide about 165 million children were stunted in 2012 and India alone accounts for 38 % of global burden of stunting. This study aims to examine the effect of pregnancy intention and maternal postnatal depressive symptoms on early childhood stunting in India. We hypothesized that effect of pregnancy intention and postnatal depressive symptoms were mediated by social support., Methods: We used data from the first wave of Young Lives Study India. Multivariate logistic regression models (using generalized estimation equation) were used to examine the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting among children aged 5-21 months. The analysis included 1833 children (out of 2011 sample children) that had complete information on pregnancy intention, maternal depression and other variables., Results: Bivariate results indicate that a higher percent of children born after unintended pregnancy (40 %) were stunted than children of intended pregnancy (26 %). Likewise, the proportion of stunted children was also higher among women with high postnatal depressive symptoms (35 %) than the low level of depression (24 %). Results of multivariate logistic regression model indicate that children born after unintended pregnancy were significantly more likely to be stunted than children born after intended pregnancy (AOR: 1.76, CI: 1.25, 2.48). Similarly, early childhood stunting was also associated with maternal postnatal depressive symptoms (AOR: 1.53, CI: 1.21, 1.92). Moreover, the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting were not mediated by social support., Conclusions: The findings of this study provide conclusive evidence regarding consequences of pregnancy intention and postnatal depressive symptoms on early childhood stunting in India. Therefore, there is a need to identify the women with unintended pregnancy and incorporate the promotion of mental health into their national reproductive and child health programme.

Background: Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs)., Methods: Using Louisiana pregnancy risk assessment monitoring system, 2000-2003, a secondary cross-sectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design., Results: In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23-2.53). Furthermore, the association between husbands/partners' who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02-1.69); while among Black women, neither parent's pregnancy intention were associated with mild or severe PPDs., Conclusions: This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.

Whereas child maltreatment research has developed considerable evidence on post-natal risk-factors, pre-natal circumstances have been largely overlooked. The circumstances surrounding a pregnancy may considerably impact the environment in which later parenting behaviors occur. This study examines one of the earliest potentially identifiable risk-factors for child maltreatment: the intentions of a pregnancy. Utilizing both mother and father reports, this study focuses on maltreatment risk, as it relates with both parents' perspectives of the pregnancy's intention. Drawing upon data from the Fragile Families and Child Well Being study, a longitudinal, birth cohort study, survey questions were used that asked parents, at the time of the birth, whether they considered abortion for the child. Unintended pregnancy demonstrates predictive value as one of the earliest identifiable risk-factors for child maltreatment. Regardless of whether the mother or father reported the unintended pregnancy, the relationship with maltreating behavior is largely the same, although for different maltreatment types. Mothers' reports of unintended pregnancy are associated with psychological aggression, and neglect. Fathers' reports of unintended pregnancy are associated with physical aggression. Fathers' perspectives regarding pregnancy intentions matter just as much as mothers,' and accounting for their perspectives could be important in understanding the maltreating behaviors of both parents. Identifiable in the earliest stages of caregiving, unintended pregnancy may be an important risk-factor in predicting and understanding child maltreatment., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Pregnancy intention is important for maternal and child health outcomes. The purpose of this study was to examine the causal relation between pregnancy intention and maternal depression and parenting stress in Korean women who gave birth during 2008., Methods: This study is a retrospective evaluation of prospectively collected data from the Panel Study on Korean Children from 2008 to 2010. Causal analyses were conducted using propensity score matching and inverse probability of treatment weighted methods. In addition, mediation analyses were performed to test mitigating effects of marital conflict, fathers' participation in childcare, and mothers' knowledge of infant development on the relation between unintended pregnancy and adverse maternal mental health., Results: Results showed that the overall effect of an unintended pregnancy on maternal depression and parenting stress was statistically significant. An unintended pregnancy was associated with 20-22% greater odds of maternal depression, 0.28-0.39 greater depression score, and 0.85-1.16 greater parenting stress score. Relations between pregnancy intention and maternal depression, maternal depression score and parenting stress score were moderately explained by marital conflict and fathers' participation in childcare., Conclusions: Unintended pregnancy contributed to increased risks of maternal depression and parenting stress. Efforts to increase fathers' participation in childcare and decrease marital conflict might be helpful to mitigate adverse impacts of unintended pregnancy on perinatal maternal mental health.

In recent years, the theory of mentalization has been applied to a number of clinically relevant areas including psychotherapy for patients with borderline personality disorder, therapy with adolescents and children, treatment of self-harm in young people, parent-infant early interventions, and even community outreach (see Midgley & Vrouvam, 2012. Minding the child: Mentalizing interventions with children, young people, and their families. London and New York: Routledge). Extending on this body of work, the present article applies the theory of mentalization to psychotherapies that aim to help first time expecting mothers psychologically adjust to and prepare for motherhood. Theory and research suggest that pregnancy represents an intermediate space in which, under ideal circumstances, the woman comes to represent herself as a mother, her unborn child as a separate and intentional being, and her emotional bond or attachment to the fetus. However, the expecting mother's own conflictual experiences being mothered are likely to influence her ability to mentalize her pregnancy, setting the stage for problems in the mother-infant dyad postpartum. This article explores how mentalizing techniques may be used in psychotherapy to help mothers-to-be to mentalize their emerging identity as a mother, their unborn child, and their developing relationship to the fetus., (2013 APA, all rights reserved)

Background: Postpartum depression is a mental disorder that occurs after birth and has negative consequences for the mother, infant, and family. The objective of this secondary analysis was to examine whether pregnancy intention was associated with postpartum depression among first-time mothers., Methods: The First Baby Study is a prospective cohort study of women aged 18-35 having a first singleton birth in Pennsylvania. Baseline data were collected during the third trimester. Postpartum depressive symptoms were measured at 1-month postpartum using the Edinburgh Postnatal Depression Scale. Logistic regression was performed to examine the association between unintended pregnancy and postpartum depression, controlling for prepregnancy anxiety/depression and sociodemographic data., Results: Of 2972 first-time mothers, 83.4% were white, 70.7% were married, and 56.9% were college educated. Nine hundred fifty-two women (32.0%) reported their pregnancy was unintended and 151 (5.1%) met the threshold for postpartum depression. The prevalence of postpartum depression was higher in women with unintended pregnancies compared to women with intended pregnancies (6.7% vs. 4.3%, p<0.01). However, after controlling for confounders, unintended pregnancy was no longer associated with postpartum depression (adjusted OR 1.41; 95% CI 0.91-2.18). Variables independently associated with postpartum depression included prepregnancy anxiety/depression, Asian race, and Hispanic ethnicity., Conclusion: Pregnancy intention was not independently associated with postpartum depression among first time mothers in Pennsylvania.

Context: High unintended pregnancy rates, and inconsistencies between reported pregnancy intentions and contraceptive behaviors, have been well documented among young U.S. women. Women's beliefs about the benefits of childbearing and motherhood may be related to the apparent disconnect between pregnancy intentions and reproductive outcomes., Methods: Perceived benefits of childbearing and feelings about a potential pregnancy were assessed among 1,377 women aged 15-24 (most of them black or Latina) participating in a longitudinal study in 2005-2008. The women, who were initiating hormonal contraception at public family planning clinics and did not want to become pregnant for one year, were followed for 12 months. Differences in perceived benefits of childbearing by participant characteristics were examined with linear regression, using a new multi-item measure. Cox proportional hazard regression was used to investigate the association of perceived benefits of childbearing with subsequent contraceptive discontinuation and pregnancy., Results: Perceptions of the benefits of childbearing decreased with increasing age (coefficient, -0.04), and white women perceived fewer benefits to childbearing than blacks (-0.2). As women's perception of the benefits of childbearing increased, their one-year pregnancy rates increased, after demographic characteristics and feelings about a potential pregnancy were controlled for (hazard ratio, 1.2). Benefits of childbearing were not associated with contraceptive discontinuation., Conclusions: To better assess pregnancy risk among young women wanting to avoid pregnancy, it may be useful to acknowledge that they hold not only explicit pregnancy desires, but also beliefs about the benefits of childbearing, which may influence sexual behavior and pregnancy., (Copyright © 2013 by the Guttmacher Institute.)

Background: Motherhood is a critical situation characterized by role conflicts. These conflicts between the roles of mother, worker, and wife are the norm in the postpartum period and may jeopardize a mother's well-being. The purpose of this study was to explore the relationships between postpartum adaptation and depression among new mothers who live in northern Taiwan., Material and Methods: A total of 186 first pregnancy mothers were recruited via convenience sampling methods and they completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, Postpartum Self-Evaluation Questionnaire, and Edinburgh Postnatal Depression Scale were used., Results: Ninety-four (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women needed to consult the doctor (EPDS > 12). The risk factors for postpartum depression symptoms included unplanned birth, low socioeconomic status, and part-time employment. The correlation between women's different aspects of postpartum adaptation and depression ranged was from low to medium. The best predictors of postpartum depression were confidence in their own competence of motherhood tasks, satisfaction with life circumstances, and partner participating in child care. These three subsets explained 44.8% of the total variance., Conclusion: This study shows that healthcare providers who work with primiparas during the first 2 months after giving birth should pay more attention to postpartum depression, keeping in mind associated risk factors. A new mother's confidence in her own abilities as a new mother may be particularly important in determining the likelihood of postpartum depression.

The terms mistimed pregnancy (MP) and unwanted pregnancy (UWP) refer to a woman's intentions regarding childbearing. Determinants for each type of pregnancy have not been well understood. The present study aims to investigate whether MP and UWP have different sets of psychosocial determinants compared to intended pregnancy, with a particular emphasis on any difference in the history of maternal psychiatric diagnosis. Using an ongoing birth cohort study, we consecutively enrolled parturients who were at mid-pregnancy (n = 780) and were expected to give birth at either of our two research sites. MP and UWP were defined according to previous studies. To avoid multiple testing, we adopted multinomial logistic regression to estimate the independent contribution of the determinants while simultaneously allowing for other variables. The dependent variable in the model had three classes: Intended pregnancy, MP and UWP. Determinants of MP included younger age (<25 years: OR = 2.6), currently working (OR = 1.6), and history of major depression (OR = 2.0). Determinants for UWP were multiparity (OR = 3.9), short (≤12 years, OR = 1.7) and long period of education (≥17 years, OR = 3.3), history of anxiety disorder (OR = 2.5), currently working (OR = 0.6) and high income (≥8 million JPY, OR = 0.4). Different sets of psychosocial determinants contribute to formulate MP and UWP. A history of mental illness plays a role in predicting pregnancy intention.

Objective: To investigate the motivation for motherhood in women with hypertensive diseases in pregnancy., Methods: A questionnaire was sent to 2600 women with hypertensive diseases in pregnancy and 1233 controls. Diagnoses from medical records were differentiated according to the International Society for the Study of Hypertension in Pregnancy criteria. After matching, data from 739 patients and 623 controls were evaluated with Student's-t, Chi square tests and multiple logistic regression models., Results: Women with hypertensive diseases in pregnancy longed more often for children (85.3%/70.3%, p < 0.0001), considered children more often as the sense of their life (33.6%/29.7%, p < 0.005) and used pregnancy more often to stop a disliked professional activity (9.7%/2.3%, p < 0.0001). Controls reported more often to give birth to avoid termination of pregnancy (5.3%/10.4%, p = 0.0005)., Conclusions: Women with hypertensive diseases in pregnancy concentrate more extensively on motherhood in their life. If this attitude is already present before pregnancy it may augment the risk for disease and might be used for prophylaxis.

Background: Women worldwide experience pregnancy-related nausea and vomiting yet tolerate this significant prenatal stressor. The physical and emotional stress caused by pregnancy-related nausea and vomiting may influence maternal psychosocial adaptation yet few studies have examined these relationships., Objectives: The purpose of the study was to examine the relationships between nausea and vomiting, perceived stress, social support and their ability to predict maternal psychosocial adaptation among Taiwanese women during early pregnancy., Design: A correlational, cross-sectional research design., Setting: Four prenatal clinics in Taiwan., Participants: Women (n=243) who had completed the 6-16 week of gestation consented to participate., Methods: Subjects completed four self-report questionnaires in additional to providing demographic data: Index of Nausea, Vomiting, and Retching (INVR), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL), and the Prenatal Self-Evaluation Questionnaire (PSEQ)., Results: Pregnancy-related nausea and vomiting was experienced in varying degrees by 188 (77.4%) women. Stepwise multiple regression analysis revealed that 37.6% of the variance in maternal psychosocial adaptation was explained by the severity of nausea and vomiting, perceived stress, social support, and pregnancy planning., Conclusions: Women at higher risk for poor maternal psychosocial adaptation have not planned their pregnancy and experience severe pregnancy-related nausea and vomiting. Severe pregnancy-related nausea and vomiting associated with high-perceived stress levels may be mediated by social support.

Aim: Among Swedish pregnant teenage girls it is unusual to continue pregnancy and to choose to have a baby. Swedish teenage mothers can therefore be expected to differ from adult mothers, at a group level. The aim of this study was to describe and compare teenage mothers who were giving birth in hospital with adult mothers as to sociodemographic background, perception of health and social support., Methods: A descriptive comparative study was conducted over one year, in a county in south-western Sweden, which comprised a group of all teenage mothers aged 15-19, who gave birth at hospital (study group n=97) and the same number of adult mothers aged 25-29, matched for parity and birth of a baby closest to the index mother (reference group). Both groups answered a questionnaire regarding sociodemographic variables, lifestyle, health, self-esteem, depressive symptoms, and support. Information on the mothers' pregnancy and delivery was obtained from their maternal health and delivery charts., Results: Teenage mothers had more often been exposed to a difficult family situation, had more often experienced school failure than adult mothers, and showed health-risk behavior. Teenage mothers perceived less support, had lower self-esteem, and more depressive symptoms than adult mothers., Conclusions: Teenage mothers differed from adult mothers regarding family situation and health behavior as well as perception of support, self-esteem, and depressive symptoms, which may negatively influence their ability to cope with parenthood. Efforts should be made early in pregnancy to meet both health and support needs of teenage mothers.

The current study aimed to estimate the prevalence and correlates of unintended pregnancy among ever-married women. The study sample was 2349 ever-married women aged 15-49 years who gave birth in 1999. Unintended pregnancy was defined as unwanted and mistimed pregnancies. Of these, 431 (18.5%) women reported unintended pregnancy: 137 were mistimed (5.9%) and 294 were unwanted (12.6%). Women of older age, living in frontier governorates, with poor knowledge of the ovulatory cycle, having a more than ideal family size, using contraceptive methods and having 4 or more children were at increased odds of reporting unintended pregnancies. Fewer antenatal care visits and low child weight at birth were significantly associated with unintended pregnancy.

Purpose: To determine the perceptions of young mothers concerning their intentions about repeat pregnancy and to determine shared meanings concerning intentionality and decision making about sexual activity and use of birth control., Design and Methods: Ethnographic, descriptive study with interviews of a purposive sample of young mothers with a repeat pregnancy. Iterative methods, recursive data sifting, and Ethnograph 5.0 were used in data analysis., Results: All of the mothers stated that their repeat pregnancies were unintended. Regarding decision making about sexual activity, some mothers discussed a conscious, rational decision-making process before sexual activity, whereas others talked about a more impulsive, spontaneous participation in unprotected sexual activity. A key finding in this study was that although mothers did not intend to get pregnant, they also did not intend to prevent pregnancy. Many discussed feeling pressured to have sex, coerced into not using birth control, unable to implement safe sex behaviors, or just "doing it.", Clinical Implications: These data suggest that much of teen sexual activity is spontaneous, unplanned, and sometimes involuntary. As such, interventions must be created that take the nature of this sexual activity into account. Consideration of young mothers' thought processes, intentions, and perspectives is integral in the design and implementation of programs and policies to prevent or delay repeat pregnancy during the adolescent years.

Objective: To examine the relationship between unintended pregnancies and prolonged breast-feeding among 18 countries on an individual and aggregated level., Design and Setting: Regional multivariate logistic regression analyses were conducted to examine this association based on 18 Demographic and Health Surveys conducted between 1995 and 2000., Subjects: Women who had a live child between 13 and 36 months old were included in these analyses (n=41 353)., Results: Regression models were adjusted for 10 covariates including child age, maternal age, pregnancy status of mother at the time of interview and parity. In 11 out of the 18 countries the odds ratio (OR) of the association between unintended pregnancies and prolonged breast-feeding was <1.0, reaching statistical significance in three countries. Pooled analyses of all 18 countries detected a significant association between unintended pregnancies and less likelihood of prolonged breast-feeding (OR=0.90, 95% confidence interval=0.85-0.96)., Conclusions: Prospective studies are needed to further understand if and how pregnancy intentions influence breast-feeding outcomes in different settings.

Maternal-fetal attachment is the purest source of the powerful attachment relationship, the gradual internalisation of the life within unspoilt by the realities and complexities of early parenting. This qualitative study searches for a definition of attachment utilising a phenomenological framework. An opportunity sample of 10 women in the final trimester of pregnancy was interviewed. Interviews were transcribed and analysed using Glaser & Strauss's (1967) constant comparative methodology. Thirteen key themes were identified, of these 4 were specific to parenting experience. A novel finding contrary to earlier studies was that women reported their overwhelming emotion was not love but an innate desire to protect. Protection, the developmental nature of attachment and importance of the emotional and physical support of a partner or parent form the kernel of an evolving paradigm.

This study looked at the frequency and determinants of unplanned births among women in Beheira governorate, Egypt, and the effects on antenatal and postnatal care sought by the mother for herself and her child. Unintended births comprised 23.6%; 13.8% were unwanted and 9.8% were mistimed. Contraceptive failure accounted for 28.8% of unintended pregnancies; 47.1% of women who reported unintended pregnancy were not using [corrected] contraception. Age, education and parity were predictors of unwanted pregnancy. Contraceptive use and maternal employment status predicted mistimed pregnancy. Unintended pregnancy was a barrier to antenatal care, but not to child care. Our findings suggest that family planning programmes should help women of reproductive age achieve spacing and fertility limits.