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Objectives: Approximately half of US pregnancies are unintended and 43% of these end in induced abortions. Male partners and their involvement in reproductive decisions is not well understood. We examined the association between couple pregnancy intentions and induced abortion in US women. Materials and Methods: Data came from the National Survey of Family Growth (2006-2010). Primiparous women who lived with one husband or partner before conception of their first pregnancy were included in the analysis (N=4263). Multiple logistic regression was used to assess the relationship between couple pregnancy intentions and induced abortion of first pregnancy. Results: Approximately 17.1% of women reported discordant intentions and 32.3% reported that pregnancy was unintended by both parents. Among these couples, the women were more likely to be unmarried, minorities, of lower income and education, and 19 years of age or younger at conception than were couples in which both parents intended pregnancy. Compared to couples with a mutually intended pregnancy, those with discordant pregnancy intentions were significantly more likely to have induced abortion, even in women who desired pregnancy. Conclusion: Partners had a vital role in decisions to have an induced abortion. Health providers should consider the interpersonal decision-making process in couples to best prevent induced abortions due to unintended pregnancy. Providers should also be aware of the role of violence on reproductive decisions in couples with discordant pregnancy intentions. Women in healthy relationships can benefit from having frequent conversations about pregnancy with their partners.

BackgroundRapid repeat pregnancy (RRP) is a major problem in the United States. Few studies have explored the influence of partner agreement on pregnancy intention and RRP.ObjectiveWe sought to examine the association between couple pregnancy intentions and RRP among women in the United States.Study designData came from the 2006 through 2010 National Survey of Family Growth. Multiparous women who cohabited with 1 husband/partner before conception of second pregnancy were included (N = 3463). The outcome, RRP, was categorized as experiencing a second pregnancy within 24 months of the first pregnancy resolution, or ≥24 months from the first pregnancy resolution. Maternal and paternal pregnancy intentions were categorized into 4 dyads: both intended (M+P+); maternal intended and paternal unintended (M+P-); maternal unintended and paternal intended (M-P+); and both unintended (M-P-). Multiple logistic regression was conducted to determine the association between couple pregnancy intentions and RRP.ResultsNearly half (49.4%) of women had RRP. Approximately 15% of respondents reported discordant couple pregnancy intentions and 22%, maternal and paternal unintendedness. Compared to couples who both intended their pregnancy (M+P+), the odds of RRP was higher when fathers intended pregnancy but not mothers (adjusted odds ratio, 2.51; 95% confidence interval, 1.45-4.35) and lower if fathers did not intend pregnancy but mothers did (adjusted odds ratio, 0.77; 95% confidence interval, 0.70-0.85). No difference was observed between concordant couple pregnancy intentions (M-P- vs M+P+).ConclusionFindings highlight the important role of paternal intention in reproductive decisions. Study results suggest that RRP is strongly influenced by paternal rather than maternal pregnancy intentions. Clinicians and public health workers should involve partners in family planning discussions and counseling on optimal birth spacing.

ObjectivesIntimate partner violence (IPV) is a major problem that could affect reproductive decision making. The aim of this study is to examine the association between IPV and contraceptive use and assess whether the association varies by receipt of prenatal birth control counseling and race/ethnicity.Study designThis study analyzed the 2004-2008 national Pregnancy Risk Assessment Monitoring System (PRAMS) that included 193,310 women with live births in the United States. IPV was determined by questions that asked about physical abuse by a current or former partner in the 12 months before or during pregnancy. The outcome was postpartum contraceptive use (yes vs. no). Multiple logistic regression analyses were conducted to assess the influence of experiencing IPV at different periods (preconception IPV, prenatal IPV, both preconception and prenatal IPV, preconception and/or prenatal IPV). Data were stratified to assess differential effects by race/ethnicity and receipt of birth control counseling.ResultsApproximately 6.2% of women reported IPV, and 15.5% reported no postpartum contraceptive use. Regardless of the timing of abuse, IPV-exposed women were significantly less likely to report contraceptive use after delivery. This was particularly true for Hispanic women who reported no prenatal birth control counseling and women of all other racial/ethnic groups who received prenatal birth control counseling.ConclusionsIPV victimization adversely affects the use of contraceptive methods following delivery in women with live births. Birth control counseling by health providers may mitigate these effects; however, the quality of counseling needs further investigation. Better integration of violence prevention services and family planning programs is greatly needed.ImplicationsConsistent with national recommendations by the U.S. Preventive Service Task Force, clinicians and public health workers are strongly encouraged to screen for IPV. Health providers should educate women on effective contraceptive options and discuss long-acting reversible contraceptives that are not partner dependent within the context of abusive relationships.

Background: Research has shown that early age of sexual debut is associated with physical dating violence (PDV), but sex-specific associations are sparse. We estimated the prevalence of PDV victimization in high school students who have initiated sexual intercourse and examined sex-specific association between age of sexual debut and PDV victimization. Methods: Data on 8637 students in grades 9 through 12 who had initiated sex was obtained from the 2009-2011 national Youth Risk Behavior Survey. The association was examined using multiple logistic regression, accounting for the complex survey design, and stratified by sex. Results: Approximately 15% of sexually active students reported past-year PDV victimization. The odds of PDV victimization among girls who had sexual debut at <12 years was 2.46 (95% CI = 1.50-4.02) and 2.20 (95% CI = 1.42-3.41) for boys, compared to those who initiated sex at 16 years and older. Conclusions: Evidence supports the belief that early sexual debut is associated with higher odds of PDV victimization, particularly for girls. Healthcare providers, school counselors, and educators should be aware of this sex difference in the association between early sexual debut age and PDV victimization while focusing PDV interventions on adolescents with early sexual debut age.

Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007-2009 to 2010-2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions., Author(s): Ramona A. Danielson [sup.1] , Jordyn T. Wallenborn [sup.2] , Donald K. Warne [sup.3] , Saba W. Masho [sup.4] Author Affiliations: (Aff1) 0000 0001 2293 4611, grid.261055.5, Department of [...]

Objectives Despite the benefits of breastfeeding, less than a fifth of American mothers breastfeed for the recommended duration. Paternal support plays a major role in maternal and child health outcomes; however, the influence of paternal pregnancy intention on breastfeeding duration is under investigated. This study examines the relationship between fathers' pregnancy intention and breastfeeding duration. Methods Data from the 2011-2013 National Survey of Family Growth were analyzed using cross-sectional methodology. Women who were pregnant, never received medical help to become pregnant, whose partner was aged 18-49 years, and who responded to questions related to paternal pregnancy intention and breastfeeding were included in the analysis (N = 2089). Multinomial logistic regression, odds ratios and 95 % confidence intervals were calculated. There was a statistically significant interaction between father's age and father's pregnancy intention (P = 0.0385) and all models were stratified by paternal age. Results Fathers aged 18-24 years with a mistimed pregnancy were 2.3 times more likely to have a child who was never breastfed, (AOR 2.27, 95 % CI 1.39-3.70) and 1.7 times more likely to have a child who was breastfed 6 months or less (AOR 1.69, 95 % CI 1.28-2.23) compared to fathers with an intended pregnancy. No statistically significant association was observed among fathers aged 25-49 years. Conclusion Findings from this study show a relationship between mistimed pregnancies and breastfeeding duration among younger fathers. Healthcare professionals should develop breastfeeding interventions targeting fathers and young families., Author(s): Jordyn T. Wallenborn [sup.1] , Saba W. Masho [sup.1] , Scott Ratliff [sup.1] Author Affiliations: (1) 0000 0004 0458 8737grid.224260.0Division of Epidemiology, Department of Family Medicine and Population Health, [...]

Objectives The link between cigarette smoking and poor birth outcomes has been well established. However, there is paucity of research investigating the effect of previous history of poor birth outcomes on smoking behavior during subsequent pregnancies. The present study seeks to determine whether a previous preterm or low birth weight delivery impacts maternal smoking during the subsequent pregnancy. Methods Data from the National Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed. Multiparous women who currently had singleton birth were included in the analysis (N = 137,297). Previous poor birth outcome and smoking were defined based on the PRAMS question that asked women whether their immediate previous baby was born preterm or low birth weight and if they smoked during the index pregnancy. Results Approximately 16.3 % of the women who reported previous poor birth outcome also reported smoking during the subsequent pregnancy. Multiple logistic regression analysis revealed that women who had previous poor birth outcome had 22 % higher odds of smoking during the subsequent pregnancy. Similarly, the odds of smoking during pregnancy were 30 and 13 % higher among women who had previous low birth weight and preterm birth, respectively. Conclusions Women who experienced previous preterm or low birth weight baby had higher prevalence of smoking during the subsequent pregnancy. The occurrence of a preterm/low birth weight may present a critical intervention point for providers to educate women on the risks of repeated poor birth outcomes and provide intervention programs to address high-risk behaviors., Author(s): Sara B. Varner[sup.1] [sup.2] , Timothy Ihongbe[sup.1] , Saba W. Masho[sup.1] [sup.3] [sup.4] Author Affiliations: (1) Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, [...]

Over 1.5 million women are physically, sexually, and emotionally abused by intimate partners in the U.S. each year. Despite the severe health consequences and costs associated with intimate partner violence (IPV), most health providers fail to assess patients for abuse. It was of interest to examine the occurrence of IPV discussions during prenatal care (PNC) visits among women who experienced IPV. This study analyzed data from the 2004-2008 National Pregnancy Risk Assessment Monitoring System which included 195, 687 women who delivered a live birth in the U.S. IPV victimization was measured using four items that addressed physical abuse by a current or former husband/partner in the 12 months before or during pregnancy. Responses were categorized as preconception, prenatal, preconception and prenatal, and preconception and/or prenatal IPV. The outcome was IPV discussions by health providers during PNC. Separate logistic regression models provided odds ratios and 95% confidence intervals. Women who reported prenatal IPV were less likely to have IPV discussions during PNC (OR = 0.81, 95% CI = 0.70-0.94). Results were similar for women experiencing IPV during the prenatal and preconception periods. Among racial/ethnic minorities, women who experienced preconception IPV were less likely to have discussions about IPV during PNC. Further, Medicaid recipients who reported preconception and/or prenatal IPV were less likely to report IPV discussions (OR = 0.75, 95% CI = 0.69-0.82). This study underscores a public health problem and missed opportunity to connect battered victims to necessary services and care. It elucidates the state of current clinical practice and better informs policies on incorporating universal IPV screening. Keywords Intimate partner violence * Pregnancy * Prenatal care * Provider discussions * Pregnancy Risk Assessment Monitoring System, Introduction Over 1.5 million women are physically, sexually, and emotionally abused by former or current intimate partners in the U.S. each year [1-3]. National estimates on the prevalence of intimate [...]

Perinatal depression screening has become an imperative for maternal and child health (MCH) home visitation programs. However, contextual life experiences and situational life stress may be equally important in determining program response. As one component of a larger research study with an urban MCH home visitation program, we examined the results from multiple measures of depression and anxiety symptoms, social support and stressful life events in a sample of 30 newly enrolled program participants. We compared commonly used tools in identifying women who were 'at risk' for perinatal depression. The analysis used published and agency practice cut-off scores, examined correlations between measures, and reflected on the role of stressful life events in this assessment. In this low-income, predominantly African-American sample, the assessed tools were inconsistent in identifying 'at risk' women for perinatal depression, ranging from 22% (Edinburgh Perinatal Depression Scale) to 75% (Center for Epidemiological Studies, Depression Scale) depending on the instrument. Depression and anxiety were correlated across most measures, although provider-collected data did not correlate as anticipated with other measures. The combination of screening for perinatal depression and stressful life events offered an additional perspective on possible symptom alleviation and psychosocial intervention that could occur within the home visiting program. Our experience suggests that introducing a brief inventory of stressful life events accompanying perinatal depression screening allowed for a more comprehensive understanding of women's experiences than perinatal depression screening alone. We encourage psychosocial risk screening which integrates assessment of social support, stressful life events and perinatal depression symptoms. Keywords Perinatal depression * Maternal depression * Depression screening * Home visiting * Mental health services * Psychosocial risk, The past decade has brought widespread awareness of the need to integrate perinatal depression screening into maternal and child health (MCH) home visiting programs. At the same time, extensive effort [...]

Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N = 902) were interviewed at their first prenatal care visit. Survey questions included items related to women's sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95% confidence intervals depicting the relationship between these factors and smoking during pregnancy. The analysis reported that maternal age [OR = 1.08, 95% CI = 1.05-1.12], less than high school education [OR = 4.30, 95% CI = 2.27-8.14], unemployed [OR = 2.33, 95% CI = 1.35-4.04], criminal history [OR = 1.66, 95% CI = 1.05-2.63], receipt of social services [OR = 2.26, 95% CI = 1.35-3.79] alcohol use [OR = 2.73, 95% CI = 1.65-4.51] and illicit drug use [OR = 1.97, 95% CI = 1.044-3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period. Keywords Smoking during pregnancy * Correlates of smoking * Criminal history * Social services * Preconception health, Introduction Maternal smoking during pregnancy is a serious and preventable risk factor that is associated with poor pregnancy outcomes. In the United States, measures of both infant morbidity and mortality [...]

In the United States the number of births to unmarried mothers is at a record high. Although being unmarried is a significant risk factor for low birth weight and preterm births, paternal presence may have a protective effect. In addition to marital status, paternity may be a proxy measure for paternal support. Virginia birth registry data were analyzed to investigate the effect of marital and paternity status on low birth weight and preterm births. Findings from this study show that women who reported being unmarried and with no paternity status were 1.6 (odds ratio = 1.57, 95% confidence interval = 1.41-1.75) and 1.4 (odds ratio = 1.39, 95% confidence interval = 1.21-1.61) times more likely to have preterm low birth weight and term low birth weight babies, respectively. Being unmarried and lack of established paternity appear to be significantly correlated with and may be important risk factors for preterm and low birth weight deliveries. Health care professionals should be aware of the potential role of paternal presence and marital status may play with respect to preterm births and low birth weight. KEYWORDS low birth weight, marital status, paternal presence, poor birth outcomes, preterm birth DOI: 10.1080/01494929.2010.499319

Male sexual assault is a serious public health issue that is mostly underreported and unrecognized. A population-based study was conducted on 705 adult men in Virginia. The study found a lifetime prevalence of 12.9% among men, with 94% assaulted for the first time before the age of 18. Regression analysis showed that male victims of sexual violence were 3.4 times more likely to be depressed and 2.4 times more likely to ideate suicide. However, only 15.4% sought counseling. This study confirms that male sexual assault is a prevalent problem. It is also evident that victimized men were more likely to be depressed and ideate suicide and yet did not seek health services. Efforts should be made to reach men with a history of sexual assault. Keywords: male sexual violence; male sexual victimization; child molestation; child rape; male rape

Short interbirth interval (IBI) has serious adverse health consequences, yet has an estimated prevalence of 35% in the United States. Similarly, intimate partner violence (IPV) around time of pregnancy, experienced by approximately 5% of women, is associated with increased risk of poor pregnancy outcomes. IPV might compromise women's decision-making, contributing to unintended pregnancy and short IBI. This study examines the relationship between pre-pregnancy IPV and short IBI, and whether insurance status moderates this relationship among multiparous women who responded to the 2009–2011 Pregnancy Risk Assessment Monitoring System survey (N = 13,675). Pre-pregnancy IPV (yes; no), insurance status (Private insurance; Medicaid/public insurance; no insurance), and short IBI (yes; no) were examined. Insurance status was identified as an effect modifier (p =.03), and maternal age, maternal and paternal education, marital status, and drinking alcohol were identified as potential confounders. Multiple logistic regression analysis stratified by insurance status provided adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CI). Overall, 4.6% of women reported IPV before pregnancy, and 48% had a short IBI. When stratified by insurance status, the odds of short IBI was about 3 times higher among women with no insurance and women on Medicaid/public insurance who reported IPV compared to women who did not report IPV (aOR = 3.36, 95% CI = [1.02, 8.02], and aOR = 2.50, 95% CI = [1.04, 5.92], respectively). There was no observed significant difference in the likelihood of short IBI by experience of IPV among privately insured women. Findings from this study strengthen the evidence that women who experience IPV before pregnancy are significantly more likely to have short IBI compared to women who do not experience pre-pregnancy IPV. Furthermore, the odds of short IBI is highest among women experiencing pre-pregnancy IPV who are uninsured or on Medicaid/public insurance. [ABSTRACT FROM AUTHOR]