Download printable version (PDF 113KB) What is PRAMS?The Pregnancy Risk Assessment Monitoring System (PRAMS), administered by the Centers for Disease Control and Prevention, is an ongoing, state-specific, population-based surveillance system of maternal behaviors and experiences before, during, and after pregnancy. Developed in 1987, PRAMS was designed to supplement vital records by providing state-specific data on maternal behaviors and experiences to be used for planning and assessing perinatal health programs. Currently conducted in 31 states and one city, PRAMS collects data on 60% of U.S. births. According to the 1995 National Survey of Family Growth (NSFG), 49% of pregnancies in the United States (excluding miscarriages) and 31% of pregnancies resulting in a live birth are unintended.1 An unintended pregnancy is either mistimed (the woman wanted to be pregnant later) or unwanted (she did not want to ever be pregnant).2,3 One analysis of the NSFG data found that the numbers of unintended pregnancies and births had declined from 1987 to 1994;1 however, more recent data from PRAMS show that these rates may not be declining in all states.2-4 One of the goals of Healthy People 2010, which establishes the nation’s health goals for the coming decade, is to decrease unintended pregnancies from 49% to 30% by 2010.5 The Impact of Unintended Pregnancy on Women and ChildrenUnintended pregnancy is of national
importance because it may influence
a woman’s behavior and experiences
during pregnancy and affect the health
of her newborn infant.6,7 Because women
whose pregnancies
are unintended are likely to discover their
pregnancies later than those with intended pregnancies,
they are less likely to adopt healthy behaviors and
start prenatal care at the beginning of pregnancy.7 For
example, women with mistimed or unwanted pregnancies
are more likely to smoke cigarettes and less likely
to follow their doctor’s advice to quit smoking than
women with intended pregnancies.7,8 Smoking during
pregnancy not only negatively affects
the mother’s health but also can
result in preterm delivery and low
infant birth weight.9 In addition,
women with unintended pregnancies
may have had inadequate pre-pregnancy
folic acid intake, which has
been linked with neural tube
defects.10 Unintended pregnancy can also
affect infant and child health after
delivery. For example, mothers with
unintended pregnancies resulting
in live births are less likely to breastfeed
their infants than women with
intended pregnancies.11 PRAMS Importance in Measuring Unintended PregnancyTo prevent unintended pregnancy, programs must understand and account for the characteristics of women at risk. The PRAMS surveillance system collects state specific data that can be generalized to the entire population of women in that state who gave birth to live infants during that year. The PRAMS questionnaire asks women what their pregnancy intentions were at the time of conception. Because PRAMS addresses multiple topic areas (e.g., unintended pregnancy, mistiming, contraception), different maternal characteristics associated with these topics can be compared. The data can then be used to improve women’s access to family planning services, increase their knowledge of reproductive health and contraception, and encourage them to use contraception Prevalence Rates and Trends in Unintended Pregnancies Resulting in Live BirthsThe 1999 PRAMS data on unintended pregnancy resulting in a live birth in 17 states indicated a prevalence range of 34%–52%.2 From 27% to 36% of pregnancies were mistimed, and 6%–14% were unwanted (Figure 1). Recent PRAMS data show little change in the prevalence of unintended pregnancy resulting in a live birth. From 1993 to 1999, the prevalence of mistimed or unwanted pregnancies declined significantly in only two PRAMS states (Florida and West Virginia).2 Unintended Pregnancy and Maternal CharacteristicsPRAMS data for 1999 show that unintended pregnancy among women giving birth to a live infant was most common among young women, black women, women with 12 or fewer years of education, and women whose prenatal care was paid by Medicaid (Table 1).
Contraception’s Role in Unintended PregnancyA large part of many women’s reproductive lives, from menarche to
menopause, may be spent trying not to become pregnant.12 Effective
contraception is important for women who wish to avoid pregnancy at certain
times during their lives. However, recent research noted that 50% of all
unintended pregnancies were among women who did not use contraception, and
that the overall rate of unintended pregnancy could be cut in half if these
women were to use highly effective contraception.13 Explanation of Figure 1: A bar chart representing Mistimed and Unwanted Pregnancy Among Women Having a Live Birth by Selected States, 1999.
Explanation of Figure 2: A bar chart that represents Contraceptive Use at Time of Conception Among Women with Unintended Pregnancies Having a Live Birth, 1999.
Trends and Prevalence in Contraceptive Use and Unintended PregnancyPRAMS data for 1999 show that the prevalence of contraceptive use at the time of conception in 17 states ranged from 33% in Ohio to 46% in Maine (Figure 2).2 Between 1996 and 1999, rates of contraceptive use declined significantly in Alabama, Florida, and New York. Contraceptive use was not significantly associated with any of the selected characteristics of women who had an unintended pregnancy. Building on ResearchUnintended pregnancy remains a serious problem in the United States for sexually active women of reproductive age. New studies need to build on existing research and improve our understanding of pregnancy intention. For example, further exploration is needed of the finding from earlier studies5,14 that causal links between unintended pregnancy and poor birth outcomes may be influenced by social and cultural factors such as poverty. Other studies have suggested that unwanted pregnancies are more likely than mistimed ones to have negative health outcomes,15 and that seriously mistimed pregnancies (more than 24 months) may have a higher risk for negative health outcomes for mother, child, and family than moderately mistimed pregnancies (less than 24 months).16 Understanding these differences is vital to measuring how pregnancy intention influences health outcomes. We also need to better understand how women’s feelings about becoming pregnant, especially feelings of ambivalence, may influence contraceptive use.17,18 Importantly, the concept of planning and pregnancy intention may not be meaningful to all women.17,18 This conceptual issue affects how we understand and measure intention. Finally, little is known about the influence of gender and power on reproductive health decision making and the role of male partners in determining pregnancy intention and contraceptive use.18 Future analyses of PRAMS data can help to answer these questions. Using PRAMS Surveillance to Improve the Health of Mothers and BabiesPRAMS, which is already a valuable data source for examining unintended pregnancy, continues to expand questions to better measure intention and track trends in unintended pregnancy and contraceptive use. Learning more about the measurement of intention and the maternal characteristics associated with not intending to get pregnant may help to improve interventions aimed at women at high risk for unintended pregnancy.
Explanation of Figure 3: is a map of the United States that represents the States participating in PRAMS in 1999 and states added since 1999.
AcknowledgementsMany thanks to Jennifer O’Brien, lead author. Others providing input and support include Diana Bensyl, Brenda Colley Gilbert, Denise D’Angelo, Lisa Angus, Nedra Whitehead, and the PRAMS Working Group. For More InformationFor additional information or to obtain copies of this fact sheet, the PRAMS 1999 Surveillance Report, or the Family Planning Practices and Pregnancy Intention Report, contact the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway, NE, Mail Stop K-22, Atlanta, Georgia 30341-3717. Learn more about PRAMS and Unintended Pregnancy.
1. Henshaw SK. Unintended pregnancy
in the United States. Family Planning Perspectives 1998;30(1):24–29.
Page last reviewed: 6/22/07 |
|
|
||||||||||||
|