JOHNS HOPKINS UNIVERSITY, THE

Unwanted childbearing has been hypothesized to have significant detrimental health, social and economic consequences for children and parents, and represents a primary justification for investment in family planning programs. While the literature supporting these claims is large, much of this work has serious methodological limitations, especially the research on low-income non-Western societies. The measurement of unintended pregnancy is complicated by a number of serious methodological challenges; foremost among these is the issue of birth rationalization, whereby respondents may be reluctant to retrospectively describe births which were unwanted at the time of conception as unwanted, and instead revise them to have been either wanted or mistimed. The proposed project focuses on the potential health consequences associated with unwanted childbearing-- children who were born to mothers who stated that they did not want more children. Through the analysis of large rural samples of births from four states in India (Bihar, Jharkhand, Maharashtra and Tamil Nadu), the research will add substantially to the literature through the identification of the effects of unwanted births on maternal and child health outcomes. A significant advantage of the proposed research is the use of a prospective measure of birth unwantedness, which will surmount many of the biases faced by previous studies. Specifically, the study will examine the effects of unwanted childbearing on perinatal, neonatal, post-neonatal, and 1-2 year mortality, on the timing and utilization of prenatal care, on early childhood immunization and on maternal depression and mental health. The analysis uses data from two sources; the 1998-99 Indian National Family Health Survey (NFHS-2) and from a 2002-03 follow-up survey, in which 6303 women from four states who were included in the NFHS-2 were re-interviewed regarding births and health outcomes during the intervening four year period. A multi-level modeling approach will be employed to identify associations between birth wantedness and subsequent child and maternal health outcomes. The study will make important substantive contributions to understanding the contributing role of unwanted childbearing to adverse child and maternal health in resource-poor settings, as well as programmatically in understanding the potential contributions which effective family planning programs can make to improving child health and maternal well-being. PUBLIC HEALTH RELEVANCE: Using two cross-sectional samples of women of reproductive age from 4 states of India, this research will examine associations between pregnancy unwantedness and maternal, child and mental health outcomes. For the mother, the analysis will examine the role of pregnancy unwantedness in shaping access to care during pregnancy and mental health outcomes; for the child, the analysis will examine associations between pregnancy unwantedness, early infant mortality and receipt of immunizations.

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