The planning of pregnancy among low-income women in central Harlem

Abstract

A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, we have compared the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal mental health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The two groups did not differ in any other risk factor or in outcome in terms of birth weight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly based interventions that are not confined to the periconceptional period.

PIP: A planned pregnancy is considered desirable, in part because of the potential of a better pregnancy outcome. Since the improvement of pregnancy outcome is of particular relevance in low-income populations, this study compares the characteristics of women with planned and unplanned pregnancies in central Harlem with regard to those factors that might affect pregnancy planning such as sociodemographic factors, attitudes toward child-rearing, environmental stress, social support, and maternal health. Of the 416 women in the study, a minority (27%) reported their pregnancy as being planned. They differed from the remainder in being more likely to be married and/or living with a boyfriend or husband and to have been born outside New York City. The 2 groups did not differ in any other risk factor or in outcome in terms of birthweight and gestational age. The results provide little support for the lack of planning of pregnancy as an indicator of risk in a low-income population and suggest that improvement of perinatal outcome must involve more broadly-based interventions that are not confined to the preiconceptional period. For example, preconceptional care programs as recommended by the recent Institute of Medicine report must involve approaches that do not require previous knowledge of the timing of pregnancy and must be directed to the entire population of urban low-income women. Also important is the aggressive management of medical problems and adverse health behaviors as early in pregnancy as possible. This study presents a picture of a group of women, regardless of whether they have planned their pregnancies, who are under high levels of environmental stress and emotional distress; many continue to smoke or to use excessive alcohol. Although traditional medical services have done much to improve the morbidity of pregnancy, these services can be anticipated to make no more than a marginal contribution to the health status of this group of pregnant women.