Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Planned Pregnancies and Child Spacing

Fall 2004

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Size of the Problem

An estimated 96,460 pregnancies occurred among the 1,087,677 women of childbearing age (15-44 years) during 2000 in Minnesota. Of these pregnancies:

  • 70% resulted in live births;
  • 14% resulted in abortions; and
  • And estimated 16% ended in miscarriage or fetal death [1,2]

National data indicate that 49% of pregnancies are unintended translating into as many as 47,000 unintended pregnancies in Minnesota annually [3]. An unintended pregnancy is defined as one that was mistimed or unwanted at the time of conception. A Minnesota survey of new mothers (PRAMS, 2002) reported that 46% had been trying to get pregnant but 52% had not [4]. The US Healthy People 2010 Goal is for 70% of all pregnancies to be intentional [5].

Which statement best describes you during the 3 months before you became pregnant? (PRAMS, 2002)
Statement Percent
Trying hard not to get pregnant
7.2%
Trying not to become pregnant but not trying very hard
18.9%
Not trying to get pregnant/keep from getting pregnant
25.7%
Trying to become pregnant
45.8%
Source: MDH. Initial Findings from the Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) 2002. August 2004.

In 2002, 27.5% of Minnesota live births (about 18,700 babies) were to unmarried mothers [1].

Minnesota Out-of-Wedlock Births, 1996-2002
Year Percent
1996
24.9%
1997
25.5%
1998
25.7%
1999
25.7%
2000
25.7%
2001
25.8%
2002
27.5%
Source: MDH. Center for Health Statistics. 2004.

Nationally, a disproportionate share (77%) of women with a pregnancy that was unintended at conception are unmarried. However, unintended pregnancy occurs in 31% of married women as well [6]. Although 75% of pregnancies to teens (15-19 years) are unintended, high percentages and the highest numbers of unintended pregnancies occur in women who are beyond the teen years (see chart below).

Seriousness

According to the March of Dimes (MOD), all women of childbearing age can take steps even before conception to improve their chances of having a healthy baby [7]. Components of planned pregnancy and child spacing include:

  • Family planning services that support a planned pregnancy;
  • Male responsibility and involvement prior to conception, during pregnancy/birth, father involvement throughout childhood and participation in planning subsequent pregnancies;
  • Risk assessment and counseling for genetic conditions based on family and pregnancy history; and
  • Access to preconceptional and interconceptional health care.
Unintended Pregnancy Among U.S. Women by Age, 1995
Age Percent
15-19
75%
20-24
59%
25-29
40%
30-34
33%
35-39
41%
over 40
51%
Source: National Survey of Family Growth. 1995

The Institute of Medicine (IOM) reports that only “casual attention” has been given to the best protections against low birth weight or other poor pregnancy outcomes: having a woman actively plan for pregnancy; enter pregnancy in good health; and be fully informed about her reproductive and general health before conception [8].

Unintended pregnancy is a risk factor for late/inadequate prenatal care, exposure of the fetus to alcohol, tobacco and other toxins, maternal depression, low birth weight, and neonatal death. Unintended pregnancy is also associated with higher rates of economic hardship, child abuse/ neglect, marital dissolution, and spousal abuse. Most abortions are due to unintended pregnancy. Reducing unintended pregnancy will reduce the number of abortions [8,9].

About 75% percent of the women obtaining abortions in Minnesota in 2001 were not using contraception at the time of conception [9].

Disparities

Poverty and race/ethnicity are two areas examined by researchers for disparities in unintended pregnancy. The percentages of unintended pregnancies by Federal Poverty Level (FPL) are: 61% for women <100% FPL; 53% for women 100-199% FPL; and 41% for women at greater than 200% FPL [10].

Racial and ethnic disparities in access to health care, including primary preventive care, family planning, preconception care, and prenatal care have been identified in Minnesota. According to Minnesota birth certificate data, rates of inadequate/no prenatal care are 3-4 times higher among populations of color compared to whites. Rates of uninsurance are much higher among populations of color, Hispanics, and American Indians and also higher among Whites in greater Minnesota than in the metropolitan area [11].

Economic

National and state studies have looked at the economic and cost effectiveness of family planning and genetic counseling efforts.

  • Minnesota Department of Human Services (DHS) estimates there were 18,553 subsidized deliveries in 2001 at an average cost of $3,386 for a total of $62,819,540. There were 22,144 recipients of first year services at a cost of $6,894 for a total of $152,669,942. If half of those births are from pregnancies that were unintended, the estimated cost for births and first year services from pregnancies begun without intent is $107,744,741 [11].
  • Healthy People 2010 notes that pregnancy care costs for a woman who does not intend to be pregnant yet is sexually active and uses no contraception is about $3,200 in a managed care setting [10].
  • The estimate of total lifetime costs to Minnesota for 12 common birth defects that occur each year was calculated at $131 million [12]. Approximately 20% (480) of the estimated 2,400 babies born in Minnesota annually with birth defects may be attributed to genetic factors [13].

Interventions

The Institute of Medicine (IOM) report and Healthy People 2010 call for more reproductive health education and access to clinical reproductive health services. The use of contraception increases the interval between births and contributes to a reduction in low birth weight, since a short interval between births is a well-established risk factor for low birth weight. Contraception also plays a role in the reduction of sexually transmitted infections that can lead to future infertility.

The IOM recommends that efforts be structured around the following five goals:

  • Improve knowledge about contraception and reproductive health;
  • Increase access to contraception;
  • Address the roles that attitudes and motivation play in avoiding unintended pregnancy;
  • Develop and evaluate local initiatives, and
  • Stimulate research on contraceptive methods, organizing services, and the determinants and antecedents of unintended pregnancy.

Family planning clinics, where available, provide an array of options for contraception and serve as an entry point into health care for many teens, low income, and uninsured or underinsured women and men. Clinics also provide screening (breast, cervical and testicular cancer, HIV, rubella), diagnosis and treatment for sexually transmitted infections (STIs), urinary tract, and other infections.

Public health nursing and other home visiting programs in Minnesota provide family planning education and information on child spacing. Family planning methods allow a woman to delay pregnancy to a time when she consciously chooses to become pregnant, thus decreasing unintended pregnancies.

Prenatal or preconceptional genetic counseling should be offered to any couple with circumstances in which there is a definable increased risk for a fetal genetic disorder that can be diagnosed by one or more methods. Prenatal genetic screening or diagnosis should be voluntary and informed. The key elements in genetic counseling are accurate diagnosis, good communication of risks and conditions, and nondirective presentation of options [14].

Effectiveness of Interventions

A California study found that every dollar spent on family planning efforts through their PACT program to reduce unintended pregnancies, saved the state $4.98 in public expenditures [15,16].

Data from a Washington state Medicaid report on birth spacing in a population qualified for family planning services for one year after delivery showed the two-year subsequent birth rate was two to three times higher for women who did not receive family planning services compared to those who did [17].

Involving young men in family planning and reproductive health has the following benefits:

  • Reduces the rates of unintended pregnancy and HIV [18].
  • Improves communication between young men and women, helping them make more informed, shared decisions for family planning/reproductive health [19].
  • Presents more positive images/models for responsible, healthy masculinity [20].
  • Increases men’s sensitivity to gender equity and reducing the incidents of violence against women [18].
  • Increases men’s access to health care [21].

Status

Minnesota Resources

In Minnesota, Local Public Health Grant, MCH Block Grant, Family Planning, and Family Home Visiting funds can be utilized by local public health agencies and tribal governments to provide preconception and interconception care and counseling.

State and federal dollars fund family planning services to low-income women, men and teens in Minnesota. However, funds cover only about half of the women in need of subsidized services. The Minnesota Medicaid 1115 waiver was recently approved by the federal government and will be implemented in 2006. This is expected to significantly increase the number of women who would qualify for subsidized family planning services funded by Medicaid.

Genetic counseling/testing resources include:

  • Access to genetic counselors and geneticists in Minnesota is limited to Level III Perinatal Centers located at eight hospitals: five in the Twin Cities and one each in Rochester, Duluth, and St. Cloud;
  • The State Genomics Coordinator educates public and professionals on genomics, the interaction of all human genes with each other, with the environment, with human behavior and how interactions impact health;
  • Newborn blood spot and hearing screening is conducted on over 90% of Minnesota births; and
  • The state Birth Defects Information System will monitor incidence trends of birth defects, detect emerging health concerns, and identify affected populations beginning in early 2005 if federal funding is secured.

Public health programs that promote male-father involvement in reproductive health and parenting include:

  • The Minnesota Fathers and Families Network resources at www.mnfathers.org [Attn: Non-MDH Link]
  • Community-based work with adolescent African American males from the North and South side neighborhoods of Minneapolis to increase STD testing/treatment, increase condom use, increase knowledge and change social norms about sexual activity and teen pregnancies.
  • Additional resources include curricula available at www.dadsmakeadifference.org [Attn: Non-MDH Link], educational information at www.teenhealth411.org/guys_sex.php [Attn: Non-MDH Link] and www.dadsanddaughters.org [Attn: Non-MDH Link]

Community Awareness

Knowledge of family planning methods and access to services are crucial to preventing unintended pregnancy. New technology and contraceptive methods have increased in effectiveness. However, there is often a higher cost associated with them, making widely disseminated information on fertility and pregnancy prevention efforts an important part of public health efforts.

References

1. MDH. Minnesota Center for Health Statistics. 2003

2. Guttmacher Institute. State Facts About Abortion: Minnesota. www.guttmacher.org/pubs/sfaa/minnesota.html [Attn: Non-MDH Link] Accessed 8-16-04.

3. MDH. Healthy Minnesotans - Public Health Improvement Goals 2004. 1998

4. MDH. Initial Findings from the Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS). August 2004.

5. U.S. DHHS. Healthy People 2010. Washington, DC: Jan.2000. Conf. Edition pp 9-3 to 9-34.

6. National Survey of Family Growth. 1995 .

7. March of Dimes Birth Defects Foundation. (2002) Preconception Health Promotion: A Focus for Women’s Wellness, White Plains, N.Y.

8. Institute of Medicine, The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, National Academy Press: Washington, D.C. 1995

9. Abortion Reporting System, MDH Center for Health Statistics; Alan Guttmacher Institute (AGI): Facts in Brief, Contraception Counts: Washington Information, Washington D.C. 1999.

10. MDH. MCH Section/Community & Family Health Division. Unintended Pregnancy in Minnesota. January 2003.

11. MDH’s Health Economics Program. 2002. Minnesota’s uninsured: Findings from the 2001 health access survey .

12. http://healthyamericans.org/state/birthdefects/ [Accessed 7-04].

13. March of Dimes Resource Center. www.modimes.org [Attn: Non-MDH Link]

14. ACOG, AAP. 2002 Guidelines for Perinatal Care, 5 th Ed. Washington, DC

15. Marty, J. Editorial: Preventing Abortion by Reducing Demand. March 2, 2004. Minneapolis Star Tribune.

16. Foster DG, Klaisle C, et al. Expanded state-funded family planning services: Estimating pregnancies averted by the family PACT Program in California, 1997-1998. AJPH. 94(8):1341-1346. 2004.

17. Cawthon L.2001. First Steps Database Postpartum Family Planning Services. Report #9.60. Olympia, Washington.

18. Drennan M. Reproductive health: New perspectives on men’s participation. Population Reports. 46.1998.

19. Becker R. Male involvement and adolescent Pregnancy prevention. Resource Center for Adolescent Pregnancy Prevention. Accessed 6-14-04. www.etr.org/recapp/theories/mip/index4.htm [Attn: Non-MDH Link]

20. Wegner MN, Landry E, Wilkinson D, Tzanis J. Men as partners in reproductive health: From issues to action. International Family Planning Perspectives. 24(1):38-42.1998.

21. Ndong I, Becker RM, et al. men’s reproductive health: defining, designing and delivering services. International Family Planning Perspectives. 25:S53-S55. 1999.