Part 1
1.
Santelli, J.S, Lindberg, L.D., Orr, M.G., Finer, L.B., Speizer, I. Jun 2009. Toward a multidimensional measure of pregnancy intentions: Evidence from the United States. Studies in Family Planning. 40, (2), 87-100. doi:10.1111/j.1728-4465.2009.00192.x
2.
Pregnancy intentions are collected retrospectively and refer to a woman's thinking at the time she became aware that she was pregnant. Measured this way, unintended pregnancies are the sum of births reported to be mistimed, unwanted, or end ing in induced abortion. "Unwanted" pregnancies are defined as occurring when no (or no more) children are desired; "mistimed" pregnancies occur earlier than expected but would have been desired at a later time; and "intended" pregnancies occur at the "right" time or may have occurred later than desired (for example, they may have been delayed because of difficulties in conceiving).
3.
Factor analysis was used to identify the dimensions of pregnancy intendedness. The categories which were defined, overdue, on time, too soon, unwanted, don't care, not sure/don't know, were then examined in relation to their association with the different possible birth outcomes – live birth, induced abortion, and miscarriage. This comparison was done to provide validation that the dimensions of intended were attached to the expected outcome of either continuing the pregnancy or terminating.
4.
Two scales were developed by the authors. The first, the desire scale, had a Cronbach's alpha of 0.85. The other was a mistiming scale and was measured in years so no reliability evidence was shared for this natural scale.
5.
Pregnancy intention is often referenced in relation to contraception use and non-use by women. A mischaracterization of these measures has potentially significant policy implications if used in the current climate of politicizing women's health. Furthermore, currently a shift in the understanding of pregnancy intention is occurring among experts from a dichotomous position to a complex range. This means researchers have to use caution in the choice of measures or risk their work being obsolete very quickly.
Part 2
1.
Finer, LB and Henshaw, SK. Disparities in rates of unintended pregnancy in the United States 1994 and 2001. Persp on Sexual and Repr Health. 2006; 38: 90–96
2.
Unintended pregnancies included both those that were mistimed (i.e., the woman wanted to become pregnant at some point in the future, but not yet) and those that were unwanted (the woman did not want to become pregnant now or in the future). Pregnancies about which women indicated they were indifferent were classified as intended.
The measurement was intended/unintended dichotomy created through a number of survey questions about the timing and desiredness of a pregnancy. The authors highlight that having only two choices limits the understanding of a complex construct, but that its use provides the ability to compare trends over time and differences in subgroups.
One in 20 American women has an unintended pregnancy each year, and the burden falls even more heavily on some groups: women aged 18–24, low-income women, cohabiting women and minority (particularly black) women. As a result of their high unintended pregnancy rates, women in these groups also have above-average rates of unintended birth and abortion.
3.
The authors don't comment on the validity or reliability of using these particular questions to create a measure of pregnancy intendedness. This method is discussed in the paper I used for part 1 so it may be that it is a widely used methodology in the field and therefore did not require further comment.
4.
The paper described the rates of pregnancy per 1000 in subgroups related to intendedness, race, education, and poverty so there was no reference group used as comparison. This meant the data was straightforward to interpret but did not described differences in risk among sub-groups.
5.
The disparity is described in absolute measures, as a rate of per 1000 women. Adding a hazard would increase the understanding of the risk of unintended pregnancy for an individual woman of a sub-group.