Pregnancy intention and breastfeeding duration: Comparing unwanted and mistimed pregnancies

Background: The most common categorization of pregnancy intendedness is “intended” versus “unintended.” Recent studies focus on the two categories of unintended pregnancy: mistimed and unwanted, questioning whether unwanted pregnancies are associated with worse outcomes than mistimed pregnancies.

Methods: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based survey of Oregon mothers 2-6 months postpartum. Oregon PRAMS asks mothers whether, just before they got pregnant, they wanted to be pregnant then or sooner (“intended”), later (“mistimed”), or not at all (“unwanted”). PRAMS also asks mothers about how long they breastfed their infant. Multivariate logistic regression evaluated the association between pregnancy intendedness and breastfeeding for ≥8 weeks, while adjusting for the complex survey design features.

Results: Of 1915 respondents who had a live birth in 2005 (weighted response rate, 75.6%), 75.3% breastfed for ≥8 weeks. 62.1% reported intended pregnancy, 30.4% reported mistimed pregnancy and 7.5% reported unwanted pregnancy. Prevalence of breastfeeding ≥8 weeks was 81.4% (intended), 67.5% (mistimed), and 57.6% (unwanted). Compared to women with unwanted pregnancies (referent), mistimed pregnancies were significantly more likely to breastfeed ≥8 weeks (OR 1.99, 95% C.I.: 1.00-3.96).

Discussion: Women reporting their pregnancies as unwanted were significantly less likely to breastfeed ≥8 weeks compared to women reporting pregnancies as mistimed. This study suggests public health programs should focus limited resources on women who have unwanted pregnancies (7.5%) because they may be at greater risk for inferior outcomes than women with mistimed pregnancies (30.4%).