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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach

Authors: Reza Omani-Samani, Mostafa Amini Rarani, Mahdi Sepidarkish, Esmaeil Khedmati Morasae, Saman Maroufizadeh, Amir Almasi-Hashiani

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country.

Methods

In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software.

Results

The Wagstaff normalized concentration index of unintended pregnancy (− 0.108 (95% Confidence Interval (CI) = − 0.119 ~ − 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother’s nationality (19%), father’s age (16%), mother’s age (10%), father’s education level (7%) and Body Mass Index (BMI) groups (5%).

Conclusion

Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.
Literature
1.
go back to reference Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of family growth. Fam Plan Perspect. 1999;31:64–93.CrossRef Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of family growth. Fam Plan Perspect. 1999;31:64–93.CrossRef
2.
go back to reference Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plan. 2014;45(3):301–14.CrossRef Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plan. 2014;45(3):301–14.CrossRef
3.
go back to reference Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plan. 2010;41(4):241–50.CrossRef Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plan. 2010;41(4):241–50.CrossRef
6.
go back to reference Moosazadeh M, Nekoei-moghadam M, Emrani Z, Amiresmaili M. Prevalence of unwanted pregnancy in Iran: a systematic review and meta-analysis. Int J Health Plann Manag. 2014;29(3):e277–e90.CrossRef Moosazadeh M, Nekoei-moghadam M, Emrani Z, Amiresmaili M. Prevalence of unwanted pregnancy in Iran: a systematic review and meta-analysis. Int J Health Plann Manag. 2014;29(3):e277–e90.CrossRef
7.
go back to reference Sadat-Hashemi SM, Ghorbani R, Majdabadi HA, Farahani FK. Factors associated with contraceptive use in Tehran, Iran. Eur J Contracept Reprod Health Care. 2007;12(2):148–53.CrossRefPubMed Sadat-Hashemi SM, Ghorbani R, Majdabadi HA, Farahani FK. Factors associated with contraceptive use in Tehran, Iran. Eur J Contracept Reprod Health Care. 2007;12(2):148–53.CrossRefPubMed
8.
go back to reference Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud. 2003;57(1):77–93.CrossRef Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud. 2003;57(1):77–93.CrossRef
9.
go back to reference Hardee K, Eggleston E, Wong EL. Irwanto, hull TH. Unintended pregnancy and women's psychological well-being in Indonesia. J Biosoc Sci. 2004;36(5):617–26.CrossRefPubMed Hardee K, Eggleston E, Wong EL. Irwanto, hull TH. Unintended pregnancy and women's psychological well-being in Indonesia. J Biosoc Sci. 2004;36(5):617–26.CrossRefPubMed
10.
go back to reference Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008;39(1):18–38.CrossRef Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008;39(1):18–38.CrossRef
11.
go back to reference Trussell J. The cost of unintended pregnancy in the United States. Contraception. 2007;75(3):168–70.CrossRefPubMed Trussell J. The cost of unintended pregnancy in the United States. Contraception. 2007;75(3):168–70.CrossRefPubMed
13.
go back to reference Wellings K, Jones KG, Mercer CH, Tanton C, Clifton S, Datta J, et al. The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet (London, England). 2013;382(9907):1807–16.CrossRef Wellings K, Jones KG, Mercer CH, Tanton C, Clifton S, Datta J, et al. The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet (London, England). 2013;382(9907):1807–16.CrossRef
14.
go back to reference Goossens J, Van Den Branden Y, Van der Sluys L, Delbaere I, Van Hecke A, Verhaeghe S, et al. The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes. Hum Reprod. 2016;31(12):2821–33.CrossRefPubMed Goossens J, Van Den Branden Y, Van der Sluys L, Delbaere I, Van Hecke A, Verhaeghe S, et al. The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes. Hum Reprod. 2016;31(12):2821–33.CrossRefPubMed
15.
go back to reference Calvert C, Baisley K, Doyle AM, Maganja K, Changalucha J, Watson-Jones D, et al. Risk factors for unplanned pregnancy among young women in Tanzania. Journal of Family Planning and Reproductive Health Care. 2013;39(4):e2.CrossRefPubMedPubMedCentral Calvert C, Baisley K, Doyle AM, Maganja K, Changalucha J, Watson-Jones D, et al. Risk factors for unplanned pregnancy among young women in Tanzania. Journal of Family Planning and Reproductive Health Care. 2013;39(4):e2.CrossRefPubMedPubMedCentral
16.
go back to reference Hamdela B, Gmariam A, Tilahun T. Unwanted Pregnancy and Associated Factors among Pregnant Married Women in Hosanna Town, Southern Ethiopia. PLoS ONE. 2012;7(6):e39074.CrossRefPubMedCentral Hamdela B, Gmariam A, Tilahun T. Unwanted Pregnancy and Associated Factors among Pregnant Married Women in Hosanna Town, Southern Ethiopia. PLoS ONE. 2012;7(6):e39074.CrossRefPubMedCentral
17.
go back to reference Kibret A, Bayu HA, M M. Prevalence of Unintended Pregnancy and Associated Factors among Pregnant Women Attending Antenatal Clinics in Debre-markos Town, North West Ethiopia 2012. J Women’s Health Care. 2015;4(3):1–6. Kibret A, Bayu HA, M M. Prevalence of Unintended Pregnancy and Associated Factors among Pregnant Women Attending Antenatal Clinics in Debre-markos Town, North West Ethiopia 2012. J Women’s Health Care. 2015;4(3):1–6.
18.
go back to reference Theme-Filha MM, Baldisserotto ML, Fraga ACSA, Ayers S, da Gama SGN, MdC L. Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012. Reproductive Health. 2016;13(3):118.CrossRefPubMedPubMedCentral Theme-Filha MM, Baldisserotto ML, Fraga ACSA, Ayers S, da Gama SGN, MdC L. Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012. Reproductive Health. 2016;13(3):118.CrossRefPubMedPubMedCentral
19.
go back to reference Sepidarkish M, Almasi-Hashiani A, Maroufizadeh S, Vesali S, Pirjani R, Samani RO. Association between previous spontaneous abortion and pre-eclampsia during a subsequent pregnancy. Int J Gynecol Obstet. 2017;136(1):83–6.CrossRef Sepidarkish M, Almasi-Hashiani A, Maroufizadeh S, Vesali S, Pirjani R, Samani RO. Association between previous spontaneous abortion and pre-eclampsia during a subsequent pregnancy. Int J Gynecol Obstet. 2017;136(1):83–6.CrossRef
20.
go back to reference Samani RO, Almasi-Hashiani A, Vesali S, Shokri F, Cheraghi R, Torkestani F, et al. Tehran survey of potential risk factors for multiple births. International journal of fertility & sterility. 2017;11(3):220. Samani RO, Almasi-Hashiani A, Vesali S, Shokri F, Cheraghi R, Torkestani F, et al. Tehran survey of potential risk factors for multiple births. International journal of fertility & sterility. 2017;11(3):220.
21.
go back to reference Omani-Samani R, Sepidarkish M, Safiri S, Esmailzadeh A, Vesali S, Farzaneh F, et al. Impact of gestational weight gain on cesarean delivery risk, perinatal birth weight and gestational age in women with normal pre-pregnancy BMI. The Journal of Obstetrics and Gynecology of India. 2017:1–6. Omani-Samani R, Sepidarkish M, Safiri S, Esmailzadeh A, Vesali S, Farzaneh F, et al. Impact of gestational weight gain on cesarean delivery risk, perinatal birth weight and gestational age in women with normal pre-pregnancy BMI. The Journal of Obstetrics and Gynecology of India. 2017:1–6.
22.
go back to reference Omani-Samani R, Ranjbaran M, Amini P, Esmailzadeh A, Sepidarkish M, Almasi-Hashiani A. Adverse maternal and neonatal outcomes in women with preeclampsia in Iranian women. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;(just-accepted):1–13. Epub ahead of print Omani-Samani R, Ranjbaran M, Amini P, Esmailzadeh A, Sepidarkish M, Almasi-Hashiani A. Adverse maternal and neonatal outcomes in women with preeclampsia in Iranian women. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;(just-accepted):1–13. Epub ahead of print
23.
go back to reference Omani-Samani R, Mohammadi M, Almasi-Hashiani A, Maroufizadeh S. Cesarean Section and Socioeconomic Status in Tehran, Iran. Journal of Research in Health Sciences. 2017;17(4):e00394.PubMed Omani-Samani R, Mohammadi M, Almasi-Hashiani A, Maroufizadeh S. Cesarean Section and Socioeconomic Status in Tehran, Iran. Journal of Research in Health Sciences. 2017;17(4):e00394.PubMed
24.
go back to reference Almasi-Hashiani A, Sepidarkish M, Safiri S, Morasae EK, Shadi Y, Omani-Samani R. Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach. BMJ Open. 2017;7(5):e013644.PubMedPubMedCentral Almasi-Hashiani A, Sepidarkish M, Safiri S, Morasae EK, Shadi Y, Omani-Samani R. Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach. BMJ Open. 2017;7(5):e013644.PubMedPubMedCentral
25.
go back to reference Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed
26.
go back to reference Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007;275(1):39–43.CrossRefPubMed Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007;275(1):39–43.CrossRefPubMed
27.
go back to reference O'Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: World Bank; 2008. O'Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: World Bank; 2008.
28.
go back to reference Combes J-B, Gerdtham U-G, Jarl J. Equalisation of alcohol participation among socioeconomic groups over time: an analysis based on the total differential approach and longitudinal data from Sweden. Int J Equity Health. 2011;10(1):10.CrossRefPubMedPubMedCentral Combes J-B, Gerdtham U-G, Jarl J. Equalisation of alcohol participation among socioeconomic groups over time: an analysis based on the total differential approach and longitudinal data from Sweden. Int J Equity Health. 2011;10(1):10.CrossRefPubMedPubMedCentral
29.
go back to reference Rarani MA, Rashidian A, Khosravi A, Arab M, Abbasian E, Morasae EK. Changes in socio-economic inequality in neonatal mortality in Iran between 1995-2000 and 2005-2010: an Oaxaca decomposition analysis. International journal of health policy and management. 2017;6(4):219.CrossRef Rarani MA, Rashidian A, Khosravi A, Arab M, Abbasian E, Morasae EK. Changes in socio-economic inequality in neonatal mortality in Iran between 1995-2000 and 2005-2010: an Oaxaca decomposition analysis. International journal of health policy and management. 2017;6(4):219.CrossRef
30.
go back to reference Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14(4):429–32.CrossRefPubMed Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14(4):429–32.CrossRefPubMed
31.
go back to reference Wagstaff A, Van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econ. 2003;112(1):207–23.CrossRef Wagstaff A, Van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econ. 2003;112(1):207–23.CrossRef
32.
go back to reference Yiengprugsawan V, Lim LL, Carmichael GA, Dear KB, Sleigh AC. Decomposing socioeconomic inequality for binary health outcomes: an improved estimation that does not vary by choice of reference group. BMC research notes. 2010;3(1):57.CrossRefPubMedPubMedCentral Yiengprugsawan V, Lim LL, Carmichael GA, Dear KB, Sleigh AC. Decomposing socioeconomic inequality for binary health outcomes: an improved estimation that does not vary by choice of reference group. BMC research notes. 2010;3(1):57.CrossRefPubMedPubMedCentral
33.
go back to reference Walsh B, Cullinan J. Decomposing socioeconomic inequalities in childhood obesity: evidence from Ireland. Economics & Human Biology. 2015;16:60–72.CrossRef Walsh B, Cullinan J. Decomposing socioeconomic inequalities in childhood obesity: evidence from Ireland. Economics & Human Biology. 2015;16:60–72.CrossRef
34.
go back to reference Yazdkhasti M, Pourreza A, Pirak A, Abdi F. Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iranian Journal of Public Health. 2015;44(1):12–21.PubMedPubMedCentral Yazdkhasti M, Pourreza A, Pirak A, Abdi F. Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iranian Journal of Public Health. 2015;44(1):12–21.PubMedPubMedCentral
35.
go back to reference Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, et al. Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reprod Health. 2014;11(1):63.CrossRefPubMedPubMedCentral Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, et al. Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reprod Health. 2014;11(1):63.CrossRefPubMedPubMedCentral
36.
go back to reference Oulman E, Kim THM, Yunis K, Tamim H. Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian maternity experiences survey. BMC Pregnancy and Childbirth. 2015;15:260.CrossRefPubMedPubMedCentral Oulman E, Kim THM, Yunis K, Tamim H. Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian maternity experiences survey. BMC Pregnancy and Childbirth. 2015;15:260.CrossRefPubMedPubMedCentral
37.
go back to reference Cheraghi P, Poorolajal J, Moeini B, Cheraghi Z. Predictors of unintended pregnancy among married women in Hamadan, western Iran: a case-control study. Iranian Journal of Public Health. 2013;42(8):854–9.PubMedPubMedCentral Cheraghi P, Poorolajal J, Moeini B, Cheraghi Z. Predictors of unintended pregnancy among married women in Hamadan, western Iran: a case-control study. Iranian Journal of Public Health. 2013;42(8):854–9.PubMedPubMedCentral
38.
go back to reference Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017;88(8):728–33.CrossRefPubMed Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology. 2017;88(8):728–33.CrossRefPubMed
39.
go back to reference Font-Ribera L, Pérez G, Salvador J, Borrell C. Socioeconomic inequalities in unintended pregnancy and abortion decision. Journal of Urban Health. 2008;85(1):125–35.CrossRefPubMed Font-Ribera L, Pérez G, Salvador J, Borrell C. Socioeconomic inequalities in unintended pregnancy and abortion decision. Journal of Urban Health. 2008;85(1):125–35.CrossRefPubMed
40.
go back to reference Izugbara C. Socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls. South African Family Practice. 2015;57(2):121–5.CrossRef Izugbara C. Socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls. South African Family Practice. 2015;57(2):121–5.CrossRef
41.
go back to reference Erreygers G, Van Ourti T. Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: a recipe for good practice. J Health Econ. 2011;30(4):685–94.CrossRefPubMedPubMedCentral Erreygers G, Van Ourti T. Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: a recipe for good practice. J Health Econ. 2011;30(4):685–94.CrossRefPubMedPubMedCentral
42.
go back to reference Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, Patel R, Webb EA, Lawlor DA, Hargreaves JR. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41(3):871–86.CrossRefPubMedPubMedCentral Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, Patel R, Webb EA, Lawlor DA, Hargreaves JR. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41(3):871–86.CrossRefPubMedPubMedCentral
43.
go back to reference Liverpool LSO, Winter-Nelson A. Asset versus consumption poverty and poverty dynamics in the presence of multiple equilibria in rural Ethiopia. Washington DC: International Food Policy Research Institute; 2010. Liverpool LSO, Winter-Nelson A. Asset versus consumption poverty and poverty dynamics in the presence of multiple equilibria in rural Ethiopia. Washington DC: International Food Policy Research Institute; 2010.
44.
go back to reference Ikamari L, Izugbara C, Ochako R. Prevalence and determinants of unintended pregnancy among women in Nairobi. Kenya BMC Pregnancy and Childbirth. 2013;13:69.CrossRefPubMed Ikamari L, Izugbara C, Ochako R. Prevalence and determinants of unintended pregnancy among women in Nairobi. Kenya BMC Pregnancy and Childbirth. 2013;13:69.CrossRefPubMed
Metadata
Title
Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach
Authors
Reza Omani-Samani
Mostafa Amini Rarani
Mahdi Sepidarkish
Esmaeil Khedmati Morasae
Saman Maroufizadeh
Amir Almasi-Hashiani
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5515-5

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