Academic journal article Demographic Research

Measuring Pregnancy Planning: An Assessment of the London Measure of Unplanned Pregnancy among Urban, South Indian Women

Academic journal article Demographic Research

Measuring Pregnancy Planning: An Assessment of the London Measure of Unplanned Pregnancy among Urban, South Indian Women

Article excerpt

Abstract

We evaluated the psychometric properties of the London Measure of Unplanned Pregnancy among Indian women using classical methods and Item Response Modeling. The scale exhibited good internal consistency and internal structure, with overall scores correlating well with each item's response categories. Items performed similarly for pregnant and non-pregnant women, and scores decreased with increasing parity, providing evidence for validity. Analyses also detected limitations, including infrequent selection of middle response categories and some evidence of differential item functioning by parity. We conclude that the LMUP represents an improvement over existing measures but recommend steps for enhancing scale performance for this cultural context.

1. Introduction

Although essential to demographic research, accurate measurement of latent variables, including individual characteristics such as acculturation or relationship power, or attitudes such as those towards partnerships and childbearing, receives relatively little attention in the demographic literature (Cleland, Johnson-Acsadi, and Marckwardt 1987). In other fields, such as psychology, quality of life research, and education, the use of valid and reliable instruments is the norm, and methods for conducting psychometric analyses are long-established (Aaronson et al. 2002; American Educational Research Association et al. 1999; Food and Drug Administration 2009). The consequences of poor measurement and misclassification include erroneous findings and conclusions from studies and potentially misguided resultant policies.

A particularly notable and oft-cited example of the absence of attention to accurate and precise measurement in demography is the assessment of pregnancy intentions (Casterline and El-Zeini 2007; Santelli et al. 2003). The measurement of unintended or unplanned pregnancy is essential to understanding fertility patterns, including why fertility differs between populations and how women decide when to have children, and to preventing unwanted childbearing. Proper measurement of pregnancy intentions is also necessary in investigating the possible influences of pregnancy intendedness on health outcomes of a mother and her baby (Gipson, Koenig, and Hindin 2008). Quantifying levels of unintended pregnancy is of particular importance in less developed regions where levels of contraceptive access and use are low and unintended pregnancy rates may be considerable (Casterline and El-Zeini 2007; Koenig et al. 2006).

Although the measurement of pregnancy intentions is critical, approaches have varied widely between studies and surveys, and most have received criticism, with their merits and utility debated and discussed (Bachrach and Newcomer 1999; Bongaarts 1990; Casterline and El-Zeini 2007; Santelli et al. 2003). With several notable exceptions (Koenig et al. 2006; Casterline and El-Zeini 2007; Bongaarts 1990), the majority of the work on improving measurement techniques has focused on the United States; significantly less attention has been devoted to debating conceptual and measurement approaches in low resource settings such as India, which is the focus of this analysis.

Approaches to measurement of pregnancy intentions have been criticized on several fronts. First, many surveys and studies utilize individual questions and/or place individuals into distinct categories of intentions. The largest source of health and pregnancy intentions data internationally, the Demographic and Health Surveys (DHS), categorizes pregnancies as intended, mistimed, or unintended based on the question: At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all? (Casterline and El-Zeini 2007; ICF Macro 2008). The DHS also asks women "if you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? …

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