The Effect of Pregnancy Intention on Important Maternal Behaviors and Satisfaction with Care in a Socially and Economically At-Risk Population Larry Humbert • Robert M. Saywell Jr. • Terrell W. Zollinger • Caitlin F. Priest • Michael K. Reger • Komal Kochhar Published online: 21 July 2010 Ó Springer Science+Business Media, LLC 2010 Abstract This study examined the association of preg- nancy intention with maternal behaviors and the woman’s perceived satisfaction with her prenatal and delivery care. Face-to-face interviews with 478 primarily Medicaid eli- gible women in Indianapolis, Indiana during their post- partum hospital stay were conducted to assess their degree of satisfaction with prenatal care and pregnancy intention, stratified into wanting to be pregnant now, later or never. Behaviors and characteristics influencing utilization of prenatal care were obtained from linked birth certificate data. A greater proportion of younger women (15–29) wanted to be pregnant later, a greater proportion of Afri- can-Americans never wanted to be pregnant, a greater proportion of divorced and never married women wanted to be pregnant later or never, and as parity increased the percentage of women never wanting to be pregnant increased. Multivariate analyses found that women never wanting to be pregnant were twice as likely to underutilize prenatal care, twice as likely to smoke while pregnant, half as likely to utilize WIC services and half as likely to rec- ommend their providers to pregnant friends or relatives compared to women with a planned pregnancy, controlling for confounding variables. Finally, women wanting to be pregnant later were half as likely to rate their overall hospital care and prenatal care provider as high. Providers assessing their patients’ pregnancy intention could better identify those women needing additional support services to adopt healthier behaviors and improve satisfaction with care. This study also demonstrated the value of more specific definitions of pregnancy intention. Keywords Pregnancy intention Á Pre-natal care utilization Á Pre-natal care satisfaction Á Maternal behavior Á Delivery and hospital care satisfaction Introduction Pregnancies can be broadly categorized as either planned or unintended and these perceptions affect the health behaviors of the mothers and ultimately the birth outcomes of the babies. An unintended pregnancy is defined as a pregnancy that at the time of conception is either mistimed (the woman wanted to be pregnant later or sooner) or unwanted (the woman did not want to be pregnant then or anytime in the future) [1]. National data from 2001, the last year for which national information is available, estimates that half of all pregnancies to women age 15–44 were unintended [2]. The rate of unintended pregnancies declined between 1984 and 2001 [3, 4], but according to the Pregnancy Risk Assessment Monitoring System [PRAMS], this may not be the case in all states [3]. A 2004 Indiana Access survey, predominantly comprised of Medicaid eligible women in an urban setting showed that 72 percent of pregnancies were unintended, with 45 percent wanting to be pregnant later and 27 percent never wanting to be pregnant [5]. L. Humbert Á C. F. Priest Indiana Perinatal Network, Indianapolis, Indianapolis, IN, USA R. M. Saywell Jr. (&) Á M. K. Reger Á K. Kochhar Department of Family Medicine, Indiana University School of Medicine, Bowen Research Center, 714 North Senate Avenue, Suite 205, Indianapolis, IN 46202, USA e-mail: rsaywell@iupui.edu T. W. Zollinger Department of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA 123 Matern Child Health J (2011) 15:1055–1066 DOI 10.1007/s10995-010-0646-z