Understanding pregnancy planning in a low-income country setting: validation of the London measure of unplanned pregnancy in Malawi

BMC Pregnancy and Childbirth

Judith Stephenson¹  Address Malata³  Andrew Copas²  Nicholas Mbwana⁵  Geraldine Barrett⁴  Jennifer Hall⁶ 

[1] Research Department of Reproductive Health, UCL Institute for Women’s Health, London, UK;Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, UK;Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi;School of Health Sciences and Social Care, Brunel University, Uxbridge, UK;MaiMwana Project, Mchinji, Malawi;UCL Institute for Global Health, 30 Guilford Street, London, UK

关键词: Pregnancy intention validation Malawi measure unplanned;   

Others  :  1132366
DOI  :  10.1186/1471-2393-13-200

 received in 2013-07-29, accepted in 2013-10-25,  发布年份 2013

【 摘 要 】

Background

The London Measure of Unplanned Pregnancy (LMUP) is a new and psychometrically valid measure of pregnancy intention that was developed in the United Kingdom. An improved understanding of pregnancy intention in low-income countries, where unintended pregnancies are common and maternal and neonatal deaths are high, is necessary to inform policies to address the unmet need for family planning. To this end this research aimed to validate the LMUP for use in the Chichewa language in Malawi.

Methods

Three Chichewa speakers translated the LMUP and one translation was agreed which was back-translated and pre-tested on five pregnant women using cognitive interviews. The measure was field tested with pregnant women who were recruited at antenatal clinics and data were analysed using classical test theory and hypothesis testing.

Results

125 women aged 15–43 (median 23), with parities of 1–8 (median 2) completed the Chichewa LMUP. There were no missing data. The full range of LMUP scores was captured. In terms of reliability, the scale was internally consistent (Cronbach’s alpha = 0.78) and test-retest data from 70 women showed good stability (weighted Kappa 0.80). In terms of validity, hypothesis testing confirmed that unmarried women (p = 0.003), women who had four or more children alive (p = 0.0051) and women who were below 20 or over 29 (p = 0.0115) were all more likely to have unintended pregnancies. Principal component analysis showed that five of the six items loaded onto one factor, with a further item borderline. A sensitivity analysis to assess the effect of the removal of the weakest item of the scale showed slightly improved performance but as the LMUP was not significantly adversely affected by its inclusion we recommend retaining the six-item score.

Conclusion

The Chichewa LMUP is a valid and reliable measure of pregnancy intention in Malawi and can now be used in research and/or surveillance. This is the first validation of this tool in a low-income country, helping to demonstrate that the concept of pregnancy planning is applicable in such a setting. Use of the Chichewa LMUP can enhance our understanding of pregnancy intention in Malawi, giving insight into the family planning services that are required to better meet women’s needs and save lives.

【 授权许可】

   
2013 Hall et al.; licensee BioMed Central Ltd.

【 图 表 】

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