UBC Theses and Dissertations
Child development among Ecuadorian children aged three to five born from intended and unintended pregnancies : a health equity analysis Delgado, Jorge Andrés
This thesis is focused on characterizing differences in developmental outcomes among children born from intended and unintended pregnancies aged three to five. The Sustainable Development Goals have a specific target to “ensure that all girls and boys have access to quality early childhood development” by 2030. There is sparse literature regarding the impact of pregnancy intention (wantedness and timing) or planning on child development, and less so about differential impacts by ethnicity, income, or sex at birth. The research chapters of this thesis consist of two studies: First, we conducted a scoping review to summarize the evidence comparing the developmental outcomes of children from unwanted, unplanned, or mistimed (‘it happened too soon’ or ‘too late’) pregnancies to those of children from wanted or planned pregnancies. We identified 8 “cohorts” with information on approximately 39,000 children born mostly in developed countries. Overall, unwanted/unplanned pregnancies were associated with poorer child development when compared with wanted/planned pregnancies. Mistimed (sometimes classified as delayed) pregnancies correlated with weaker effects in the same direction. Second, we estimated the effect of unintended pregnancy on early childhood development in Ecuadorian children aged three to five, participating in the latest National Health and Nutrition Survey (2018) using a design-based regression model, stratified by ethnicity, sex at birth, and socioeconomic status. We also estimated to what extent eliminating unintended pregnancy would close the gap among the most privileged (i.e., high-income, white/mestizo, males) and other groups of each stratum. Among 6,687 observations representing 620,625 Ecuadorian children, unintended pregnancy was associated with 33% higher risk of inadequate development (RR: 1.33; 95% CI: 1.06; 1.64) after adjusting for available confounders. Black/montubio children were the most affected (RR: 2.78; 95% CI: 1.72; 3.85). These results suggest that these ethnic groups, along with low-income households, might benefit the most from interventions that support intended pregnancy. Together, the studies in this thesis underline the importance of policies that create environments supportive of wanted conception and access to safe abortion to reach the target for sustainable development goal 4, related to child development. In Ecuador, these interventions are particularly important for black/montubio and low-income populations.
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