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Therefore, this paper aims to explore the prevalence and socioeconomic correlates of unintended pregnancy among rural women in Bangladesh. The survey used a multistage cluster sampling procedure to gather information from a weighted sample of ever married women from the six administrative divisions in the country. The survey obtained detailed information on fertility, marriage, fertility preference and intention, awareness and use of family planning methods, childhood mortality, and maternal and child health, among others.

A written consent was obtained from all the respondents prior to starting the interview. The sample was weighted by the weighting factor provided in the survey data. Of the respondents, rural women had at least one live birth during the five years preceding the survey; they are the basis of the study. The details of the survey are described elsewhere. The latter two were merged as 'unintended' to make the variable binary. In this study, as in other studies,5,19 some women are assumed to state that an 'unintended' pregnancy had been 'intended' and vice versa due to memory collapse.

Analytical approach Both bivariate and multivariate statistical analyses were employed in this study. After performing chi-square tests to examine the association between the dependent and independent variables, binary logistic regression models were constructed to examine the net effects of the independent variables on unintended pregnancy.

Prior to performing the statistical analyses, multi-colinearity was tested. Age and pregnancy order were shown to have co-linearity. To avoid this co-linearity two separate logistic regression models were constructed.

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Model I was constructed by including age and other selected independent variables, except for pregnancy order, while in model II age was replaced by pregnancy order.

To check for significant interaction effects among the explanatory variables, we tested major interaction terms between age, regions and wealth; however, they were not statistically significant.

Therefore, the models constructed without interaction terms are the mostly parsimonious models, which provide the best estimations of the effects of the explanatory variables.

The statistical analyses in this study were analyzed using SPSS v Results Profile of the respondents Table I shows the background characteristics of the respondents. The mean age, age at marriage, and mean number of children ever born were The vast majority of the respondents were Muslims. Fifty-two percent of the women discussed FP with their husbands.

Of the respondents, Trends of unintended pregnancy Figure 1 shows the trends of unintended pregnancy at the national level in Bangladesh as obtained from the last five BDHSs conducted during The figures revealed fluctuations in the rate of unintended pregnancy over this period. Pregnancy intention status Table II shows the prevalence of unintended pregnancy by selected background characteristics of the women. Unintended pregnancy varied significantly by all selected variables.

The incidence of unintended pregnancy increased with age. The oldest women were more likely to report to have had unintended pregnancy than the adolescents Unintended pregnancy differed by Unplanned pregnancy was higher among women who were married before age 18 than those who got marriage at age 18 and above Muslim women, as compared to non-Muslim, had a higher incidence of unintended pregnancy Pregnancy order showed a positive association with intention status, with the prevalence of unintended pregnancy being lower among women who discussed FP with their husbands than those who never discussed it The incidence of unintended pregnancy was lower in the Rajshahi division and higher in Barisal division.

Wealth index showed an inverse association with unintended pregnancy. Reporting of unintended pregnancy was more common among contraceptive users than non-users. The corresponding figure for the poor combining the poorest and the poor was The results of multivariate logistic regression were almost the same for all the covariates in the two separate models.

In both models, women's education, age at marriage, inter-spousal communication about FP and current use of FP methods appeared to have insignificant effects on unintended pregnancy when other variables were controlled, whereas pregnancy order, age, religion, ever use of FP methods, region and wealth index were significantly associated with pregnancy intention status.

Age was positively related to unintended pregnancy, that is, the higher the age the higher was the risk of unintended pregnancy. Non-Muslim women were Risk of unintended pregnancy for women from the Khulna and Rajshahi divisions was less than that for women from the Barisal division.

Women from richer and richest families were Women who ever used traditional methods and modern methods were In addition, Table IV shows that the higher the pregnancy order the higher the risk of unplanned pregnancy.

For instance, the likelihood of unintended pregnancy for women whose most recent pregnancy was reported as second was 2. Discussion This study examined the prevalence and socioeconomic correlates of unintended pregnancy among rural women in Bangladesh. Findings reveal that, overall, Nonetheless, it is likely that the reported incidence of unintended pregnancy was underreported by Bangladeshi rural women.

This is because some women are unwilling to report having had an unwanted pregnancy. In a hospital-based study, the reported rate of unintended pregnancy was Our study suggests that millions of Bangladeshi rural women have confronted unwanted pregnancy at some point in their lives.

Our findings show that age, religion, administrative region, wealth index, and ever use of any contraceptive method were significantly associated with unintended pregnancy, while pregnancy order was the most single determinant of unplanned pregnancy. Findings indicate that particular groups of women had an increased risk of unplanned pregnancies, thus the urgent need for quality family planning services in rural Bangladesh.

For example, the significant difference in the pregnancy intention status by region suggests the need for expanded and improved family planning services among women of Barisal, Chittagong and Sylhet, as these divisions are distinctive in terms of their geographical nature and cultural variations among the inhabitants. According to the BDHS, women from these three divisions had higher levels of fertility and a lower use rate of contraceptive methods as compared to other divisions. As was expected, older and Muslim women were at increased risk to have experienced an unintended pregnancy as compared to younger and non-Muslim women.

It is evident that Muslim women as compared to their non-Muslim peers are less likely to use modern methods due to their traditional beliefs and cultural norms, while older women are more reluctant to use modern methods as compared to their younger counterparts, resulting in a higher risk of unintended pregnancy among the former. Bangladesh has a long tradition of early marriage and has one of the lowest mean ages at first marriage for females around the world. This results in women having marriages with longer duration and, hence, increases the risk of frequent and unintended pregnancies.

The above findings are consistent with many studies conducted elsewhere. This finding is contradictory to those of other studies25,26 and consistent with studies conducted in Nepal, Palestine, Japan and Indonesia. However, the fact is that this relationship persists after controlling for fertility preference and family planning practice, suggesting that the relationship between education and unplanned fertility may be quite complex and not fully explainable by this factor.

The increased risk of unintended pregnancy among women with more than two living children could be a sign of discontinuity or experiencing difficulty with using contraceptive methods. These findings suggest that poor and middle class women were similar to one another and unable to afford family planning services, unlike rich women,5 and therefore less able to control their fertility. This will help policy makers to develop public health prevention programs for unintended pregnancies, as well as programs to protect the value of every human life, even in the mist of socio-economic difficulties and challenges.

ENLC offers free and confidential pregnancy tests, information for pregnancy decisions, limited ultrasounds, referral for prenatal care, life skills classes, material assistance, men's ministry, and post abortion recovery.

Most of the clients who receive services at ENLC are of low socio-economic status. Information obtained at ENLC from client information sheets was used. For the purpose of this study, all the client information sheets used had been completed between September and July The client information sheet is an instrument used by ENLC to register socio-demographic information on clients when they come to the center for a free pregnancy test or material assistance.

For example, when a client visits a woman's center to obtain a free pregnancy test, she is provided with a client information sheet. The client fills in personal information such as name, address, telephone number, age, date of birth, and number of children in the household. Also, clients are asked for socio-demographic information such as marital status, household income, education, insurance, religious preference, ethnicity, and referral source. Other sets of questions included on the client information sheet are: The data for this study were abstracted from the database containing the client information data.

The study began after approval by the Internal Review Board in September of and ended in November The target population included females who tested positive for pregnancy at a pregnancy crisis center ENLC in Montgomery County, Ohio between September and July The criteria for inclusion in the study were women who: Had tested positive for pregnancy at the time the data was collected.

Completed the client information sheet. Were assessed as either intending to have an abortion abortion-minded or intending to carry to term nonabortion- minded. The criteria for exclusion from the study were: Incomplete client information sheet Negative pregnancy test Women who were assessed as being neither abortionminded nor non-abortion-minded, but were abortionvulnerable not certain to carry to term, but not certain to have an abortion either.

The following data were extracted from the database: No names, addresses, telephone numbers, or personal identifiers were taken from the database. The number of subjects calculated to achieve power in the statistical analysis was After repeated records were eliminated, the total number of subjects was reduced to The percentage of clients grouped by pregnancy intentions dependent variable and socio-demographic characteristics independent variables was determined to address the first research question: What socio-demographic characteristics are associated with abortion-minde clients and non-abortion-minded clients at ENLC?

Chi-square analysis was performed to address the research questions regarding the relationship between categorical independent variables center, marital status, race, income, educational level, and religion and the dependent binary variable abortion-minded clients vs. As to marital status, the client information sheet used at ENLC to collect data has seven categories: For this study, only five categories were considered.

Single and engaged women were grouped into one category. Also, divorced and separated women were grouped into one category. The five categories used for the statistical analysis were single, married, divorced, widowed and living together. For the statistical analysis, a chi-square test was done first to compare single vs. In order to increase the power of the analysis, the abortion vulnerability of single women was compared to that of women in all the other marital categories.

The independent variable of race was grouped into five categories: To increase the power of the analysis for race, comparisons between Blacks and other races were performed. Abortion vulnerability also was compared between White clients and other races. To determine differences between abortion-minded clients and non-abortion-minded clients by income, two analyses were performed. First, the eight house hold- income categories used on the client information sheet at ENLC were grouped into five categories.

Clients who reported welfare or SSI were included in theincome category.

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The second analysis according to household income levels was performed by grouping all clients into two categories: Two analyses were performed for educational level. First, eight categories were taken into account: Educational level also was compared by grouping clients into two categories: SPSS was used to perform independent sample T tests. This test was done to address the research question regarding differences between the continuous variables age at the time of service, age at the first sexual encounter, number of sexual partners, total number of previous pregnancies, number of live births, and number of previous abortions and the dependent binary variable abortion-minded versus non-abortion-minded.

A separate multivariate logistic regression model was run on SAS statistical software. The variables selected for inclusion were those statistically significant in the bivariate analysis. Logistic regression was performed to determine which independent variables that had two or more categories were associated with the dependent binary variable abortion-minded clients vs.

Of these information sheets, more than half of the clients were non- abortion-minded clients The descriptive analysis, with distribution and results, is presented below.

Table 1 summarizes the results of the chi square analysis for each of the independent categorical variables: Center Two centers were used to gather data: The Kettering center accounted for In the analysis of center by localization Dayton vs. The Dayton location has about twice as many abortion-minded clients compared to Kettering's center. There was a significant difference between single vs. The percentage of abortion-minded clients who were single was significantly higher than that of abortion-minded clients who were married.

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A higher percent of the abortion-minded clients were single, compared to all the other categories of marital status. Race As to race, half of the population Within races, the percentage of abortion-minded clients was higher for Blacks, followed by biracial women, other races, Whites, and Hispanics. These differences were signifi cant. Table 1 A comparison between the percentage of Black and White abortion-minded clients, the percentage of Black abortion-minded clients was almost twice the percentage of White abortion-minded clients.

Signifi cantly, more Black clients were abortion-minded vs. The percentage of White abortion-minded clients was lower than the percentage for all other races. When comparing the income levels of abortion-minded vs. In the analysis by religious affi liation, Protestants represented a higher percentage of abortion-minded clients, compared to abortion-minded Catholics, no religion, and other religion.

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The descriptive analysis of the continuous variables and the results of the independent samples T test are presented in Table 2. The mean age at the time of service for all clients was The mean age at the first sexual experience was The mean number of sexual partners was 5. The mean number of live births was 0.

The mean number of previous abortions was 0. The independent samples T test, demonstrated significant differences between the two groups: The results of the independent samples T test for the continuous variables are presented in Table 2. Age at First Sexual Encounter In the analysis according to age at first sexual encounter, 26 cases were excluded due to missing values.

The age at first sexual encounter was significantly different for abortion-minded clients vs. Abortion-minded clients had their first sexual encounter sooner compared to non abortion-minded clients, who had their first sexual encounter later. Number of Sexual Partners In the analysis by number of sexual partners, 78 cases were excluded due to missing values. Abortion-minded clients had more previous abortions compared to non-abortion-minded clients. The odds ratios for independent variables are summarized for each variable in Table 3.

The odds ratio for marital status married versus single was This means that the odds of being abortionminded are about 10 times higher for single clients. The odds ratio for race, comparing Black clients to White clients, was 2. This means that Black clients are 2.

The odds ratio for center location was 1. This means that clients at the Dayton center are 1.