Unintended pregnancy and postpartum depressive symptoms among rural and urban women in the United States

Background

Unintended pregnancy (UP) has been associated with higher risk of postpartum depression (PPD) in women. Women in rural areas have higher prevalence of UP than women in urban areas. This study aims to determine if women with UP in rural areas have higher risk of postpartum depressive symptoms (PDS) than women in urban areas. 

Methods

Data come from the 2009-2011 national Pregnancy Risk Assessment Monitoring System and linked birth certificate data. Study population included women (N= 57,602) who had singleton births and provided valid responses to questions on pregnancy intention, PDS and geographic region. Pregnancy intention was categorized into intended, mistimed and unwanted pregnancy, and PDS was defined based on three PDS survey questions. Multiple logistic regression was conducted adjusting for potential confounders and accounting for the complex survey design.

Results

Approximately 43% and 45% of women in urban and rural areas reported UP, respectively. The odds of PDS in women whose pregnancies were mistimed was similar for both rural and urban women (OR, 1.26; 95% CI, 1.04-1.53 vs OR, 1.21; 95% CI, 1.05-1.41). However, in women whose pregnancies were unwanted, the odds of PDS was higher in rural women (OR, 2.15; 95% CI, 1.68-2.76) than in urban women (OR, 1.74; 95% CI, 1.44-2.10), compared to women with intended pregnancies.

Conclusion

This study shows that women with unintended pregnancies in rural areas have higher risk of PDS than women in urban areas. Measures to improve reproductive health services such as birth control in rural areas should be implemented.