CFRP Working Paper Series | W14004

Showing Up is Half The Battle: Predicting Mothers’ Pregnancy Complications Among Unmarried Parents

November 2014

Cynthia Osborne and Daniel Dillon

The University of Texas at Austin | LBJ School of Public Affairs | Child and Family Research Partnership

Cynthia Osborne is an Associate Professor at the LBJ School of Public Affairs at the University of Texas at Austin, and Director of the Child and Family Research Partnership at the LBJ School. Daniel Dillon is a Senior Research Associate at the Child and Family Research Partnership.

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Prior research has documented an association between prenatal father involvement and positive outcomes for maternal and child health, including increased prenatal care usage, decreased smoking and alcohol consumption, and a reduction in low birth weight, preterm birth, and infant mortality. While these studies have established an empirical basis for the notion that a father’s commitment to the mother during pregnancy carries real-world implications for her health, many of the studies suffer from loose approximations of father involvement that fail to capture the complex nature of parents’ prenatal experience. We contribute to this line of research by investigating a broad set of prenatal indicators intended to help isolate the factors most related to maternal health complications during pregnancy and at the time of birth.

Drawing on data collected through the Paternity Establishment Study (PES), a longitudinal birth cohort study of approximately 800 Texas mothers who gave birth outside of marriage in 2013, we investigate the predictors of maternal pregnancy complications through two related research questions. First, we examine the association between pregnancy complications and ten prenatal indicators indented to capture 1) parents’ commitment prior to conception, 2) prenatal relationship quality, and 3) prenatal father involvement. Second, given that much of the parents’ prenatal experience is unobserved by the medical or policy communities, we investigate two observable events during the prenatal period that may signal an increased risk of pregnancy complications and provide an access point for policy to intervene—fathers’ attendance at the 20-week ultrasound, and fathers’ attendance at the birth.

Overall, we find 19.7 percent of unmarried mothers report serious health complications during pregnancy or at the time of birth. Mothers with pregnancy complications are significantly more likely to report unintended pregnancies, doubts about paternity from the father’s family, breakups and worsening relationships during pregnancy, family violence, and a lack of instrumental or financial support from the father during pregnancy. In multivariate models, however, we find that these prenatal variables are highly correlated with one another and fail to predict pregnancy complications when considered jointly. In subsequent models, we find that indicators of a poor prenatal experience are associated with fathers’ absence from the 20-week ultrasound, which is itself predictive of pregnancy complications. Additionally, we find a strong and significant relationship between fathers’ absence from the birth and increased odds of pregnancy complications, an effect that remains unaccounted for even when controlling for all prenatal factors and fathers’ absence from the ultrasound.

We urge further research into the implications of fathers’ birth attendance as a signal for pregnancy complications and other negative outcomes, especially in view of its usefulness as a point of intervention.

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