Research validates London Measure of Unplanned Pregnancy in Malawi

A research has shown that the London Measure of Unplanned Pregnancy (LMUP), a new and psychometrically valid measure of pregnancy intention that was developed in the United Kingdom, can be used in the country, according to University of London Research Fellow Jennifer Hall.

The research was conducted in the central district of Malawi, Mchinji and was aimed to validate the LMUP for use in the Chichewa language in Malawi.

LMUP is 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.

Presenting the results in Lilongwe, Hall said 125 women aged between 15 and 43 with parities of one to eight completed the Chichewa LMUP.

“All pregnant women aged 15 or over attending any one of these clinics in the week of 8th October 2012 were invited to participate. Given the accepted guidance for an appropriate sample size for the validation of a questionnaire, 100 was selected as the target total sample size with at least 50 completing the re-test,” she said.

Hall added that, “There were no missing data. The full range of LMUP scores was captured. In terms of reliability, the scale was internally consistent and test-retest data from 70 women showed good stability. In terms of validity, hypothesis testing confirmed that unmarried women, women who had four or more children alive  and women who were below 20 or over 29 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.”

Hall said the validation of the Chichewa LMUP using classical test theory shows that the Chichewa LMUP meets the pre-set criteria for acceptability, endorsement, targeting, internal consistency, reliability and construct validity by hypothesis testing.

“The original English LMUP has now been translated and validated into five other languages in high-, middle- and low-income countries. Although analysis by classical test theory shows slightly weaker performance by all translations than the original, they remain acceptable,” she said.

Malawi is a low-income country ranking 170 out of 187 countries in the Human Development Index. It has a high maternal mortality of 460 per 100 000 live births  and 26 percent of married women have an unmet need for family planning leading to 45 percent of pregnancies being reported as unplanned .

MamaYe Malawi Director Charles Makwenda said the validation of LMUP in a low-income country helps to demonstrate that the concept of pregnancy planning is applicable in these settings.

“The Chichewa LMUP represents a methodological advance on the DHS-style pregnancy intention questions, particularly by allowing a more nuanced picture of pregnancy intention and planning, and can be used for a range of research questions pertaining to pregnancy intention such as enhancing understanding of pregnancy planning behaviour or investigating relationships between pregnancy intention and maternal and neonatal health. This should lead to insights for the provision of family planning programmes to aid Malawi in designing programmes to meet the unmet need for family planning and reduce maternal and child deaths,” he said.

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