Pregnancy Attitudes and Contraceptive Use among Young Adults with Histories of Foster Care

Exploring longitudinal associations between social determinants of health during adolescence and self-reported contraceptive use in young adulthood in the United States

Objective

Childhood environment and socioeconomic status influence adult health. Past research links early social and economic disadvantages to later-life diseases and substance abuse, but their effects on contraceptive use remain unexplored. This longitudinal study utilizes the Social Determinants of Health (SDH) framework to explore the associations between social domains in adolescence and contraceptive use in young adulthood.

Study design

Fourteen measures of the SDH domains were extracted from the National Longitudinal Study of Adolescent and Adult Health Wave I data (1994-95) to explore associations with reported ever-use and consistent use of contraception among young adults in the U.S (18-26 years) at Wave III (2001) using multilevel logistic regression.

Results

Among 11,172 participants, 87.60 % reported past-year ever-use of contraception, while 47.30 % were consistent contraceptive users. Measures significantly associated with the past year's ever-use of contraceptives in young adulthood included parents' high school graduation status (positive/+), volunteering experience (+), history of foster care (negative/-), and parental reporting a trash problem in the neighborhood (-) during adolescence. For consistent use of contraception in young adulthood, parent high school education (+), volunteering experience (+), higher social cohesion scores (+), access to health care (+), receiving family planning counseling (-), parental receipt of public assistance (-), non-English language spoken at home (-) and the number of neighborhood crimes (-) during adolescence were found to be significant.

Conclusions

A favorable environment during adolescence provides a foundation for positive health behaviors. Interventions aimed at improving contraceptive use in young adulthood should consider creating supportive environments for adolescents.

Sexual and Reproductive Health Protective Factors among Adolescents with Child Welfare Involvement

Youth with child welfare involvement experience disproportionate rates of sexual and reproductive health (SRH) risks and adverse outcomes. However, little is known about SRH protective factors among youth with child welfare involvement. This study examined whether birth control knowledge or SRH agency, norms, and expectancies differed by gender, age, race/ethnicity, or out-of-home care status among 245 youth, ages 12-15, with open child welfare cases due to maltreatment. Less than half of participants had received information on birth control or knew how to access birth control services; however, the majority reported high confidence in avoiding sex when not desired, strong peer norms for condoms, and few perceived benefits to unprotected sex. Males and younger adolescents had fewer protective attitudes and birth control knowledge, while Latinas had more protective attitudes. This study highlights the protective SRH attitudes already held by youth (ages 12-15) with child welfare involvement, as well as the need for early and gender-inclusive SRH education.

Attitudes Toward Pregnancy Among Women Enrolled in Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in Moshi, Tanzania

For pregnant women living with HIV (WLWH), feelings about pregnancy may influence their emotional well-being and health seeking behaviors. This study examined attitudes toward pregnancy and associated factors among women enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Moshi, Tanzania. 200 pregnant WLWH were enrolled during their second or third trimester of pregnancy and completed a structured survey. Univariable and multivariable regression models examined factors associated with attitudes toward pregnancy, including demographics, interpersonal factors, and emotional well-being. Attitudes toward the current pregnancy were generally positive, with 87% of participants reporting feeling happy about being pregnant. In the final multivariable model, having higher levels of partner support, being newly diagnosed with HIV, and having fewer children were significantly associated with more positive attitudes toward their pregnancy. Findings point to a need for tailored psychosocial support services in PMTCT, as well as comprehensive reproductive health care for WLWH.

"I can try and plan, but still get pregnant": The complexity of pregnancy intentions and reproductive health decision-making for adolescents

INTRODUCTION

Teen pregnancy rates have declined in the United States; however, disparities continue to persist particularly among minority, low-income adolescents. A greater understanding of how pregnancy intentions are conceptualized for adolescents, and the role of the social context may illuminate reasons for disparities. The aim of this study was to expand the lens in which adolescents' perspectives of pregnancy are studied by exploring the contextual factors that frame how pregnancy intentions are developed among urban adolescents.

METHODS

Thirteen focus groups (N = 46) were conducted with male and female adolescents 15-19 years old in Baltimore, Maryland. Participants were recruited from local high schools, and focus groups were stratified by sex and age (15-17 and 18-19). A phenomenological approach was applied to analyze the data both deductively and inductively, allowing for themes to emerge and align within an existing conceptual framework.

RESULTS

Two themes identified were stated pregnancy intentions and shared schemas of sex and pregnancy. Participants discussed a range of pregnancy intentions and expressed five social perspectives which informed those intentions: sex is a gendered responsibility, teen pregnancy is cyclical and common, teen pregnancy is not a completely negative experience, having a child fulfills emotional and relational voids, and pregnancy should happen early, just not too early.

CONCLUSION

Pregnancy intentions for adolescents are expansive and driven by complex social perspectives set in their context. More consideration of the context is needed to provide and offer adolescents, particularly those of vulnerable communities, supports that align with their reproductive health needs.