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Newmyer L, Yabiku ST. Pregnancy scares, pregnancy uncertainty, and abortion attitude change. SOCIAL SCIENCE RESEARCH 2022; 108:102785. [PMID: 36334923 PMCID: PMC10425883 DOI: 10.1016/j.ssresearch.2022.102785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/05/2022] [Accepted: 08/14/2022] [Indexed: 06/16/2023]
Abstract
Women's attitudes towards abortion are often assessed infrequently in their lives. This measurement may not capture how lifetime events, such as reproductive experiences, potentially influence attitudes towards abortion. Although reproductive attitudes can fluctuate with life's circumstances, there is little research on how abortion attitudes may change when a woman suspects she might be pregnant. Using an intensive longitudinal dataset collected in Michigan, the Relationship Dynamics and Social Life (RDSL) study (2008-2012), we test the relationship between the timing of pregnancy scares and uncertainty and abortion attitudes using hybrid effects models. We find that women become less supportive of abortion while experiencing a pregnancy scare or uncertainty; however, this association exists only during a scare or uncertainty. These findings highlight that abortion attitudes may change when a woman suspects she might be pregnant. However, attitudinal change may not last past this period.
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Affiliation(s)
- Lauren Newmyer
- Department of Sociology and Criminology and the Population Research Institute, The Pennsylvania State University, University Park, PA, 16802, United States.
| | - Scott T Yabiku
- Department of Sociology and Criminology and the Population Research Institute, The Pennsylvania State University, University Park, PA, 16802, United States
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Ehrenberg S, Stransky OM, Wright CE, Jain R, Kazmerski TM. Partner perspectives on women's sexual and reproductive healthcare in cystic fibrosis. J Cyst Fibros 2022; 22:217-222. [PMID: 35970694 DOI: 10.1016/j.jcf.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/30/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women with cystic fibrosis (CF) face many sexual and reproductive health (SRH) concerns. Studies suggest that educating and involving partners in SRH care can improve outcomes. This study investigated partners' perceptions of and preferences for women's SRH care in CF. METHODS We surveyed partners of women with CF from ten United States (U.S.) CF centers regarding their attitudes and preferences related to CF SRH care. Items assessed experiences with SRH care, sexual relationships, family planning, pregnancy, fertility, and parenthood. We used descriptive statistics to assess results related to the timing, content, setting and delivery of CF SRH care. RESULTS A total of 94 partners completed the survey (94% male; average age 36±1 years; 70% married; 36% parents). Among those who/whose partners experienced a pregnancy, 48% received preconception counseling and 29% fertility testing/treatment. One-third of all respondents (32%) worried their children would have CF and 86% would undergo CF genetic testing if their CF partner became pregnant. One-third (34%) indicated that they did not have any SRH conversations with their partner's CF team, while 70% would like to have such discussions. The topics that respondents would most like to discuss were pregnancy (50%), fertility (43%), sexual functioning (36%), sexual activity (31%) and parenthood (29%). CONCLUSIONS Partners report gaps in SRH care and counseling despite the majority wanting to discuss SRH concerns with their partner's CF team. CF partners serve as key supports for women with CF and results can be used to design patient-centered interventions to optimize CF SRH care.
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Affiliation(s)
- Sarah Ehrenberg
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Olivia M Stransky
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Catherine E Wright
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States
| | - Raksha Jain
- University of Texas Southwestern, Dallas, TX, United States
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, United States.
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Thorman A, Engle A, Brintz B, Simmons RG, Sanders JN, Gawron LM, Turok DK, Kaiser JE. Quantitative and qualitative impact of One Key Question on primary care providers' contraceptive counseling at routine preventive health visits. Contraception 2022; 109:73-79. [PMID: 35038448 PMCID: PMC9258909 DOI: 10.1016/j.contraception.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES One Key Question (OKQ) is a clinical screening tool to assess pregnancy desire in the next year. We aimed to 1) describe the effect of OKQ implementation on contraceptive counseling rates at preventive health visits and 2) evaluate primary care providers' perception of OKQ implementation on their contraceptive counseling practices. STUDY DESIGN We performed a quantitative retrospective chart review of preventive health visits at eight federally qualified health centers in Utah between 2014 and 2017. Implementation of OKQ included a brief training and inclusion of OKQ in the electronic medical record. Providers received OKQ training in August 2015 and re-training in March 2017. We assessed OKQ and contraceptive counseling documentation rates using interrupted-time-series analysis. We then conducted semi-structured interviews with providers and queried them about the impact of OKQ. We identified dominant themes using modified grounded theory to create an explanatory framework. RESULTS Abstracting 6634 charts yielded 9840 visits with 56 unique providers (51% physician assistant, 34% physician, 14% nurse practitioner). Interrupted-time-series analysis showed a documentation increase of OKQ in late 2015 (2.6%) and again in spring 2017 (9%), however rates remained low. Contraceptive counseling rates (39.7%) did not change after OKQ implementation. Charts with evidence of a current contraceptive method were less likely to have a OKQ response documented. Interviewees reported OKQ's algorithm did not alter their contraceptive counseling. CONCLUSIONS OKQ did not change documented rates of contraceptive counseling and uptake was low in quantitative and qualitative analyses. Our study suggests limited usefulness of OKQ in the primary care setting. IMPLICATIONS Implementation of the One Key Question tool through training and optional EHR field did not increase documented rates of contraceptive counseling in a large federally qualified health center or affect provider contraceptive counseling. Our study suggests limited usefulness of OKQ as a robust screening tool in this primary care setting.
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Affiliation(s)
- Alyssa Thorman
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Alyssa Engle
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Benjamin Brintz
- University of Utah, Study Design and Biostatistics Center, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jessica N Sanders
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Lori M Gawron
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - David K Turok
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States.
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Dalessandro C, Kaiser J, Sanders JN. Reproductive autonomy and feelings of control over pregnancy among emerging adult clients in a Utah (USA) contraceptive initiative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 31:100688. [PMID: 34864316 PMCID: PMC8898276 DOI: 10.1016/j.srhc.2021.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/26/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research has called for more exploration into how reproductive autonomy (which includes agency over pregnancy decisions) is related to structural, relational, and individual elements. Thus, we use surveys to investigate how one potential indicator of reproductive autonomy-feelings of control over pregnancy-may relate to structural, relational, and individual factors in emerging adults' (age 18-24) lives. METHODS Using survey data from 2594 emerging adult women participating in a contraceptive initiative in Utah (USA), we analyzed level of agreement with the statement: "I feel that I have control over whether or not I get pregnant," exploring relationships between sociodemographic characteristics and agreement with the statement. We used chi-square tests and multinomial logistic regression to investigate relationships between individual, relational, and structural factors and feelings of control. RESULTS Most participants (86%) agreed with the statement (n = 2231), while the remainder were neutral or disagreed. Participants reporting poverty-level incomes (RRR: 1.80; 95 %CI 1.25-2.59) and previous unwanted pregnancies (RRR: 2.74; 95 %CI: 1.56-4.81) were more likely to describe "neutral" feelings of control. CONCLUSION Findings indicate a relationship between feelings of control over pregnancy and several factors, and these results may help identify reproductive autonomy access gaps among emerging adults. More work should investigate these relationships as well as the meaning of "neutral" responses when it comes to assessments of control over pregnancy. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02734199, Registered 12 April 2016.
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Affiliation(s)
- Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
| | - Jennifer Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
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O'Connor-Terry C, Harris J. Pregnancy decision-making in women with physical disabilities. Disabil Health J 2021; 15:101176. [PMID: 34353758 DOI: 10.1016/j.dhjo.2021.101176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with physical disabilities experience barriers to knowledge about pregnancy and adequate reproductive healthcare, which impedes decision-making processes and negatively impacts their pregnancy planning. OBJECTIVE The purpose of this study was to learn more about pregnancy decision-making in women with physical disabilities. METHODS We conducted a qualitative study utilizing semi-structured interviews with women with physical disabilities. We asked questions regarding pregnancy, parenting, reproductive health, relationships and interactions with the healthcare system. We utilized interview transcripts and notes to form a codebook regarding pregnancy and parenting decision-making, knowledge, and fears. We then organized codes into themes based on pre-existing literature regarding fertility and conceptualization of the self. RESULTS We completed and analyzed 16 interviews. Themes overall reflected the participants grappling with their own baseline assumptions that they were infertile, as well as managing similar assumptions from others. However, many of the participants recall an exact point where they began to contemplate the fact that having children was possible for them. Finally, disability-related parenting challenges are considered very early in pregnancy decision-making process. CONCLUSIONS Women with physical disabilities experience barriers to contemplating pregnancy including inadequate information on pregnancy and reproductive healthcare that affects their decision-making regarding pregnancy and parenting. All healthcare providers should talk to patients with disabilities about family planning and address possible barriers to contemplating pregnancy.
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Affiliation(s)
| | - John Harris
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
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Barber JS, Guzzo KB, Budnick J, Kusunoki Y, Hayford SR, Miller W. Black-White Differences in Pregnancy Desire During the Transition to Adulthood. Demography 2021; 58:603-630. [PMID: 33834223 DOI: 10.1215/00703370-8993840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article explores race differences in the desire to avoid pregnancy or become pregnant using survey data from a random sample of 914 young women (ages 18-22) living in a Michigan county and semi-structured interviews with a subsample of 60 of the women. In the survey data, desire for pregnancy, indifference, and ambivalence are very rare but are more prevalent among Black women than White women. In the semi-structured interviews, although few women described fatalistic beliefs or lack of planning for future pregnancies, Black and White women did so equally often. Women more often described fatalistic beliefs and lack of planning when retrospectively describing their past than when prospectively describing their future. Using the survey data to compare prospective desires for a future pregnancy with women's recollections of those desires after they conceived, more Black women shifted positive than shifted negative, and Black women were more likely to shift positive than White women-that is, Black women do not differentially retrospectively overreport prospectively desired pregnancies as having been undesired before conception. Young women's consistent (over repeated interviews) prospective expression of strong desire to avoid pregnancy and correspondingly weak desire for pregnancy, along with the similarity of Black and White women's pregnancy plans, lead us to conclude that a "planning paradigm"-in which young women are encouraged and supported in implementing their pregnancy desires-is probably appropriate for the vast majority of young women and, most importantly, is similarly appropriate for Black and White young women.
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Affiliation(s)
- Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, USA
| | | | - Jamie Budnick
- Population Studies Center and Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Yasamin Kusunoki
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sarah R Hayford
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Warren Miller
- Transnational Family Research Institute, Aptos, CA, USA
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Helfferich C, Gerstner D, Knittel T, Pflügler C, Schmidt F. Unintended conceptions leading to wanted pregnancies - an integral perspective on pregnancy acceptance from a mixed-methods study in Germany. EUR J CONTRACEP REPR 2021; 26:227-232. [PMID: 33596147 DOI: 10.1080/13625187.2020.1870951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The study examines the differences within unintended first pregnancies in the life course of 20-44 year old women. Special attention is paid to response and pregnancy acceptance. Exploring determinants and dynamics, this study will contribute to a better understanding of 'happiness with an unintended pregnancy', as this is assumed to be indicative of fewer social problems and health risks. METHODS Retrospective survey data on first unintended pregnancies carried to term (n = 2,306) were analysed using bivariate analysis. Qualitative analysis of the narrations of such pregnancies (n = 59) used the technique of comparing cases. Standardised and qualitative data are available for first intended or aborted pregnancies as comparison groups. All data were collected from the cross-sectional mixed-methods study of 'Women's Lives: Family Planning in the Life Course' (2012-2018, Federal Centre of Health Education, Germany). RESULTS Two-fifth of the unintended pregnancies carried to term were '(very) welcome'. Pregnancy intention, contraceptive use, living conditions, and attitudes had a significant impact. Five pathways of acceptance - sooner or later, more easy or hard to achieve - were identified in the qualitative data. CONCLUSION Unintended pregnancies form a continuum ranging from readily accepted 'happy' pregnancies to pregnancies hard to accept. A new measure should also include postconception acceptance, besides preconception desire.
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Affiliation(s)
- Cornelia Helfferich
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Dominik Gerstner
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg, Germany
| | - Tilmann Knittel
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Carina Pflügler
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
| | - Franziska Schmidt
- Social Science Research Institute for Gender Issues (SoFFI.F), Freiburg, Germany
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Maddow-Zimet I, Kost K. Effect of Changes in Response Options on Reported Pregnancy Intentions: A Natural Experiment in the United States. Public Health Rep 2020; 135:354-363. [PMID: 32302249 PMCID: PMC7222695 DOI: 10.1177/0033354920914344] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives The Pregnancy Risk Assessment Monitoring System (PRAMS), conducted by the
Centers for Disease Control and Prevention in collaboration with state
health departments, is the largest state-level surveillance system that
includes a question on the intention status of pregnancies leading to live
birth. In 2012, the question was changed to include an additional response
option describing uncertainty before the pregnancy about the desire for
pregnancy. This analysis investigated how this additional response option
affected women’s responses. Methods We used the change in the pregnancy intention question in 2012 as a natural
experiment, taking advantage of relatively stable distributions of pregnancy
intentions during short periods of time in states. Using PRAMS data from
2009-2014 (N = 222 781), we used a regression discontinuity-in-time design
to test for differences in the proportion of women choosing each response
option in the periods before and after the question change. Results During 2012-2014, 13%-15% of women chose the new response option, “I wasn’t
sure what I wanted.” The addition of the new response option substantially
affected distributions of pregnancy intentions, drawing responses away from
all answer choices except “I wanted to be pregnant then.” Effects were not
uniform across age, parity, or race/ethnicity or across states. Conclusions These effects could influence estimated levels and trends of the proportion
of births that are characterized as intended, mistimed, or unwanted, as well
as estimates of differences between demographic groups. These findings will
help to inform new strategies for measuring pregnancy and childbearing
desires among women.
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Manze MG, Watnick D, Besthoff C, Romero D. Examining Women's and Men's Ideal Criteria Before Forming Families. JOURNAL OF FAMILY STUDIES 2019; 28:239-254. [PMID: 35299887 PMCID: PMC8923530 DOI: 10.1080/13229400.2019.1702079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/01/2019] [Indexed: 06/14/2023]
Abstract
In the United States, family formation decision-making is more complex than the predominant models that have been used to capture this phenomenon. Understanding the context in which a pregnancy occurs requires a more nuanced examination. In-depth interviews were conducted with 60 men and women, aged 18-35, who had children or were pregnant. Using grounded theory analysis, themes emerged that revealed participants' ideal criteria desired before pregnancy. We stratified by those who met and did not meet these criteria. Almost universally, participants shared ideal criteria: to graduate, gain financial stability, establish a relationship, and then become pregnant. Many participants did not accomplish these goals. Those who had not met their criteria had experienced traumatic childhoods and suffered economic concerns. For this group, having children prompted positive changes within their control, but financial stability remained limited. Efforts should focus on improving circumstances for all individuals to fulfill their criteria before pregnancy.
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Affiliation(s)
- Meredith G. Manze
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
| | - Dana Watnick
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
- Albert Einstein College of Medicine, Center for AIDS Research, New York, NY
| | | | - Diana Romero
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
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Shepherd H, Marshall EA. Childbearing Worldviews and Contraceptive Behavior Among Young Women. JOURNAL OF MARRIAGE AND THE FAMILY 2019; 81:1144-1161. [PMID: 33041369 PMCID: PMC7546315 DOI: 10.1111/jomf.12581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To classify young women into groups based on their childbearing worldviews-patterns of attitudes about domains related to childbearing-and to test whether these groups predict contraceptive behavior. BACKGROUND Contraceptive behavior-defined here as contraceptive use or abstinence-among young women in the United States illustrates the often puzzling relationship between attitudes and behavior. This study argues that considering sets of attitudes relevant to childbearing in relation to each other can explain apparent contradictions between attitudes and contraceptive behavior. METHOD Using data from the Relationship Dynamics and Social Life study of young women (N=832), this study analyzes the relationships among attitudes about childbearing by using latent class analysis to partition survey respondents into meaningful groups, and then multinomial logistic regression analysis to examine the relationship between group membership and contraceptive behavior. Latent class analysis (LCA) identifies classes that share similar relationships between responses across a series of variables to measure childbearing worldviews. RESULTS Latent class analysis identifies six classes of young women that share childbearing worldviews, four of which were predicted by existing literature. Membership in those classes is then shown to predict contraceptive behavior, an important behavioral outcome. CONCLUSION The concept of worldviews and the method for identifying them will allow family researchers to identify meaningful groups in a population, as well as to generate theories about childbearing and contraceptive behavior.
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Affiliation(s)
- Hana Shepherd
- Rutgers University, Department of Sociology, Davison Hall, New Brunswick, NJ 08901
| | - Emily A Marshall
- Franklin and Marshall College, Department of Sociology and Public Health Program, Gerhart House, Lancaster, PA 17604
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Bauleni EM, Hooker L, Vally HP, Taft A. Intimate-partner violence and reproductive decision-making by women attending Victorian Maternal- and Child-Health services: a cross-sectional study. Aust J Prim Health 2019; 24:422-427. [PMID: 30107139 DOI: 10.1071/py17183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/23/2018] [Indexed: 11/23/2022]
Abstract
The reproductive years are a critical period where women experience greater risk of intimate-partner violence (IPV). Most studies investigating the association between IPV and reproductive health have been completed in low- and middle-income countries. This study aimed to examine the relationship between IPV and women's reproductive decision-making in Victoria, Australia. We analysed secondary data from a cluster-randomised trial of IPV screening that surveyed new mothers attending Maternal- and Child-Health centres in Melbourne. Survey measures included the experience of partner abuse in the past 12 months using the Composite Abuse Scale and four reproductive decision-making indicators. Results showed that IPV affects reproductive decision-making among postpartum women. Women who reported abuse were less likely to plan for a baby (adjusted Odds Ratio 0.48, 95% CI: 0.31-0.75) than were non-abused women, significantly more likely to have partners make decisions for them about contraception (Risk ratio (RR) 4.09, 95% CI: 1.31-12.75), and whether and when to have a baby (RR 12.35, 95% CI: 4.46-34.16), than they were to make decisions jointly. Pregnant and postpartum women need to be screened for partner violence that compromises women's decision-making power regarding their reproductive rights.
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Affiliation(s)
- Esther M Bauleni
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora , Vic. 3086, Australia
| | - Leesa Hooker
- Department of Rural Nursing and Midwifery, La Trobe Rural Health School, PO Box 199, Bendigo, Vic. 3552, Australia
| | - Hassan P Vally
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora , Vic. 3086, Australia
| | - Angela Taft
- Judith Lumley Centre (for mother, infant and family health research), School of Nursing and Midwifery, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3086, Australia
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Kost K, Zolna M. Challenging unintended pregnancy as an indicator of reproductive autonomy: a response. Contraception 2019; 100:5-9. [PMID: 31059700 DOI: 10.1016/j.contraception.2019.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kathryn Kost
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038.
| | - Mia Zolna
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038
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Lyons S, Arcara J, Deardorff J, Gomez AM. Financial Strain and Contraceptive Use Among Women in the United States: Differential Effects by Age. Womens Health Issues 2019; 29:153-160. [PMID: 30723058 DOI: 10.1016/j.whi.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Low-income and young women experience disproportionately high rates of unintended pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators of financial status, particularly during emerging adulthood. This study investigates the relationship between financial strain and contraceptive use, focusing on the differential effects by age group. METHODS Multinomial logistic regression analyses assessed the relationship between financial strain and contraceptive use in a national sample of U.S. women ages 18-39 years (N = 932). Models were adjusted for income, employment status, and other sociodemographic characteristics and tested the interaction of financial strain and age group. RESULTS Women with high financial strain were less likely to use short-acting methods (compared with using no method) in the adjusted model; when the age and financial strain interaction was included, associations held only for women ages 18-24 and 25-29 years of age. Relative to contraceptive nonuse, women ages 18-24 years with high financial strain were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95% confidence interval [CI], 0.01-0.99) and short-acting hormonal (RRR, 0.03; 95% CI, 0.00-0.18) methods. Women ages 25-29 with high financial strain were less likely to use short-acting hormonal (RRR, 0.20; 95% CI, 0.05-0.87) and coital-specific (RRR, 0.11; 95% CI, 0.02-0.51) methods. IMPLICATIONS FOR PRACTICE AND/OR POLICY Young women may be vulnerable to the effect of high financial strain on contraceptive nonuse. Providers working with this group should consider incorporating financial strain into screening tools to identify patients who may need extra attention in contraceptive decision-making conversations. Antipoverty programs could also have a positive effect on effective contraceptive use.
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Affiliation(s)
- Sophie Lyons
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California; Department of Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Julianna Deardorff
- Department of Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California.
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Gomez AM, Arteaga S, Ingraham N, Arcara J, Villaseñor E. It's Not Planned, But Is It Okay? The Acceptability of Unplanned Pregnancy Among Young People. Womens Health Issues 2018; 28:408-414. [PMID: 30143419 DOI: 10.1016/j.whi.2018.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is well-established that current measures of pregnancy intentions fail to capture the complexity of couples' lived experiences and decisions regarding reproductive decision making. Despite limitations, these measures guide programs, policy, and clinical practice. Herein, we explore prospective pregnancy acceptability, which captures whether individuals anticipate considering an unexpected pregnancy welcomed, manageable, or okay. METHODS Individual qualitative interviews were conducted with 50 young (ages 18-24 years) women and their male partners (N = 100) to elucidate prospective pregnancy desires and perspectives on pregnancy planning. Using a thematic approach, we analyzed data from a subsample (n = 88) of participants who did not currently desire a pregnancy. RESULTS Despite lack of pregnancy desire, 37 participants indicated that a pregnancy would be acceptable. Several themes emerged as reasons for pregnancy acceptability, including feeling prepared for children, relational stability, having knowledge of what it takes to parent, and taking a "whatever happens" approach toward pregnancy planning. Notably, a number of reasons for pregnancy acceptability were also described as reasons for lack of acceptability. For example, although many parents in the sample found pregnancy acceptable owing to their knowledge of the time and resources that raising children required, other parents found pregnancy unacceptable for this same reason. CONCLUSIONS Acceptability captures nuances of prospective views on pregnancy and what it means for young people's lives that current intentions language and framing often neglects. Additionally, acceptability may be a construct that resonates with the perspectives and lives of young people for whom the notion of active pregnancy planning is not salient.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California
| | - Natalie Ingraham
- Department of Sociology and Social Services, California State University, East Bay, Hayward, California
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California
| | - Elodia Villaseñor
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California
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15
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Pregnancy scares and change in contraceptive use. Contraception 2018; 98:260-265. [PMID: 30056159 DOI: 10.1016/j.contraception.2018.07.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined whether the experience of a "pregnancy scare" is related to subsequent changes in contraceptive use that increase the risk of unintended pregnancy. METHODS We used data from the Relationship Dynamics and Social Life (RDSL) study, which interviewed a random, population-based sample of 1003 young women weekly for 2.5 years. We used multivariate regression models to predict the effect of experiencing a pregnancy scare on change in contraceptive use. RESULTS We found pregnancy scares are associated with changes in contraceptive use that increase the risk of pregnancy. Experiencing a pregnancy scare is related to discontinued contraceptive use, change from consistent to inconsistent use of contraception, and change from a more effective to a less effective method of contraception. We also found pregnancy scares are associated with continued inconsistent use of contraception. CONCLUSIONS Our findings suggest that the experience of a pregnancy scare does not serve as a "wake-up call" to start using contraception, to start using it consistently, or to switch to a more effective method to reduce the risk of unintended pregnancy. Instead, contraceptive use after a pregnancy scare typically remains the same or worsens. IMPLICATIONS Clinicians should be aware that young women who have experienced pregnancy scares may be at increased risk of unintended pregnancy, relative to young women who did not experience a pregnancy scare.
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16
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Ferrer Serret L, Solsona Pairó M. The place of abortion in the pregnancy decision-making process in young adult women in Catalonia, Spain. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1087-1103. [PMID: 29785717 DOI: 10.1111/1467-9566.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Induced abortion is one option to control fertility in Spain. Young adult women (25-34 years old) show a different abortion pattern compared to women in other age groups, being less likely to seek abortions than younger women and having one of the lowest proportions of unintended pregnancies. We aimed to analyse the factors involved in the pregnancy decision-making process to better understand why young adult women seek abortions in Catalonia, Spain. In-depth semi-structured interviews with 25 nulliparous pregnant young adult women and one focus group discussion with healthcare providers were conducted in 2008/2010. We found that inconsistent contraceptive use prior to an unintended pregnancy was due to ambivalence and weighing of priorities during sex. The quality of the relationship was paramount to the abortion decision whereas other reasons (financial/employment status, fulfilling aspirations, support networks) were less important. We conclude that the motivations for the abortion decision are interrelated and based on the current life stage of women and that there is pressure on young adult women in Spain to become mothers. Induced abortion is perceived as the last resort to postpone motherhood. Our findings reinforce the unequal societal burden placed on women to take responsibility for prevention of unintended pregnancy.
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Affiliation(s)
- Laia Ferrer Serret
- Centre for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Public Health Agency of Catalonia (APSCAT), Generalitat de Catalunya, Spain
- CIBER for Epidemiology and Public Health (CIBERESP), Spain
- Germans Trias i Pujol Health Sciences Research Institute (IGTP), Spain
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17
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Morse JE, Ramesh S, Jackson A. Reassessing Unintended Pregnancy: Toward a Patient-centered Approach to Family Planning. Obstet Gynecol Clin North Am 2017; 44:27-40. [PMID: 28160891 DOI: 10.1016/j.ogc.2016.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Underserved women, especially those with low incomes and from racial and ethnic minorities, experience a disproportionate share of unintended pregnancies in the United States. Although unintended pregnancy rates are general markers of women's health and status, they may not accurately capture women's experiences of these pregnancies or their social circumstances. A patient-centered approach to family planning optimizes women's reproductive preferences, is cognizant of historical harms and current disparities, and may more comprehensively address the issue of unintended pregnancy. Clinicians, researchers, and policy makers can all adopt a patient-centered approach to help underserved women regain their reproductive autonomy.
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Affiliation(s)
- Jessica E Morse
- Family Planning Division, Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, Campus Box #7570, Chapel Hill, NC 27514, USA.
| | - Shanthi Ramesh
- Family Planning Division, Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, Campus Box #7570, Chapel Hill, NC 27514, USA
| | - Andrea Jackson
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 2356 Sutter Street, 5th Floor, San Francisco, CA 94143, USA
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18
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Callegari LS, Aiken ARA, Dehlendorf C, Cason P, Borrero S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol 2017; 216:129-134. [PMID: 27776920 DOI: 10.1016/j.ajog.2016.10.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
Abstract
Engaging women in discussions about reproductive goals in health care settings is increasingly recognized as an important public health strategy to reduce unintended pregnancy and improve pregnancy outcomes. "Reproductive life planning" has gained visibility as a framework for these discussions, endorsed by public health and professional organizations and integrated into practice guidelines. However, women's health advocates and researchers have voiced the concern that aspects of the reproductive life planning framework may have the unintended consequence of alienating rather than empowering some women. This concern is based on evidence indicating that women may not hold clear intentions regarding pregnancy timing and may have complex feelings about achieving or avoiding pregnancy, which in turn may make defining a reproductive life plan challenging or less meaningful. We examine potential pitfalls of reproductive life planning counseling and, based on available evidence, offer suggestions for a patient-centered approach to counseling, including building open and trusting relationships with patients, asking open-ended questions, and prioritizing information delivery based on patient preferences. Research is needed to ensure that efforts to engage women in conversations about their reproductive goals are effective in both achieving public health objectives and empowering individual women to achieve the reproductive lives they desire.
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Affiliation(s)
- Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA; Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA.
| | - Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX
| | - Christine Dehlendorf
- Departments of Family and Community Medicine, Obstetrics, Gynecology, and Reproductive Sciences, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Patty Cason
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Sonya Borrero
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity, Research, and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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Wise A, Geronimus A, Smock P. The Best of Intentions: A Structural Analysis of the Association between Socioeconomic Disadvantage and Unintended Pregnancy in a Sample of Mothers from the National Longitudinal Survey of Youth (1979). Womens Health Issues 2017; 27:5-13. [PMID: 27913056 PMCID: PMC5219931 DOI: 10.1016/j.whi.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Births to less educated women are more likely to be classified as unintended than other births. We question a common interpretation that this association reflects a lack of contraceptive knowledge or self-efficacy among less educated women. We theorize that differences in early life educational advantages structure pregnancy desires and the salience and opportunity costs of precise fertility timing. We hypothesize that net of covariates indicative of early educational disadvantage, mothers with less education are not more likely to report births as unintended compared with mothers who have attained higher levels of education before becoming mothers. METHODS Using multivariate regression, we analyze a sample of women in the National Longitudinal Survey of Youth (1979) who had their first births by 1994. We test whether an index measure of educational advantage in youth predicts unintended first birth. RESULTS Unadjusted results confirm well-documented associations between educational disadvantage and greater likelihood of unintended pregnancy. However, once covariates are controlled, those with high educational advantage in youth are more likely to report their first birth as mistimed (relative risk ratio, 1.57). DISCUSSION Educational advantage captures expectations about how much education a young woman will obtain before giving birth and is a structural dynamic that precedes proximate factors related to family planning access and behaviors. CONCLUSIONS These findings highlight the need to incorporate structural factors that condition perceptions of pregnancy intention in the study of unintended pregnancy and to critically reevaluate the conceptualization and interpretation of pregnancy intention measures.
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Affiliation(s)
- Akilah Wise
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109,
| | - Arline Geronimus
- University of Michigan, Population Studies Center, 426 Thompson Street, Ann Arbor, MI 48108,
| | - Pamela Smock
- University of Michigan, Population Studies Center, 426 Thompson Street, Ann Arbor, MI 48108,
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Patient Experiences with Pregnancy Planning and Perspectives on Reproductive Care in Community Health Centers: A Qualitative Study of African American Women in Chicago. Womens Health Issues 2016; 27:322-328. [PMID: 27931733 DOI: 10.1016/j.whi.2016.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/15/2016] [Accepted: 10/27/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Given the potential benefits of preventive reproductive health care for both women and children, it is important that clinicians routinely offer preconception and contraceptive counseling in ways that are responsive to patients' wishes. The goal of this study is to gain knowledge about the components of preventive reproductive health care that patients at Federally Qualified Health Centers value, and to elicit patient perspectives on how best to deliver this care. METHODS We conducted three focus groups with African American women (n = 21) at two Federally Qualified Health Centers in Chicago. The groups were facilitated using an open-ended, semistructured interview guide. We asked women to reflect on past experiences, advice they would give their teenage daughters, and how to design an ideal clinic. All groups were recorded and transcribed verbatim. Transcripts were coded and analyzed using an inductive approach with ATLAS.ti software. RESULTS Although participants wanted comprehensive information about sex and pregnancy, they reported receiving no information at all, or many negative messages. The idea of timing and spacing pregnancies was generally embraced by participants. They described an ideal clinic as having a patient population diverse in income, trusting relationships with providers, comprehensive services, and educational opportunities. CONCLUSIONS The women in our study expressed a desire for more information and comprehensive care in the setting of an equitable clinic where they feel respected as individuals. Our findings support the idea behind the patient-centered medical home and challenge prior literature, which suggests the concept of pregnancy planning does not resonate with low-income African American women.
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21
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Godiwala P, Appelhans BM, Moore Simas TA, Xiao RS, Liziewski KE, Pagoto SL, Waring ME. Pregnancy intentionality in relation to non-planning impulsivity. J Psychosom Obstet Gynaecol 2016; 37:130-136. [PMID: 27319571 PMCID: PMC5045788 DOI: 10.1080/0167482x.2016.1194390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Half of US pregnancies are unintended. Understanding risk factors is important for reducing unintended pregnancy rates. AIM We examined a novel risk factor for unintended pregnancies, impulsivity. We hypothesized that non-planning impulsivity, but not motor or attentional impulsivity, would be related to pregnancy intention. METHODS Pregnant women (N = 116) completed self-report measures during their second or third trimester. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS-15); subscales measured motor, attentional and non-planning impulsivity (subscale range: 5-20). On each subscale, high impulsivity was indicated by a score of ≥11. Pregnancy intention was assessed by asking women whether they were trying to become pregnant at the time of conception (yes or no). Crude and multivariable-adjusted logistic regression models estimated the cross-sectional association between impulsivity and unplanned pregnancy. RESULTS Thirty-four percent of women reported that their current pregnancy was unplanned, and 32% had high non-planning impulsivity. Fifty-one percent of women with high non-planning impulsivity reported an unplanned pregnancy versus 25% of women with low impulsivity. Women with high non-planning impulsivity had 3.53 times the odds of unplanned pregnancy compared to women with low non-planning impulsivity (adjusted OR =3.53, 95% CI: 1.23-10.14). Neither motor (adjusted OR =0.55, 95% CI: 0.10-2.90) nor attentional (adjusted OR =0.84, 95% CI: 0.25-2.84) impulsivity were related to pregnancy intentionality. CONCLUSIONS High non-planning impulsivity may be a risk factor for unplanned pregnancy. Further research should explore whether increasing the use of long-acting reversible contraceptives or integrating if-then planning into contraceptive counseling among women with higher non-planning impulsivity can lower unplanned pregnancy rates.
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Affiliation(s)
- Prachi Godiwala
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Department of Obstetrics & Gynecology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | - Tiffany A. Moore Simas
- Division of Research, Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Rui S. Xiao
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kathryn E. Liziewski
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Worcester Polytechnic Institute, Worcester, MA
| | - Sherry L. Pagoto
- Division of Behavioral and Preventive Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Division of Research, Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA
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22
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Evolutionary Concept Analysis of Reproductive Life Planning. J Obstet Gynecol Neonatal Nurs 2016; 46:78-90. [PMID: 27837650 DOI: 10.1016/j.jogn.2016.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 10/20/2022] Open
Abstract
Reproductive life planning is recommended as an important topic of discussion at every health care interaction with women and men of reproductive age; however, this intervention has not been well studied. Therefore, the purpose of this evolutionary concept analysis was to synthesize the relevant literature, identify the essential attributes of the concept, and develop a conceptual definition to guide future research and to help implement reproductive life planning in routine health care practice.
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23
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Mumford SL, Sapra KJ, King RB, Louis JF, Buck Louis GM. Pregnancy intentions-a complex construct and call for new measures. Fertil Steril 2016; 106:1453-1462. [PMID: 27490044 PMCID: PMC5159192 DOI: 10.1016/j.fertnstert.2016.07.1067] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of unintended pregnancies under relaxed assumptions regarding birth control use compared with a traditional constructed measure. DESIGN Cross-sectional survey. SETTING Not applicable. PATIENT(S) Nationally representative sample of U.S. women aged 15-44 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Prevalence of intended and unintended pregnancies as estimated by [1] a traditional constructed measure from the National Survey of Family Growth (NSFG), and [2] a constructed measure relaxing assumptions regarding birth control use, reasons for nonuse, and pregnancy timing. RESULT(S) The prevalence of unintended pregnancies was 6% higher using the traditional constructed measure as compared with the approach with relaxed assumptions (NSFG: 44%, 95% confidence interval [CI] 41, 46; new construct 38%, 95% CI, 36, 41). Using the NSFG approach, only 92% of women who stopped birth control to become pregnant and 0 women who were not using contraceptives at the time of the pregnancy and reported that they did not mind getting pregnant were classified as having intended pregnancies, compared with 100% using the new construct. CONCLUSION(S) Current measures of pregnancy intention may overestimate rates of unintended pregnancy, with over 340,000 pregnancies in the United States misclassified as unintended using the current approach, corresponding to an estimated savings of $678 million in public health-care expenditures. Current constructs make assumptions that may not reflect contemporary reproductive practices, so improved measures are needed.
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Affiliation(s)
- Sunni L Mumford
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland.
| | - Katherine J Sapra
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | - Rosalind B King
- Population Dynamics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
| | | | - Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland
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Dhakal S, Song JS, Shin DE, Lee TH, So AY, Nam EW. Unintended pregnancy and its correlates among currently pregnant women in the Kwango District, Democratic Republic of the Congo. Reprod Health 2016; 13:74. [PMID: 27305901 PMCID: PMC4910199 DOI: 10.1186/s12978-016-0195-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/08/2016] [Indexed: 12/01/2022] Open
Abstract
Background Unintended pregnancy is an important reproductive health problem in both developed and developing countries and is most prominent in low-middle income countries. In the Democratic Republic of the Congo, the total fertility rate is high at 5.9 births per women, and a mother’s probabily of dying at an age between 15–49 years is also high (53 %). Women with unintended pregnancies are less likely to utilize available necessary services for their own health and the health of their children. Therefore, unintended pregnancy is a crucial factor of maternal health in the Democratic Republic of the Congo. This study aims to identify the prevalence of unintended pregnancy and its associated factors in the Democratic Republic of the Congo. Methods Data were collected from June 20 to 29, 2014 among women aged 15–49 years who had children younger than 5 years old. The women were from a representative sample of 602 households. Multiple logistic regression analysis was performed to evaluate the associations between the dependent variable and the explanatory variables. Results Unintended pregnancy was reported in 51.4 % of the respondents. Multivariate logistic regression showed an association between education status (AOR, 3.4; CI, 1.21–9.90) and age of the last child (AOR, 5.17; CI, 1.23–21.70) with an unintended pregnancy. Unintended pregnancies were low among women who owner a cell phone (AOR, 0.18; CI, 0.47–0.73) and those who were aware of family planning method (AOR 0.20; CI, 0.06–0.60). Conclusion The unintended pregnancy rate high and was significantly associated with female education, previous use of family planning methods, ownership of cell phone, and age of the last child. Maternal health interventions should focus on increasing family planning service utilization, awareness of family planning, and access to communication and income.
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Affiliation(s)
- Sarita Dhakal
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-do, Korea.,Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea.,Institite for Poverty Alleviation and International Development (IPAID), Yonsei University, Wonju, Korea
| | - Jin Sung Song
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-do, Korea.,Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea
| | - Dong Eun Shin
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-do, Korea.,Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea
| | - Tae Ho Lee
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-do, Korea.,Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea
| | - Ae Young So
- Department of Nursing, Gangneung-Wonju National University, Wonju, Korea
| | - Eun Woo Nam
- Yonsei Global Health Center, Yonsei University, Wonju, Gangwon-do, Korea. .,Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea. .,Institite for Poverty Alleviation and International Development (IPAID), Yonsei University, Wonju, Korea.
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25
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Nelson AL, Shabaik S, Xandre P, Awaida JY. Reproductive Life Planning and Preconception Care 2015: Attitudes of English-Speaking Family Planning Patients. J Womens Health (Larchmt) 2016; 25:832-9. [PMID: 26974353 DOI: 10.1089/jwh.2015.5323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Reproductive life planning has become an essential element in programs designed to promote preconceptional care and increase utilization of effective contraceptive methods. This study sought to determine if women have reproductive life plans and what they think women should do to prepare for pregnancy. MATERIALS AND METHODS Indigent English-speaking women in a family planning clinic were asked individually about their reproductive life plans, preparations needed for pregnancy, and the relative health risks of pregnancy compared to oral contraceptives. RESULTS Of the 250 women interviewed, only 53% were confident how many pregnancies they wanted in their lifetime; 46.3% were confident about when they desired their next pregnancy. Although virtually all agreed that women should plan and prepare for pregnancy, only 25.8% of women mentioned that any medical preparations were necessary before pregnancy. Women's choice of contraception did not match their pregnancy intentions. Over 60% of women thought that the pill was at least as hazardous to a woman's health as pregnancy. CONCLUSIONS In this study, many English-speaking women had no distinct reproductive life plans. Most did not think that medical preparations are needed before pregnancy. New approaches may be useful to more productively identify women who need individualized counseling, preconception care, and/or more effective contraceptive methods.
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Affiliation(s)
- Anita L Nelson
- 1 Department of Obstetrics and Gynecology, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center , David Geffen School of Medicine at UCLA, Manhattan Beach, California
| | - Salma Shabaik
- 2 Department of Family Medicine, Harbor-UCLA Medical Center , Harbor City, California
| | - Pamela Xandre
- 3 Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, School of Nursing at California State University , Long Beach, California
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Schreiber CA, Ratcliffe SJ, Sammel MD, Whittaker PG. A self-assessment efficacy tool for spermicide contraceptive users. Am J Obstet Gynecol 2016; 214:264.e1-264.e7. [PMID: 26525365 DOI: 10.1016/j.ajog.2015.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Easily accessible contraceptive methods, such as chemical and barrier methods, are used currently by approximately 1 in 6 women who use contraception in the United States. Even in the face of suboptimal effectiveness, coitally dependent methods likely will always have a role in fertility management. Because most contraceptive efficacy stratifications use population-based data, for women to make informed decisions about the individual fit of a contraceptive method, better evidence-based, user-friendly tools are needed. OBJECTIVES Spermicides are a readily available, over-the counter, woman-controlled contraceptive method, but their effectiveness is user-dependent. Patient-decision aids for spermicides and other barrier methods are not well-developed, and overall failure rates could be improved by aids that account for individual characteristics. We sought to derive a prediction rule for successful use of spermicides for pregnancy prevention and to convert those data to a point-of-care instrument that women can use when they are considering spermicide use during contraceptive decision-making. STUDY DESIGN We pooled local data from 3 randomized clinical trials that were published in 2004, 2007, and 2010 that tested spermicide efficacy. We constructed a prediction rule for unintended pregnancy using bootstrap validation and developed a scoring system. RESULTS Data from 621 women showed a mean age of 29 years; 49% of the women were African American, and 43% were white. The overall pregnancy rate was 10.3% (95% confidence interval, 7.9-12.7) over 6 months. In adjusted logistic regression, age >35 years was protective against pregnancy (odds ratio, 0.19; 95% confidence interval, 0.06-0.58; P = .003), and multigravidity was associated with high failure rates (odds ratio, 7.24; 95% confidence interval, 3.04-17.3; P < .001). These risk factors (together with frequency of unprotected sex) were used in a model that maximized sensitivity for pregnancy prediction to compute the predicted probability of unintended pregnancy for each woman. This model was 97% accurate in predicting women who had a <5% pregnancy risk while using spermicides. CONCLUSION Using prospectively collected data, we built a simple risk calculator for contraceptive failure that women can consult when considering spermicide use. This instrument could support patient-centered contraceptive decision-making.
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27
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Aiken AR. Happiness about unintended pregnancy and its relationship to contraceptive desires among a predominantly Latina cohort. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:99-106. [PMID: 26095732 PMCID: PMC4487420 DOI: 10.1363/47e2215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire. METHODS Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings. RESULTS The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness. CONCLUSIONS Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods.
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Martin-de-las-Heras S, Velasco C, Luna JDD, Martin A. Unintended pregnancy and intimate partner violence around pregnancy in a population-based study. Women Birth 2015; 28:101-5. [DOI: 10.1016/j.wombi.2015.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 11/25/2022]
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Raymo JM, Musick K, Iwasawa M. Gender Equity, Opportunity Costs of Parenthood, and Educational Differences in Unintended First Births: Insights from Japan. POPULATION RESEARCH AND POLICY REVIEW 2015; 34:179-199. [PMID: 25914433 PMCID: PMC4406482 DOI: 10.1007/s11113-014-9348-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examine educational differences in the intendedness of first births in Japan using data from a nationally representative survey of married women (N = 2,373). We begin by describing plausible scenarios for a negative, null, and positive educational gradient in unintended first births. In contrast to well-established results from the U.S., we find evidence of a positive educational gradient in Japan. Net of basic demographic controls, university graduates are more likely than less-educated women to report first births as unintended. This pattern is consistent with a scenario emphasizing the high opportunity costs of motherhood in countries such as Japan where growing opportunities for women in employment and other domains of public life have not been accompanied by changes in the highly asymmetric roles of men and women within the family. We discuss potential implications of this suggestive finding for other low-fertility settings.
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Affiliation(s)
- James M Raymo
- Department of Sociology and Center for Demography and Ecology, University of Wisconsin, 1180 Observatory Dr., Madison, WI 53706, USA
| | - Kelly Musick
- Department of Policy Analysis and Management and Cornell Population Center, Cornell University, Ithaca, NY, USA
| | - Miho Iwasawa
- National Institute of Social Security and Population Research, Tokyo, Japan
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James‐Hawkins L. Why Female College Students Risk Pregnancy: I Just Wasn't Thinking. J Midwifery Womens Health 2015; 60:169-74. [DOI: 10.1111/jmwh.12272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kost K, Lindberg L. Pregnancy intentions, maternal behaviors, and infant health: investigating relationships with new measures and propensity score analysis. Demography 2015; 52:83-111. [PMID: 25573169 PMCID: PMC4734627 DOI: 10.1007/s13524-014-0359-9] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87-100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers' background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.
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Affiliation(s)
- Kathryn Kost
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, 10038, USA,
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Borrero S, Nikolajski C, Steinberg JR, Freedman L, Akers AY, Ibrahim S, Schwarz EB. "It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning. Contraception 2015; 91:150-6. [PMID: 25477272 PMCID: PMC4303515 DOI: 10.1016/j.contraception.2014.09.014] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Unintended pregnancy is common and disproportionately occurs among low-income women. We conducted a qualitative study with low-income women to better typologize pregnancy intention, understand the relationship between pregnancy intention and contraceptive use, and identify the contextual factors that shape pregnancy intention and contraceptive behavior. STUDY DESIGN Semistructured interviews were conducted with low-income, African-American and white women aged 18-45 recruited from reproductive health clinics in Pittsburgh, PA, to explore factors that influence women's pregnancy-related behaviors. Narratives were analyzed using content analysis and the constant comparison method. RESULTS Among the 66 participants (36 African-American and 30 white), we identified several factors that may impede our public health goal of increasing the proportion of pregnancies that are consciously desired and planned. First, women do not always perceive that they have reproductive control and therefore do not necessarily formulate clear pregnancy intentions. Second, the benefits of a planned pregnancy may not be evident. Third, because preconception intention and planning do not necessarily occur, decisions about the acceptability of a pregnancy are often determined after the pregnancy has already occurred. Finally, even when women express a desire to avoid pregnancy, their contraceptive behaviors are not necessarily congruent with their desires. We also identified several clinically relevant and potentially modifiable factors that help to explain this intention-behavior discrepancy, including women's perceptions of low fecundity and their experiences with male partner contraceptive sabotage. CONCLUSION Our findings suggest that the current conceptual framework that views pregnancy-related behaviors from a strict planned behavior perspective may be limited, particularly among low-income populations. IMPLICATIONS This study identified several cognitive and interpersonal pathways to unintended pregnancy among low-income women in Pittsburgh, PA, including perceptions of low reproductive control, perceptions of low fecundity and male partner reproductive coercion.
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Affiliation(s)
- Sonya Borrero
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
| | - Cara Nikolajski
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Julia R Steinberg
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Lori Freedman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Aletha Y Akers
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital and University of Pittsburgh, Pittsburgh, PA
| | - Said Ibrahim
- VA Center for Health Equity, Research, and Promotion, Philadelphia VA Medical Center, Philadelphia, PA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eleanor Bimla Schwarz
- Department of Medicine, University of California, Davis School of Medicine, Sacramento, CA
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Paterno MT, Han HR. Development and psychometric testing of the attitude toward potential pregnancy scale. J Obstet Gynecol Neonatal Nurs 2014; 43:710-8. [PMID: 25316218 DOI: 10.1111/1552-6909.12511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop and test a comprehensive tool for measuring women's attitudes toward the possibility of becoming pregnant. DESIGN Cross-sectional mixed methods study. SETTING Two obstetric/gynecologic (OB/GYN) clinics and one family planning clinic in Baltimore, Maryland. PARTICIPANTS One-hundred thirty (130) nonpregnant, primarily African American women (84%) age 18 to 29. METHODS Participants completed a computer-based survey as part of a larger retrospective mixed-methods study. The Attitude Toward Potential Pregnancy Scale (APPS) was assessed using exploratory factor analysis and hypothesis testing. RESULTS Cronbach's alpha for internal consistency for the APPS was 0.86. Item-total correlations ranged from 0.56 to 0.75. All items loaded on one factor. Support for construct validity was demonstrated using logistic regression, where the odds of being a highly effective contraceptive user decreased by 8% with each one-point increase in score on the APPS (odds ratio = 0.92; confidence interval [0.87, 0.98]). CONCLUSIONS This study provides support for reliability and validity of the APPS. The APPS may be a useful tool for understanding pregnancy attitude in future studies and in clinical practice. Further research is needed to assess the usefulness of the scale with other groups of women, its utility in the clinical practice setting, and its potential predictive validity for unintended pregnancy.
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Ayoola AB, Zandee GL, Johnson E, Pennings K. Contraceptive use among low-income women living in medically underserved neighborhoods. J Obstet Gynecol Neonatal Nurs 2014; 43:455-64. [PMID: 24958447 DOI: 10.1111/1552-6909.12462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the rate of contraceptive use and types of contraception used by low-income women. DESIGN A descriptive study was used to survey women about their contraceptive use and sexual behaviors 12 months prior to the time of the interview. PARTICIPANTS AND SETTING A convenience sample of 110 low-income women living in three urban medically underserved neighborhoods who enrolled in a larger study was included. METHODS Univariate and bivariate descriptive analyses were conducted using STATA 10. RESULTS Forty-eight (43.6%) of the women were African American, 43 (39.1%) were Hispanic, and 17 (15.5%) were White. The women were age 18 to 55 years (Mean = 31 years). Forty percent of these women who were not pregnant or planning to get pregnant had sex without contraceptives in the past 12 months. The percentage of women who used contraception decreased from 77.3% users in the last 12 months to 63.6% current users. The most common methods used within the last 12 months were condom use by male partner (28.2%), birth control pills (14.6%), contraceptive injection (12.7%), intrauterine device (10.9%), and the patch (1.8%). CONCLUSIONS Many of the low-income women from medically underserved neighborhoods did not use contraceptives and of those who used contraceptives, the majority used the least effective methods.
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Peri-implantation intercourse lowers fecundability. Fertil Steril 2014; 102:178-82. [PMID: 24746744 DOI: 10.1016/j.fertnstert.2014.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the impact of sexual intercourse around the time of implantation on the probability of achieving a pregnancy. DESIGN Time-to-pregnancy cohort using day-specific probability of pregnancy modeling to account for intercourse during the fertile window. SETTING Community cohort. PATIENT(S) Women trying to conceive naturally, ages 30-44, without known infertility. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Positive pregnancy test. RESULT(S) A total of 564 women provided 1,332 complete cycles for analysis. Intercourse frequency during the fertile window and during the peri-implantation window were significantly correlated. Cycles in which couples had 2 or more days with intercourse during the implantation window were significantly less likely to result in a positive pregnancy test compared with cycles in which couples did not have intercourse in this window, after adjusting for age, race, history of regular menstrual cycles, previous pregnancy, and body mass index (fecundability ratio, 0.62; 95% confidence interval, 0.42-0.91). CONCLUSION(S) Intercourse during the peri-implantation window may be detrimental to natural fertility. Methods that allow couples to time intercourse to the fertile window may decrease time to pregnancy by not only increasing the probability of fertilization but also decreasing the probability of failed implantation.
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Abstract
While recently there have been renewed interest in women's childbearing intentions, the authors sought to bring needed research attention to understanding men's childbearing intentions. Nationally representative data from the 2006-2010 National Survey of Family Growth (NSFG) was used to examine pregnancy intentions and happiness for all births reported by men in the 5 years preceding the interview. We used bivariate statistical tests of associations between intention status, happiness about the pregnancy, and fathers' demographic characteristics, including joint race/ethnicity and union status subgroups. Multivariate logistic regressions were used to calculate adjusted odds ratios of a birth being intended, estimated separately by father's union status at birth. Using comparable data and measures from the male and female NSFG surveys, we tested for gender differences intentions and happiness, and examined the sensitivity of our results to potential underreporting of births by men. Nearly four out of ten of births to men were reported as unintended, with significant variation by men's demographic traits. Non-marital childbearing was more likely to be intended among Hispanic and black men. Sixty-two percent of births received a 10 on the happiness scale. Happiness about the pregnancy varied significantly by intention status. Men were significantly happier than women about the pregnancies, with no significant difference in intention status. Potential underreporting of births by men had little impact on these patterns. This study brings needed focus to men's childbearing intentions and improves our understanding of the context of their role as fathers. Men need to be included in strategies to prevent unintended pregnancy.
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Rocca CH, Harper CC, Raine-Bennett TR. Young women's perceptions of the benefits of childbearing: associations with contraceptive use and pregnancy. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2013; 45:23-32. [PMID: 23489854 PMCID: PMC3620026 DOI: 10.1363/4502313] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
CONTEXT High unintended pregnancy rates, and inconsistencies between reported pregnancy intentions and contraceptive behaviors, have been well documented among young U.S. women. Women's beliefs about the benefits of childbearing and motherhood may be related to the apparent disconnect between pregnancy intentions and reproductive outcomes. METHODS Perceived benefits of childbearing and feelings about a potential pregnancy were assessed among 1,377 women aged 15-24 (most of them black or Latina) participating in a longitudinal study in 2005-2008. The women, who were initiating hormonal contraception at public family planning clinics and did not want to become pregnant for one year, were followed for 12 months. Differences in perceived benefits of childbearing by participant characteristics were examined with linear regression, using a new multi-item measure. Cox proportional hazard regression was used to investigate the association of perceived benefits of childbearing with subsequent contraceptive discontinuation and pregnancy. RESULTS Perceptions of the benefits of childbearing decreased with increasing age (coefficient, -0.04), and white women perceived fewer benefits to childbearing than blacks (-0.2). As women's perception of the benefits of childbearing increased, their one-year pregnancy rates increased, after demographic characteristics and feelings about a potential pregnancy were controlled for (hazard ratio, 1.2). Benefits of childbearing were not associated with contraceptive discontinuation. CONCLUSIONS To better assess pregnancy risk among young women wanting to avoid pregnancy, it may be useful to acknowledge that they hold not only explicit pregnancy desires, but also beliefs about the benefits of childbearing, which may influence sexual behavior and pregnancy.
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Affiliation(s)
- Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, CA, USA.
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Abstract
Reducing unintended pregnancies - particularly among Hispanic and Black women, who have relatively high rates - is a key public health goal in the United States. However, descriptive literature has suggested that Hispanic women are happier about these pregnancies compared with White and Black women, which could mean that there is variation across groups in the consequences of the resulting births. The purpose of this study was to examine variations in happiness about unintended births by race-ethnicity and to assess possible explanations for these differences. Using data from the National Survey of Family Growth (n=1,462 births) I find that Hispanic women report being happier about unintended births compared with White and Black women. Higher happiness among Hispanics was particularly pronounced among a subgroup of women: those who were foreign-born and very religious. Overall, results confirm previous findings that intention status alone is incomplete for capturing pregnancy experiences. Happiness offers complementary information that is important when making comparisons by race-ethnicity and nativity.
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Affiliation(s)
- Caroline Sten Hartnett
- University of Michigan Institute for Social Research 426 Thompson Street, Room 2030 Ann Arbor, MI 48104
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Nelson AL. New frontiers in female contraception (and male condoms): 2012. Expert Opin Investig Drugs 2012; 21:677-93. [DOI: 10.1517/13543784.2012.679342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anita L Nelson
- Harbor UCLA Medical Center,
1457 3rd Street, Manhattan Beach, CA 90266, USA ;
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Morof D, Steinauer J, Haider S, Liu S, Darney P, Barrett G. Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women. PLoS One 2012; 7:e35381. [PMID: 22536377 PMCID: PMC3334919 DOI: 10.1371/journal.pone.0035381] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the reliability and validity of the London Measure of Unplanned Pregnancy (a U.K.-developed measure of pregnancy intention), in English and Spanish translation, in a U.S. population of women. Methods A psychometric evaluation study of the London Measure of Unplanned Pregnancy (LMUP), a six-item, self-completion paper measure was conducted with 346 women aged 15–45 who presented to San Francisco General Hospital for termination of pregnancy or antenatal care. Analyses of the two language versions were carried out separately. Reliability (internal consistency) was assessed using Cronbach's alpha and item-total correlations. Test-retest reliability (stability) was assessed using weighted Kappa. Construct validity was assessed using principal components analysis and hypothesis testing. Results Psychometric testing demonstrated that the LMUP was reliable and valid in both U.S. English (alpha = 0.78, all item-total correlations >0.20, weighted Kappa = 0.72, unidimensionality confirmed, hypotheses met) and Spanish translation (alpha = 0.84, all item-total correlations >0.20, weighted Kappa = 0.77, unidimensionality confirmed, hypotheses met). Conclusion The LMUP was reliable and valid in U.S. English and Spanish translation and therefore may now be used with U.S. women.
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Affiliation(s)
- Diane Morof
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital and the Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America.
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Nelson JA, O'Brien M. Does an Unplanned Pregnancy have Long-Term Implications for Mother-Child Relationships? JOURNAL OF FAMILY ISSUES 2012; 33:506-526. [PMID: 28179747 PMCID: PMC5293288 DOI: 10.1177/0192513x11420820] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The effect of pregnancy planning on the quality of mother-adolescent relationships 15 years later was examined among 373 first-time parents and 472 experienced parents using a mediated moderation model. Among first-time mothers only, the experience of an unplanned pregnancy was related to higher maternal depressive symptoms when mothers also experienced high parenting stress over the first three years. High maternal depressive symptoms over those early years were, in turn, related to more conflict and hostility in the parent-adolescent relationship according to mother and adolescent reports. Additionally, interactions between parity and pregnancy planning revealed that experienced mothers with unplanned pregnancies had the most early parenting stress, though an unplanned pregnancy and high parenting stress did not predict higher depressive symptoms for these mothers as it did for first-time mothers. The findings provide support for the importance of early parenting emotions and experiences on later parent-adolescent relationship quality.
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Affiliation(s)
- Jackie A Nelson
- Department of Human Development and Family Studies, The University of North Carolina at Greensboro, Greensboro, NC 27402-6170. 336-334-3601, fax 336-256-0545
| | - Marion O'Brien
- Department of Human Development and Family Studies, The University of North Carolina at Greensboro, Greensboro, NC 27402-6170. 336-334-3601, fax 336-256-0545
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Greil AL, McQuillan J, Shreffler KM, Johnson KM, Slauson-Blevins KS. Race-ethnicity and medical services for infertility: stratified reproduction in a population-based sample of U.S. women. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2011; 52:493-509. [PMID: 22031500 DOI: 10.1177/0022146511418236] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of "stratified reproduction" in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.
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Affiliation(s)
- Arthur L Greil
- Social Sciences Department, Alfred University, Alfred, NY 14802, USA.
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Meiksin R, Chang JC, Bhargava T, Arnold R, Dado D, Frankel R, Rodriguez KL, Ling B, Zickmund S. Now is the chance: patient-provider communication about unplanned pregnancy during the first prenatal visit. PATIENT EDUCATION AND COUNSELING 2010; 81:462-467. [PMID: 20884161 PMCID: PMC3006669 DOI: 10.1016/j.pec.2010.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/31/2010] [Accepted: 09/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Unplanned pregnancy is associated with psychosocial stress, post-partum depression, and future unplanned pregnancies. Our study describes how topics related to unplanned pregnancy were addressed with patients during the first prenatal visit. METHODS We audio-recorded and transcribed initial prenatal visits between 48 patients and 16 providers from a clinic serving racially diverse, lower-socio-economic patients. We conducted a fine-grained thematic analysis of cases in which the patient's pregnancy was unplanned. RESULTS Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits for unplanned pregnancies (83%) included discussion of the patient's feelings about the pregnancy. Approximately half (51%) of the visits touched on partner or other types of social support. Six patients (17%) were offered referrals to counseling or social services. Only four visits (11%) touched on future birth control options. CONCLUSION Most initial prenatal visits for unplanned pregnancies included discussion of patient feelings about the pregnancy. However, opportunities to discuss future birth control and for more in-depth follow-up regarding social support and psychological risks associated with unplanned pregnancy were typically missed. PRACTICE IMPLICATIONS Obstetrics care providers should be cautious about making assumptions and should consider discussing pregnancy circumstances and psychosocial issues in more depth when treating patients facing unplanned pregnancy.
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Barrett G, Morof D, Rocca CH. Valid and precise measurement. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:220-221. [PMID: 20887297 DOI: 10.1363/4222010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Rocca CH, Doherty I, Padian NS, Hubbard AE, Minnis AM. Pregnancy intentions and teenage pregnancy among Latinas: a mediation analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:186-96. [PMID: 20887287 PMCID: PMC2951312 DOI: 10.1363/4218610] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
CONTEXT The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high. METHODS Prospective, time-varying data from 2001-2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression. RESULTS Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low power in a sexual relationship with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%. CONCLUSIONS Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.
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Affiliation(s)
- Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, CA, USA.
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Rocca CH, Krishnan S, Barrett G, Wilson M. Measuring pregnancy planning: An assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women. DEMOGRAPHIC RESEARCH 2010; 23:293-334. [PMID: 21170147 PMCID: PMC3001625 DOI: 10.4054/demres.2010.23.11] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We evaluated the psychometric properties of the London Measure of Unplanned Pregnancy among Indian women using classical methods and Item Response Modeling. The scale exhibited good internal consistency and internal structure, with overall scores correlating well with each item's response categories. Items performed similarly for pregnant and non-pregnant women, and scores decreased with increasing parity, providing evidence for validity. Analyses also detected limitations, including infrequent selection of middle response categories and some evidence of differential item functioning by parity. We conclude that the LMUP represents an improvement over existing measures but recommend steps for enhancing scale performance for this cultural context.
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Affiliation(s)
- Corinne H Rocca
- Department of Epidemiology, University of California, Berkeley, School of Public Health, 101 Haviland Hall, Berkeley, CA 94720-7358, USA.; Women's Global Health Imperative (WGHI), RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA
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Abstract
Researchers studying infertility from the perspective of anthropology and other the social sciences seldom examine the assumptions embedded in the biomedical definition of infertility. Implicit in the biomedical definition is the assumption that people can be divided straightforwardly into those who are trying to conceive and those who are not trying to conceive. If being infertile implies "intent to conceive," we must recognize that there are various degrees of intent and that the line between the fertile and the infertile is not as sharp as is usually imagined. Drawing on structured interview data collected from a random sample of Midwestern U.S. women and from qualitative interviews, we demonstrate that that there is a wide range of intent among those classified as infertile according to the biomedical definition. We explore the implications of this for research.
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48
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Abstract
Unintended pregnancy often leads to undesirable outcomes for both mothers and children. However, the definition of unintended pregnancy in the sociology of family formation has been restricted to the intentions of mothers. The intentions of fathers--and, with them, the possible role of disagreement about pregnancy intention--remain outside most conceptual frameworks and research programs. This article draws together a number of indicators of unilateral pregnancy in research on contemporary family formation in the United States. Studies of pregnancy intendedness and contraceptive use consistently provide evidence suggesting a significant role for unilateral pregnancy in family formation. Working on the assumption that unilateral pregnancy presents great potential for social dislocation, this article argues for the integration of the concept of unilateral pregnancy into the theoretical framework informing research on family formation.
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Hughes C, Spence D, Holmes VA, McCorry NK. Preconception care for women with diabetes: the midwife's role. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjom.2010.18.3.46915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gribaldo A, Judd MD, Kertzer DI. An "Imperfect" Contraceptive Society: Fertility and Contraception in Italy. POPULATION AND DEVELOPMENT REVIEW 2009; 35:551-584. [PMID: 25045191 PMCID: PMC4100579 DOI: 10.1111/j.1728-4457.2009.00296.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Italy represents an unexpected and in some ways paradoxical outcome in terms of fertility control: a drop to one of the lowest birth rates in the world has been accompanied by the preponderant use of "traditional" methods despite the availability of "modern" contraception. Using data from 349 interviews conducted in 2005-2006 in four Italian cities, we argue that Italian women achieve "unplanned" AND desired conceptions through the use of withdrawal and natural methods. While data from other countries reveal similar notions of ambivalence surrounding pregnancy intentions and contraceptive use, Italy stands out for the surprising correlation between highly "managing" the conditions under which children are born and the socially commended approach of "letting births happen". Such results suggest the need to rethink theoretical understandings of low fertility. Through the use of non-technological methods individuals manipulate culturally produced norms and beliefs about the appropriate moment to have a child; simultaneously, their actions are embedded in larger cultural, economic, and political processes.
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