1
|
Erato G, Shreffler KM, Ciciolla L, Quigley A, Addante S. Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness. J Reprod Infant Psychol 2024; 42:180-193. [PMID: 35819014 PMCID: PMC9834437 DOI: 10.1080/02646838.2022.2097208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.
Collapse
Affiliation(s)
- Gina Erato
- Department of Psychology, Oklahoma State University
| | | | | | | | | |
Collapse
|
2
|
Zimmerman LA, Karp C, Magalona S, Shiferaw S, Seme A, Ahmed S. Exploring Multiple Measures of Pregnancy Preferences and Their Relationship with Postpartum Contraceptive Uptake Using Longitudinal Data from PMA Ethiopia. Stud Fam Plann 2023; 54:467-486. [PMID: 37589248 DOI: 10.1111/sifp.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
There are significant gaps in our understanding of how the experience of an unintended pregnancy affects subsequent contraceptive behavior. Our objective was to explore how three measures of pregnancy preferences-measuring timing-based intentions, emotional orientation, and planning status-were related to the uptake of postpartum family planning within one year after birth. Additionally, we tested whether the relationship between each measure and postpartum family planning uptake differs by parity, a key determinant of fertility preference. Adjusted hazards regression results show that the timing-based measure, specifically having a mistimed pregnancy, and the emotional response measure, specifically being unhappy, were associated with contraceptive uptake in the extended postpartum period, while those related to pregnancy planning, as measured by an adapted London Measure of Unplanned Pregnancy, were not. This effect differed by parity; high parity women were consistently the least likely to use contraception in the postpartum period, but the effect of experiencing an unwanted pregnancy or having a mixed reaction to a pregnancy was significantly stronger among high parity compared to low parity women. Greater attention to the entirety of women's responses to unanticipated pregnancies is needed to fully understand the influence of unintended pregnancy on health behaviors and outcomes for women and their children.
Collapse
|
3
|
Mengesha B, Steinauer J, Carter J, Rodriguez A, Dehlendorf C. Pregnancy Conceptualizations in Women Who Have Had Recent Bariatric Surgery. J Womens Health (Larchmt) 2023; 32:478-485. [PMID: 36787471 DOI: 10.1089/jwh.2022.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Objectives: To describe bariatric surgery patients' perioperative conceptualizations about pregnancy. Materials and Methods: We performed a secondary analysis of a cross-sectional study performed in 2016, evaluating a nationally recruited convenience sample of U.S. women aged 18-45 years who underwent bariatric surgery within the past 24 months. We assessed four pregnancy constructs: intent, desire, emotional orientation, and importance to avoid. We examined relationships between constructs, with time since surgery, postoperative pregnancy, and contraceptive use using descriptive statistics. Results: We included 363 eligible women (response rate 80%). Participant median age was 36 years, 71% (n = 258) were White, 77% (n = 279) were sexually active at the time of the study, and 39% (n = 140) experienced preoperative infertility. Most reported no desire to become pregnant (59%, n = 175) and that it was important to avoid pregnancy (78%, n = 283) within the first 24 months after surgery. Relationships between constructs were complex. Respondents in their first postoperative year more likely reported they would feel upset about a hypothetical pregnancy (40%, n = 74) than those in their second year (27%, n = 48, p = 0.02). Of those with a postoperative pregnancy, 46% (n = 17) felt it was important to avoid pregnancy compared with 81% (n = 266) of those who did not have a pregnancy (p < 0.001). Most used postoperative contraception (66%, n = 241), and those who felt it was important to avoid pregnancy more likely used contraception (82%, n = 197) than those who did not feel it was important (18%, n = 44, p = 0.01). Conclusions: Women undergoing bariatric surgery have diverse and complex conceptualizations about future pregnancy. These varied based on time from surgery and influenced postoperative contraceptive use.
Collapse
Affiliation(s)
- Biftu Mengesha
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jody Steinauer
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan Carter
- Division of General Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Amanda Rodriguez
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Christine Dehlendorf
- Division of Zuckerberg San Francisco General, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA.,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Arcara J, Caton L, Gómez AM. Desire, acceptability, and expected resolution: A latent class analysis of current pregnancy orientation in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:13-23. [PMID: 35156298 DOI: 10.1363/psrh.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Scant research has examined latent and contextual dimensions of pregnancy intentions, conventionally classifying unintended pregnancies as mistimed (wanted later) or unwanted (not wanted at all). Being at risk of mistimed pregnancy likely encompasses a broad spectrum of emotions and expectations regarding pregnancy and merits further exploration. METHOD Using a national sample from GfK's online KnowledgePanel of women aged 15-39 considered at risk of mistimed pregnancy in 2017 (n = 1278), we conducted a latent class analysis to assess underlying patterns of current pregnancy orientation using three items: pregnancy desire, pregnancy acceptability, and expected pregnancy resolution. As class structure varied by relationship status (serious or not), we stratified analyses by relationship status. RESULTS Among women in serious relationships, three classes emerged: "No," "Slightly okay," and "Acceptable." For those not in serious relationships, there were two classes: "Strong no" and "Ambiguous." Overall, the classes indicate varied patterns of wantedness, acceptability, and anticipated resolution to potential pregnancy. CONCLUSIONS This analysis reinforces that the construct of mistimed pregnancy is too restrictive to reflect the inherent diversity of prospective pregnancy orientation. The combination of relationship type as a grouping variable for stratified analyses, financial hardships' impact, and the overall effect of increasing age on increasing interest in pregnancy suggest the importance of locating pregnancy intentions within the broader reproductive life course. Scholars, clinicians, and public health programs should allow for multidimensionality of pregnancy perspectives, locate them within the broader life course, and acknowledge the potential impacts of stratified relationship formation on eventual pregnancy intentions.
Collapse
Affiliation(s)
- Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California, USA
| | - Lauren Caton
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California, USA
| | - Anu Manchikanti Gómez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California, USA
| |
Collapse
|
5
|
Shandley LM, Kipling LM, Spencer JB, Morof D, Mertens AC, Howards PP. Factors Associated with Unplanned Pregnancy Among Cancer Survivors. J Womens Health (Larchmt) 2021; 31:665-674. [PMID: 34860591 PMCID: PMC9133970 DOI: 10.1089/jwh.2021.0176] [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: 11/12/2022] Open
Abstract
Background: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. Methods: Female cancer survivors aged 22-45 years, diagnosed between ages 20-35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. Results: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85-1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age <30 years at diagnosis (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.32-2.44), black race (HR: 1.55, 95% CI: 1.13-2.12; referent: white), receiving fertility counseling (aHR: 1.41, 95% CI: 1.04-1.92), and having at least one child before diagnosis (aHR: 1.44, 95% CI: 1.05-1.97). Conclusion: Cancer survivors and comparison women had similar likelihood of unplanned pregnancy. Rates of unplanned pregnancy after cancer were not higher for cancer survivors compared with comparison women, but 46.4% of survivors with a postcancer pregnancy reported an unplanned pregnancy. Cancer patients may benefit from patient-centered guidelines and counseling before cancer treatment that covers both risks of infertility and risks of unplanned pregnancy.
Collapse
Affiliation(s)
- Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Diane Morof
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Ann C Mertens
- Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Callegari LS, Nelson KM, Arterburn DE, Dehlendorf C, Magnusson SL, Benson SK, Schwarz EB, Borrero S. Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care. J Gen Intern Med 2021; 36:2989-2999. [PMID: 33538956 PMCID: PMC8481447 DOI: 10.1007/s11606-020-06506-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-centered counseling to help women achieve their reproductive goals is an essential yet often absent component of primary care. OBJECTIVE We developed and piloted MyPath, a novel web-based decision support tool integrating reproductive goals assessment, information about optimizing health before pregnancy, and contraceptive decision support, for use prior to primary care visits in the Veterans Administration (VA). DESIGN We created MyPath using best practices for decision tool development, including a conceptual framework informed by theory and user-centered design with input from patients, providers, and scientific experts. We conducted a non-randomized pilot in two VA Women's Health primary care clinics. A control group (n = 28) was recruited prior to and intervention group (n = 30) recruited after introduction of MyPath into clinics. PARTICIPANTS Women Veterans ages 18-44 with an upcoming visit scheduled with one of eight providers. INTERVENTIONS After recruitment of controls, providers and staff received a brief introduction to MyPath. Patients scheduled to see providers in the intervention phase used MyPath on an iPad in the waiting room prior to their visit. MAIN MEASURES Acceptability, feasibility, discussions about pregnancy and/or contraceptive needs, and contraceptive decision quality by a survey of participants and providers. KEY RESULTS Nearly all participants who used MyPath reported they learned new information (97%) and would recommend it to other Veterans (93%). No providers reported that MyPath significantly increased workload. A greater proportion of intervention participants reported having discussions about reproductive needs in their visit compared to controls (93% vs 68%; p = 0.02). Intervention participants also experienced greater increases in pre-/post-visit knowledge and communication self-efficacy and a trend towards greater reduction in contraceptive decision conflict compared to controls. CONCLUSIONS MyPath was highly acceptable to women, increased the proportion of primary care visits addressing reproductive needs, and improved decision quality without increasing providers' perceived workload. A larger randomized evaluation of effectiveness is warranted.
Collapse
Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
| | - Karin M Nelson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Christine Dehlendorf
- Department of Family Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara L Magnusson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Samantha K Benson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - E Bimla Schwarz
- Department of Medicine, University of California, Davis, Davis, CA, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Myers K, Dalessandro C, Geist C, Sufrin C. Jail as a Point of Contraceptive Care Access: Needs and Preferences Among Women in an Urban Jail. J Midwifery Womens Health 2021; 66:787-794. [PMID: 34463421 DOI: 10.1111/jmwh.13270] [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: 10/27/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Individuals who are incarcerated in the United States often struggle to access family planning care because of the common practice of jails not providing contraceptives on site. However, less is known about the contraceptive needs and preferences, including the desirability of intrauterine devices and implants, among those who are incarcerated. METHODS Cross-sectional, in-person surveys were administered to 148 reproductive-age women (aged 18-48) incarcerated at an urban jail in Utah to identify women's contraceptive needs and preferences while incarcerated. We used summary statistics and logistic regression to investigate relationships between demographic characteristics, the desire to access contraceptive services while incarcerated, and interest in specific contraceptive methods. RESULTS Surveys indicate a high interest in accessing contraceptives while in jail (73%). Participants who were more likely to prefer access to contraceptive services in jail were also more likely to be interested in the injectable (odds ratio [OR], 4.75; 95% CI, 1.03-21.94), the implant (OR, 8.44; 95% CI, 1.70-41.99), and intrauterine devices (OR, 10.04; 95% CI, 3.46-29.20) than participants indicating no desire to access contraceptive services while in jail. DISCUSSION Jails could be an access point for contraceptive methods requiring health care provider intervention in the state of Utah. However, care must be taken due to broader historical legacies of reproductive coercion in carceral settings.
Collapse
Affiliation(s)
- Kyl Myers
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Cristen Dalessandro
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
8
|
Manze MG, Romero DR. Revisiting the Association between Race, Ethnicity, and Beliefs about Pregnancy. Ethn Dis 2020; 30:525-532. [PMID: 32989352 DOI: 10.18865/ed.30.4.525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Black and Latinx individuals are often the focus of health educational efforts to 'correct' perceived flawed beliefs about pregnancy, in order to increase contraceptive use and reduce unintended pregnancies. We sought to revisit the association between race, ethnicity, and beliefs about pregnancy. Methods We administered a web-based survey to 2,099 heterosexual men and women aged 21-44 years, using non-probability quota sampling. We analyzed a subset who were not currently pregnant (n=1,884) and conducted chi-square tests to examine the association between race/ethnicity and beliefs about avoiding pregnancy (can be avoided, determined by fate/God, 'just happens,' and is a natural process). We then performed a two-stage multinomial logistic regression, modeling the belief that pregnancy can be avoided. The first model included sociodemographic characteristics and the second model added feelings about pregnancy. Results Bivariate analyses revealed that, compared with Whites, those who identified as Black/African American or Latinx were significantly more likely to believe that pregnancy was determined by fate/God (15%,13% vs 9%, respectively) or a natural process (13%,13% vs 9%, respectively) and less likely to report that it can be avoided (57%,56% vs 67%, respectively; P=.001). In the first regression model, these differences persisted. However, in the second model, being Black/African American or Latinx was not significantly associated with beliefs about avoiding pregnancy. Conclusions Our findings suggest that once more nuanced beliefs about pregnancy prevention are considered, Black and Latinx individuals do not hold strongly different beliefs than Whites. Efforts that exclusively focus on people of color to change beliefs about pregnancy appear unwarranted.
Collapse
Affiliation(s)
- Meredith G Manze
- City University of New York Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
| | - Diana R Romero
- City University of New York Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, New York, NY
| |
Collapse
|
9
|
Melo CRME, Borges ALV, Duarte LS, Nascimento NDC. Contraceptive use and the intention to become pregnant among women attending the Brazilian Unified Health System. Rev Lat Am Enfermagem 2020; 28:e3328. [PMID: 32813784 PMCID: PMC7426141 DOI: 10.1590/1518-8345.3451.3328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/08/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the use of contraceptive methods and the intention to become pregnant among women attending the Brazilian Unified Health System. Method: a cross-sectional study conducted with 688 women aged 18-49 years old, attending the Family Health Strategy Facilities in the eastern part of the city of São Paulo, Brazil, who were awaiting medical or nursing consultation. Data were obtained through interviews with a structured instrument, allocated in tablets. The analysis was conducted with “strong desire to avoid pregnancy” as the dependent variable. Chi-square and multiple logistic regression were used, calculated in Stata 14.2. Results: 56.5% used some contraceptive method, covariates of the strong desire to avoid pregnancy were marital status (OR=0.49; CI95%=0.33-0.74), parity – two and more children (OR=15.9; IC95%=4.29-59.1); and pregnancy planning – planned (OR=0.69; IC95%=0.73-0.94) and ambivalent (OR=2.94; IC95%=1.30-3.83). There was no statistical difference between the strong desire to avoid pregnancy and the type of contraceptive used. Conclusion: women with a strong desire to avoid pregnancy used basically the same types of contraceptive methods as women in general, which shows that they have not been supported to achieve their reproductive preferences.
Collapse
|
10
|
Parker A, Johnson-Motoyama M, Mariscal ES, Guilamo-Ramos V, Reynoso E, Fernandez C. Novel Service Delivery Approach to Address Reproductive Health Disparities within Immigrant Latino Communities in Geographic Hot Spots: An Implementation Study. HEALTH & SOCIAL WORK 2020; 45:155-163. [PMID: 32632448 DOI: 10.1093/hsw/hlaa014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/16/2019] [Accepted: 04/02/2019] [Indexed: 06/11/2023]
Abstract
Latinx youths continue to have the highest rates of teenage births in the United States and are at increased risk of acquiring sexually transmitted infections, including HIV/AIDS. A community-based research partnership piloted Families Talking Together, a brief, parent-based sexual risk reduction program using a novel and culturally relevant approach. This mixed-methods study examined the feasibility and acceptability of Spanish-speaking promotoras de salud (that is, community health workers) as implementers of an evidence-based intervention (EBI) to reach underserved immigrant communities. Findings suggest that promotoras are capable of implementing the EBI with positive organizational, client, and implementation outcomes. Furthermore, promotoras hold particular promise for addressing reproductive health disparities as they are indigenous and trusted members of the community who can reach members of marginalized Latino populations.
Collapse
Affiliation(s)
- Amittia Parker
- School of Social Welfare, University of Kansas, 1545 Lilac Lane, Lawrence, KS 66045
| | | | | | | | | | | |
Collapse
|
11
|
Judge-Golden CP, Wolgemuth TE, Zhao X, Mor MK, Borrero S. Agreement between Self-Reported "Ideal" and Currently Used Contraceptive Methods among Women Veterans Using the Veterans Affairs Healthcare System. Womens Health Issues 2020; 30:283-291. [PMID: 32321666 DOI: 10.1016/j.whi.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women veterans who use the Veterans Affairs Healthcare System theoretically have access to the full range of contraceptive methods. This study explores match between currently used and self-reported "ideal" methods as a potential marker of contraceptive access and preference matching. METHODS This mixed methods study uses data from a nationally representative survey of reproductive-aged women veterans who use the Veterans Affairs Healthcare System for primary care, including 979 participants at risk of unintended pregnancy. Women reported all contraceptive methods used in the past month and were asked, "If you could choose any method of contraception or birth control to prevent pregnancy, what would be your ideal choice?" and selected a single "ideal" method. If applicable, participants were additionally asked, "Why aren't you currently using this method of contraception?" We used adjusted logistic regression to identify patient-, provider-, and system-level factors associated with ideal-current method match. We qualitatively analyzed open-ended responses about reasons for ideal method nonuse. RESULTS Overall, 58% were currently using their ideal method; match was greatest among women selecting an IUD as ideal (73%). Non-White race/ethnicity (adjusted odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and mental illness (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.92) were negatively associated with ideal-current match in adjusted analyses; the presence of a gynecologist at the primary care site was associated with an increased odds of match (adjusted odds ratio, 1.35; 95% confidence interval, 1.03-1.75). Modifiable barriers to ideal method use were cited by 23% of women, including access issues, cost concerns, and provider-level barriers; 79% of responses included nonmodifiable reasons for mismatch including relationship factors and pregnancy plans incongruent with ideal method use, suggesting limitations of our measure based on differential interpretation of the word "ideal." CONCLUSIONS Many women veterans are not currently using the contraceptive method they consider ideal. Results emphasize the complexity of contraceptive method selection and of measuring contraceptive preference matching.
Collapse
Affiliation(s)
| | | | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
12
|
Abstract
INTRODUCTION Standard survey measures of fertility preferences, such as the desire for and preferred timing of future births, do not capture the complexity of individuals' preferences. New research focuses on additional dimensions of emotions and expectations surrounding childbearing. Few quantitative studies, however, consider the influence of all three dimensions of fertility preferences concurrently. METHODS Using longitudinal survey data from the Tsogolo la Thanzi project (2009-2012) in Malawi, this study employed logistic regression analysis to investigate the influence of young women's emotions, expectations, and a standard measure of fertility preferences on pregnancy and modern contraceptive use. RESULTS Young women experienced high unmet need; across survey waves, over three-quarters of women who desired a child in more than 2 years were not currently using modern contraceptives and over three-quarters of women who thought a pregnancy in the next month would be bad news (garnered from a measure of emotions surrounding pregnancy) were not currently using modern contraceptives. In regression models including all three measures of fertility preferences, each was significantly associated with the likelihood of a future pregnancy. The standard measure and emotions measure were significantly associated with modern contraceptive use. DISCUSSION Emotions and expectations surrounding pregnancy and childbirth appear to be distinct and salient aspects of fertility preferences in addition to the standard measure. A better understanding of the multidimensional nature of fertility preferences will help individuals define and achieve their reproductive goals and obtain appropriate services. Furthermore, future research should incorporate new measures of fertility preferences into surveys internationally.
Collapse
|
13
|
Carpenter E, Everett BG, Greene MZ, Haider S, Hendrick CE, Higgins JA. Pregnancy (im)possibilities: identifying factors that influence sexual minority women's pregnancy desires. SOCIAL WORK IN HEALTH CARE 2020; 59:180-198. [PMID: 32208846 PMCID: PMC7784242 DOI: 10.1080/00981389.2020.1737304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Sexual minority women (SMW) face both increased risk for unintended pregnancy and barriers to achieving wanted pregnancy, but little research investigates SMW's pregnancy desires. To fill this gap, we conducted five focus groups and 11 in-depth interviews with 20-30-year-old SMW in three US cities. Findings highlight that the heteronormative pregnancy planning paradigm lacks salience for SMW. While some SMW clearly wish to avoid pregnancy, many others are unsure, and factors influencing this uncertainty include relationship context, anticipating logistical barriers, and discord between queer identity and pregnancy.
Collapse
Affiliation(s)
- Emma Carpenter
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - C. Emily Hendrick
- School of Community Health Sciences, University of Nevad-Reno, Reno, NV, USA
| | - Jenny A. Higgins
- Departments of Gender and Women’s Studies and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Callegari LS, Aiken ARA, Dehlendorf C, Borrero S. Reproductive Life Planning and Patient-Centered Care: Can the Inconsistencies be Reconciled? Matern Child Health J 2019; 23:869-870. [PMID: 31152282 DOI: 10.1007/s10995-019-02734-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa S Callegari
- Departments of Obstetrics & Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.
- VA Health Services Research & Development, Puget Sound Health Care System, Department of Veterans Affairs, 1660 South Columbian Way S-152, Seattle, WA, 98108, USA.
| | - Abigail R A Aiken
- LBJ School of Public Affairs and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Christine Dehlendorf
- Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sonya Borrero
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- VA Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| |
Collapse
|
16
|
Gómez AM, Arteaga S, Villaseñor E, Arcara J, Freihart B. The Misclassification of Ambivalence in Pregnancy Intentions: A Mixed-Methods Analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:7-15. [PMID: 30762937 PMCID: PMC6476569 DOI: 10.1363/psrh.12088] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 05/23/2023]
Abstract
CONTEXT Researchers have developed various measures of pregnancy ambivalence in an effort to capture the nuance overlooked by conventional, binary measures of pregnancy intention. However, the conceptualization and operationalization of the concept of ambivalence vary widely and may miss the complexity inherent in pregnancy intentions, particularly for young people, among whom unintended pregnancy rates are highest. METHODS To investigate the utility and accuracy of current measures of pregnancy ambivalence, a mixed-methods study was conducted with 50 young women and their male partners in northern California in 2015-2016. Survey data were used to descriptively analyze six existing pregnancy ambivalence measures; in-depth interviews addressing pregnancy desires and plans were deductively coded and thematically analyzed to understand why some participants appeared to be ambivalent from the survey data when their interview responses suggested otherwise. RESULTS Eighty participants would be considered ambivalent by at least one measure. After assessment of the interview data, however, these measures were deemed to have misclassified almost all (78) participants. Qualitative analysis revealed several themes regarding misclassification: conflation of current pregnancy desires with expected postconception emotional responses; acceptability of an undesired pregnancy; tempering of survey responses to account for partners' desires; perceived lack of control regarding pregnancy; and, among participants with medical conditions perceived to impact fertility, subjugation of pregnancy desires in the interest of self-protection. CONCLUSIONS Current approaches to measuring pregnancy ambivalence may fail to capture the intricacies of pregnancy intentions and may be ineffective if they do not account for young people's experiences, especially when used to inform clinical practice, programs and policy.
Collapse
Affiliation(s)
- Anu Manchikanti Gómez
- Assistant Professor and Director, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Stephanie Arteaga
- Research Associate, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Elodia Villaseñor
- Project Director, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Jennet Arcara
- Research Associate, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| | - Bridget Freihart
- Graduate Student Researcher, Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley
| |
Collapse
|
17
|
Combs KM, Brown SM, Begun S, Taussig H. Pregnancy Attitudes and Contraceptive Use among Young Adults with Histories of Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2018; 94:284-289. [PMID: 31105369 PMCID: PMC6519940 DOI: 10.1016/j.childyouth.2018.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study examined pregnancy attitudes and contraceptive use among young adults with histories of foster care. METHODS 209 female and male young adults, aged 18-22, with histories of foster care were interviewed about their intentions and feelings towards pregnancy. Respondents were then categorized as having pro-pregnancy (i.e., having positive pregnancy intentions and happy feelings about pregnancy), ambivalent (either intentions or happy feelings), or anti-pregnancy (no intentions and unhappy feelings) attitudes. Participants also reported their past-year contraceptive use, and the relationship between pregnancy attitudes and contraceptive use was subsequently explored for the overall sample, and by sex and history of pregnancy using Chi-square tests. RESULTS Only 13.4% of participants had positive pregnancy intentions, though 41.9% reported that they would feel happy with a pregnancy. Over half (55.9%) of participants were anti-pregnancy, a third (32.8%) were ambivalent and 11.3% were pro-pregnancy. Compared to females, males were more likely to have positive pregnancy intentions (18.6% vs. 7.8%, p = .03) and to be pro-pregnancy (16.5% vs. 5.6%, p = .04). No differences in pregnancy attitudes were found as a function of pregnancy history. Consistent contraceptive use was significantly associated with pregnancy attitudes; 22.2% of pro-pregnancy participants reported consistent contraceptive use versus 52.9% of ambivalent and 62.2% of anti-pregnancy participants. DISCUSSION In this exploratory study, few participants held pro-pregnancy attitudes and a high percentage of participants who were anti-pregnancy did not use contraception consistently. Although studies with larger samples examining this topic are needed, professionals should distinguish between young adults' intentions and feelings about pregnancy in an effort to better address contraceptive needs.
Collapse
Affiliation(s)
- Katie Massey Combs
- Graduate School of Social Work, University of Denver; 2148
S. High Street, Denver, CO 80208
| | - Samantha M. Brown
- School of Social Work, Colorado State University; 1586
Campus Delivery, Fort Collins, CO 80523
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of
Toronto, 246 Bloor Street West, Office 434, Toronto, ON M5S 1V4
| | - Heather Taussig
- Graduate School of Social Work, University of Denver; 2148
S. High Street, Denver, CO 80208
- Kempe Center, University of Colorado School of Medicine.
13123 E 16th Ave., Aurora, CO 80045
| |
Collapse
|
18
|
Wolgemuth T, Judge-Golden C, Callegari L, Zhao X, Mor M, Borrero S. Associations between Pregnancy Intention, Attitudes, and Contraceptive Use among Women Veterans in the ECUUN Study. Womens Health Issues 2018; 28:480-487. [PMID: 30241794 PMCID: PMC6215491 DOI: 10.1016/j.whi.2018.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although pregnancy intention is strongly associated with contraceptive use, little is known about the interaction between pregnancy intention and attitude, or how they jointly affect contraceptive use. METHODS Cross-sectional data from a national survey of women veterans who receive care within the Veterans Affairs Healthcare System were used to examine relationships among pregnancy intention (in next year, in >1 year, never, not sure), attitude toward hypothetical pregnancy (worst thing, neutral, best thing), and contraceptive use among women at risk for unintended pregnancy. Bivariate and multivariable analyses assessed associations between pregnancy intention and attitude, both separately and jointly, with contraceptive use. Multinomial regression assessed the relationship of intention and attitude with contraceptive method effectiveness. RESULTS Among 858 women at risk of unintended pregnancy, bivariate analysis demonstrated that pregnancy intention and attitude were associated, but not perfectly aligned. In logistic regression models including both variables, intention of never versus in next year (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.34-5.75) and attitude of worst thing versus best thing (aOR, 2.86; 95% CI, 1.42-5.74) were each positively associated with contraception use. Among women using contraception, intention of never (aOR, 3.17; 95% CI, 1.33-7.59) and attitude of worst thing (OR, 2.09; 95% CI, 1.05-4.17) were associated with use of highly effective (e.g., intrauterine devices and implants) versus least effective (e.g., barrier) methods. CONCLUSIONS These findings support prior research suggesting that pregnancy intention alone does not fully explain contraceptive behaviors and imply that attitude toward pregnancy plays an important role in shaping contraceptive use independent of pregnancy intentions.
Collapse
Affiliation(s)
- Tierney Wolgemuth
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Colleen Judge-Golden
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington, Seattle, Washington; Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Maria Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| |
Collapse
|
19
|
Estrada F, Suárez-López L, Hubert C, Allen-Leigh B, Campero L, Cruz-Jimenez L. Factors associated with pregnancy desire among adolescent women in five Latin American countries: a multilevel analysis. BJOG 2018; 125:1330-1336. [DOI: 10.1111/1471-0528.15313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F Estrada
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - L Suárez-López
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - C Hubert
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - B Allen-Leigh
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Campero
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Cruz-Jimenez
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| |
Collapse
|
20
|
Parent, Teacher, and School Stakeholder Perspectives on Adolescent Pregnancy Prevention Programming for Latino Youth. J Prim Prev 2018; 37:513-525. [PMID: 27628931 DOI: 10.1007/s10935-016-0447-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Teen pregnancy remains a public health concern particularly among Latinos, whose pregnancy rate of 83.5 per 1000 girls constitutes one of the highest rates of teen pregnancy among all ethnic and racial groups in the United States. To enhance the effectiveness of interventions for diverse Latino populations in the US, it is crucial to assess the community's understanding of the etiology of the problem of adolescent pregnancy and to implement programs that reflect the local community's beliefs and preferences. We present findings from six focus groups held with parents (n = 18), teachers (n = 23) and school stakeholders (n = 8) regarding teen pregnancy prevention among Latino youth at a high school located in a large, Midwestern city. Two investigators analyzed data iteratively using a template organizing approach. A consensus emerged across the groups regarding content that emphasized respect for oneself and one's family, a focus on personal and shared responsibility in reproductive health behavior, information about the "realities" or consequences associated with engaging in sexual activity, and information about contraceptives. The strong request from participants to include a parental education component reflects the community's belief that parents play a crucial, protective role in the socialization and development of adolescent sexual behavior, a view that is supported by empirical research. Findings highlight the importance of involving local school communities in identifying adolescent pregnancy prevention strategies that are responsive to the community's cultural values, beliefs, and preferences, as well as the school's capacity and teacher preferences.
Collapse
|
21
|
|
22
|
Race and ethnicity may not be associated with risk of unintended pregnancy. Contraception 2017; 97:313-318. [PMID: 29288654 DOI: 10.1016/j.contraception.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to use improved measures and methodology to investigate whether race and ethnicity are associated with unintended pregnancy. STUDY DESIGN Cross-sectional study of English- or Spanish-speaking women, aged 16-44, with pregnancies <24weeks' gestation recruited from pregnancy testing and abortion care sites in New Haven, CT, between June 2014 and June 2015. Participants completed self-assessments of race, ethnicity and multidimensional measures of pregnancy "context," including timing, intention, wantedness, desirability, happiness and planning (measured with the London Measure of Unplanned Pregnancy). Multivariable analysis was performed, adjusting for maternal demographics, language, recruitment site, substance use and medical conditions including history of depression. RESULTS Among 161 participants (mean age=27.2±6.6years), mean gestational age was 9±4.6weeks. Overall, 14% self-identified as White non-Hispanic, 37% Black non-Hispanic, 42% Hispanic and 7% multiracial. Most (85%) were unmarried, and 75% had at least one child. After adjustment, happiness about new pregnancies was more likely among Black non-Hispanic than White non-Hispanic women OR=5.66 (95%CI: 1.51-21.20). Neither race nor ethnicity was significantly associated with pregnancy intention, wantedness, planning, timing or desirability. CONCLUSION In a diverse cohort with multiple, antenatal measures of pregnancy context, neither race nor ethnicity is significantly associated with unintended pregnancy, as previous studies reported. Black non-Hispanic women were more likely to report happiness about new pregnancies than White non-Hispanic women. This study improves upon previous analyses that used retrospective and limited assessments of pregnancy intention, excluded women with miscarriages or abortions, and lacked adjustment for confounding. IMPLICATIONS Evaluation of multidimensional pregnancy contexts assessed antenatally is important and may capture the experiences of women more accurately, especially Black and Hispanic women.
Collapse
|
23
|
Higgins JA. Pregnancy Ambivalence and Long-Acting Reversible Contraceptive (LARC) Use Among Young Adult Women: A Qualitative Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:149-156. [PMID: 28419700 PMCID: PMC5597464 DOI: 10.1363/psrh.12025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 05/16/2023]
Abstract
CONTEXT Many young adults are unclear about how much they want to have, or prevent having, a baby. However, pregnancy ambivalence is an underexamined factor in the uptake of long-acting reversible contraceptive (LARC) methods-IUDs and implants-the most effective methods available. METHODS In 2014, investigators conducted six focus groups and 12 interviews with 50 women aged 18-29 in Dane County, Wisconsin; participants were either university students or community residents receiving public assistance. A modified grounded theory approach was used to analyze the data. RESULTS Four themes emerged. First, participants described a pregnancy desire spectrum: Those strongly motivated to avoid pregnancy were most receptive to LARC methods, while those with less clear or mixed desires worried that these methods would prevent "accidental" pregnancies that might not be unwelcome. Second, women within a few years of wanting children perceived LARC methods as too "permanent," despite awareness of their reversibility. Third, age and life stage were important factors: Younger women and those attending school or beginning careers were more likely than others to consider these methods because they had clearer motivations to avoid pregnancy. Finally, relationship stage influenced receptiveness to LARC methods: Women in newer relationships were more receptive than were those in longer term relationships who imagined having a baby with their partner someday. CONCLUSION Effectiveness is not the only factor in women's selection and use of contraceptive methods. Individual preferences will lead some women to choose non-LARC methods even when fully informed of their options.
Collapse
Affiliation(s)
- Jenny A Higgins
- associate professor of gender and women's studies, University of Wisconsin-Madison
| |
Collapse
|
24
|
Callegari LS, Zhao X, Schwarz EB, Rosenfeld E, Mor MK, Borrero S. Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans. Am J Obstet Gynecol 2017; 216:504.e1-504.e10. [PMID: 28063910 DOI: 10.1016/j.ajog.2016.12.178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/01/2016] [Accepted: 12/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Significant racial/ethnic disparities in unintended pregnancy persist in the United States, with the highest rates observed among low-income black and Hispanic women. Differences in contraceptive preferences, beliefs, and self-efficacy may be instrumental in understanding contraceptive behaviors that underlie higher rates of unintended pregnancy among racial/ethnic minorities. OBJECTIVES Our objective was to understand how contraceptive preferences, beliefs, and self-efficacy vary by race and ethnicity among women veterans. STUDY DESIGN We analyzed data from the Examining Contraceptive Use and Unmet Need Study, a national telephone survey of women veterans aged 18-44 years who had received primary care at the Veterans Administration in the prior 12 months. Participants rated the importance of various contraceptive characteristics and described their level of agreement with contraceptive beliefs using Likert scales. Contraceptive self-efficacy was assessed by asking participants to rate their certainty that they could use contraception consistently and as indicated over time using a Likert scale. Multivariable logistic regression was used to examine associations between race/ethnicity and contraceptive attitudes, controlling for age, marital status, education, income, religion, parity, deployment history, and history of medical and mental health conditions. RESULTS Among the 2302 women veterans who completed a survey, 52% were non-Hispanic white, 29% were non-Hispanic black, and 12% were Hispanic. In adjusted analyses, compared with whites, blacks had lower odds of considering contraceptive effectiveness extremely important (adjusted odds ratio; 0.55, 95% confidence interval, 0.40-0.74) and higher odds of considering the categories of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.94, 95% confidence interval, 1.56-2.41, and adjusted odds ratio; 1.99, 95% confidence interval, 1.57-2.51, respectively). Hispanics also had higher odds than whites of considering the category of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.72, 95% confidence interval, 1.29-2.28, and adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19, respectively). Compared with whites, blacks and Hispanics had higher odds of expressing fatalistic beliefs about pregnancy (adjusted odds ratio, 1.79, 95% confidence interval, 1.35-2.39, and adjusted odds ratio, 1.48, 95% confidence interval, 1.01-2.17, respectively); higher odds of viewing contraception as primarily a woman's responsibility (adjusted odds ratio, 1.92, 95% confidence interval, 1.45-2.55, and adjusted odds ratio, 1.77; 95% confidence interval, 1.23-2.54, respectively); and lower odds of being very sure that they could use a contraceptive method as indicated over the course of a year (adjusted odds ratio, 0.73, 95% confidence interval, 0.54-0.98, and adjusted odds ratio, 0.66, 95% confidence interval, 0.46-0.96, respectively). CONCLUSION Women veterans' contraceptive preferences, beliefs, and self-efficacy varied by race/ethnicity, which may help explain observed racial/ethnic disparities in contraceptive use and unintended pregnancy. These differences underscore the need to elicit women's individual values and preferences when providing patient-centered contraceptive counseling.
Collapse
|
25
|
Kirkman M, Stubber C, Rowe H, Holton S, Bayly C, Jordan L, McBain J, McNamee K, Sinnott V, Fisher J. Subjective meanings of 'unintended' pregnancy: interviews from understanding fertility management in contemporary Australia. CULTURE, HEALTH & SEXUALITY 2017; 19:179-193. [PMID: 27684303 DOI: 10.1080/13691058.2016.1214287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Unintended pregnancy can be difficult to identify and conceptualise. We aimed to understand how unintended pregnancies are constructed, explained and situated in a reproductive life. A total of 41 women and 7 men aged 20-50 years were interviewed in depth. Transcripts were analysed using iterative hermeneutic techniques informed by narrative theory. Of 34 participants who had been pregnant or had a partner in pregnancy, 12 women and 1 man described 23 'unintended' pregnancies, about half of which ended in abortion. Their accounts reveal that an unintended pregnancy is identified subjectively, that the same pregnancy may be identified by one partner in the pregnancy as unintended and by the other as intended, and that a researcher's supposedly objective assessment of an unintended pregnancy may be inconsistent with the assessment of the woman who experienced it. A pejorative discourse was evident, predominantly among participants who did not report having an unintended pregnancy: women use an 'unintended' pregnancy to entrap men. Accounts from five participants reporting an unintended pregnancy were selected for illustration. An appreciation of the role such a pregnancy might play in an individual life requires a nuanced understanding of the complexity of human experience and a resistance to simple binary categorisation.
Collapse
Affiliation(s)
- Maggie Kirkman
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Claire Stubber
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Heather Rowe
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Sara Holton
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - Chris Bayly
- b Royal Women's Hospital , Melbourne , Australia
| | - Lynne Jordan
- c Family Planning Victoria , Melbourne , Australia
| | | | | | - Vikki Sinnott
- e Victorian Government Department of Health , Melbourne , Australia
| | - Jane Fisher
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| |
Collapse
|
26
|
Jones RK. Change and consistency in US women's pregnancy attitudes and associations with contraceptive use. Contraception 2017; 95:485-490. [PMID: 28137557 DOI: 10.1016/j.contraception.2017.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/23/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study examines the cognitive and affective dimensions of pregnancy attitudes in order to better recognize the role of each in pregnancy ambivalence as well as the relative importance of each in understanding contraceptive use. STUDY DESIGN Data from a national sample of 2894 women aged 18-39, gathered at baseline and 6 months later, were used to examine a measure of pregnancy avoidance (cognitive) and a measure of happiness about pregnancy (affective), both separately and jointly. I used bivariate and multivariate analysis to examine associations between attitudinal measures and consistent contraceptive use. I also examined changes in attitudes over time and associations between changes in attitudes and changes in consistent contraceptive use. RESULTS While a majority of women, 53%, indicated that it was very important to avoid pregnancy, a substantially lower proportion, 23%, would have been very unhappy to be pregnant. In logistic regression models that included both measures, only pregnancy avoidance was associated with consistent contraceptive use. Cognitive attitude was less likely than affective attitude to change over time; additionally, change in pregnancy avoidance, but not happiness, was associated with change in consistent contraceptive use. CONCLUSION(S) Pregnancy avoidance appears to play a more important role in understanding consistent contraceptive use. Findings from this study provide support for the idea that positive feelings about a pregnancy do not contradict a desire to avoid conception and that feelings and intentions may be distinct concepts for many women. IMPLICATIONS Health care providers should assess patients' pregnancy avoidance attitude but also recognize that this can change over a short period of time for some women and should be evaluated regularly.
Collapse
Affiliation(s)
- Rachel K Jones
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038, USA.
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Aiken ARA, Borrero S, Callegari LS, Dehlendorf C. Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts? PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:147-51. [PMID: 27513444 PMCID: PMC5028285 DOI: 10.1363/48e10316] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 05/26/2023]
Affiliation(s)
- Abigail R A Aiken
- assistant professor, LBJ School of Public Affairs; and faculty associate, Population Research Center, University of Texas at Austin.
| | - Sonya Borrero
- associate professor, Center for Research on Health Care, Department of Medicine, University of Pittsburgh; and codirector, VA Advanced Fellowship Program in Women's Health, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Lisa S Callegari
- assistant professor, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle; and advanced research fellow, Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle
| | - Christine Dehlendorf
- associate professor, Departments of Family and Community Medicine; Obstetrics, Gynecology and Reproductive Sciences; and Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|