Search results

Most researchers examining educational disparities in unintended pregnancy take a rational-choice perspective, defining pregnancy intention as a fixed state within decontextualized individuals. However, evidence suggests that women’s reproductive intentions may be more relational than rational, and that relationship context varies by education. This study investigated if relationship context could explain educational disparities in unintended pregnancy.

Using the 2006–2015 National Survey of Family Growth (n = 4,320 pregnancies), I calculated structural equation models and predicted probabilities to examine if relational stability (marital status) and partner specificity (wanting a baby with a particular man) mediated the association between education and pregnancy intendedness for White, Hispanic, and Black women.

Relational stability and partner specificity mediated the association between education and pregnancy intention for all three groups. Education was rendered insignificant after controlling for race, marital status, partner specificity, and age. Marital status was a better predictor for White women than Hispanic women, and was not statistically significant for Black women. Partner specificity had greater influence on pregnancy intendedness than marital status, and its effect varied only slightly by race. Thus, disparities in marriage and access to desired partners influence educational disparities in unintended pregnancy.

These findings suggest that partner specificity could prove particularly useful in predicting unintended pregnancy as rates of non-marital pregnancies continue to rise. They also indicate that a shift in research and policy focus from decontextualized individuals to relationships between women and men is warranted.

The purpose of this paper is to assess the effect of delaying first pregnancy in reducing burden of unintended pregnancy (UP) among married adolescent girls in urban slums of Bangladesh.

This cross-sectional survey was conducted among 783 married adolescents in five urban slums of Bangladesh during January 2013–January 2014.

Half of the respondents’ first pregnancy was reported as unintended. Of the respondents, 58 percent with no school education had experienced UP which was 38 percent among respondents with eight year’s education. Respondents who did not willingly agreed to their marriage experienced more UP (61 percent) than those who were agreed/got married by their own choice (51 percent). Respondents having five years of age difference with their husbands experienced more UP (58 percent) than those with ten years of age difference (46 percent). Respondents aged 14 years at first conception experienced 63 percent UP, while the respondents aged 18 years had 35 percent UP experience. Of the respondents, 66 percent who became pregnant within one year of marriage reported their pregnancy as unintended which was 29 percent among those who delayed their first pregnancy for three years.

Significant association was observed between pregnancy intention with respondents’ educational status (p=0.03), age difference with husbands (p=0.02), age at first conception (p<0.01) and delaying first pregnancy (p<0.001).

Past research suggests that whether pregnancies are wanted, unwanted, or mistimed may influence breastfeeding behavior. The purpose of this chapter is to develop a more precise understanding of this relationship. Specifically, this chapter asks three questions: first, do pregnancy intentions matter most in sustaining breastfeeding for long or for short durations postpartum; second, at what time postpartum are rates of breastfeeding discontinuation most differentiated by pregnancy intentions; and third, how does poverty (measured here by Medicaid receipt) moderate the relationship between pregnancy intentions and breastfeeding duration.

Logistic regression analysis of survey data from a national sample representative of US mothers is used to determine the relationship of pregnancy intentions to whether breastfeeding continues for various durations and through various intervals after birth. Interaction terms between pregnancy intentions and mother’s Medicaid status are used to test for relationships specific to poor or nonpoor mothers between pregnancy intentions and breastfeeding duration.

Results show that pregnancy timing matters most for sustaining breastfeeding for durations past 6 months and that differences in rates of breastfeeding discontinuation between mothers with wanted, unwanted, and mistimed pregnancies are most pronounced in the 3–7 months postpartum period. In addition, findings show that Medicaid recipients (but not nonrecipients) are less likely to exclusively breastfeed for 6 months when their pregnancies are mistimed.

The literature on fundamental causes of health disparities typically suggests that poverty impairs access to resources necessary for effective planning to achieve desirable health outcomes. This study’s results, however, show that planning of pregnancies is more critical for poor mothers to sustain exclusive breastfeeding. Further research is needed to explain this relationship. The results also suggest that policy interventions to help mothers with unplanned pregnancies to sustain breastfeeding should target the period from 3 to 7 months postpartum.

These findings can help shape policies for facilitating the continuation of breastfeeding for durations recommended by health authorities and advance our understanding of the effects of poverty on health behaviors.

University students who have low knowledge, attitudes and intentions regarding the prevention of unintended pregnancies may experience higher rates of unintended pregnancies. An educational program was developed based on the self-efficacy theory and peer-led education to improve unintended pregnancy problems among university students. The purpose of this paper is to examine the effect of an educational program on knowledge, attitudes and intentions regarding the use of condoms and emergency contraceptive pills among Thai university students.

The effectiveness of the educational program was tested by a quasi-experimental study with a pre- and post-test design. The study was conducted between September and October 2017. Multistage sampling was used to recruit 73 Thai female university students, including 36 students in the intervention group and 37 students in the comparison group. The intervention group received an eight-week educational program, while the comparison group did not. A self-administered questionnaire was used to assess the improvement of knowledge, attitudes and intention regarding condom and emergency contraceptive pill use. Descriptive statistics, paired samples t-test, Wilcoxon test and Mann–Whitney tests were used for data analysis.

Most participants in both groups had sexual intercourse. After the end of the program, the before-after mean score of the intervention group’s knowledge (8.0, 11.0), attitudes (29.4, 32.4) and intention (17.4, 20.4) were significantly increased (p-value<0.001). Post-intervention, there were statistically significant differences in knowledge scores (p-value<0.001) and intention scores (p-value=0.04) between the intervention group and the comparison group.

This educational program increases knowledge and intention but does not influence attitudes toward using condoms and emergency contraceptive pills.

Racial/ethnic minority, low-income teens represent a significantly underserved group in terms of reproductive health care including birth control and prenatal care. This paper provides patients’ perspectives through analysis of in-depth interviews with 51 African American teen mothers about their reproductive health care and focuses on the influence of gender ideologies and behavior expectations on teens’, and their perceptions of their mothers’, decisions around these issues. The findings suggest that attention to cultural influences of gender on teens’ decisions around sexuality and reproduction is critical to our theoretical and practical approaches to expanding health care services to underserved populations.

The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.

A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.

In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.

Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.

The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.

The purpose of this paper is to examine the risk of unintended pregnancy among women during Cook County Jail intake by assessing basic contraceptive history, the need for emergency contraception (EC) at intake, and contraception at release.

This is a cross-sectional study of women 18–50 years old at Cook County Jail in Chicago, Illinois from June 2011 through August 2012. The authors administered the survey at the time of intake on 33 convenient evenings. Surveys consisted of multiple-choice close-ended questions administered via interview. Topics included contraceptive use, pregnancy risk and pregnancy desire. The authors computed frequencies to describe the distribution of question responses and used logistic regression modeling to identify factors significantly related to the use of contraception at intake and to the acceptance of contraception at release.

Overall, 194 women participated. Excluding women not at risk for pregnancy (4.6 percent currently pregnant, 17.5 percent surgically sterilized/postmenopausal and 4.6 percent using long-acting reversible contraceptives), 73.2 percent of women were at risk for pregnancy (n = 142) and, therefore, had a potential need for contraception. Among these women at risk for unintended pregnancy, 68 (47.9 percent) had unprotected intercourse within five days prior to survey administration. When asked about EC, most women (81.4 percent) would be interested if available. Additionally, 141 (72.7 percent) of women would be interested in contraceptive supplies if provided free at release.

Newly incarcerated women are at high risk for unintended pregnancy. Knowledge about EC and ability to access birth control services are both significantly limited. These conclusions support providing an intake screening in jails to identify women at risk for unintended pregnancy.

A robust body of scholarship has attached unintended childbearing, cohabitation, and stepfamily living arrangements to a greater risk of union instability in the United States. These aspects of family life, which often co-occur, are overrepresented among disadvantaged populations, who also have an independently higher risk of union instability. Existing scholarship has modeled these family experiences as correlated events to better understand family and union instability, yet the authors assert a direct effort to test whether or how unintended childbearing differs across marital and stepfamily statuses makes important contributions to established research on relationship stability. Drawing on the 2006–2017 National Survey of Family Growth (NSFG), the authors test potential moderating effects to better understand the linkages between unintended childbearing and union dissolution among 7,864 recent, higher-order births to partnered mothers via discrete-time, event history logistic regression models. Findings confirm that unintended childbearing, cohabitation, and stepfamily status are all linked with a greater risk of dissolution. However, unintended childbearing is differentially linked to instability by marital status, with unintended childbearing being associated with a higher risk of dissolution for married couples relative to cohabiting couples. Unintended fertility does not seem to increase the risk of instability across stepfamily status. Findings provide more evidence in support of selection, rather than causation, in explaining the association between unintended childbearing and union instability among higher-order births. Results suggest that among higher-order births, unintended childbearing may reflect underlying relationship issues.

Public health programs facilitate access to resources that not only provide individuals’ options but also often foreclose individual preference through prescriptive requirements. This chapter takes two disparate cases from public health – vaccines and family planning –that reveal patterns of inequality in who has access to individual choice and who requires state support to exercise choice. Looking specifically at dynamics of funding and compulsion, this chapter elucidates how reliance on the rhetoric of individual choice as an expression of freedom rewards those with the greatest access to resources and fails to make sure that all members of the community have the resources to shape their own outcomes or to make sure collective health is protected.

Incarcerated women around the globe are predominantly of reproductive age. Most of these women have been pregnant before, and many want to be sexually active and avoid pregnancy upon release. Yet few of these women are on a regular method of contraception. Providing contraceptive services for women in custody benefits individual and public health goals of reducing unintended pregnancy. This policy briefing reviews evidence for an unmet need for family planning in the correctional setting, and policy implications for expanding services. The paper aims to discuss these issues.

The authors describe four model programs in the USA with established contraceptive services on site, highlighting practical steps other facilities can implement.

Correctional facilities health administrators, providers, advocates, and legislators should advance policies which should counsel women on family planning and should make a range of contraceptive methods available before release, while remaining sensitive to the potential pressure these women may feel to use birth control in this unique environment.

Family planning services for incarcerated women benefits individuals, facilities, and the community.

Policies which enable correctional facilities to provide comprehensive family planning to incarcerated women – including reproductive life goals counseling and contraceptive method provision – promote equity in access to critical reproductive health services and also provide broad scale population level benefits in preventing unintended pregnancy or enabling counseling for healthy pregnancies for a group of women who often have limited access to such services.

This policy briefing highlights an area of health care in prisons and jails which gets little attention in research and in policy circles: family planning services for incarcerated women. In addition to reviewing the importance of such services for this population, the authors also highlight model family planning programs in correctional facilities. These provide actionable insights for other administrators and providers.