"It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning.

Title"It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning.
Publication TypeJournal Article
Year of Publication2015
AuthorsBorrero S, Nikolajski C, Steinberg JR, Freedman L, Akers AY, Ibrahim S, Schwarz EBimla
JournalContraception
Volume91
Issue2
Pagination150-6
Date Published2015 Feb
ISSN1879-0518
KeywordsAdolescent, Adult, Coercion, Cohort Studies, Contraception Behavior, Family Planning Services, Female, Health Knowledge, Attitudes, Practice, Humans, Intention, Interpersonal Relations, Interviews as Topic, Pennsylvania, Poverty, Pregnancy, Pregnancy, Unplanned, Reproductive Behavior, Self Efficacy, Sexual Partners, Urban Health Services, Young Adult
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.

DOI10.1016/j.contraception.2014.09.014
Alternate JournalContraception
PubMed ID25477272
PubMed Central IDPMC4303515
Grant List1 R21 HD068736-01 / HD / NICHD NIH HHS / United States
K01HD075834 / HD / NICHD NIH HHS / United States
R21 HD068736 / HD / NICHD NIH HHS / United States
R24 HD041041 / HD / NICHD NIH HHS / United States