The overarching aim of the proposed research is to inform strategies to aid in the prevention of unintended pregnancy by providing a better understanding of women's future childbearing intentions and feelings at the prospect of pregnancy, particularly when these two concepts appear to be mismatched. When women report feeling happy at the prospect of pregnancy, but at the same time report wanting no more children, current theoretical perspectives interpret these mismatched or incongruent feelings and intentions as ambivalence (i.e. the lack of a clear and strong desire to avoid pregnancy). Going a step further, ambivalence is assumed to be a marker of decreased quality of contraceptive use, and thereby increased likelihood of getting pregnant. It is also more common among ethnic minority groups, particularly Latinas. The proposed research investigates the hypothesis that incongruent intentions and feelings are not a reflection of ambivalence, but rather two distinct concepts: women may be quite resolute about avoiding future pregnancies, yet still express happiness at the prospect of pregnancy. Classifying these women as ambivalent would lead to inaccurate measurement of unintended pregnancy, hinder understanding of the meaning and significance of pregnancy intentions, and limit the ability to address disparities in unintended pregnancy across racial and ethnic groups. A key aspect of the proposed research is the integration of perspectives on the public health issue of unintended pregnancy from across multiple disciplines. Dr. Abigail Aiken will combine her background in medicine and public health with rigorous training in population and public policy approaches to research. Under the guidance of Dr. Joseph Potter and Dr. Cynthia Osborne at the University of Texas at Austin, she will conduct the proposed project and associated training as a key part of her transition to becoming an independent reproductive health researcher, highly qualified for a successful academic research career. The specific objectives of the proposed research are to: 1. Determine whether incongruent pregnancy intentions and feelings are more prevalent among Hispanic women than among Non-Hispanic White women;2. Assess whether women with incongruent intentions and feelings less likely to choose more effective methods of contraception;3. Measure whether women with incongruent intentions and feelings more likely to become unintentionally pregnant in the future;4. Describe whether women with incongruent intentions and feelings are equivocal about their desire to avoid pregnancy;5. Describe what factors influence and explain happiness at the prospect of an unintended pregnancy among women who are not ambivalent about their intention to avoid conception. The first three questions will be answered quantitatively using a 24-month prospective cohort study of postpartum women, interviewed about their future pregnancy intentions and feelings, contraceptive desires and use, and any subsequent pregnancies they experience. The fourth and fifth require a qualitative approach, using in-depth interviews to gain deeper insight into women's perspectives.

Public Health Relevance

Unintended pregnancy is a persistent public health issue in the United States: an estimated 50% of pregnancies occurring each year are unintended. This research would aid in the development of state and national surveys measuring pregnancy intentions, such as PRAMS and NSFG, bring new insight to bear on public health research examining unintended pregnancy and maternal child health outcomes, improve clinical counseling in reproductive health care settings, and allow the development of population-level strategies to decrease unintended pregnancy that would take into account the actual perspectives of women to whom they are targeted.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-F16-L (20))
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King, Rosalind B
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University of Texas Austin
Schools of Arts and Sciences
United States
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Aiken, Abigail R A; Creinin, Mitchell D; Kaunitz, Andrew M et al. (2014) Global fee prohibits postpartum provision of the most effective reversible contraceptives. Contraception 90:466-7
Potter, Joseph E; Hopkins, Kristine; Aiken, Abigail R A et al. (2014) Unmet demand for highly effective postpartum contraception in Texas. Contraception 90:488-95