Unintended pregnancy is of epidemic proportions in the United States: the majority of all pregnancies are unintended, and half of these end in abortion. Among American Indians, the rates may be even higher, given the presence of several key risk factors: they are a youthful population; birthrates are extremely high; and the combination of poverty and isolation results in serious barriers to prescription and non-prescription contraception and abortion services. Research indicates that the intentionality of a conception and the wantedness of a pregnancy are not identical constructs; both phenomena may better be conceptualized along a continuum rather than as dichotomous, either/or constructs. Since some evidence shows that a woman' perspective of conception intentionality may change over time, national estimates of unintended pregnancy based on retrospective reports may underestimate the actual prevalence. Because of problems with measuring conception intent, the determinants of unintended pregnancy have also been difficult to isolate. Working with two American Indian communities, the goal of this project is to develop reliable and valid measures of pregnancy intentionality by more fully and carefully elucidating the cultural, familial, and individual contexts of this phenomenon. Using a paper-and-pencil survey annually for four years, supplemented by interviews after a pregnancy has been reported, this study will explore the determinants of unintended and intended pregnancies among 16- to 24-year-olds. In addition, it will build on three years of earlier data gathered from these participants during middle adolescence. Analyses will capitalize on the strengths of four different analytic approaches--ethnographic, psychometric, structural equation modeling/multiple regression, and logistic/survival methods--in understanding unintended pregnancy in Indian communities. Moreover, in studying this population, we will also collect data which will provide an interesting contrast to most work in this area, which has previously focused on inner-city youth or mainstream middle-class populations.
