Unintended pregnancy is a substantial problem in the U.S., and racial/ethnic minorities are at particularly high risk of experiencing an unintended pregnancy. Unintended pregnancy confers significant adverse consequences for women, their children, and society;and disparities in unintended pregnancy can contribute to the cycle of disadvantage experienced by vulnerable populations. As African American (AA) women overall have less effective contraceptive use patterns compared to white women, disparities in unintended pregnancy rates are directly related to differences in contraceptive use. Attempting to understand the reasons underlying racial disparities in contraceptive use will require a closer scrutiny of the construct of pregnancy intention as this is an immediate and direct determinant of contraceptive behavior. Among women whose pregnancy intentions are clear (i.e. either desire pregnancy or want to avoid pregnancy), intention and contraceptive behavior appear to be congruent. However, there is research indicating that failure to form intentions and ambivalence about pregnancy is common, and perhaps more so among minority and lower socio-economic communities. Moreover, those who report ambiguous or ambivalent intentions about pregnancy are less likely to use contraception consistently and are more likely to get pregnant than those who unequivocally intend to avoid pregnancy. Existing literature exploring the correlates and consequences of unclear pregnancy intention focuses mostly on adolescents although the majority of unintended pregnancies occur among adult women. Attempting to intervene on racial differences in unintended pregnancy, therefore, will require a greater understanding of how the conceptualization of pregnancy intention varies by race as well as how contextual factors, including culturally-based norms and attitudes, shape intention and its relationship with contraceptive behavior among adult women. We propose a qualitative study with low-income, adult AA and white women in Pittsburgh, PA to gain insight about contraceptive decision making in a population that is at particularly high risk of unintended pregnancy. We propose to conduct one-on-one semi-structured interviews to identify categories of pregnancy intention (Aim 1), to elucidate the relationship between pregnancy intention and contraceptive use (Aim 2), and to explore how cultural, structural, and relationship factors shape pregnancy intention and contraceptive use (Aim 3). This study will lay the groundwork for an R01 to test an intervention designed to help women clarify their pregnancy intentions and promote effective contraceptive use. To this end, this study will provide a taxonomy which can be used to more effectively communicate about pregnancy intention and will also pinpoint specific contextual factors that contribute toward undefined pregnancy intentions, poor contraceptive behaviors, and risk for unintended pregnancy among low-income AA and white women in Pittsburgh.

Public Health Relevance

Unintended pregnancy is an enormous problem in the United States, and racial/ethnic minorities are at particularly high risk of experiencing an unintended pregnancy. The purpose of this study is to identify how socio-cultural factors contribute to unintended pregnancy among low-income, AA and white women in Pittsburgh, PA. This research will lay the groundwork for a culturally-relevant intervention designed to empower women to make meaningful reproductive decisions, improve family planning practices, and decrease unintended pregnancy.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Community Influences on Health Behavior (CIHB)
Program Officer
Newcomer, Susan
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University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
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Gelman, Amanda; Rosenfeld, Elian A; Nikolajski, Cara et al. (2017) Abortion Stigma Among Low-Income Women Obtaining Abortions in Western Pennsylvania: A Qualitative Assessment. Perspect Sex Reprod Health 49:29-36
Vanderberg, Rachel H; Farkas, Amy H; Miller, Elizabeth et al. (2016) Racial and/or Ethnic Differences in Formal Sex Education and Sex Education by Parents among Young Women in the United States. J Pediatr Adolesc Gynecol 29:69-73
Nikolajski, Cara; Miller, Elizabeth; McCauley, Heather L et al. (2015) Race and reproductive coercion: a qualitative assessment. Womens Health Issues 25:216-23
Grady, Cynthia D; Dehlendorf, Christine; Cohen, Elan D et al. (2015) Racial and ethnic differences in contraceptive use among women who desire no future children, 2006-2010 National Survey of Family Growth. Contraception 92:62-70
Borrero, Sonya; Nikolajski, Cara; Steinberg, Julia R et al. (2015) ""It just happens"": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning. Contraception 91:150-6
Dehlendorf, Christine; Krajewski, Colleen; Borrero, Sonya (2014) Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol 57:659-73
Craig, Amaranta D; Dehlendorf, Christine; Borrero, Sonya et al. (2014) Exploring young adults' contraceptive knowledge and attitudes: disparities by race/ethnicity and age. Womens Health Issues 24:e281-9
Dehlendorf, Christine; Park, Seo Young; Emeremni, Chetachi A et al. (2014) Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences. Am J Obstet Gynecol 210:526.e1-9
Gelman, Amanda; Miller, Elizabeth; Schwarz, Eleanor Bimla et al. (2013) Racial disparities in human papillomavirus vaccination: does access matter? J Adolesc Health 53:756-62
Borrero, Sonya; Farkas, Amy; Dehlendorf, Christine et al. (2013) Racial and ethnic differences in men's knowledge and attitudes about contraception. Contraception 88:532-8