Unintended pregnancy confers significant adverse consequences for women, their children, and society, and is closely associated with intimate partner violence (IPV) and sexual assault (SA). Native American (NA) women are at particularly high risk for experiencing unintended pregnancy and IPV/SA. IPV confers risk for unintended pregnancy through multiple mechanisms including forced unprotected sex and compromised decision making regarding contraceptive use as well as through reproductive coercion - male partners promote pregnancy through threats and contraceptive sabotage. Studies have not included sufficient numbers of NA women to understand how IPV, reproductive coercion, pregnancy intentions, and contraceptive behaviors may differ from non-NA women. A family planning clinic-based brief safety card intervention has been shown to reduce reproductive coercion, and is being tested in a large cluster-randomized controlled trial to assess the impact on IPV and unintended pregnancy (1R01HD064407-01A1, PI Miller). However, in a pilot demonstration project funded by the Office on Women's Health with the Hoopa tribe in Northern California, health care providers and victim advocates identified limitations with this safety card for use with NA women on reservations including limited access to clinical and victim services, low levels of contraceptive use, and ambivalence around pregnancy. We propose to conduct a qualitative study with NA adolescent and adult women in three diverse tribal communities: the Hoopa tribe in Northern California, the tribal nations and pueblos of New Mexico, and the Maliseets and surrounding tribes in Maine. We propose to conduct one-on-one semi-structured interviews with NA adolescent and adult women ages 16 to 35 in these communities (N=60) to identify pathways connecting IPV, reproductive coercion, pregnancy intentions, contraceptive behaviors, and reproductive histories among NA women (Aim 1);to explore how cultural, structural, and relationship factors shape NA women's experiences with IPV, pregnancy, contraceptive use, and care seeking behaviors (Aim 2), and to test face and construct validity of existing survey items for assessing IPV, reproductive coercion and unintended pregnancy with NA adolescent and young adult women (Aim 3). To date, no studies have examined NA women's experiences with reproductive coercion, IPV/SA, and unintended pregnancy. This study will help clarify how NA adolescent and adult women describe pregnancy intention and contraceptive behavior, and the cultural, structural, and relationship factors including violence which affect their intentions and behaviors. This study will advance our understanding of the relationships among unintended pregnancy, violence, race and contraceptive decision making while simultaneously pinpointing targets for intervention. This study will lay the groundwork for an R01 to adapt and test a brief intervention designed to help NA women connect their relationship experiences with pregnancy intentions, promote effective contraceptive use, and reduce IPV and unintended pregnancy.
Unintended pregnancy confers significant adverse consequences for women, their children, and society, and is closely associated with intimate partner violence (IPV), sexual assault (SA), and reproductive coercion (male partners promote pregnancy through threats and contraceptive sabotage). Native American (NA) women are at particularly high risk for experiencing unintended pregnancy and IPV/SA, yet to date, no studies have examined NA women's experiences with IPV/SA, reproductive coercion, and unintended pregnancy. This qualitative study will clarify how NA adolescent and adult women describe pregnancy intention and contraceptive behavior, and the cultural, structural, and relationship factors including violence and reproductive coercion which affect their reproductive decision making, to lay the groundwork for a randomized clinical trial to test a brief intervention designed to help NA women connect their relationship experiences with pregnancy intentions, promote effective contraceptive use, and reduce IPV and unintended pregnancy.
