Nearly half of all pregnancies in the United States are unintended. Preventing unintended pregnancy is critical to optimize pregnancy outcomes as unintended pregnancy is strongly associated with inadequate prenatal care, poor maternal mental health, and adverse birth and early childhood outcomes. Unintended pregnancy may be particularly salient for the approximately 11% of U.S. women of childbearing age with disabilities, who are more likely to be of low socioeconomic status, to lack health insurance, and to experience intimate partner violence (IPV), all factors associated with unintended pregnancy. Yet research describing the incidence or correlates of unintended pregnancy among women with disabilities is extremely limited. To address this gap our multi-disciplinary team, together with a community advisory board of diverse women living with disabilities, proposes a mixed-methods study to meet the following specific aims: 1) To identify risk and protective factors for unintended pregnancy among women with disabilities and to compare these factors across women with and without disabilities; 2) To examine whether receipt of reproductive health care services moderates or mediates the association between disability and unintended pregnancy; and 3) to explore the experiences and barriers to reproductive health care of diverse women with disabilities who have experienced unintended pregnancy, including personal, interpersonal, and physical factors, as well as women's own priorities for intervention development. We will analyze recently released data from the 2011-13 National Survey for Family Growth (NSFG) (N=5600), the first population-based survey to employ evidence-based data standards set forth by the Affordable Care Act for defining disability. Quantitative findings will then inform qualitative interviews wit a sample of women with disabilities (N=50), recruited purposively to maximize diversity in terms of disability type (i.e., racial/ethnic minority status, and urban/rural residence. Study findings wil be the first to quantify the prevalence of unintended pregnancy, and risk and protective factors for unintended pregnancy, among a historically marginalized group of women who have frequently experienced disparities in health care. Further, qualitative interviews with women living with diverse disabilities will explore additional factors, not fully captured in the NSFG, to best understand barriers to optimal reproductive health care. Importantly, hearing, vision, cognition, mobility) this research will also serve as the foundation for the development and evaluation of future prevention interventions, including our own team's planned R01 submission to support development and testing of an evidence-based intervention to support effective preconception care, prevent unintended pregnancies, and thereby optimize pregnancy outcomes for women of childbearing age living with disability.

Public Health Relevance

The proposed study addresses four goals of Healthy People 2020: to improve pregnancy planning and spacing, and prevent unintended pregnancy; to improve access to comprehensive, quality health care services, to promote the health and well-being of people with disabilities, and to improve the health and well-being of women, infants, children, and families. To contribute to the attainment of these goals, the proposed study will leverage existing data, using the first population-based data from the National Survey on Family Growth (NSFG) that uses six disability status questions required by the Affordable Care Act, and will integrate qualitative dat designed to improve the understanding of the role of context, risk, and protective factors for unintended pregnancy among women with disabilities.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1)
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Miodovnik, Menachem
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University of Virginia
Schools of Nursing
United States
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Mosher, William; Hughes, Rosemary B; Bloom, Tina et al. (2018) Contraceptive use by disability status: new national estimates from the National Survey of Family Growth. Contraception 97:552-558
Mosher, William; Bloom, Tina; Hughes, Rosemary et al. (2017) Disparities in receipt of family planning services by disability status: New estimates from the National Survey of Family Growth. Disabil Health J 10:394-399
Bloom, Tina L; Mosher, William; Alhusen, Jeanne et al. (2017) Fertility Desires and Intentions Among U.S. Women by Disability Status: Findings from the 2011-2013 National Survey of Family Growth. Matern Child Health J 21:1606-1615