Understanding Pregnancy in a Population of Inner-City Women in New Orleans-Results of Qualitative Research

Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.
Social Science & Medicine (Impact Factor: 2.89). 02/2005; 60(2):297-311. DOI: 10.1016/j.socscimed.2004.05.007
Source: PubMed


Unintended pregnancy has conventionally been defined as a pregnancy that is mistimed or unwanted, and this classification has been widely used in survey research. This study explores the utility of these constructs for women who visited a family planning clinic and a prenatal clinic in inner-city New Orleans, LA, and, by extension, for women of similar background and experience. We used semi-structured, open-ended research to explore sexual debut and history, contraceptive knowledge and use, pregnancy history, partner relations, and service use among 77 women (73 of whom were African-American). This study addresses the apparent paradox of high-risk sexual and contraceptive behavior in the presence of expressed preferences to postpone childbearing. It provides some insight into the cultural and social context in which these events and decisions take place and explores the multiple dimensions that shape women's sexual behaviors and their desires for pregnancy. The dimensions explored include perceptions of and experiences with sex/sexuality, values concerning childbearing/motherhood, relationships with partners, experiences with contraception, and attitudes toward abortion. The apparent ambivalence seen in reports of women asked whether a pregnancy was intended, such as statements that they did not want to get pregnant but were either not using contraception or using it irregularly, calls into question the idea that intendedness can be routinely and easily inferred from survey research. Correspondingly, it is not possible to simply assume that either intentionality or future intentions directly affect decisions to use contraception. The problem is that the many factors-structural and individual-affect women's preferences and ability to postpone a pregnancy or to use contraception.

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    • "a et al . ( 2011 ) , women considered pregnancies to be unwanted when they occurred in contexts that do not reinforce traditional notions of consummate motherhood and of women as nurturers and wives ; were incompatible with customary beliefs about ' proper ' reproduction ; and divulged their use of their sexuality in culturally unacceptable ways . Kendall et al . ( 2005 ) found a deep recognition among women and girls that particular forms of fertility , such as single parenthood can be so - cially and economically - demanding . Geronimus ( 2003 ) also argued that the planning of fertility was a gendered tactic among women for countering their structural susceptibility . Women ' s reference to gender n"
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    ABSTRACT: Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent. Copyright © 2015. Published by Elsevier Ltd.
    Social Science & Medicine 07/2015; 141. DOI:10.1016/j.socscimed.2015.07.019 · 2.89 Impact Factor
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    • "However, concerns have been growing about its use for individuallevel analyses, and numerous thoughtful critiques of this measure of childbearing intentions have been published (see Bachrach and Newcomer 1999; Klerman 2000; Luker 1999; Miller and Jones 2009; Peterson and Mosher 1999; Santelli et al. 2003). Indeed, the critiques of the conventional measure have become so numerous as to form their own body of research (see also Bachrach and Morgan 2013; Barrett and Wellings 2002; Fischer et al. 1999; Gerber et al. 2002; Higgins et al. 2012; Kaufman et al. 1997; Kavanaugh and Schwarz 2009; Kendall et al. 2005; Lifflander et al. 2007; McCormick et al. 1987; Moos et al. 1997; Petersen and Moos 1997; Poole et al. 2000; Santelli et al. 2006; Santelli et al. 2009; Stanford et al. 2000; Trussell et al. 1999; Westoff and Ryder 1977). "
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    ABSTRACT: The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87–100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers’ background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.
    Demography 01/2015; 52(1). DOI:10.1007/s13524-014-0359-9 · 1.93 Impact Factor
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    • "Social support is associated with better health during pregnancy and the postpartum period [28,29], and with reduced depression among new mothers, abortion patients, and other groups [13,14,30]. There is evidence that social networks change during the transition to parenthood [31]. Effective nation-wide programs such as the Nurse Family Partnership are based on the model that social support for low education, low income and/or unmarried pregnant women and new mothers improves long-term health and well-being for the mother and family [32]. "
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    ABSTRACT: Background Examining women’s stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women’s well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups. Methods The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility’s gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months. Results Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups’ levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time. Conclusions Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.
    BMC Women's Health 06/2014; 14(1):76. DOI:10.1186/1472-6874-14-76 · 1.50 Impact Factor
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