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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    • "isadvantage ( Geronimus , 2004 ) . Qualitative studies facilitate understanding and give voice to the lived experiences of mar - ginalized and / or stigmatized communities in - cluding pregnant / parenting adolescents . Previ - ous qualitative studies among pregnant / parenting adolescents include explorations of intentionality and contraception ( Kendall et al . , 2005 ) , sources of support ( De Jonge , 2001 ; Ste - venson et al . , 1999 ) and perceived advantages and disadvantages of adolescent pregnancy ( Lesser et al . , 1998 ; Rosengard et al . , 2006 ; Spear , 2004 ) , among other topics . A meta - analysis of qualitative data by Spear and Lock ( 2003 ) identified four main themes consistent thr"
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    ABSTRACT: Adolescent childbearing has been viewed as a social, political, and public health priority since the 1970s. Research has primarily focused on the negative consequences of teen pregnancy; less research has explored factors associated with healthy pregnancy and birth experiences in this population. Using open-ended and qualitative techniques, researchers performed individual interviews with 15 adolescent mothers (15 to 19 years of age) recruited from a Women's and Children's Clinic in Southern Louisiana, who had experienced a healthy pregnancy and bore a full-term, normal birth weight infant. We used a resiliency framework to identify factors that may have supported positive health outcomes despite risks associated with low-income and/or marginalized minority status. A total of 15 mothers of multiple racial/ethnic identities were included in the analysis. Mothers discussed potential protective factors that we classified as either assets (internal factors) or resources (external factors). Mothers demonstrated strong assets including self-efficacy and self-acceptance and important resources including familial support and partner support during pregnancy which may have contributed to their resiliency. Ensuring access to social and structural supports as well as supporting adolescent-friendly health and social policies may be key to promoting healthy maternal and infant outcomes among young women who become pregnant. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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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.
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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.
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