A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women

Mary T. Paterno, Matthew J. Hayat, Jennifer Wenzel, Jacquelyn C Campbell

Research output: Contribution to journalArticle

Abstract

Background: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women’s multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior. Methods: We used mixed methods to examine women’s perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18–29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data. Results: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that’s on you; Motherhood means everything; and Make sure you're stable. Women’s qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior. Conclusion: The incongruities between women’s ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women’s pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalJournal of racial and ethnic health disparities
DOIs
StateAccepted/In press - Mar 22 2016

Fingerprint

Contraception
contraceptive
African Americans
young adult
Young Adult
low income
pregnancy
Contraceptive Agents
Pregnancy
Contraception Behavior
confidence
Odds Ratio
Confidence Intervals
motherhood
Interviews
Minority Groups
American
Sexual Partners
Pregnancy Rate
qualitative interview

Keywords

  • Contraceptive
  • Mixed methods
  • Motherhood
  • Pregnancy attitude
  • Relationships

ASJC Scopus subject areas

  • Health(social science)
  • Sociology and Political Science
  • Anthropology
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

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title = "A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women",
abstract = "Background: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women’s multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior. Methods: We used mixed methods to examine women’s perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18–29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data. Results: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 {\%} confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 {\%} CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 {\%} CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that’s on you; Motherhood means everything; and Make sure you're stable. Women’s qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior. Conclusion: The incongruities between women’s ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women’s pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.",
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AB - Background: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women’s multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior. Methods: We used mixed methods to examine women’s perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18–29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data. Results: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that’s on you; Motherhood means everything; and Make sure you're stable. Women’s qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior. Conclusion: The incongruities between women’s ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women’s pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

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