Race, contraceptive behavior, and unintended pregnancy

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DESCRIPTION (provided by applicant): Unintended pregnancy is a substantial problem in the U.S., and racial/ethnic minorities are at particularly high risk of experiencing an unintended pregnancy. Unintended pregnancy confers significant adverse consequences for women, their children, and society; and disparities in unintended pregnancy can contribute to the cycle of disadvantage experienced by vulnerable populations. As African American (AA) women overall have less effective contraceptive use patterns compared to white women, disparities in unintended pregnancy rates are directly related to differences in contraceptive use. Attempting to understand the reasons underlying racial disparities in contraceptive use will require a closer scrutiny of the construct of pregnancy intention as this is an immediate and direct determinant of contraceptive behavior. Among women whose pregnancy intentions are clear (i.e. either desire pregnancy or want to avoid pregnancy), intention and contraceptive behavior appear to be congruent. However, there is research indicating that failure to form intentions and ambivalence about pregnancy is common, and perhaps more so among minority and lower socio-economic communities. Moreover, those who report ambiguous or ambivalent intentions about pregnancy are less likely to use contraception consistently and are more likely to get pregnant than those who unequivocally intend to avoid pregnancy. Existing literature exploring the correlates and consequences of unclear pregnancy intention focuses mostly on adolescents although the majority of unintended pregnancies occur among adult women. Attempting to intervene on racial differences in unintended pregnancy, therefore, will require a greater understanding of how the conceptualization of pregnancy intention varies by race as well as how contextual factors, including culturally-based norms and attitudes, shape intention and its relationship with contraceptive behavior among adult women. We propose a qualitative study with low-income, adult AA and white women in Pittsburgh, PA to gain insight about contraceptive decision making in a population that is at particularly high risk of unintended pregnancy. We propose to conduct one-on-one semi-structured interviews to identify categories of pregnancy intention (Aim 1), to elucidate the relationship between pregnancy intention and contraceptive use (Aim 2), and to explore how cultural, structural, and relationship factors shape pregnancy intention and contraceptive use (Aim 3). This study will lay the groundwork for an R01 to test an intervention designed to help women clarify their pregnancy intentions and promote effective contraceptive use. To this end, this study will provide a taxonomy which can be used to more effectively communicate about pregnancy intention and will also pinpoint specific contextual factors that contribute toward undefined pregnancy intentions, poor contraceptive behaviors, and risk for unintended pregnancy among low-income AA and white women in Pittsburgh.