Risks and protective factors for unintended pregnancy in women with disabilities

 描述（由申请人提供） 在美国，近一半的怀孕是意外的。预防意外怀孕对于优化妊娠结局至关重要，因为意外怀孕与产前护理不足、孕产妇心理健康状况差以及不良分娩和幼儿结局密切相关。意外怀孕可能是特别突出的约11%的美国育龄妇女的残疾，谁更有可能是低社会经济地位，缺乏健康保险，并经历亲密伴侣暴力（IPV），所有因素与意外怀孕。然而，描述残疾妇女意外怀孕发生率或相关因素的研究极为有限。为了弥补这一差距，我们的多学科团队与由不同残疾妇女组成的社区咨询委员会一起，提出了一项混合方法研究，以实现以下具体目标：1）确定残疾妇女意外怀孕的风险和保护因素，并比较残疾妇女和非残疾妇女的这些因素;（2）研究接受生殖保健服务是否调节或介导残疾与意外怀孕之间的关联; 3）探讨各种意外怀孕残疾妇女的生殖保健经验和障碍，包括个人、人际关系和身体因素，以及妇女自己制定干预措施的优先事项。我们将分析2011-13年全国家庭增长调查（NSFG）（N=5600）最近发布的数据，这是第一次基于人口的调查，采用《平价医疗法案》规定的基于证据的数据标准来定义残疾。然后，定量调查结果将为与残疾妇女样本（N=50）的定性访谈提供信息，这些残疾妇女是有目的地招募的，以最大限度地扩大残疾类型的多样性（即，种族/少数民族地位和城市/农村居住地。研究结果将是第一个量化意外怀孕的患病率，以及意外怀孕的风险和保护因素，在历史上被边缘化的妇女群体中，她们经常经历医疗保健方面的差异。此外，与患有各种残疾的妇女进行的定性访谈将探讨NSFG中未完全涵盖的其他因素，以最好地了解最佳生殖保健的障碍。重要的是，听力，视力，认知，移动性）这项研究也将作为未来预防干预措施的开发和评估的基础，包括我们自己的团队计划的R 01提交，以支持开发和测试基于证据的干预措施，以支持有效的孕前护理，预防意外怀孕，从而优化育龄残疾妇女的妊娠结局。

 DESCRIPTION (provided by applicant) 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.