Race, contraceptive behavior, and unintended pregnancy

描述(申请人提供)：意外怀孕在美国是一个严重的问题，少数族裔经历意外怀孕的风险特别高。意外怀孕会给妇女、她们的子女和社会带来严重的不利后果；意外怀孕方面的差异可能会助长弱势群体经历的不利循环。由于非裔美国人(AA)妇女总体上与白人妇女相比，避孕措施的使用模式不那么有效，意外怀孕率的差异与避孕措施使用的差异直接相关。要想了解避孕用具使用中存在种族差异的原因，就需要对怀孕意向的构成进行更仔细的审查，因为这是避孕行为的直接和直接决定因素。在怀孕意图明确的女性中(即想要怀孕或想要避免怀孕)，意图和避孕行为似乎是一致的。然而，有研究表明，未能形成对怀孕的意图和矛盾心理是很常见的，在少数族裔和较低的社会经济群体中可能更是如此。此外，那些报告对怀孕有模棱两可或矛盾意图的人，与那些明确打算避免怀孕的人相比，不太可能始终如一地使用避孕措施，更有可能怀孕。现有文献探讨不明确怀孕意向的相关性和后果主要集中在青少年身上，尽管大多数意外怀孕发生在成年妇女中。因此，试图干预意外怀孕的种族差异，将需要更好地了解怀孕意图的概念化如何因种族而异，以及背景因素，包括基于文化的规范和态度如何影响成年妇女的意图及其与避孕行为的关系。我们建议对宾夕法尼亚州匹兹堡的低收入成年AA和白人女性进行定性研究，以深入了解意外怀孕风险特别高的人群的避孕决策。我们建议进行一对一的半结构式访谈，以确定怀孕意向的类别(目标1)，阐明怀孕意向与避孕用具使用之间的关系(目的2)，并探索文化、结构和关系因素如何影响怀孕意向和避孕用具的使用(目的3)。这项研究将为R01测试一种旨在帮助女性明确怀孕意图和促进有效避孕措施使用的干预措施奠定基础。为此，这项研究将提供一个分类，可以用来更有效地交流怀孕意图，并将准确地确定导致匹兹堡低收入AA和白人女性怀孕意向不明、避孕行为不良和意外怀孕风险的特定背景因素。 公共卫生相关性：意外怀孕在美国是一个巨大的问题，少数族裔经历意外怀孕的风险特别高。这项研究的目的是确定社会文化因素如何在宾夕法尼亚州匹兹堡的低收入、AA和白人妇女中导致意外怀孕。这项研究将为一项与文化相关的干预措施奠定基础，该干预措施旨在增强妇女做出有意义的生育决定、改进计划生育做法和减少意外怀孕的能力。

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. PUBLIC HEALTH RELEVANCE: Unintended pregnancy is an enormous problem in the United States, and racial/ethnic minorities are at particularly high risk of experiencing an unintended pregnancy. The purpose of this study is to identify how socio-cultural factors contribute to unintended pregnancy among low-income, AA and white women in Pittsburgh, PA. This research will lay the groundwork for a culturally-relevant intervention designed to empower women to make meaningful reproductive decisions, improve family planning practices, and decrease unintended pregnancy.