Race, contraceptive behavior, and unintended pregnancy

描述（由申请人提供）：意外怀孕在美国是一个严重的问题，少数种族/族裔经历意外怀孕的风险特别高。意外怀孕给妇女、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加剧弱势群体所经历的不利循环。由于非洲裔美国人（AA）妇女总体上避孕药具使用效率低于白色妇女，意外怀孕率的差异与避孕药具使用的差异直接相关。试图了解的原因，潜在的种族差异，在避孕药具的使用将需要更仔细地审查的结构怀孕的意图，因为这是一个直接和直接的决定因素避孕行为。在怀孕意图明确的女性中（即希望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，对怀孕没有形成意愿和矛盾心理是很常见的，在少数民族和社会经济地位较低的社区中可能更是如此。此外，那些报告对怀孕的模糊或矛盾意图的人不太可能坚持使用避孕措施，并且比那些明确打算避免怀孕的人更有可能怀孕。现有的文献探讨不明确的怀孕意图的相关性和后果主要集中在青少年，虽然大多数意外怀孕发生在成年女性。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，以及如何上下文因素，包括基于文化的规范和态度，塑造意图及其与成年女性避孕行为的关系。我们提出了一个定性研究，低收入，成年AA和白色妇女在匹兹堡，PA了解避孕决策的人口，特别是在意外怀孕的高风险。我们建议进行一对一的半结构化访谈，以确定怀孕意向的类别（目标1），阐明怀孕意向和避孕药具使用之间的关系（目标2），并探讨文化，结构和关系因素如何塑造怀孕意向和避孕药具使用（目标3）。这项研究将为R 01奠定基础，以测试旨在帮助妇女澄清其怀孕意图并促进有效避孕的干预措施。为此，本研究将提供一个分类，可用于更有效地沟通怀孕的意图，也将查明具体的上下文因素，有助于不明确的怀孕意图，不良的避孕行为，以及意外怀孕的风险低收入AA和白色妇女在匹兹堡。

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.