Elizabeth Wildsmith

Relationship Characteristics and Contraceptive Use Among Young Adults

CONTEXT Young adults have high rates of unintended childbearing and STDs, yet little research has examined the role of relationship characteristics in their contraceptive use. METHODS Data collected from the 2002-2005 rounds of the National Longitudinal Survey of Youth yielded a sample of 4,014 dating relationships among sexually active 18-26-year-olds. Bivariate analysis and multivariate logistic and multinomial logistic regressions assessed associations between relationship characteristics and contraceptive use at last sex. RESULTS In three-quarters of the relationships, respondents had used some method at last intercourse; respondents in 26% of the relationships had used a condom only, in 26% a hormonal method only and in 23% dual methods. Compared with respondents in relationships in which first sex occurred within two months of starting to date, those who first had sex before dating were more likely to have used any method at last sex (odds ratio, 1.4), particularly condoms or dual methods (relative risk ratio, 1.5 for each). The relative risk of using a hormonal method only, rather than no method or condoms only, increased with relationship duration (1.01) and level of intimacy (1.1-1.2). Discussing marriage or cohabitation was associated with reduced odds of having used any method (0.7) and a reduced relative risk of having used condoms alone or dual methods (0.6 for each). Increasing levels of partner conflict and asymmetry were also linked to reduced odds of any method use (0.97 and 0.90, respectively). CONCLUSIONS Prevention programs should address relationship context in contraceptive decision making, perhaps by combining relationship and sex education curricula to foster communication and negotiation skills.

Repeat Unintended, Unwanted and Seriously Mistimed Childbearing in the United States

CONTEXT The high level of unintended fertility in the United States is a serious public health issue. Whether unintended fertility occurs across the population or is concentrated among a subset of women who experience multiple unintended births is unclear. METHODS Data from the 2002 National Survey of Family Growth were used to determine levels of unintended, unwanted and seriously mistimed childbearing, and chi-square and t tests were used to identify group differences in these measures, in two cohorts of women (those born in 1958-1962 and those born in 1965-1969). Both births (by ages 33-37) and mothers were used as units of analysis. RESULTS The proportion of births identified as unintended was greater in the 1965-1969 cohort than in the earlier cohort (37% vs. 34%), largely because a higher proportion of births to women in the former cohort were unwanted. In both cohorts, more than a third of women (36-41%) reporting at least one unintended birth had had at least one more, and women reporting unintended or unwanted births had higher overall fertility than others. Levels of repeat unintended fertility were greatest among black women, and the proportion of blacks who reported two or more unwanted births was 94% higher in the 1965-1969 cohort than in the 1958-1962 cohort (19% vs. 10%). CONCLUSIONS Repeat unintended fertility is common, especially among black women, who may differ from other groups in their contraceptive and fertility decisions as well as in their access to and ability to afford family planning services.

Union Transitions Following the Birth of a Child to Cohabiting Parents

Despite a growing interest in the family trajectories of unmarried women, there has been limited research on union transitions among cohabiting parents. Using data from the 2002 National Survey of Family Growth, we examined how family complexity (including relationship and fertility histories), as well as characteristics of the union and birth, were associated with transitions to marriage or to separation among 1,105 women who had a birth in a cohabiting relationship. Cohabiting parents had complex relationship and fertility histories, which were tied to union transitions. Having a previous nonmarital birth was associated with a lower relative risk of marriage and a greater risk of separation. In contrast, a prior marriage or marital birth was linked to union stability (getting married or remaining cohabiting). Characteristics of the union and birth were also important. Important racial/ethnic differences emerged in the analyses. Black parents had the most complex family histories and the lowest relative risk of transitioning to marriage. Stable cohabitations were more common among Hispanic mothers, and measures of family complexity were particularly important to their relative risk of marriage. White mothers who began cohabiting after conception were the most likely to marry, suggesting that “shot-gun cohabitations” serve as a stepping-stone to marriage.

Measurement problems in assessing trends in unwanted fertility.

In a recent issue of Journal of Adolescent Health, Kissin and colleagues [1] examined trends in unintended and unwanted childbearing in the United States. They report that the proportion of unwanted births increased between 1995 and 2002, particularly among women under age 25. Kissin and colleagues [1] analyze trends using multiple waves of the National Survey of Family Growth (NSFG). This survey was designed to study change over time. However, recent research suggests that the 1995 and 2002 measures of unwanted fertility are not, in fact, comparable, and that the apparent increase in unwanted fertility is attributable to survey effects. As in all surveys, question wording and sampling procedures in the NSFG vary slightly over time. The effects of these differences can be assessed by comparing measures for periods of time in which the two surveys overlap. In an article presented at the 2008 NSFG User’s Conference, my colleagues and I [2] compared proportions of births reported as unwanted during the period 1990–1994 using both the 1995 and 2002 NSFG. Unwanted birth rates during this period are substantially higher when measured using the 2002 survey than when measured using the 1995 survey. Furthermore, measurement differences are largest for adolescent women. These measurement differences are large enough to completely explain the apparent trend reported by Kissin and colleagues [1]. Using the 1995 NSFG, an estimated 10% of births between 1990 and 1994 to non-Hispanic white, non-Hispanic black, and U.S. born Hispanic women age 15–19 were unwanted. Using the 2002 NSFG to measure births to women the same age during the same time period, 20% of births were unwanted. Thus, unwanted fertility in this age group appears more than twice as common when measured using the 2002 survey than when measured using the 1995 survey. The wording of the NSFG question on unwanted fertility was changed during this period. In 1995, and in earlier cycles, the primary question on fertility intentions was ‘‘At the time you became pregnant, did you yourself actually want to have (a)nother baby at some time?’’ In the 2002 survey, the question was changed to ‘‘Right before you became pregnant, did