Heather Gatny

The effects of ambivalent fertility desires on pregnancy risk in young women in the USA

Many different definitions of the construct of motivational ambivalence have appeared in the literature on reproductive health. Using a theoretical framework in which motivational ambivalence is defined as an interaction between positive and negative pregnancy desires, we propose two hypotheses. The first is that positive and negative pregnancy desires independently predict the risk of an unplanned pregnancy. The second is that ambivalence and three related constructs that are also based on the interaction between positive and negative desires are each important predictors of pregnancy risk. We use weekly journal data collected from a US sample of 1,003 women aged 18–19 years and conduct hazard model analysis to test our hypotheses. Using both dummy and continuous predictors, we report results that confirm both hypotheses. The proposed interaction framework has demonstrated validity, compares favourably with previously reported alternative approaches, and incorporates a set of constructs that have potential importance for further research directed at the prevention of unplanned pregnancy.

Black-White Differences in Attitudes Related to Pregnancy among Young Women

In this article, we use newly available data from the Relationship Dynamics and Social Life (RDSL) study to compare a wide range of attitudes related to pregnancy for 961 black and white young women. We also investigate the extent to which race differences are mediated by, or net of, family background, childhood socioeconomic status (SES), adolescent experiences related to pregnancy, and current SES. Compared with white women, black women generally have less positive attitudes toward young nonmarital sex, contraception, and childbearing, and have less desire for sex in the upcoming year. This is largely because black women are more religious than white women and partly because they are more socioeconomically disadvantaged in young adulthood. However, in spite of these less positive attitudes, black women are more likely to expect sex without contraception in the next year and to expect more positive consequences if they were to become pregnant, relative to white women. This is largely because, relative to white women, black women had higher rates of sex without contraception in adolescence and partly because they are more likely to have grown up with a single parent. It is unclear whether attitudes toward contraception and pregnancy preceded or are a consequence of adolescent sex without contraception. Some race differences remain unexplained; net of all potential mediators in our models, black women have less desire for sex in the upcoming year, but they are less willing to refuse to have sex with a partner if they think it would make him angry and they expect more positive personal consequences of a pregnancy, relative to white women. In spite of these differences, black women’s desires to achieve and to prevent pregnancy are very similar to white women’s desires.

Willingness to Participate in Research during Pregnancy: Race, Experience, and Motivation

This article examines the willingness of pregnant women to participate in research on health. The authors investigate attitudes toward multiple methods of data collection, including survey and biomarker data collection. Complete interviews were obtained from a sample of 90 pregnant women in a matched control–comparison study of patients receiving prenatal care in private practice and clinic settings. Women experiencing prenatal care at a clinic reported less willingness to participate in research than women experiencing prenatal care at a private practice. Women who deemed “contributing to science,” “learning about pregnancy health,” and “helping future patients” as important motivations for participating in research were more likely to express willingness to participate in a study. African American women reported less willingness to answer questions in a survey than white women. The results suggest that motivational factors should be integrated into the design of a study of pregnant women to encourage participation.

Stress symptoms and frequency of sexual intercourse among young women

INTRODUCTION We have previously documented the relationships between stress and depression symptoms and adolescent womens nonuse and misuse of condoms and other contraceptive methods and on their unintended pregnancy rates. AIM Here, we examine relationships between mental health symptoms and another understudied adolescent reproductive health behavior-frequency of sexual intercourse. MAIN OUTCOME MEASURE Our outcome was weekly sexual intercourse activity. METHODS We used panel data from a longitudinal, population-based cohort study of 992 women ages 18-20. Weekly journals measured sociodemographic, relationship, reproductive, and mental health characteristics, sexual and contraceptive behaviors, and pregnancy history. We examined 27,130 surveys from 952 women during the first study year. Predictors of weekly sexual intercourse were moderate to severe stress (Perceived Stress Scale-4) and depression (Center for Epidemiologic Studies Depression Scale-5) symptoms measured at baseline. Multilevel, mixed-effects logistic regression models estimated the relationships between stress and depression symptoms and the weekly odds of sexual intercourse while adjusting for covariate fixed effects and random woman effects. RESULTS Nearly a quarter of the sample had moderate to severe stress (23%) and depression (24%) symptoms at baseline. Women reported sexual intercourse in 36% of weeks. Proportions of sexually active weeks were higher among women with stress (43%) and depression (40%) compared with those without symptoms (35% and 35%, respectively; P values<0.001). Controlling for covariates, women with baseline stress symptoms had 1.6 times higher weekly odds of sexual intercourse compared with women without stress (adjusted odds ratio 1.6, confidence interval [1.1, 2.5]; P=0.04). Depression symptoms were not associated with sexual intercourse frequency in adjusted models. CONCLUSIONS Stress symptoms were positively associated with sexual intercourse frequency among these young women. Research and practice efforts are needed to identify effective sexual health promotion and risk-reduction strategies, including contraceptive education and counseling, in the context of mental health symptoms and unintended pregnancy.

Pregnancy scares and subsequent unintended pregnancy

Background A substantial number of young women experience pregnancy scares – thinking they might be pregnant, and later discovering that they are not. Although pregnancy scares are distressing events, little is known about who experiences them and whether they are important to our understanding of unintended pregnancy. Objective We describe the young women who experience pregnancy scares, and examine the link between pregnancy scares and subsequent unintended pregnancy. Methods We used data from the Relationship Dynamics and Social Life Study. T-tests and regression analyses were conducted using baseline and weekly data to estimate relationships between respondent characteristics and subsequent pregnancy scares. Event history methods were used to assess pregnancy scares as a predictor of unintended pregnancy. Results Nine percent of the young women experienced a pregnancy scare during the study. African-American race, lack of two-parent family structure, lower GPA, cohabitation, and sex without birth control prior to the study are associated with experiencing a pregnancy scare and with experiencing a greater number of pregnancy scares. Further, experiencing a pregnancy scare is strongly associated with subsequent unintended pregnancy, independent of background factors. Forty percent of the women who experienced a pregnancy scare subsequently had an unintended pregnancy during the study period, relative to only 11% of those who did not experience a pregnancy scare. Conclusions Young women from less advantaged backgrounds are more likely to experience a pregnancy scare, and pregnancy scares are often followed by an unintended pregnancy.

Young Women’s Relationships, Contraception and Unintended Pregnancy in the United States

In this chapter, we describe new research to investigate relationships, contraception and unintended pregnancies during the transition to adulthood. The Relationship Dynamics and Social Life (RDSL) study began with a 60-minute in-person interview about family background and current relationship characteristics. At the conclusion of the interview, respondents were enrolled in the journal-based portion of the study, which consisted of a 5-minute survey via web or phone and occurred weekly for 2.5 years. We begin by describing the prevalence and significance of unintended pregnancy in the United States and the limitations of past research on unintended pregnancy as background for our study. Then we describe the specific aims of our study and its design strengths. Next we provide a description of the young women in our sample, their relationships and their pregnancy intentions as of the baseline interview, as well as a summary of any changes across the weekly journals. Finally, we provide a summary of study findings that provide new insights into the contexts producing unintended pregnancies among young women. The results presented throughout the chapter are preliminary as data collection only recently ended in January 2012.

Mediation models of pregnancy desires and unplanned pregnancy in young, unmarried women

This paper examines the proposition that sexual and contraceptive behaviours mediate the relationship between the pregnancy desires of young, unmarried women and their having an unplanned pregnancy. The sample consisted of 854 18- to 19-year-old women living in Michigan, USA. First, the positive and negative pregnancy desires of these women were measured, as were the womens perceptions of the positive and negative desires of their sexual partners. Then the extent to which these four types of desires, as well as several types of interactions between them, prospectively predicted the occurrence of subsequent pregnancies were tested with logistic regression analyses, initially alone and then after the addition of several types of sexual and contraceptive mediator variables. The results demonstrated that four of the ten significant motivational predictors became non-significant following the introduction of the contraceptive mediator variables and that the predictive strength of the other six significant motivational predictors was substantially reduced by their introduction. A number of factors that may account for only a partial mediational effect in some models are discussed.

The Dynamics of Intimate Partner Violence and the Risk of Pregnancy during the Transition to Adulthood

Using a reproductive coercion framework, we investigate the role of intimate partner violence (IPV) in pregnancy during the transition to adulthood. We use two types of data from a population-based sample of 867 young women in a Michigan county: a 60-minute survey interview with 2.5 years of weekly follow-up surveys, and semi-structured interviews with a subsample of 40 pregnant women. The semi-structured interviews illustrate the violence women experienced. Discrete-time logit hazard models demonstrate that threats and physical assault are associated with higher pregnancy rates during ages 18 to 22. However, this holds only when the violence is recent; violence occurring more than a month earlier is not associated with higher pregnancy rates. These associations are independent of violent experiences with prior partners, which are also associated with higher pregnancy rates. Fixed-effects models show that during violent weeks, women perceive more pregnancy desire from their partners, have more sex, and use less contraception than during nonviolent weeks. Finally, mediation analyses and the semi-structured interviews are consistent with reproductive coercion: violent young men are more likely to want their girlfriends pregnant, and they use threats and physical assault to implement their preferences via sex and contraceptive non-use, which in turn increase pregnancy rates.