Jane Mauldon

The Effect of Marital Disruption on Children's Health

This study uses retrospective illness histories to investigate whether children’s health deteriorates after parental separation. Separation is associated with illness in a multivariate cross-sectional analysis as well as in an analysis of a sample of disrupted children only, in which illness rates before and after separation are compared. Three explanations are hypothesized: (1) divorce reduces the resources available to children, (2) the stress of divorce depletes children’s health, and (3) frailer children are selected into divorce. The first hypothesis has stronger support than the second, but the data are too poor for a rigorous test of either. The selection hypothesis is not supported.

Informed Policy Making for the Prevention of Unwanted Pregnancy Understanding Low-Income Women's Experiences With Family Planning

California health and welfare officials asked the authors to identify ways that their programs could encourage service use among low-income women. The project posed a challenge: The clients wanted to identify supply-side barriers amenable to intervention, but prior research suggested other factors might be more influential. The approach was to examine service-related issues, but in the broader context of womens experiences. The authors identify factors amenable to intervention, including inaccurate beliefs about methods. Other important influences—such as instability of relationships, skepticism about planning, or unsatisfactory method experiences—may be beyond the reach of specific policies, but are nevertheless critical to understanding program context. Findings suggest that punitive messages and policies based on a simplistic model of behavior may be unrealistic and ineffective.

Effect of abortion vs. carrying to term on a woman's relationship with the man involved in the pregnancy.

CONTEXT When a woman who seeks an abortion cannot obtain one, having a child may reshape her relationship with the man involved in the pregnancy. No research has compared how relationship trajectories are affected by different outcomes of an unwanted pregnancy. METHODS Data from the Turnaway Study, a prospective longitudinal study of women who sought abortion in 2008-2010 at one of 30 U.S. facilities, are used to assess relationships over two years among 862 women who had abortions or were denied them because they had passed the facilitys gestational age limit. Mixed-effects models analyze effects of abortion or birth on womens relationships with the men involved. RESULTS At conception, most women (80%) were in romantic relationships with the men involved. One week after seeking abortion, 61% were; two years later, 37% were. Compared with women who obtained an abortion near the facilitys gestational age limit, women who gave birth had greater odds of having ongoing contact with the man (odds ratio at two years, 1.7). The odds of romantic involvement at two years did not differ by group; however, the decline in romantic involvement was initially slower among those giving birth. Relationship quality did not differ between groups. CONCLUSIONS Giving birth temporarily prolonged romantic relationships of women in this study; most romantic relationships ended soon, whether or not the woman had an abortion. However, giving birth increased the odds of nonromantic contact between women and the men involved throughout the ensuing two years.

Public perceptions about unplanned pregnancy

A nationally representative telephone survey in 1994 of 2,002 adults indicates that 60% believe that unplanned pregnancy is a very big problem in the United States, and virtually all (90%) say it is at least a somewhat big problem. Two-thirds mistakenly believe that a larger percentage of women have unplanned pregnancies now than 10 years ago. A decline in moral standards is cited by 89% of respondents as contributing very much or somewhat to the problem. Lack of education is mentioned as a significant factor by 87%, and 88% see any of three barriers to contraceptive use--knowledge about use, access or cost--as being important factors. Never-married women with children, women in general, low-income respondents, Hispanics and those aged 65 or older are the most likely to believe that barriers to contraceptive access contribute very much to unplanned pregnancy; they are especially likely to cite cost or an inability to obtain contraceptives.

Providing Subsidies and Incentives for Norplant, Sterilization and Other Contraception: Allowing Economic Theory to Inform Ethical Analysis

Policymakers use financial incentives to achieve a wide variety of public objectives from pollution reduction to the employment of welfare recipients. Combining insights from economic theory with lessons learned from actual implementation this article analyzes the implications of two such policies: first subsidizing contraception and second offering financial incentives to individuals for sterilization or for using a long-term semi-permanent method of contraception such as the Intra-Uterine Device (IUD) Depo-Provera or Norplant. These subsidy and incentive policies achieve their goals through a myriad of individuals who make their reproductive choices in response to particular costs and benefits. Such programs are ethically and politically controversial. In this paper I address the question of whether they can be justified either economically or ethically. The first section of this article presents an economic theory to assess whether a subsidy tax or incentive is economically efficient both generally and in the context of contraception. The second section discusses noneconomic rationales for the use of subsidies and incentives in family-planning programs: philanthropy eugenics and education. In the third section I present data from policy experiments and innovations to determine what are the actual impacts of subsidy and incentive programs. I then simulate the likely effects of three different policies: offering subsidized contraception to all low-income women offering incentives for Norplant use to welfare recipients and offering incentives for any long-acting birth control method to drug addicts. The fourth section considers the ethical and practical objections to incentive programs and the fifth section concludes the article. (authors)

Young Women's Contraceptive Decision Making: Do Preferences for Contraceptive Attributes Align with Method Choice?

CONTEXT Understanding how womens preferences for certain attributes of contraceptive methods relate to their method choice can inform the content of contraceptive counseling. METHODS Data from 715 women aged 18-29 who had ever used contraceptives were drawn from the 2009 National Survey of Reproductive and Contraceptive Knowledge. Chi-square tests and multivariable logistic regression analyses were used to examine how womens preferences for specific contraceptive attributes were related to their social and demographic characteristics and their current contraceptive choice. RESULTS The majority of women considered it extremely important for a method to be very effective at preventing pregnancy (79%) and to be effective at preventing HIV and STDs (67%); fewer than one-quarter felt similarly about a methods being hormone-free (22%). Women who felt it was quite or extremely important for a method to be very effective at preventing pregnancy were not more likely to use the most effective methods than were women who considered this attribute not at all or only slightly important. Women who considered it quite or extremely important for a method to be hormone-free were less likely than others to use hormonal methods (odds ratio, 0.4), and women who considered STD protection quite or extremely important had elevated odds of relying on condoms alone, rather than on an effective contraceptive method alone (3.6). CONCLUSIONS Most women desire a very effective method for pregnancy prevention, but it is unclear how this translates to their contraceptive use. The associations between womens preferred contraceptive attributes and method choice warrant further attention.