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A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women

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Abstract

Background

Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women’s multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior.

Methods

We used mixed methods to examine women’s perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18–29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data.

Results

Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that’s on you; Motherhood means everything; and Make sure you're stable. Women’s qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior.

Conclusion

The incongruities between women’s ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women’s pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

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Acknowledgments

Research reported in this manuscript was supported by the National Institute of Mental Health (T32MH20014), the National Institute of Child Health and Human Development (T32HD064428), and the National Center for Research Resources (TL1RR025007) of the National Institutes of Health. It was also supported by the Ellen Levi Zamoiski Doctoral Fellowship.

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Authors and Affiliations

  1. College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA

    Mary T. Paterno

  2. Division of Epidemiology and Biostatistics, Georgia State University, School of Public Health, Atlanta, GA, USA

    Matthew J. Hayat

  3. School of Nursing, Johns Hopkins University, Baltimore, MD, USA

    Jennifer Wenzel & Jacquelyn C. Campbell

Authors
  1. Mary T. Paterno
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  2. Matthew J. Hayat
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  3. Jennifer Wenzel
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  4. Jacquelyn C. Campbell
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Corresponding author

Correspondence to Mary T. Paterno.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Paterno, M.T., Hayat, M.J., Wenzel, J. et al. A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women. J. Racial and Ethnic Health Disparities 4, 184–194 (2017). https://doi.org/10.1007/s40615-016-0217-0

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  • DOI: https://doi.org/10.1007/s40615-016-0217-0

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