Skip to main content

Advertisement

SpringerLink
Log in

Structural Inequity and Pregnancy Desires in Emerging Adulthood

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18–24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the “Things Will Be Different Later” theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the “I Don’t Have Everything I Need” theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the “I’ll Never Have Everything I Need” theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Level of social advantage was largely the same within couples; only within four couples were participants classified as having different levels of social advantage.

References

  • Aiken, A. R. A., Borrero, S., Callegari, L. S., & Dehlendorf, C. (2016). Rethinking the pregnancy planning paradigm: Unintended conceptions or unrepresentative concepts? Perspectives on Sexual and Reproductive Health, 48(3), 147–151.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aiken, A. R. A., Dillaway, C., & Mevs-Korff, N. (2015). A blessing I can’t afford: Factors underlying the paradox of happiness about unintended pregnancy. Social Science and Medicine, 132, 149–155.

    Article  PubMed  Google Scholar 

  • Arnett, J. J. (2014). Emerging adulthood: The winding road from the late teens through the twenties (2nd ed.). Oxford, England: Oxford University Press.

    Book  Google Scholar 

  • Arteaga, S., Caton, L., & Gómez, A. M. (2019). Planned, unplanned and in-between: The meaning and context of pregnancy planning for young people. Contraception, 99(1), 16–21.

    Article  PubMed  Google Scholar 

  • Becker, D., & Tsui, A. O. (2008). Reproductive health service preferences and perceptions of quality among low-income women: Racial, ethnic and language group differences. Perspectives on Sexual and Reproductive Health, 40(4), 202–211.

    Article  PubMed  Google Scholar 

  • Bell, M. C., Edin, K., Wood, H. M., & Mondé, G. C. (2018). Relationship repertoires, the price of parenthood, and the costs of contraception. Social Service Review, 92(3), 313–348.

    Article  Google Scholar 

  • Benkert, R., Hollie, B., Nordstrom, C. K., Wickson, B., & Bins-Emerick, L. (2009). Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners. Journal of Nursing Scholarship, 41(2), 211–219.

    Article  PubMed  Google Scholar 

  • Bird, S. T., & Bogart, L. M. (2001). Perceived race-based and socioeconomic status (SES)-based discrimination in interactions with health care providers. Ethnicity and Disease, 11(3), 554–563.

    PubMed  Google Scholar 

  • Borrero, S., Nikolajski, C., Steinberg, J. R., Freedman, L., Akers, A. Y., Ibrahim, S., & Schwarz, E. B. (2015). “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception, 91(2), 150–156.

    Article  PubMed  Google Scholar 

  • Callegari, L. S., Aiken, A. R. A., Dehlendorf, C., Cason, P., & Borrero, S. (2017). Addressing potential pitfalls of reproductive life planning with patient-centered counseling. American Journal of Obstetrics and Gynecology, 216(2), 129–134.

    Article  PubMed  Google Scholar 

  • Carpenter, E., Everett, B. G., Greene, M. Z., Haider, S., Hendrick, C. E., & Higgins, J. A. (2020). Pregnancy (im)possibilities: Identifying factors that influence sexual minority women’s pregnancy desires. Social Work in Health Care, 59(3), 180–198.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carter, M., Kraft, J. M., Hock-Long, L., & Hatfield-Timajchy, K. (2013). Relationship characteristics and feelings about pregnancy among Black and Puerto Rican young adults. Perspectives on Sexual and Reproductive Health, 45(3), 148–156.

    Article  PubMed  PubMed Central  Google Scholar 

  • Casares, W. N., Lahiff, M., Eskenazi, B., & Halpern-Felsher, B. L. (2010). Unpredicted trajectories: The relationship between race/ethnicity, pregnancy during adolescence, and young women’s outcomes. Journal of Adolescent Health, 47(2), 143–150.

    Article  Google Scholar 

  • Daniels, K., & Abma, J. C. (2018). Current contraceptive status among women aged 15–49: United States, 2015–2017. Retrieved January 27, 2019, from https://www.cdc.gov/nchs/products/databriefs/db327.htm.

  • Diaz, C. J., & Fiel, J. E. (2016). The effect(s) of teen pregnancy: Reconciling theory, methods, and findings. Demography, 53(1), 85–116.

    Article  PubMed  Google Scholar 

  • Downey, M. M., & Gómez, A. M. (2018). Structural competency and reproductive health. AMA Journal of Ethics, 20(3), 211–223.

    Article  PubMed  Google Scholar 

  • Downing, R. A., LaVeist, T. A., & Bullock, H. E. (2007). Intersections of ethnicity and social class in provider advice regarding reproductive health. American Journal of Public Health, 97(10), 1803–1807.

    Article  PubMed  PubMed Central  Google Scholar 

  • Edin, K., & Kefalas, M. (2005). Promises I can keep: Why poor women put motherhood before marriage. Berkeley, CA: University of California Press.

    Google Scholar 

  • Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773–1778.

    Article  PubMed  PubMed Central  Google Scholar 

  • Geronimus, A. T. (2003). Damned if you do: Culture, identity, privilege, and teenage childbearing in the United States. Social Science and Medicine, 57(5), 881–893.

    Article  PubMed  Google Scholar 

  • Gibson-Davis, C. M., Edin, K., & McLanahan, S. (2005). High hopes but even higher expectations: The retreat from marriage among low-income couples. Journal of Marriage and Family, 67(5), 1301–1312.

    Article  Google Scholar 

  • Gómez, A. M., Arteaga, S., Aronson, N., Goodkind, M., Houston, L., & West, E. (2020). No perfect method: Exploring how past contraceptive methods influence current attitudes toward intrauterine devices. Archives of Sexual Behavior, 49, 1367–1378.

    Article  PubMed  Google Scholar 

  • Gómez, A. M., Arteaga, S., Ingraham, N., Arcara, J., & Villaseñor, E. (2018a). It’s not planned, but is it okay? The acceptability of unplanned pregnancy among young people. Women’s Health Issues, 28(5), 408–414.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gómez, A. M., Arteaga, S., Villaseñor, E., Arcara, J., & Freihart, B. (2019). The misclassification of ambivalence in pregnancy intentions: A mixed-methods analysis. Perspect Sex Reprod Health, 51(1), 7–15.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gómez, A. M., Mann, E. S., & Torres, V. (2018b). “It would have control over me instead of me having control”: Intrauterine devices and the meaning of reproductive freedom. Critical Public Health, 28(2), 190–200.

    Article  Google Scholar 

  • Gómez, A. M., & Wapman, M. (2017). Under (implicit) pressure: Young Black and Latina women’s perceptions of contraceptive care. Contraception, 96(4), 221–226.

    Article  PubMed  Google Scholar 

  • Gubrium, A. C., Mann, E. S., Borrero, S., Dehlendorf, C., Fields, J., Geronimus, A. T., … Luker, K. (2016). Realizing reproductive health equity needs more than long-acting reversible contraception (LARC). American Journal of Public Health, 106, 18–19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guttmacher Institute. (2016). Fact sheet: Unintended pregnancy in the United States. Retrieved September 23, 2018, from https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html#6.

  • Haider, S., Stoffel, C., Donenberg, G., & Geller, S. (2013). Reproductive health disparities: A focus on family planning and prevention among minority women and adolescents. Global Advances in Health and Medicine, 2(5), 94–99.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haskins, R. (2013). Three simple rules poor teens should follow to join the middle class. Retrieved August 21, 2020, from https://www.brookings.edu/opinions/three-simple-rules-poor-teens-should-follow-to-join-the-middle-class/.

  • Hofferth, S. L., Reid, L., & Mott, F. L. (2001). The effects of early childbearing on schooling over time. Family Planning Perspectives, 33(6), 259–267.

    Article  PubMed  Google Scholar 

  • Jackson, A. V., Karasek, D., Dehlendorf, C., & Foster, D. G. (2016). Racial and ethnic differences in women’s preferences for features of contraceptive methods. Contraception, 93(5), 406–411.

    Article  PubMed  Google Scholar 

  • Jones, R. K., Frohwirth, L. F., & Blades, N. M. (2016). “If I know I am on the pill and I get pregnant, it’s an act of God”: Women’s views on fatalism, agency and pregnancy. Contraception, 93(6), 551–555.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jones, C. P., Jones, C. Y., Perry, G. S., Barclay, G., & Jones, C. A. (2009). Addressing the social determinants of children’s health: A cliff analogy. Journal of Health Care for the Poor and Underserved, 20(4A), 1–12.

    Article  PubMed  Google Scholar 

  • Kavanaugh, M. L., & Jerman, J. (2018). Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014. Contraception, 97(1), 14–21.

    Article  PubMed  Google Scholar 

  • Kavanaugh, M. L., Kost, K., Frohwirth, L., Maddow-Zimet, I., & Gor, V. (2017). Parents’ experience of unintended childbearing: A qualitative study of factors that mitigate or exacerbate effects. Social Science and Medicine, 174, 133–141.

    Article  PubMed  Google Scholar 

  • Kaye, K., Suellentrop, K., & Sloup, C. (2009). The fog zone: How misperceptions, magical thinking, and ambivalence put young adults at risk for unplanned pregnancy. Retrieved August 21, 2020, from https://powertodecide.org/what-we-do/information/resource-library/fog-zone.

  • Kendall, C., Afable-Munsuz, A., Speizer, I., Avery, A., Schmidt, N., & Santelli, J. (2005). Understanding pregnancy in a population of inner-city women in New Orleans—results of qualitative research. Social Science and Medicine, 60(2), 297–311.

    Article  PubMed  Google Scholar 

  • Klein, J. D., & American Academy of Pediatrics Committee on Adolescence. (2005). Adolescent pregnancy: Current trends and issues. Pediatrics, 116(1), 281–286.

    Article  PubMed  Google Scholar 

  • Luna, Z., & Luker, K. (2013). Reproductive justice. Annual Review of Law and Social Science, 9(1), 327–352.

    Article  Google Scholar 

  • Lyons, S., Arcara, J., Deardorff, J., & Gómez, A. M. (2018). Financial strain and contraceptive use among women in the United States: Differential effects by age. Women’s Health Issues, 29(2), 153–160.

    Article  Google Scholar 

  • Maietta, R. C. (2006). State of the art: Integrating software with qualitative analysis. In L. Curry, R. Shield, & T. Wetle (Eds.), Improving aging and public health research: Qualitative and mixed methods (pp. 117–139). Washington, DC: American Public Health Association and the Gerontological Society of America.

    Google Scholar 

  • Miles, M. B., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis: A methods sourcebook. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Minnis, A. M., Marchi, K., Ralph, L., Biggs, M. A., Combellick, S., Arons, A., … Braveman, P. (2013). Limited socioeconomic opportunities and Latina teen childbearing: A qualitative study of family and structural factors affecting future expectations. Journal of Immigrant and Minority Health, 15(2), 334–340.

    Article  PubMed  PubMed Central  Google Scholar 

  • National Academies of Sciences, E., & Medicine. (2017). Communities in action: Pathways to health equity. Washington, DC: National Academies Press.

  • Reeves, R., Rodrigue, E., & Gold, A. (2015). Following the success sequence? Success is more likely if you’re white. Retrieved September 7, 2020, from https://www.brookings.edu/research/following-the-success-sequence-success-is-more-likely-if-youre-white.

  • Roberts, D. (1997). Killing the Black body: Race, reproduction, and the meaning of liberty. New York: Pantheon Books.

    Google Scholar 

  • Ross, L., & Solinger, R. (2017). Reproductive justice: An introduction. Berkeley, CA: University of California Press.

    Google Scholar 

  • Saldaña, J. (2016). The coding manual for qualitative researchers (3rd ed.). Los Angeles, CA: Sage.

    Google Scholar 

  • Sawhill, I. V. (2014). Generation unbound: Drifting into sex and parenthood without marriage. Washington, DC: Brookings Institution Press.

    Google Scholar 

  • Sedgh, G., Finer, L. B., Bankole, A., Eilers, M. A., & Singh, S. (2015). Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health, 56(2), 223–230.

    Article  Google Scholar 

  • Sisson, G. (2012). Finding a way to offer something more: Reframing teen pregnancy prevention. Sexuality Research and Social Policy, 9(1), 57–69.

    Article  Google Scholar 

  • Sorkin, D. H., Ngo-Metzger, Q., & De Alba, I. (2010). Racial/ethnic discrimination in health care: Impact on perceived quality of care. Journal of General Internal Medicine, 25(5), 390–396.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stevens, L. M. (2015). Planning parenthood: Health care providers’ perspectives on pregnancy intention, readiness, and family planning. Social Science and Medicine, 139, 44–52.

    Article  PubMed  Google Scholar 

  • Svedberg, P., Nygren, J. M., Staland-Nyman, C., & Nyholm, M. (2016). The validity of socioeconomic status measures among adolescents based on self-reported information about parents occupations, FAS and perceived SES; implication for health related quality of life studies. BMC Medical Research Methodology, 16, 48. https://doi.org/10.1186/s12874-016-0148-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • U.S. Department of Health and Human Services. (2020). Healthy people 2030: Reduce the proportion of unintended pregnancies—fp-01. Retrieved September 18, 2020, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/family-planning/reduce-proportion-unintended-pregnancies-fp-01.

  • Washington, H. A. (2006). The Black stork. In Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present (pp. 189–215). New York: First Anchor Books (Broadway Books).

  • Wilde, E. T., Batchelder, L., & Ellwood, D. T. (2010). The mommy track divides: The impact of childbearing on wages of women of differing skill levels (No. W16582). Cambridge, MA: National Bureau of Economic Research.

  • Wise, A., Geronimus, A. T., & Smock, P. J. (2017). The best of intentions: A structural analysis of the association between socioeconomic disadvantage and unintended pregnancy in a sample of mothers from the National Longitudinal Survey of Youth (1979). Women’s Health Issues, 27(1), 5–13.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2010). A conceptual framework for action on the social determinants of health (9241500859). Retrieved September 18, 2020, from https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf.

  • Wright, K. Q. (2020). Contraceptive selection and practice: Associations with self-identified race and socioeconomic disadvantage. Social Science & Medicine, 266. https://doi.org/10.1016/j.socscimed.2020.113366.

  • Yee, L. M., & Simon, M. A. (2011). Perceptions of coercion, discrimination and other negative experiences in postpartum contraceptive counseling for low-income minority women. Journal of Health Care for the Poor and Underserved, 22(4), 1387–1400.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Research reported in this publication was supported by the Berkeley Population Center and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Numbers R00HD070874 and R24HD073964. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors extend their thanks to Elodia Villaseñor, Jennet Arcara, Miguel Alcala, Elizabeth Gonzalez, Natalie Ingraham, Marlene Meza, Kylie Mulvaney, Josué Meléndez Rodríguez, and Bill Stewart for their work interviewing participants and supporting data analysis. Additionally, we thank Krystale Littlejohn, Zakiya Luna, Lakisha Simmons, Ariana Bennett, Maggie Downey, Cristina Gomez-Vidal, and Allen Ratliff for providing feedback on this analysis and article.

Author information

Authors and Affiliations

  1. Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA

    Anu Manchikanti Gomez, Stephanie Arteaga & Bridget Freihart

Authors
  1. Anu Manchikanti Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Arteaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bridget Freihart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anu Manchikanti Gomez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The Committee for the Protection of Human Subject at the University of California, Berkeley approved the study protocol. 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 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomez, A.M., Arteaga, S. & Freihart, B. Structural Inequity and Pregnancy Desires in Emerging Adulthood. Arch Sex Behav 50, 2447–2458 (2021). https://doi.org/10.1007/s10508-020-01854-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-020-01854-0

Keywords

Search

Navigation