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Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power

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Abstract

Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15–21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.

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Abbreviations

NSFG:

National Survey of Family Growth

Yc-PCR:

Test for Y-chromosome using polymerase chain reaction

IQR:

Interquartile range

IRR:

incidence rate ratio

CI:

confidence interval

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Acknowledgments

This research was funded by T-32 AI050056 from the Sexually Transmitted Diseases Division of the Centers for Disease Control and Prevention (Dr. Zenilman), the Eunice Kennedy Shriver National Center for Child Health and Human Development grant R24-HD041041 (Maryland Population Research Center), and the School of Public Health at SUNY Downstate Medical Center. The data collection was funded by R01 MH061210 from the Center for Mental Health Research on AIDS, National Institute of Mental Health, Bethesda, MD (Drs. DiClemente and Wingood).

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Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Janet E. Rosenbaum

  2. Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Jonathan Zenilman

  3. Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Eve Rose, Gina Wingood & Ralph DiClemente

Authors
  1. Janet E. Rosenbaum
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  2. Jonathan Zenilman
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  3. Eve Rose
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  4. Gina Wingood
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  5. Ralph DiClemente
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Corresponding author

Correspondence to Janet E. Rosenbaum.

Appendix

Appendix

Table 6 Measures of unprotected sex: time period (14 days, 60 days, or last sex), definition, and bivariate analysis between each unprotected sex measure and pregnancy at the subsequent wave
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Rosenbaum, J.E., Zenilman, J., Rose, E. et al. Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power. J Urban Health 93, 493–510 (2016). https://doi.org/10.1007/s11524-016-0047-8

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