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The present study sought to determine if inequities exist in Hispanic women's pregnancy intentions and birth outcomes by metropolitan status. In the U.S. pregnancy intentions and birth outcomes of young Hispanic women are a significant public health problem as they are often overlooked on health issues such as pregnancy and childbirth. Data were from the 2015 to 2019 National Survey of Family Growth and focused on the first pregnancies of Hispanic women aged 18 to 24 years old who were not pregnant at the time of the interview and answered the nativity question. Multivariable multinomial regression was used to evaluate how metropolitan status affects pregnancy intentions and birth outcomes. Additionally, multivariable multinomial regression was used to evaluate how metropolitan status affects each pregnancy intention-birth outcome combination. There was no significant association solely between metropolitan status and pregnancy intention (i.e. unintended pregnancy). Metropolitan Hispanic women reported more miscarriages than live births. Hispanic women in the suburbs were more likely to miscarry during an intended pregnancy than those in urban. These findings can improve family planning services for rural women by identifying the specific factors that affect pregnancy intentions and developing targeted interventions to reduce unintended pregnancies.

Unplanned or unwanted pregnancies and births are linked to adverse maternal outcomes, but the extent to which such relationships hold for all racial/ethnic groups remains unknown. In this paper, I use large-scale data to estimate unadjusted and inverse propensity weighted associations between a five-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. I find substantial racial/ethnic variation. White and Hispanic mothers who reported that their pregnancies were mistimed, unwanted, or that they were unsure how they felt were significantly more likely to experience adverse outcomes than same-race/ethnicity mothers who reported that their pregnancy was intended, but the pattern was much more tenuous for Black mothers. After adjusting for potential confounding variables, relationships between pregnancy intentions and adverse outcomes remain substantial only for white and Hispanic mothers., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Scant research has examined latent and contextual dimensions of pregnancy intentions, conventionally classifying unintended pregnancies as mistimed (wanted later) or unwanted (not wanted at all). Being at risk of mistimed pregnancy likely encompasses a broad spectrum of emotions and expectations regarding pregnancy and merits further exploration., Method: Using a national sample from GfK's online KnowledgePanel of women aged 15-39 considered at risk of mistimed pregnancy in 2017 (n = 1278), we conducted a latent class analysis to assess underlying patterns of current pregnancy orientation using three items: pregnancy desire, pregnancy acceptability, and expected pregnancy resolution. As class structure varied by relationship status (serious or not), we stratified analyses by relationship status., Results: Among women in serious relationships, three classes emerged: "No," "Slightly okay," and "Acceptable." For those not in serious relationships, there were two classes: "Strong no" and "Ambiguous." Overall, the classes indicate varied patterns of wantedness, acceptability, and anticipated resolution to potential pregnancy., Conclusions: This analysis reinforces that the construct of mistimed pregnancy is too restrictive to reflect the inherent diversity of prospective pregnancy orientation. The combination of relationship type as a grouping variable for stratified analyses, financial hardships' impact, and the overall effect of increasing age on increasing interest in pregnancy suggest the importance of locating pregnancy intentions within the broader reproductive life course. Scholars, clinicians, and public health programs should allow for multidimensionality of pregnancy perspectives, locate them within the broader life course, and acknowledge the potential impacts of stratified relationship formation on eventual pregnancy intentions., (© 2022 University of Ottawa.)

Sexual minority women (SMW) face both increased risk for unintended pregnancy and barriers to achieving wanted pregnancy, but little research investigates SMW's pregnancy desires. To fill this gap, we conducted five focus groups and 11 in-depth interviews with 20-30-year-old SMW in three US cities. Findings highlight that the heteronormative pregnancy planning paradigm lacks salience for SMW. While some SMW clearly wish to avoid pregnancy, many others are unsure, and factors influencing this uncertainty include relationship context, anticipating logistical barriers, and discord between queer identity and pregnancy.

Background: With the high rates of unintended pregnancy and associated maternal morbidity and mortality in the United States, particularly among poor and minority women, it is imperative that all individuals have information about and access to long-acting reversible contraception (LARC) methods in the immediate postpartum period., Objective: The creation of a framework to provide guidance, address barriers, and dispel myths associated with the implementation of an immediate postpartum LARC program., Methods: A multistep approach to develop a framework to guide planning and implementation of an immediate postpartum LARC program. A literature review, telephone and e-mail interviews with clinical experts involved with successful implementation of immediate postpartum LARC programs, development of a list of interdisciplinary specialists, and steps required to initiate a change in current practice., Results: The provision of a framework to guide the planning and implementation of an immediate postpartum LARC program to streamline the process while addressing perceived barriers and myths., Conclusions: Addressing the lack of knowledge about LARCs, financial concerns, and absence of a standardized framework related to planning and implementation of this complex process will hopefully begin the process of making effective and reliable contraception available., Implications for Nursing: The use of a standardized framework to guide the implementation of an immediate postpartum LARC program provides the potential for easier access to LARC methods in this critical time period., (© Copyright 2020 Springer Publishing Company, LLC.)

The US Latino/a population is considered to be at high risk for unintended pregnancy; some research indicates that Latino/a parents are more likely to express happiness about an unintended pregnancy than other racial/ethnic groups. Associations between pregnancy attitudes and factors such as religiosity and nativity have also been documented in the Latino/a population, but existing research is sparse, dated and primarily focused on women of Mexican heritage. This study sought to expand this literature by examining the relationship between religiosity and pregnancy acceptability and assessing effect modification by generational status and gender in a national sample of young Latino/a cisgender women and men of various ancestral backgrounds currently in relationships. In multivariable logistic regression models, there was a positive association between importance of religion and pregnancy acceptability for both men and women; being highly or moderately religious was associated with elevated odds of finding a pregnancy acceptable. Effect modification by generational status was significant for women, but not for men. Results suggest that religiosity, gender and generational status have differential influences on and relationships to pregnancy orientations for Latina women and Latino men and should be considered in the design and delivery of family planning care for Latino/a clients.

Compared with their heterosexual peers, sexual minority women (SMW; e.g., queer, bisexual, lesbian, pansexual) have an elevated risk for unintended pregnancy.A team of social science and clinical researchers qualitatively documented the multilevel pathways leading to this disparity, particularly the contexts of contraceptive use. From August 2017 to April 2018, we conducted focus groups and interviews with young adult cisgender SMW in 3 cities: Chicago, Illinois; Madison, Wisconsin; and Salt Lake City, Utah.Most participants reported experience with both penile-vaginal intercourse and contraception. However, they faced several queer-specific barriers to preventing unwanted pregnancy, including a comparative lack of self-concept as contraceptive users, fear of stigma from both queer and health care communities, use of less-effective methods because of infrequent penile-vaginal intercourse and a sense that longer-acting methods were "overkill," and previous experiences of discrimination such as homophobia and gender-based violence. However, participants also reported ways that contraception could align with queer identity, including both taking advantage of noncontraceptive benefits and framing contraception as sex- and queer-positive. These facilitators can inform future efforts to help SMW better meet their pregnancy prevention needs.

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8 years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

Objectives: To understand how having or being denied an abortion affects the likelihood of trying to become pregnant, overall pregnancy rates, and the rate and timing of an intended pregnancy in the future., Study Design: The Turnaway Study is a prospective cohort study of women who received or were denied a wanted abortion. Women were recruited from one of 30 US abortion facilities. We examined subsequent intended pregnancy among those who presented just under the facility's gestational limit and received an abortion (Near-Limit Abortion Group, n=413) and those who presented for abortion just beyond the facility's gestational limit, were denied an abortion and went on to parent the child (Parenting Turnaways, n=146). First, we modeled the probability of trying to become pregnant using multivariable mixed-effects logistic regression. We then used Cox proportional-hazards models to compare overall pregnancy rates and intended pregnancy rates over 5 years., Results: Parenting Turnaways had lower predicted probabilities of reporting trying to become pregnant in the first 1.5 years after birth/abortion than the Near-Limit Abortion Group. They also had lower pregnancy rates overall [40.4 per 100 woman-years vs. 53.5 per 100 woman-years, adjusted hazards ratio (aHR)=0.69, 95% confidence interval (CI): 0.54-0.89]. The 5-year intended pregnancy rate was low among both groups, but compared to the Near-Limit Abortion Group, Parenting Turnaways had a lower intended pregnancy rate (2.2 per 100 woman-years vs. 7.5 per 100 woman-years, aHR=0.29, 95% CI: 0.10-0.85)., Conclusion: Being able to obtain a wanted abortion may enable women to have an intended pregnancy later., Implications: Ensuring that women can obtain an abortion for an unwanted pregnancy may enable them to have a subsequent pregnancy when they are ready to have a baby., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To examine the prevalence, correlates, and influences of male partner reproductive coercion (RC) and intimate partner violence (IPV) on unintended pregnancy (UIP)., Design: Retrospective cohort study using population-based data., Setting: Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS)., Participants: Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth., Methods: Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP., Results: Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors., Conclusion: In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP., (Copyright © 2019 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: This study examined the influences of information sources on Zika-relevant knowledge and behaviors in US households containing members who are pregnant, intend to become pregnant, or have a higher probability of unintended pregnancy in Zika-affected regions (i.e. respondents who are younger, are black, have less education, are unmarried, and reside in the southern USA)., Methods: Over 32 000 US adults completed a survey measuring Zika-relevant knowledge and behaviors along with information sources (e.g. discussing Zika with practitioners), general media usage (e.g. TV) and demographic information over 30 weeks., Results: Respondents in the group with (versus without) either pregnancy or intended pregnancy were more likely to use all information sources, which in turn created differences in knowledge and behavior responses. To gauge information sources in US-South respondents with a high probability of having a household member with unintended pregnancy based on demographics, younger, less-educated, unmarried, black respondents had fewer Zika discussion with practitioners than another group., Conclusions: Efforts to increase Zika-related knowledge and protective behaviors should target households with members who are pregnant or intending to become pregnant via practitioners, family and friends. Additional efforts should target information channels to reach younger, less educated, unmarried, black respondents, which are at risk for unintended pregnancy.

Objectives: In the United States, 45% of pregnancies continue to be unintended. Although many previous studies have focused on external barriers to contraceptive use such as cost or access, fewer studies have evaluated internal barriers such as individual characteristics. We hypothesize that high self-efficacy for contraception will be associated with use of more effective contraceptive methods., Study Design: The analytic sample is 861 privately insured Pennsylvania women aged 18 to 40 years not intending pregnancy for 12 months at enrollment. Contraceptive self-efficacy (high vs. low) was measured using an eight-item scale. The association of self-efficacy with prescription contraceptive use was determined using multivariable logistic regression adjusting for future pregnancy intention, history of unintended pregnancy, number of live births, non-White race, frequency of sexual intercourse, marital status, and age group., Results: Prescription contraceptive use was higher among those with high self-efficacy (adjusted odds ratio, 1.75; 95% confidence interval, 1.29-2.37)., Conclusions: Women with high self-efficacy for contraception had an increased use of prescription contraceptive methods compared with nonprescription methods. Strategies for encouraging effective contraceptive choices in women with low contraceptive self-efficacy should be further studied., (Copyright © 2018. Published by Elsevier Inc.)

Background: The lifetime prevalence of unintentional pregnancy among women enrolled in medically assisted treatment (MAT) for opioid use disorder (OUD) has been reported to exceed 80%. Consistent voluntary contraception use by women enrolled in MAT programs can reduce their risk of unintended pregnancies and increase their opportunity to plan the family size they want, yet little is understood about past and current contraception use or associated barriers and facilitators for this population of women., Materials and Methods: Women enrolled in treatment for OUD at two MAT clinics in East Tennessee were invited to participate in an anonymous survey about contraception. We describe the sociodemographic and health characteristics of the women (N = 287; estimated response rate of 81.0%), report on their contraception knowledge and attitudes, and assess how these characteristics are associated with current contraception use., Results: Most of the 287 women had been sexually active in the past 12 months (88%), were pregnant at least once (98%), and were insured (58%). Women having undergone bilateral tubal ligation had a greater average number of pregnancies (including those while on birth control), lower mean levels of depressed mood, and higher mean level of agreement that avoiding pregnancy now was important and that pregnant women should not use painkillers, compared to the women not using contraception., Conclusions: Strategies to ensure all women enrolled in MAT for OUD have knowledge of effective contraception and affordable, quality contraception care that is responsive to their complicated and oftentimes traumatic histories are necessary to enhance the women's reproductive health.

Introduction: Premenstrual, perinatal, and/or perimenopausal psychiatric problems require specific screening, assessment, and treatment strategies. The scope of these reproductive-linked psychiatric symptoms among women veterans is unknown. Due to high rates of sexual trauma among women veterans, it is also important to ascertain relationships between sexual trauma experiences and reproductive cycle mood problems. This pilot study investigates the prevalence of self-reported premenstrual, perinatal, and perimenopausal emotional problems and whether these correlate with pre-military sexual abuse, military sexual harassment, and/or military sexual assault, among veterans receiving psychiatric evaluations within a Veterans Administration Women's Health Clinic., Materials and Methods: Participants included all women veterans (N = 186) who received psychiatric evaluations within a Veterans Administration Women's Health Clinic over a 13-mo period. Evaluations included a clinical questionnaire, a psychiatric interview, and medical record review. De-identified data were extracted from a clinical data repository for this descriptive study., Results: High proportions of study participants reported emotional problems premenstrually (43.3%), during pregnancy (35.1%), postpartum (30.4%), or during perimenopause (31.2%). Unintended pregnancy (73.3% of pregnancies) and pregnancy loss (56.6% of women who had been pregnant) were prominent perinatal stressors. Military sexual harassment was significantly associated with emotional problems during pregnancy and postpartum., Conclusion: These pilot data suggest the need for further study of the reproductive mental health needs of women veterans and their relationship with sexual trauma. The findings underscore the need for Veterans Administration facilities and other providers of veterans' health care to be prepared to detect, diagnose, and treat premenstrual, perinatal, and perimenopausal mental health problems.

Objective: To investigate whether demographic, socioeconomic, and reproductive health characteristics affect long-acting reversible contraceptive (LARC) use differently by race-ethnicity. Results may inform the dialogue on racial pressure and bias in LARC promotion., Study Design: Data derived from the 2011-2013 and 2013-2015 National Surveys of Family Growth (NSFG). Our study sample included 9321 women aged 15-44. Logistic regression analyses predicted current LARC use (yes vs. no). We tested interaction terms between race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) and covariates (for example, education, parity, poverty level) to explore whether their effects on LARC use vary by race-ethnicity., Results: In the race-interactions model, data did not show that low income and education predict LARC use more strongly among Black and Hispanic women than among White women. There was just one statistically significant race-interaction: experience of unintended pregnancy (p=.014). Among Whites and Hispanics, women who reported ever experiencing an unintended pregnancy had a higher predicted probability of LARC use than those who did not. On the other hand, among Black women, the experience of unintended pregnancy was not associated with a higher predicted probability of LARC use., Conclusions: With the exception of the experience of unintended pregnancy, findings from this large, nationally representative sample of women suggest similar patterns in LARC use by race-ethnicity., Implications: Results from this analysis of NSFG data do not provide evidence that observed differences in LARC use by race-ethnicity represent socioeconomic disparities, and may assuage some concerns about reproductive coercion among women of color. Nevertheless, it is absolutely critical that providers use patient-centered approaches for contraceptive counseling that promote women's autonomy in their reproductive health care decision-making., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: High rates of sexually transmitted infections (STIs) and unintended pregnancy suggest a role for multipurpose prevention technologies (MPTs) designed to combine contraception and infection prophylaxis into one unified method. This study aims to determine factors associated with interest in MPTs among US women., Study Design: We administered a national cross-sectional survey via MTurk. Eligibility criteria included female gender, age 18-29 years, residence in the USA, and sexual activity with a male partner in the past three months. In total, 835 surveys were suitable for analysis. Bivariable and multivariable logistic regressions were performed to determine factors associated with interest in MPTs., Results: Eighty-three percent of women were interested in MPTs. Factors associated with interest included oral sex in the past three months (aOR 1.87, 95% CI 1.07, 3.53), recent use of oral contraceptive pills (OCPs; aOR 1.78, 95% CI 1.08, 2.93), HIV test within one year (aOR 2.10, 95% CI 1.29, 3.40), and increased STI worry score (aOR 1.98, 95% CI 1.36, 2.86). No use of contraception in the past three months was associated with decreased interest in MPTs (aOR 0.31, 95% CI 0.17, 0.58). HIV risk factors including race were not associated with MPT interest., Conclusion: Our data show that young, sexually active, US women are interested in MPTs. Women who used contraception, specifically OCPs, or evidenced concern for infection were most likely to be interested in such a product. Women reporting unsafe sexual habits were less likely to be interested, highlighting the importance of HIV/STI prevention education., Implications: Women in the USA are interested in multipurpose prevention technologies, particularly those women who currently use contraception or are concerned about their risk of infection. Our results emphasize the importance of moving forward with MPT development as well as continued HIV/STI prevention education., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: We investigated the influence of depression on subsequent risk of unintended pregnancy and social disparities within this relationship, during adolescence and young adulthood., Methods: Drawing upon 15-year, nationally representative data from 8,810 young U.S. women in the National Longitudinal Study of Adolescent to Adult Health, we estimated associations between depression and time to first pregnancies reported as unintended, overall and stratified by race/ethnicity, socioeconomic status, and age with Cox proportional hazard models., Results: Moderate/severe depression symptoms were associated with an increased risk of unintended first pregnancy (hazard ratio [HR], 1.21; confidence interval [CI], 1.02-1.44). In stratified models, depression increased the pregnancy risk for all minority groups (HRs, 1.36-3.25) but not white women. Depression increased the pregnancy risk for women with $0-$19,999 (HR, 1.48; CI, 1.11-1.98) and $20,000-$49,999 (HR, 1.33; CI, 1.05-1.68) income levels but not those at higher levels. Depression increased the pregnancy risk for adolescents <20 years (HR, 1.35; CI, 1.07-1.71) but decreased the risk for women >24 years (HR, .47; CI, .25-.86)., Conclusions: Findings may inform more equitable, holistic public health strategies that target depression as a modifiable risk factor for adverse reproductive outcomes during adolescence and young adulthood., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Significant racial/ethnic disparities in unintended pregnancy persist in the United States, with the highest rates observed among low-income black and Hispanic women. Differences in contraceptive preferences, beliefs, and self-efficacy may be instrumental in understanding contraceptive behaviors that underlie higher rates of unintended pregnancy among racial/ethnic minorities., Objectives: Our objective was to understand how contraceptive preferences, beliefs, and self-efficacy vary by race and ethnicity among women veterans., Study Design: We analyzed data from the Examining Contraceptive Use and Unmet Need Study, a national telephone survey of women veterans aged 18-44 years who had received primary care at the Veterans Administration in the prior 12 months. Participants rated the importance of various contraceptive characteristics and described their level of agreement with contraceptive beliefs using Likert scales. Contraceptive self-efficacy was assessed by asking participants to rate their certainty that they could use contraception consistently and as indicated over time using a Likert scale. Multivariable logistic regression was used to examine associations between race/ethnicity and contraceptive attitudes, controlling for age, marital status, education, income, religion, parity, deployment history, and history of medical and mental health conditions., Results: Among the 2302 women veterans who completed a survey, 52% were non-Hispanic white, 29% were non-Hispanic black, and 12% were Hispanic. In adjusted analyses, compared with whites, blacks had lower odds of considering contraceptive effectiveness extremely important (adjusted odds ratio; 0.55, 95% confidence interval, 0.40-0.74) and higher odds of considering the categories of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.94, 95% confidence interval, 1.56-2.41, and adjusted odds ratio; 1.99, 95% confidence interval, 1.57-2.51, respectively). Hispanics also had higher odds than whites of considering the category of does not contain any hormones and prevents sexually transmitted infections extremely important (adjusted odds ratio, 1.72, 95% confidence interval, 1.29-2.28, and adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19, respectively). Compared with whites, blacks and Hispanics had higher odds of expressing fatalistic beliefs about pregnancy (adjusted odds ratio, 1.79, 95% confidence interval, 1.35-2.39, and adjusted odds ratio, 1.48, 95% confidence interval, 1.01-2.17, respectively); higher odds of viewing contraception as primarily a woman's responsibility (adjusted odds ratio, 1.92, 95% confidence interval, 1.45-2.55, and adjusted odds ratio, 1.77; 95% confidence interval, 1.23-2.54, respectively); and lower odds of being very sure that they could use a contraceptive method as indicated over the course of a year (adjusted odds ratio, 0.73, 95% confidence interval, 0.54-0.98, and adjusted odds ratio, 0.66, 95% confidence interval, 0.46-0.96, respectively)., Conclusion: Women veterans' contraceptive preferences, beliefs, and self-efficacy varied by race/ethnicity, which may help explain observed racial/ethnic disparities in contraceptive use and unintended pregnancy. These differences underscore the need to elicit women's individual values and preferences when providing patient-centered contraceptive counseling., (Published by Elsevier Inc.)

Births resulting from an unintended pregnancy affect individuals differentially, and some may experience more negative consequences than others. In this study, we sought to describe the mechanisms through which the severity of effects may be mitigated or exacerbated. We conducted in-depth interviews with 35 women and 30 men, all with a youngest child born resulting from an unintended pregnancy, in two urban sites in the United States. Respondents described both negative and positive effects of the child's birth in the areas of school; work and finances; partner relationships; personal health and outlook on life trajectories. Mechanisms through which unintended pregnancies mitigated or exacerbated certain effects fell at the individual (e.g. lifestyle modification), interpersonal (e.g. partner support) and structural (e.g. workplace flexibility) levels. These qualitative findings deepen understanding of the impact of unintended childbearing on the lives of women, men and families., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Using U.S. Natality data for 1996 through 2009 and an event analysis specification, we investigate the dynamics of the effects of state insurance contraceptive mandates on births and measures of parental investment: prenatal visits, non-marital childbearing, and risky behaviors during pregnancy. We analyze outcomes separately by age, race, and ethnicity. Among young Hispanic women, we find a 4% decline in the birth rate. There is evidence of a decrease in births to single mothers, consistent with increased wantedness. We also find evidence of selection into motherhood, which could explain the lack of a significant effect on birth outcomes., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods., Study Design: We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions., Results: The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion., Conclusions: Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs., Implications: Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Increasing use of long-acting methods of contraception, such as intrauterine devices (IUDs), has been recognized as a promising strategy to reduce the incidence of unintended pregnancy. While men may play an important role in promoting or discouraging contraceptive use, very little research has examined men's knowledge of and attitudes toward IUDs., Study Design: We used data from the 903 men included in the 2009 National Survey of Reproductive and Contraceptive Knowledge to examine their awareness and knowledge of IUDs and other contraceptive methods by several individual-level characteristics., Results: Men's awareness and perceived knowledge of IUDs is low in comparison to condoms and birth control pills. Men's perceived knowledge of IUDs was lower than their objective knowledge, as measured by true/false questions about IUDs, suggesting that men may be more knowledgeable of IUDs than they perceive. In the multivariate models, men who were uninsured [adjusted odds ratio (AOR), 0.4; 95% confidence interval (CI), 0.2-0.6], identified as Christian (AOR, 0.6; 95% CI, 0.3-1.0) and who had never had a sexual health visit (AOR, 0.6; 95% CI, 0.4-1.0) were less likely to have heard of IUDs. Among men who had heard of the method, Hispanic men were less likely (AOR, 0.2; 95% CI, 0.1-0.5) to be more knowledgeable of the method., Conclusion: Young men report low awareness of IUDs in comparison to other methods, and this varies by demographic characteristics including health insurance status. Family planning programs should consider targeted knowledge promotion for young men, with a focus on contraceptive methods besides condoms and oral contraception., Implications: Male partners are influential in contraceptive use, yet little research has examined their IUD knowledge. Our findings indicate that healthcare providers may play important role in increasing young men's knowledge of contraceptive methods, including IUDs. This study highlights the need to better incorporate young men into contraception research and programs., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Context: Most studies of contraceptive behavior rely on cross-sectional data and are unable to adequately measure fluctuations in contraceptive use or changes in circumstances and attitudes that are likely to be associated with this outcome., Methods: Between November 2012 and May 2014, four waves of data were gathered from a national sample of 1,842 women aged 18-39 at baseline. Cross-tabulations were used to examine change and stability in time-varying characteristics theorized to be associated with consistent contraceptive use. Random-effects and fixed-effects logistic regression models were used to examine variables associated with consistent contraceptive use., Results: While a majority of women were at risk of unintended pregnancy during each survey period, only 42% were at risk during all four. Random-effects logistic regression analysis revealed that the odds of being a consistent contraceptive user were 10 times as high for a woman who expressed a strong pregnancy avoidance attitude as for a woman who had a weak attitude. This strong association was confirmed in the fixed-effects model. However, having a strong desire to avoid pregnancy was not static; among women at risk of unintended pregnancy during at least one survey period, 53% reported a change in attitude., Conclusions: These findings build on prior research suggesting that pregnancy avoidance attitudes are an important motivator for contraceptive use. It is critical to recognize that the context in which many women make decisions about pregnancy and contraceptive use changes over relatively short periods of time., (Copyright © 2015 by the Guttmacher Institute.)

Comprehensive transition planning by pediatric providers is essential for successful transition into adulthood and transfer to adult medical health care settings. Yet, little is known about the level and type of transition planning and preparation provided by pediatric primary care providers. This study examined the range of transition services provided in primary care pediatric centers. Primary care pediatricians across two states in the Midwest were mailed an anonymous survey designed to examine the transition practices of community pediatricians. A response rate of 38.4% was obtained. Most endorsed transferring patients to adult care at age 18 or older, and using patient chronological age, health status, and patient relationship with pediatric provider as criteria to gauge transfer time. About 60% of responders provide preparation to patients before transition, usually by providing a list of adult providers or by transferring medical records. Few responders provide additional type of transition or transfer planning. Many primary care pediatricians provide transition planning, yet there is high variability in the degree of transition planning provided and 40% of pediatricians provide no such support to their patients. Transition planning is also largely limited to providing referrals and transferring medical records. Study findings support the need for outreach efforts so that all youth receive the needed education and resources to successfully transition and transfer to adult health care.

Objective: To identify patterns of contraceptive use and pregnancy in an academic adult congenital cardiology practice., Methods: In this cross-sectional study, from October 2013 through March 2014, 100 women with congenital heart disease aged 18-45 years were recruited from an academic congenital heart disease clinic and administered a survey regarding pregnancy history, contraception use, and understanding of pregnancy-related and contraceptive-related risk. The primary outcome was current use of long-acting reversible contraception, including intrauterine devices or subdermal implants., Results: Of 83 sexually active women, 63 (75.9%, 95% confidence interval [CI] 65.3-85.1) reported currently using any contraceptive method, including 30 of 83 (36.1%, 95% CI 25.9-47.4) using tier I methods (typical-use failure rates of less than 1% per year) and 20 of 83 (24.1%, 95% CI 15.4-34.7) using tier II methods (typical-use failure rates of 6-12% per year). Nine of 83 (10.8%, 95% CI 5.1-19.6) reported currently using long-acting reversible contraception. Sixty-four of 141 total pregnancies (45.4%, 95% CI 31.9-58.9) were self-reported by participants as "unexpected" rather than "planned." Only one (1.6%, 95% CI 0-4.6) of the 64 unintended pregnancies occurred when the woman was using a tier I method of contraception at the time of conception., Conclusion: Most women with congenital heart disease of childbearing age are sexually active. The high incidence of unintended pregnancy in this group may be related to underuse of highly effective methods of contraception. Specific counseling on tier I methods may reduce unintended pregnancies in women with congenital heart disease., Level of Evidence: III.

Context: Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire., Methods: Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings., Results: The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness., Conclusions: Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods., (Copyright © 2015 by the Guttmacher Institute.)

Unintended pregnancy refers to unwanted, unplanned, or mistimed pregnancies. One-half of all pregnancies in the United States are unintended, and family physicians are often asked to provide counseling, support, and resources for women with unintended pregnancies. Options include carrying the infant to term and raising the child, carrying the infant to term and choosing adoption, or having an induced abortion. Family physicians should be equipped to direct women who choose to raise the infant to appropriate care and resources. Most U.S. women do not choose adoption, but there are multiple resources for women interested in this option. Physicians should not broker adoptions, match potential parents with mothers, or adopt children of their own patients. Induced abortion is performed in the first or second trimester of pregnancy. Medical management is comparable with surgical management, and both methods are safe and effective. Combination regimens with mifepristone and misoprostol are the most effective medical methods. Dilation and curettage and vacuum aspiration are the most common surgical methods.

Purpose: Prior research linking young women's mental health to family planning outcomes has often failed to consider their social circumstances and the intersecting biosocial mechanisms that shape stress and depression as well as reproductive outcomes during adolescence and young adulthood. We extend our previous work to investigate relationships between social discrimination, stress and depression symptoms, and unintended pregnancy among adolescent and young adult women., Methods: Data were drawn from 794 women aged 18-20 years in a longitudinal cohort study. Baseline and weekly surveys assessed psychosocial information including discrimination (Everyday Discrimination Scale), stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies-Depression Scale), and reproductive outcomes. Multilevel, mixed-effects logistic regression and discrete-time hazard models estimated associations between discrimination, mental health, and pregnancy. Baron and Kenny's method was used to test mediation effects of stress and depression on discrimination and pregnancy., Results: The mean discrimination score was 19/45 points; 20% reported moderate/high discrimination. Discrimination scores were higher among women with stress and depression symptoms versus those without symptoms (21 vs. 18 points for both, p < .001). Pregnancy rates (14% overall) were higher among women with moderate/high (23%) versus low (11%) discrimination (p < .001). Discrimination was associated with stress (adjusted relative risk ratio, [aRR], 2.2; 95% confidence interval [CI], 1.4-3.4), depression (aRR, 2.4; CI, 1.5-3.7), and subsequent pregnancy (aRR, 1.8; CI, 1.1-3.0). Stress and depression symptoms did not mediate discrimination's effect on pregnancy., Conclusions: Discrimination was associated with an increased risk of mental health symptoms and unintended pregnancy among these young women. The interactive social and biological influences on reproductive outcomes during adolescence and young adulthood warrant further study., (Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The premise that unintended childbearing has significant negative effects on the behavior of mothers and on the health of infants strongly influences public health policy and much of current research on reproductive behaviors. Yet, the evidence base presents mixed findings. Using data from the U.S. National Survey of Family Growth, we employ a measure of pregnancy intentions that incorporates the extent of mistiming, as well as the desire scale developed by Santelli et al. (Studies in Family Planning, 40, 87-100, 2009). Second, we examine variation in the characteristics of mothers within intention status groups. Third, we account for the association of mothers' background characteristics with their pregnancy intentions and with the outcomes by employing propensity score weighting. We find that weighting eliminated statistical significance of many observed associations of intention status with maternal behaviors and birth outcomes, but not all. Mistimed and unwanted births were still less likely to be recognized early in pregnancy than intended ones. Fewer unwanted births received early prenatal care or were breast-fed, and unwanted births were also more likely than intended births to be of low birth weight. Relative to births at the highest level of the desire scale, all other births were significantly less likely to be recognized early in pregnancy and to receive early prenatal care.

Unintended pregnancy among adult women is a significant public health challenge in the United States. Research has identified ambivalence as a risk factor for not using contraceptives. The qualitative study presented here examined women's narratives about ambivalence toward unintended pregnancy. In-depth interviews were conducted in 2012 with 28 women aged 20-45 years old who were recruited primarily via flyers in family planning clinics in a rural, Midwestern state. The interviews were coded for salient themes. Almost 40 percent of the women said that they had experienced an unintended pregnancy. All but two women expressed ambivalence, stating that they had both good and bad feelings about getting pregnant unintentionally. Women expressed if a pregnancy did occur, they would just have to step up and "deal with it." They recognized a baby was something special but not without negative aspects. Those who were less ambivalent (and more negative) had compelling reasons why, but even those women expressed some positive feelings. At times, ambivalence was expressed by negative reactions about having a child that coincided with believing that becoming a parent or having another child would have a positive impact on themselves. This study provides an examination of women's narratives about ambivalence toward pregnancy. Overall, women's narratives constructed ambivalence as arising from both positive and negative emotions, as well as beliefs about costs and benefits, associated with unintended pregnancy. Given its association with a lack of contraceptive use, understanding the components of ambivalence (e.g., feelings, beliefs) is important to bolstering interventions aimed toward decreasing ambivalence and increasing contraceptive use.

Objective: To develop and test a comprehensive tool for measuring women's attitudes toward the possibility of becoming pregnant., Design: Cross-sectional mixed methods study., Setting: Two obstetric/gynecologic (OB/GYN) clinics and one family planning clinic in Baltimore, Maryland., Participants: One-hundred thirty (130) nonpregnant, primarily African American women (84%) age 18 to 29., Methods: Participants completed a computer-based survey as part of a larger retrospective mixed-methods study. The Attitude Toward Potential Pregnancy Scale (APPS) was assessed using exploratory factor analysis and hypothesis testing., Results: Cronbach's alpha for internal consistency for the APPS was 0.86. Item-total correlations ranged from 0.56 to 0.75. All items loaded on one factor. Support for construct validity was demonstrated using logistic regression, where the odds of being a highly effective contraceptive user decreased by 8% with each one-point increase in score on the APPS (odds ratio = 0.92; confidence interval [0.87, 0.98])., Conclusions: This study provides support for reliability and validity of the APPS. The APPS may be a useful tool for understanding pregnancy attitude in future studies and in clinical practice. Further research is needed to assess the usefulness of the scale with other groups of women, its utility in the clinical practice setting, and its potential predictive validity for unintended pregnancy., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Unintended birth and mental health are major public health problems in the United States. To date, little research has examined the relationship between depressive symptoms and unintended births, and no research has examined this relationship among men. Data from the National Longitudinal Survey of Adolescent Health (N = 14,271) were used to examine the relationship between depressive symptoms among females and males in adolescence and unintended first birth in emerging adulthood. Respondents who reported higher levels of depressive symptoms in adolescence were more likely to report an unintended birth (OR 1.93, p < 0.001) compared with respondents who did not have children. They were also more likely to report an unintended birth compared with respondents who had an intended birth (OR 1.28, p < 0.05). The relationship between adolescent depressive symptoms and unintended birth remained significant, controlling for background variables, and it did not differ by gender. Adolescent depressive symptoms are associated with unintended birth in emerging adulthood. Thus, policies designed to treat depressive symptoms in adolescence may be effective in reducing unintended pregnancy among young adults.

Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report., (Copyright © 2014 by the American Academy of Pediatrics.)

Substance use among adolescents increases the risk of unplanned pregnancies, which then increases the risk of fetal exposure to addictive, teratogenic substances. Specific interventions are necessary to target pregnancy planning and contraception among reproductive-age substance users. Screening for substance use using the CRAFFT is recommended in all health care settings treating adolescent patients. Screening for tobacco and nicotine use is also recommended along with the provision of smoking cessation interventions. Using motivational interviewing style and strategies is recommended to engage adolescents in discussions related to reducing substance use, risky sexual behavior, and probability of unplanned pregnancy or late-detection pregnancy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

While recently there have been renewed interest in women's childbearing intentions, the authors sought to bring needed research attention to understanding men's childbearing intentions. Nationally representative data from the 2006-2010 National Survey of Family Growth (NSFG) was used to examine pregnancy intentions and happiness for all births reported by men in the 5 years preceding the interview. We used bivariate statistical tests of associations between intention status, happiness about the pregnancy, and fathers' demographic characteristics, including joint race/ethnicity and union status subgroups. Multivariate logistic regressions were used to calculate adjusted odds ratios of a birth being intended, estimated separately by father's union status at birth. Using comparable data and measures from the male and female NSFG surveys, we tested for gender differences intentions and happiness, and examined the sensitivity of our results to potential underreporting of births by men. Nearly four out of ten of births to men were reported as unintended, with significant variation by men's demographic traits. Non-marital childbearing was more likely to be intended among Hispanic and black men. Sixty-two percent of births received a 10 on the happiness scale. Happiness about the pregnancy varied significantly by intention status. Men were significantly happier than women about the pregnancies, with no significant difference in intention status. Potential underreporting of births by men had little impact on these patterns. This study brings needed focus to men's childbearing intentions and improves our understanding of the context of their role as fathers. Men need to be included in strategies to prevent unintended pregnancy.

Objective: To summarize birth mothers' descriptions of how their adolescent or young adult unplanned pregnancies and decision for open infant adoption placement influenced their lives., Design: Naturalistic inquiry using unstructured interviews., Setting & Methods: One to 2-hour telephone interviews with participants in their home settings were recorded and transcribed. Deidentified transcripts were analyzed for qualitative content themes., Participants: Fifteen women who had experienced unplanned adolescent or young adult pregnancy and relinquished their infants through open adoption were interviewed. Birth mothers who had been members of an agency support group were identified by an agency representative as having been typical of open adoption and were purposively recruited for study participation., Results: Participants described the open adoption decision as "one of the most difficult but best" choices of their lives. Themes were summarized using the acronym AFRESH: A--adoption accomplishments, F--fresh start, R--relationship changes, E--emotions, S--support, H--healing. Findings indicated that benefits of open adoption outweighed challenges of pregnancy, birth, and emotional transitions. Birth children were perceived as thriving with adoptive families who were cherished like extended family. Birth mothers perceived themselves as being better people with better lives than before the unintended pregnancy. Growth with improved life direction was seen as a result of personal maturation from the experience., Conclusions: Open adoption is reinforced as a positive resolution of adolescent unintended pregnancy. Birth mothers believed teens who feel "stuck" with a pregnancy should consider open adoption; nurses should provide support and uphold the process., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Background: Both unintended and adolescent childbearing disproportionately impact the Hispanic population of the United States., Methods: We used the 2006-2010 National Survey of Family Growth (NSFG) to provide the most recent, nationally representative description of pregnancy, childbearing, and contraception for Hispanic females aged 15-44. We determined baseline fertility data for self-identified Hispanic female respondents. Among those reporting a pregnancy history, we calculated the proportion of pregnancies identified as unintended and their association with sociodemographic variables. We also assessed outcomes and estimates of relative risk for unintended pregnancy. Finally, we examined contraceptive use prior to self-reported unintended pregnancies., Results: Approximately 70% of Hispanic women reported ever being pregnant, including 18% of teenagers. Over half (51%) of those pregnancies were unintended, including 81% among teenagers. The adjusted risk of unintended pregnancy was highest in women 15 to 19 years old and those with three or more pregnancies (incidence rate ratio [IRR] 1.64, 95% confidence interval [CI]: 1.44-1.88 and IRR 1.77, 95% CI: 1.53-2.06, respectively). Half of unintended pregnancies were preceded by no contraception. The most common reason for unintended pregnancy preceded by contraception was "improper use" (45%) and among pregnancies without use, the most common response (37%) was "I did not think I could get pregnant.", Conclusions: There is a high frequency of unintended pregnancy and lack of contraceptive use among Hispanic women. These findings highlight the need for improved reproductive education and contraceptive counseling in this population.

Background: Unintended pregnancy has been significantly associated with subsequent female sterilization. Whether women who are sterilized after experiencing an unintended pregnancy are less likely to express desire for sterilization reversal is unknown., Methods: This study used national, cross-sectional data collected by the 2006-2010 National Survey of Family Growth. The study sample included women ages 15-44 who were surgically sterile from a tubal sterilization at the time of interview. Multivariable logistic regression was used to examine the relationship between a history of unintended pregnancy and desire for sterilization reversal while controlling for potential confounders., Results: In this nationally representative sample of 1,418 women who were sterile from a tubal sterilization, 78% had a history of at least one unintended pregnancy and 28% expressed a desire to have their sterilization reversed. In unadjusted analysis, having a prior unintended pregnancy was associated with higher odds of expressing desire for sterilization reversal (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.15-2.79). In adjusted analysis controlling for sociodemographic factors, unintended pregnancy was no longer significantly associated with desire for reversal (OR: 1.46; 95% CI: 0.91-2.34)., Conclusion: Among women who had undergone tubal sterilization, a prior history of unintended pregnancy did not decrease desire for sterilization reversal.

Clinicians across disciplines and practice settings are likely to encounter adolescents who are at risk for a pregnancy. In 2010, 34.2/1000 15-19-year-old teens had a live birth in the United States, many more will seek care for a pregnancy scare or options counseling. Teen mothers are also at risk for a second or higher-order pregnancy during adolescence. This paper provides clinicians with adolescent-friendly clinical and counseling strategies for pregnancy prevention, pre- and post-pregnancy test counseling, pregnancy-related care, and a review of the developmental challenges encountered by teens in the transition to parenthood. Clinicians are in a better position to approach the developmental, health and mental health needs of adolescents related to pregnancy if they understand and appreciate the obstacles adolescents may face negotiating the healthcare system. In addition, when clinical services are specially tailored to the needs of the adolescent, fewer opportunities will be lost to prevent unintended pregnancies, assist teens into timely prenatal services, and improve outcomes for their pregnancies and the transition to parenthood., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Context: Racial and ethnic differences in unintended fertility are well documented, but mechanisms underlying these differences are poorly understood. To identify the factors that may contribute to such disparities, differences in distal characteristics theoretically linked to unintended fertility-such as the motivation to avoid a pregnancy-need to be identified., Methods: Data on sexual and reproductive attitudes and behavior among a sample of 1,573 unmarried men and women aged 18-29 came from the 2009 National Survey of Reproductive and Contraceptive Knowledge. Ordinal logistic regression analysis was conducted to examine two measures of motivation: one cognitive (perceived importance of avoiding pregnancy) and one affective (predicted feelings about experiencing an unplanned pregnancy)., Results: Seventy-seven percent of young adults reported that avoiding pregnancy is very important, and 34% would be very upset if they were to experience an unplanned pregnancy. In multivariate analyses, the cognitive measure of motivation was not associated with race and ethnicity. The affective measure, however, was: Foreign-born Hispanics would be less upset than whites, and blacks would be more upset than whites, if they were to experience an unplanned pregnancy (coefficients, -1.7 and 0.5, respectively)., Conclusions: Differences in motivation to avoid pregnancy-particularly in predicted emotional responses to an unplanned pregnancy-should be further investigated as a potential factor in Hispanics' relatively high rates of unintended births. Future research should also examine connections between motivation to avoid pregnancy and reproductive behavior., (Copyright © 2013 by the Guttmacher Institute.)

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.

Objective: To evaluate the reliability and validity of the London Measure of Unplanned Pregnancy (a U.K.-developed measure of pregnancy intention), in English and Spanish translation, in a U.S. population of women., Methods: A psychometric evaluation study of the London Measure of Unplanned Pregnancy (LMUP), a six-item, self-completion paper measure was conducted with 346 women aged 15-45 who presented to San Francisco General Hospital for termination of pregnancy or antenatal care. Analyses of the two language versions were carried out separately. Reliability (internal consistency) was assessed using Cronbach's alpha and item-total correlations. Test-retest reliability (stability) was assessed using weighted Kappa. Construct validity was assessed using principal components analysis and hypothesis testing., Results: Psychometric testing demonstrated that the LMUP was reliable and valid in both U.S. English (alpha = 0.78, all item-total correlations >0.20, weighted Kappa = 0.72, unidimensionality confirmed, hypotheses met) and Spanish translation (alpha = 0.84, all item-total correlations >0.20, weighted Kappa = 0.77, unidimensionality confirmed, hypotheses met)., Conclusion: The LMUP was reliable and valid in U.S. English and Spanish translation and therefore may now be used with U.S. women.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

Unintended pregnancy often leads to undesirable outcomes for both mothers and children. However, the definition of unintended pregnancy in the sociology of family formation has been restricted to the intentions of mothers. The intentions of fathers--and, with them, the possible role of disagreement about pregnancy intention--remain outside most conceptual frameworks and research programs. This article draws together a number of indicators of unilateral pregnancy in research on contemporary family formation in the United States. Studies of pregnancy intendedness and contraceptive use consistently provide evidence suggesting a significant role for unilateral pregnancy in family formation. Working on the assumption that unilateral pregnancy presents great potential for social dislocation, this article argues for the integration of the concept of unilateral pregnancy into the theoretical framework informing research on family formation.

Background and Methodology: Unintended pregnancy is a concern in the USA due to its association with adverse physical, mental, social and economic outcomes. Few studies have examined this issue among married women from a social and contextual perspective. This study targeted married women to examine factors associated with unintended pregnancy using the ecological model of health promotion that focuses attention on both individual and social environmental factors. Data from the National Survey of Family Growth (NSFG) were merged with NSFG contextual files to examine the major predictive factors., Results: Multilevel logistic regression modelling revealed that married women of lower socioeconomic status, higher parity, who lived in communities with a high rate of marital dissolution had a higher probability of an unintended pregnancy. Women reported that their husbands were likely to concur with the unintended designation of the pregnancy., Discussion and Conclusions: This study utilised a unique perspective to examine contextual factors related to unintended pregnancy among married women. The results support the need to focus on the couple as a unit for prevention efforts. Social policies to enhance access to family planning services are necessary to improve outcomes and prevent unintended pregnancies.

Objectives: Given that approximately half of all pregnancies in the United States are unplanned, the authors sought to understand the relation between pregnancy intention and health behaviors., Methods: Mothers of live-born infants without major birth defects were interviewed as part of the National Birth Defects Prevention Study. The interview assessed pregnancy intention as well as exposures to vitamins, alcohol, tobacco, illicit drugs, occupational hazards, exogenous heat (e.g., hot tubs and saunas) and caffeine. Crude odds ratios and 95% confidence intervals were calculated and stratified analyses were performed to assess interaction. Multiple logistic regression was used to calculate adjusted odds ratios., Results: Both before and after the diagnosis of pregnancy, women with unintended pregnancies were more likely to use illicit drugs, smoke, be exposed to environmental smoke, and not take folic acid or multivitamins. The degree to which women altered behaviors after they realized they were pregnant was also associated with their pregnancy intention status. For certain behaviors, maternal age or parity altered the association between pregnancy intention and changing behaviors after awareness of pregnancy., Conclusion: Pregnancy intention status is a key determinant of pregnancy-related behavior. To improve reproductive outcomes, preconceptional and prenatal programs should consider a woman's desire for pregnancy.

Widely used dichotomous categorical measures of pregnancy intentions do not represent well the complexity of factors involved in women's intentions. We used a variety of exploratory statistical methods to examine measures of pregnancy intention in the 2002 National Survey of Family Growth (N = 3,032 pregnancies). Factor analyses identified two key dimensions of pregnancy intentions (desire and mistiming) and two smaller nondimensional categories (overdue and don't care). Desire included both affective and cognitive variables, as well as partner-specific factors. Similar pregnancy-intention dimensions were found for adolescent and adult women, across socioeconomic status, and among racial and ethnic groups. Both desire and mistiming were highly predictive of the decision to abort or continue the pregnancy. These analyses strongly support prior demographic thinking about the importance of both the timing of pregnancy and wanting a baby, but suggest that multidimensional rather than simple categorical measures of pregnancy intentions should be used.

The discordance between fertility intentions and outcomes may be associated with mental health in the general population. This requires data directly linking individuals' fertility intentions with their outcomes. This study brings together two streams of research on fertility and psychological distress to examine whether unintended childlessness and unplanned births are associated with psychological distress, compared with intended childlessness and planned births. We also examine whether unintended childlessness and unplanned births are differently associated with distress at two stages of the individuals' life course: in early and late 30s. As women are more directly affected by the decline in fertility with age and the experience of motherhood is more central to women's identity, we also examined gender differences in these associations. Thus, we examined the association between four possible fertility events (planned and unplanned births, intended and unintended childlessness) and psychological distress of men and women, at two different stages over the life course (early and late 30s). We used longitudinal data from the US National Longitudinal Study of Youth 1979 (N=2524) to link individuals' fertility intentions and outcomes to evaluate the association of depressive symptoms (CES-D) with four possible fertility events occurring in two-year intervals, for men and women separately. Contrary to our first hypothesis, unintended childlessness and unplanned births were not associated with psychological distress for women. Among men, only unplanned births in their early 30s were associated with increases in psychological distress. We did not find support for our second hypothesis that unintended childlessness and unplanned births have a different association with psychological distress for men and women and as a function of the stage of life. These findings are discussed in the context of previous literature in this area.

Since research has shown that victims of violence are more likely to be involved in subsequent risky sexual behaviors, we hypothesized that coercive first intercourse would be associated with unintended first births. Using nationally representative data from the 2002 National Survey of Family Growth, we analyzed female respondents aged 18-44 years who reported a live birth (n = 4,136). Coercion was classified as none/minimal, mild, or significant based on self-report. In 2002, 13.7% of U.S. women aged 18-44 who had at least one live birth experienced mild coercion and 9.8% experienced significant coercion at first intercourse. Compared with women who experienced no coercion, the odds of reporting an unintended first birth was greater for women who experienced mild (OR: 1.9, 95% CI: 1.4-2.6) or significant coercion (OR: 2.3, 95% CI: 1.6-3.4).

Objectives: Poor women of childbearing age who use crack, cocaine, marijuana, and heroin may be at risk for having an alcohol-exposed pregnancy because of concurrent alcohol use. Women who use illicit drugs may not know the harmful effects of fetal alcohol exposure. Fetal alcohol exposure is a leading cause of developmental disabilities and mental retardation., Methods: We report findings of a survey administered to 2672 women 18-44 years of age in settings serving low-income women, including an urban jail, a drug treatment facility, and healthcare facilities in Florida, Virginia, and Texas. We compared women who reported using more than one illicit drug (drug users) and women who reported never using illicit drugs (nonusers) for frequent alcohol consumption, binge drinking, failure to use contraception, unplanned pregnancies, and drinking during pregnancy., Results: Of women interviewed, 75% (2000) reported using more than one illicit drug. Drug users were more likely to report frequent drinking (33%, relative risk [RR] 12.73, 95% confidence interval [CI] 7.9-20.4, binge drinking (39%, RR 5.7, 95% CI 4.9-7.6), and drinking during pregnancy (37%, RR 2.10, 95% CI 1.75-2.53) compared with nonusers (3%, 7%, 17%, respectively, p < 0.0001). Greater proportions of drug users (27%, RR 2.20, 95% CI 1.75-2.53) also failed to used contraception compared with nonusers (19%, p < 0.05). Notable proportions of both groups, drug users (91%) and nonusers (82%), reported unplanned pregnancies., Conclusions: The findings suggest that poor women who reported ever using more than one illicit drug were at greater risk for having an alcohol-exposed pregnancy. Unplanned pregnancies in both groups surpassed national averages. Poor women likely require enhanced education about the hazards of drinking during pregnancy and methods to reduce unplanned pregnancies.