Demographic diversity in the measurement and meaning of unintended pregnancy
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Unintended pregnancy is a significant public policy issue in the United States, yet current understanding of the measurement and meaning of women’s pregnancy intentions is incomplete. The aim of this dissertation is to provide new theoretical insight into women’s childbearing intentions and feelings about pregnancy, particularly when these two measures appear to be incongruent (i.e. women report feeling happy about pregnancy, but at the same time report wanting no more children). Incongruence is particularly common among Hispanic women, and current literature tends to view such women as ambivalent, assuming that they lack a clear and strong desire to avoid conception. Ambivalence, in turn, has been linked to less effective contraceptive use. Using a mixed-methods approach, this dissertation examines the hypothesis that incongruent intentions and feelings are not necessarily a reflection of ambivalence but rather two distinct concepts: women may be quite resolute about avoiding future pregnancies, yet for various reasons still express happiness at the prospect of a pregnancy. In Chapter 1, we examine prospectively measured happiness and intentions among a cohort of Latina pill-users at the U.S.-Mexico border, providing evidence that feelings of happiness about pregnancy may co-exist with effective use of contraception and with plans to continue method use long-term to prevent conception. In Chapter 2, we investigate the relationship between happiness and contraceptive desires, demonstrating that women with incongruent intentions and feelings often desire highly effective or permanent methods that they do not have the ability to access. Finally, in Chapter 3, we explore the concepts of happiness and intentions and the factors underlying each from women’s own perspectives through in-depth interviews, and provide a range of explanations for why happiness about pregnancy may be expressed even when another child would be a significant financial or emotional burden. Findings strongly suggest that automatically classifying women with incongruent intentions and feelings as ambivalent may lead to inaccurate measurement of unintended pregnancy, hinder understanding of the difficulties these women face in obtaining effective contraception, and limit the ability to devise strategies to prevent unintended pregnancy and address disparities across racial and ethnic groups.