Measuring pregnancy “intentions” of young African-American women: A prospective mixed methods study

Nearly half of U.S. pregnancies are unintended at conception, with higher rates among never married, low-income and African American women. We report preliminary results of a mixed-methods study designed to develop new instrumentation for prospectively capturing women's complex and nuanced feelings toward future reproduction, so that policies and intervention efforts can better address their family planning needs. We describe baseline characteristics of participants, and triangulate results of three research methods: a survey covering demographics, sexual and reproductive histories, contraceptive knowledge and practices, and reproductive desires and intentions; an in-depth qualitative interview; and a “Q-sort task” in which each participant ranks subjective statements about pregnancy based on similarity to her own feelings. Analyses include descriptive statistics, by-person factor analysis of Q-sorts, and comparison of the survey and Q-sort results, supplemented with qualitative findings.

Participants included 144 African American women age 15-25. They collectively experienced 175 past pregnancies, 70% of them unintended. Over 25% of women desiring no future reproduction reported not currently using contraception, though all said regular use was important. Q-sort analysis yielded five factors which constitute candidate intention categories. One factor represents women positively disposed to becoming pregnant, though most were not actively trying to conceive. The other four factors discriminate among varying degrees of negative orientation toward pregnancy in the near or distant future. Qualitative data illuminate inconsistencies between measures of subjective preference and fertility-related behaviors. New instruments to be developed, once validated with diverse populations, will address needs of population-based surveillance as well as family planning services.