Neighborhood and Individual-Level Violence and Unwanted Pregnancy

Background: Half of all pregnancies in the U.S. are not intended, and unintened pregnancy is linked to a variety of negative pregnancy and infant health outcomes.

Objective: To determine if urban women who experience neighborhood and individual-level violence are at increased risk of experiencing unwanted pregnancy.

Methods: 1536 pregnant women seeking care in an emergency department in Philadelphia Pennsylvania were recruited in their first trimester and participated in in-person interviews. Information on demographic characteristics, social support, substance abuse, current experience and history of interpersonal and neighborhood-level violence, and the wantedness of their current pregnancy was gathered. Multiple Logistic regression analyses were conducted to assess the relationship between violence indicators and pregnancy wantedness.

Results: 627 women (41%) were classified as having an unwanted pregnancy. Not feeling safe in one's neighborhood was predictive of unwanted pregnancy (OR: 1.28, 95% CI: 1.02-1.61) when demographic, neighborhood, and individual-level violence indicators were accounted for. Furthermore, history of sexual abuse (OR: 1.5, p=.01), violence in previous pregnancy (OR=1.7, p=.01), and high index of spousal abuse score (OR=1.6, p=<.01) were associated with unwanted pregnancy in multiple logistic regression models.

Conclusions: These findings may be used to develop interventions to identify women who are at increased risk of experiencing an unintended pregnancy such as women with a history of sexual violence and those who feel unsafe in their communities.