226721 Childbearing motivations and pregnancy desires among adolescents in Baltimore: Does HIV serostatus make a difference?

Monday, November 8, 2010

Sarah Finocchario Kessler, PhD MPH , Internaltional Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Michael Sweat, PhD , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Jacinda Dariotis, PhD , Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Jean Anderson, MD , Obstetrics & Gynecology, Johns Hopkins School of Medicine, Baltimore, MD
Jacky Jennings, MD , Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
Jean Keller, PAC , Obstetrics & Gynecology, Johns Hopkins School of Medicine, Baltimore, MD
Amita Vyas, PhD , Department of Prevention and Community Health, George Washington University School of Public Health, Washington, DC
Maria Trent, MD, MPH , Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
  
Purpose: To determine if and how childbearing motivations, pregnancy desires, and perceived partner desire for a child differ among adolescents (15-24 years) in Baltimore based on HIV serostatus. Methods: We utilized two sources of data to compare the perspectives of a population-based sample of adolescents (n=355) with those of HIV-infected adolescents in Baltimore (n=57). We compared demographic characteristics, contraceptive use, childbearing motivations (positive and negative), pregnancy desires (immediate and future), and perceived partner desire for pregnancy between HIV-infected and HIV-uninfected adolescents. Multivariable logistic regression identified factors associated with pregnancy desires among adolescents, controlling for HIV serostatus. Results: Adolescents in both groups were predominately African American (>85%), mean age of 19.6 years, with low (<40%) consistent condom or hormonal contraception use. While positive childbearing motivations were nearly identical, HIV-infected adolescents had a significantly lower mean score for negative childbearing motivations compared to uninfected peers (p=0.01). We found no significant difference in pregnancy desires, however, HIV-infected adolescents were more likely to perceive a positive response from their partner to becoming pregnant compared to uninfected peers (p=0.01). The significant predictors of future pregnancy desires in multivariate analysis included: positive childbearing motivations (AOR=2.2, p<0.001), perceived positive partner response to pregnancy (AOR=2.2, p=0.025), contraception use (AOR=0.43, p=0.015) and parity (AOR=0.40, p=0.001). Conclusion: Similar to adolescents in the general population, HIV-infected adolescents have strong desires for childbearing that are not attenuated by their serostatus. Direct discussion with all adolescents regarding childbearing desires is needed, with referral to preconception counseling for HIV-infected adolescents as appropriate.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Public health or related laws, regulations, standards, or guidelines
Social and behavioral sciences

Learning Objectives:
1. List the two primary outcomes for which a significant difference between HIV-infected and HIV-uninfected adolescents was found. 2. Identify at least two reasons why communication about pregnancy desires with adolescents must occur early. 3. Explain at least two ways in which relationship dynamics impact female adolescents' sexual health.

Keywords: Adolescent Health, Reproductive Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The findings reflect my doctoral dissertation research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3180.0: Adolescent Pregnancy Interventions