Attitudes toward birth spacing among low-income women: A qualitative analysis

Objective: To explore attitudes toward birth spacing among low-income, postpartum women.

Methods: We conducted focus groups with 47 postpartum women. Transcripts were analyzed for themes related to birth spacing.

Results: 36% of women desired more children and 23% wanted another pregnancy within a year. Women seemed unaware of adverse health consequences associated with short intervals. Few reported advice from providers regarding birth spacing. Maternal health status was mentioned as a determinant of when to pursue a pregnancy occasionally. Other factors that influenced birth spacing were finances, desire for closely-spaced children and career. African-Americans often expressed conflict between their and their partner's desire for more children.

Many women reported unplanned pregnancies. Many felt that pregnancy planning is not useful. Themes such as “there's no guarantee things will turn out as planned,” “not planning, but being prepared” and “you just roll with it” were pervasive.

When asked about rates of unplanned pregnancies among African-Americans and Latinas, women felt these were problems for their communities. Lack of education, role modeling, and community resources were identified as contributors in African-American communities, while foreign-born Latinas cited the need to work hard to succeed in the U.S. to explain their lower risk relative to U.S.-born Latinas. Although most agreed that postpartum contraception is important, many viewed contraceptive failures as an indication that a pregnancy was “meant to be.”

Conclusion: Among low-income women, attitudes regarding birth spacing are largely driven by social considerations. Interventions to reduce unintended pregnancies should consider cultural and social context.