Social discrimination, mental health and unintended pregnancy among young women

Objective: To investigate relationships between social discrimination, stress, depression, and risk of unintended pregnancy.

Methods: Data were drawn from a longitudinal cohort study of 992 women ages 18-20yrs, 98% of whom reported a strong desire to avoid pregnancy. Women completed baseline and weekly surveys assessing relationship, sex, contraception, health, and social context characteristics and pregnancy outcomes. Our analytic sample included 794 women contributing 36,809 journals in the first 18 months. Standardized instruments measured discrimination (Everyday Discrimination Scale), stress (PSS), and depression (CES-D). Weekly pregnancy status was self-reported. Multi-level, mixed-effects regression and discrete-time hazard models estimated associations between discrimination, mental health and pregnancy. Baron and Kenny’s technique tested for mediation effects of mental health on associations between discrimination and pregnancy.

Results: The sample mean time-variant discrimination score was 19±6 out of 45 points; 20% of women reported moderate/high discrimination (1SD above mean). Discrimination scores were higher among women with stress and depression symptoms (21 and 21 points, respectively) versus those without (18 and 18, p’s<0.001). Pregnancy rates (14% overall) were higher among women with moderate/high (23%) versus low (11%) discrimination scores. In multivariable models, moderate/high discrimination was predictive of stress (aOR 2.2, 95%CI 1.4-3.4), depression (aOR 2.4, CI 1.5-3.7), and pregnancy (aOR 1.8, CI 1.1-3.0). In mediation models, stress and depression did not alter the effects of discrimination on pregnancy.

Conclusions: Social discrimination was independently associated with mental health and unintended pregnancy among these young women. We are continuing to examine the biosocial context of stress and depression on reproductive outcomes.