The rate of adolescent unintended pregnancy in the United States is high compared to other developed countries. While past research and interventions have largely focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men’s knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control like condoms or withdrawal. However, less is known about how young men can contribute to or participate in decision-making with female partners about contraception other than condoms. The purpose of this systematic review was to explore how young men communicate with their partners and its impact on contraception use to prevent pregnancy. A systematic review of five databases was conducted to identify English-language articles published from January 1, 2002, through July 7, 2018. The review specifically explored how male partner communication affects female partner use of contraception other than condoms among young men ages 11-24 years. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, strategies employed by young men, and which dynamics of partner communication are measured in studies. Of the 15 articles identified as exploring areas of communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, and three of those produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Three qualitative studies provided supporting narratives of how young men have communicated with partners and influenced their contraception use with female partners. The remaining seven articles explored the other research questions of timing, strategies, and dynamics identifying topics, prompts, and communication cues among young men. Measurements of both communication and contraception varied across studies. With the small number of studies identified in this systematic review, it is recommended that future research seek to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

Estimates suggest that about eight million American teens and young adults experience clinical symptoms of mental illness. For many, these mental health challenges will develop into a diagnosable and potentially life-long psychiatric disorder. Together they form a large population of adults who enter their prime reproductive age as psychiatric patients. Though individuals with mental illness enjoy the same reproductive rights as those without psychiatric conditions, social and medical discourses often portray their parenthood as risky and undesirable. Women with mental illness are in a particularly difficult position. As women, they are subjected to the gendered expectation that they become mothers. Yet at the same time, their mental illness results in their motherhood being frowned upon. Carrying these contradicting values, this study asks how women with psychiatric disorders make reproductive decisions. Do these women think of their reproductive capacity through the psychiatric framing of risk, or through gendered narratives of desired motherhood? Using open ended interviews with women with a psychiatric diagnosis, this study shows that women with mental illness approach their reproductive decision-making by utilizing narratives of both normal reproduction and disability. Some women portray their mental illness as an obstacle to motherhood while others create a separation between their mental and reproductive health. Still others defy the distinction between psychiatry and normalcy and describe their reproduction as a way to bring the two together. Despite the difference in framing, all the women in this study engage with the discourse of risk(s) that is brought on by their mental illness. To weigh risk and act upon it, they visit their and their peer’s biographical stories of illness, assess their fitness into normative ideas of good motherhood, and evaluate the worth of medical and scientific information. They question the way medical information is created, distributed, and made applicable to the idiosyncrasy of their reproductive life. In doing so, these women draw boundaries around trust as well as redefine medical neutrality. Finally, we show that women with mental illness and their health providers rely on a vaguely defined stepwise plan to approach reproduction. This plan brings normativity – and desirability - to their reproduction at the same time that it threatens to exclude them from motherhood. By bringing these arguments together we arrive at the overall conclusion that women with mental illness do not approach their reproduction as a monolithic group. Nor do they organize along diagnosis lines. This study shows that women across psychiatric diagnoses share similar reproductive desires, some hoping to have children and others wishing to avoid motherhood altogether. The popular idea that certain psychiatric diagnoses render women unsuitable for motherhood is not echoed by the women in this study. Instead, their embodied experience of mental illness allows them to embrace the newfound reproductive choice of psychiatric patients and highlights the stigma that perpetuates fears of motherhood with mental illness.

Every year, approximately 21 million girls aged 15 to 19 living in low- and middle-income countries (LMICs) become pregnant and over 12 million of these girls give birth. Complications from pregnancy are the leading cause of death for girls aged 15 to 19 in LMICs and adolescent mothers face an elevated risk of life-long morbidities due to pregnancy and childbirth. The risk of early childbearing and its associated consequences vary significantly depending on age, socioeconomic status, and place of residence. Adolescents affected by conflict or natural disasters are often recognized as one of the most vulnerable groups in this regard; among the countries with the highest adolescent birth rates globally, most are affected by conflict or fragility. This dissertation aimed to fill a critical gap in the literature on adolescent pregnancy in humanitarian settings. The three studies in this dissertation utilize qualitative and quantitative research to better understand the myriad drivers of adolescent pregnancy and, in the context of protracted conflict in Democratic Republic of the Congo (DRC), how exposure to armed conflict may or may not modify certain risk and protective factors. The findings of this dissertation confirm that risk and protective factors for adolescent pregnancy are numerous, interrelated, and complex; preventing early and unintended pregnancy requires multi-level interventions that build the protective assets of adolescents while also engaging with male partners, parents and caregivers, and community members. The research deepens this understanding by demonstrating the extent to which long-standing and deeply rooted sociocultural norms influence adolescents’ individual and inter-personal behaviors in diverse contexts, including settings affected by armed conflict. Thus, instead of considering how standalone risk and protective factors for adolescents differ depending on the context, the research highlights the importance of understanding linkages between environmental, inter-personal, and individual factors and the pathways through which these linkages influence reproductive health decision-making among adolescents. This dissertation also provides new evidence as to how the presence of armed conflict does not uniformly influence risk and protective factors for adolescent pregnancy. Instead, it finds that, in the case of DRC, underlying social norms and differences in social, demographic, and economic characteristics outweigh the effect of armed conflict on incidence of adolescent pregnancy. This finding does not mean that armed conflict does not have any impact on adolescent pregnancy; rather, it confirms the need for continued research in different humanitarian contexts and informs how to apply best practices from development settings to improve sexual and reproductive health (SRH) outcomes among adolescents affected by humanitarian crises. Meeting the SRH needs of adolescents requires going beyond service provision and understanding the numerous, interrelated risk and protective factors that exist at the individual, inter-personal, and community levels. Situations of conflict and displacement may present additional complexities for understanding and meeting the SRH needs of adolescents. However, this dissertation shows the feasibility of conducting research and utilizing existing data to understand some of the root causes of adolescent pregnancy in a conflict-affected setting. Moreover, the studies highlight how more robust evidence can challenge some of our longstanding assumptions about adolescents affected by humanitarian crises. Continued rigorous research and taking the time to listen to adolescents and their communities can lead to more responsive adolescent SRH programs and services that contribute to adolescents’ healthy transitions to adulthood.