Unintended pregnancy is a significant public policy issue in the United States, yet current understanding of the measurement and meaning of women’s pregnancy intentions is incomplete. The aim of this dissertation is to provide new theoretical insight into women’s childbearing intentions and feelings about pregnancy, particularly when these two measures appear to be incongruent (i.e. women report feeling happy about pregnancy, but at the same time report wanting no more children). Incongruence is particularly common among Hispanic women, and current literature tends to view such women as ambivalent, assuming that they lack a clear and strong desire to avoid conception. Ambivalence, in turn, has been linked to less effective contraceptive use. Using a mixed-methods approach, this dissertation examines the hypothesis that incongruent intentions and feelings are not necessarily a reflection of ambivalence but rather two distinct concepts: women may be quite resolute about avoiding future pregnancies, yet for various reasons still express happiness at the prospect of a pregnancy. In Chapter 1, we examine prospectively measured happiness and intentions among a cohort of Latina pill-users at the U.S.-Mexico border, providing evidence that feelings of happiness about pregnancy may co-exist with effective use of contraception and with plans to continue method use long-term to prevent conception. In Chapter 2, we investigate the relationship between happiness and contraceptive desires, demonstrating that women with incongruent intentions and feelings often desire highly effective or permanent methods that they do not have the ability to access. Finally, in Chapter 3, we explore the concepts of happiness and intentions and the factors underlying each from women’s own perspectives through in-depth interviews, and provide a range of explanations for why happiness about pregnancy may be expressed even when another child would be a significant financial or emotional burden. Findings strongly suggest that automatically classifying women with incongruent intentions and feelings as ambivalent may lead to inaccurate measurement of unintended pregnancy, hinder understanding of the difficulties these women face in obtaining effective contraception, and limit the ability to devise strategies to prevent unintended pregnancy and address disparities across racial and ethnic groups. / text

Contraceptive practices entail a wide spectrum of concepts, namely, contraceptive methods, the use of contraceptives, the discontinuation of such use, and the non-use of contraceptives or failure to use them. The use of contraceptives and contraceptive services is influenced by a number of factors that either motivate or demotivate women to use contraceptives effectively. The aim of this literature review is to identify and describe factors impacting on the contraceptive practices of women. The discussion includes factors impacting positively or negatively on contraceptive practices in terms of age-related issues, education and status, religion, socio-cultural beliefs, values and norms, knowledge about contraceptives, contraceptive providers and the accessibility of contraceptive services.

Background: Just under half of pregnancies in the United States are unintended. And unintended births are particularly high among married and cohabiting adult women. Though family planning behaviors occur in a dyadic context with potentially joint influences of men and women on contraceptive use and pregnancy, most research on pregnancy and contraceptive use is based on reports from only women. Methods: I examined the pregnancy beliefs and contraceptive values of both members of cohabiting and married adult couples to determine how these individual-level characteristics come together at the dyad-level to shape pregnancy outcomes for the couple. I performed multinomial logit structural equation modeling analyses using longitudinal data from the National Couples Survey. I included demographic covariates that have been implicated in prior research as influential for contraceptive use and unintended pregnancy. Results: The male partner's pregnancy beliefs and contraceptive values significantly predicted dyadic risk of unintended pregnancy even after accounting for female partner's responses on these variables. Non-Hispanic Black race and low socioeconomic status emerged as risk factors. Discussion: This study indicates that dyadic analyses are needed to account for male partner influences to appropriately model risk for unintended pregnancy in research. The findings of this research also highlight demographic groups that may benefit from targeted dyadic intervention. / Ph. D. / Background: Just under half of pregnancies in the United States are unplanned at conception. Unintended births are particularly high among married and cohabiting adult women. Though family planning behaviors occur in a couple context, and men and women likely both influence contraceptive use and pregnancy, most research on pregnancy and contraceptive use is based on reports from only women. Methods: I examined beliefs about positive outcomes of pregnancy and values for contraception to be effective of men and women in cohabiting and married adult couples to determine how these individual-level attitudes come together to shape pregnancy outcomes for the couple. I used existing longitudinal data from the National Couples Survey, the theory of triadic influence, and structural equation modeling to test whether my hypothesized relationships between attitudes and behaviors were supported. I also accounted for demographic factors that prior research has flagged as influential for contraceptive use and unintended pregnancy. Results: The male partner’s pregnancy beliefs and contraceptive values significantly predicted whether the couple became unintentionally pregnant (or was at high risk of becoming so) even after accounting for their female partner’s responses on these variables. Non-Hispanic Black race and low socioeconomic status emerged as risk factors. Discussion: The results of this study highlight the importance of including both men and women in research to reach a more nuanced understanding of the factors that shape unintended pregnancy. The findings of this research also suggest that couples in specific demographic groups may benefit from targeted intervention to help them attain their reproductive goals.

In this research, I study the unintended consequences of implementing information technology. Understanding the causes of these unintended effects is important because information technology is ubiquitous in the modern economy. I used three research protocols to study this phenomenon. The first approach was a literature review to explore and understand what was already written on the subject of implementing information technology. The second approach was an experiment using the beer distribution game to study the implementation of information technology. The third approach I used was a case study in which I used system dynamics modeling to study the information technology in an engineering and architecture firm. I tested the implementation of information technology in the beer distribution game by modifying the play with a change that simulated implementing information technology. I compared the performance of test subjects with control groups that played the game at the same time, without the modification. I also compared the subjects' performance against the performance of trials first published in 1989. I hypothesized that implementing information technology would result in an immediate improvement of the teams' performance. The results of implementing information technology in the beer distribution game were not as expected; implementing information technology did not improve performance. When it became clear that my experimental hypotheses were incorrect, I went back to the literature to see if there was an explanation for this failure that could be derived from the literature on the beer game. I studied the information technology in the case study firm in order to extend the learning from the experimental research. The results of the experiment were not as I expected; I learned a great deal about the effect of information technology in a very controlled experimental setting. By expanding the research to include a case study I was able to explore the behavior in a more realistic environment. The beer distribution game provided me with an unexpected insight into the alignment of users mental models and the structure of the organization. The case study was completed using system dynamics tools to model, and then simulate, the effect of misalignment in a real world organization. Considering the results of the beer distribution game and the case study, I suggest that one explanation for the unintended consequences of implementing information technology is the misalignment of users' mental models with the altered structure of the organization after information technology is implemented. / Ph. D.

Nearly half of all pregnancies in the United States are unintended. In 2002, the direct medical costs of unintended pregnancies were estimated to be almost five billion dollars. Moreover, women with unintended pregnancies tend to delay seeking prenatal care and making the necessary life style changes for the fetus. Subsequently, unintended pregnancies have the potential to lead to low birth weight infants and potentially poorer long-term child development. Although there are negative consequences with unintended pregnancies, repeat unintended pregnancies impose even greater health risks for both mothers and infants. To prevent unintended and repeat unintended pregnancies, family planning methods must be utilized effectively. Despite the potential risk associated with negative health outcomes of mothers and infants, repeated unintended pregnancies have not been studied extensively. Therefore, the purpose of this study was to examine the relationship between the number of unintended pregnancies and effective use of family planning methods. A secondary analysis of The National Statistics of Family Growth, cycle 6 (2002) was done. The study showed a statistically significant relationship association between the number of unintended pregnancies and effective contraceptive use after adjusting for confounders which include age, race, annual household income, marital status and types of insurance. The recommendation of this study include creating better strategies for family planning practices and the need to improving contraceptive education and service delivery for those with higher risk.

Student Number : 0411802R - MSc (Med) research report - Faculty of Health Sciences / Unintended pregnancy among the youth is a serious public health problem for it exposes the young women and the foetuses to higher risk of morbidity and mortality. Although recognised as a major public health problem, studies on it have been limited and localised in South Africa. Using the 1998 South African Demographic and Health Survey (SADHS) data set, this study examines the distribution of and factors associated with unintended pregnancy among South African youth. The 1998 SADHS was a nationally representative cross-sectional survey with a probability sample of twelve thousand (12 000) women between the ages of 15 and 49. The survey used a structured questionnaire to collect information on fertility issues in general from the respondents. Analysis was based on 1 395 observations which was arrived at after sub setting observations of women aged 15-24 that had pregnancy at the time of and/or three years preceding the survey. Logistic regression model was employed to estimate the effects of identified predictors on unintended pregnancy. The results show a high level of unintended pregnancy with only 29% of the pregnancies wanted. The level of unintended pregnancy varies by region and some socio-economic variables. Respondents from KwaZulu Natal had the highest percentage (81%) of unintended pregnancy while North West had the lowest at 56%. It was also found that the higher the educational level of the respondents, the higher the incidence of unwanted pregnancy. Among the respondents using modern method of contraception, 74% reported having unintended pregnancy while the probability of unintended pregnancy was found to decrease with increase in age at first intercourse. Overall, about 69% of respondents who reported unintended pregnancy had last sexual relation with their regular partners, 21% with marital partners and 10% with casual partners. Using stepwise logistic regression, five critical predictors of unintended pregnancy among South African youth were identified. These are: age group, region, marital status, education and relationship to the last sexual partner. The findings of this study have implications for reproductive health policies and programs in designing appropriate national programs for reducing the incidence of unintended pregnancy among South African youth. The need for further research into this area using triangulated methodology is recommended.

Thesis advisor: June Horowitz / Objective: The purpose of this study is to identify the psychosocial needs and views about desired services and decision making of women with unintended pregnancies who seek the help of pregnancy counselors or caregivers. Women were asked to describe in their own words what they found helpful and unhelpful in counseling. This information will be used to more clearly define the role of caregivers with women during their experience in hopes of improving maternal and newborn outcomes in unintended pregnancies. Design: A mixed-method design with a quantitative descriptive component and a qualitative descriptive component was used Setting: Data were collected over the course of several months and took place at two locations of Pregnancy Help. Pregnancy Help are pregnancy resources centers located in Brighton and Natick near Boston, MA. Population: Pregnancy Help serves women ranging from teenage years to women over 40, with mostly of lower socioeconomic status, and lower educational attainment with a wide range of backgrounds such as Caucasian, African-American, Haitian, Brazilian, and women from other countries. Methods: Prospective participants were contacted on the telephone and invited to participate in the study during their third trimester and up to 2 years postpartum. All 23 participants were included in the 15 to 35 minute quantitative descriptive component which consisted of completing a questionnaire composed of three instruments: (1) Prenatal Self-Evaluation Questionnaire (Lederman & Weis, 2009), (2) Pregnancy Decision-Making Questionnaire, and (3) Demographic Information Questionnaire. Of all participants, 10 women were asked to partake in the qualitative component which consisted of a 30 to 60 minute open-ended Pregnancy Counseling Interview. Results: As with the national demographics of women with unintended pregnancies, the women who participated in this study were mostly young, single African American or Latina women of lower socioeconomic status, and lower educational attainment. Their psychosocial profiles indicated decreased maternal adaptation in every psychosocial dimension. Qualitative data from interviews served as an illustration of the psychosocial and demographic profiles, revealing background and the experience of unintended pregnancy for each woman. This data provided insight into the difficulty and complexity of their experience and of pregnancy decision-making. Aspects of counseling such as being welcoming, encouraging, non-judgmental, motherly, and informative were perceived as beneficial to the women. Women also appreciated the combination of counseling with material support and referrals to social, financial, and medical services. / Thesis (BA) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: College Honors Program. / Discipline: Nursing.

Orientador: Renato Passini Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T12:03:46Z (GMT). No. of bitstreams: 1 Dias_TabataReginaZumpano_M.pdf: 2287469 bytes, checksum: 960058f223b535a82e398b29d32d89ff (MD5) Previous issue date: 2012 / Resumo: Introdução: A interrupção voluntária da gravidez, proibida no Brasil, pode levar a situações de abortamento inseguro, que é reconhecidamente um grave problema de saúde pública. É necessário conhecer as circunstâncias envolvidas nesta situação para que seja possível compreender melhor o contexto em que as mulheres recorrem a um abortamento, bem como identificar subgrupos com necessidades especiais de atendimento pelos serviços de saúde. Objetivo: Avaliar alguns fatores sociodemográficos e epidemiológicos associados à interrupção voluntária da gestação. Sujeitos e métodos: Estudo descritivo analítico de corte transversal envolvendo o envio de um questionário estruturado e pré-testado a 15.800 funcionários de uma entidade pública do Estado de São Paulo. Os questionários preenchidos pelos participantes foram enviados de volta em envelope resposta pré-selado. Foram preenchidos 1660 questionários (11% de taxa de resposta), nos quais houve 296 gestações indesejadas e, destas, 165 terminaram em aborto induzido voluntário. Foram realizadas análises bivariada e multivariada por regressão de Poisson para estudar a associação entre a ocorrência de um aborto quando diante de uma gravidez indesejada com algumas características sociodemográficas selecionadas. Resultados: Um quinto dos participantes relatou vivenciar uma gravidez indesejada anterior, e 55,7% deles recorreram ao abortamento naquela ocasião. As maiores proporções de decisão e realização do abortamento foram encontradas entre os participantes do sexo masculino (62,1%), que tinham de 18 a 24 anos por ocasião da gravidez de sua parceira (62,3%), sem filhos (58,9%), não unidos (61,7%) e entre os respondentes com escolaridade superior (70,3%). A maioria das interrupções foi realizada por um médico e pouco mais de 10% dos participantes relataram ter feito uso do misoprostol. A maioria dos abortos (45%) realizou-se entre 1980 e 1989. Dentre os respondentes que referiram aborto realizado por médico, mais da metade (54%) ocorreram na mesma década (entre 1980 e 1989). Dentre aqueles que fizeram uso de misoprostol, 58% o fizeram entre 1990 e 1999. Os participantes relataram que 22,9% das mulheres que abortaram necessitaram de atendimento médico após o aborto e 16,6% foram internadas após recorrerem ao aborto. Conclusão: Na amostra estudada foi possível verificar que um de cada dois dos respondentes por ocasião de uma gravidez indesejada optou pelo abortamento. Chama atenção que as pessoas tiveram acesso a condições menos inseguras para interromper uma gestação indesejada, ainda que num contexto de ilegalidade dessa prática / Abstract: Introduction: Unsafe abortion is a serious public health problem in Brazil and other countries where it is considered a crime. It's necessary to understand the context of these abortions to approach the issue . Objective: To evaluate some sociodemographic and epidemiological factors associated with induced abortion. Method: Cross-sectional study. A self-responded questionnaire was sent to 15.800 employees of a public organization. 1660 questionnaires were completed. There were 296 unintended pregnancies and 165 induced abortions. Bivariate and multivariate Poisson regression analyses were performed to explore the association between the occurrence of abortion when faced an unintended pregnancy with some sociodemographic characteristics. Findings: One fifth of respondents reported an unintended pregnancy and 55.7% of those respondents resorted to abortion. The highest rates of abortion were found among male participants (62.1%) who were between 18 and 24-years-old at the time of pregnancy (62.3%), childless (58.9%), not united (61.7%) and with a college education (70.3%). Most of the respondent's abortions were performed by a doctor, and 17.8% of participants reported misoprostol use. Medical attention was necessary for 22.9% of these women after abortion and 16.6% were hospitalized. Most abortions (45%) took place between 1980 and 1989, and 54% of respondents who had abortions in this decade resorted to a doctor. Those who used misoprostol, 58% did between 1990 and 1999. Conclusion: In this sample we observed that half of respondents opted for abortion during an unintended pregnancy. It is noteworthy that people had access to fewer unsafe conditions for stopping an unintended pregnancy, even in the context of illegal practice / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Unintended pregnancy remains to be a public health priority for adolescents as there are a myriad of negative social and developmental consequences for both young mothers and their children. The goal of this study was to examine associations of individual-level determinants of health with sexual risk behaviors and protective factors among a sample of African American female adolescents. African American adolescent females were recruited from sexual health clinics to participate in a cross-sectional survey at 18 months post-participation in a STD/HIV prevention trial. Surveys were administered using Audio Computer Assisted Self Interview (ACASI). Statistical analyses were run to determine associations of protective and sexual risk behaviors with age, education, household income status, sexual history, other contraception use and knowledge of emergency contraception (EC). A total of 410 surveys were included in the analyses. (N=410; mean age=19.06) Almost sixteen percent (n=65) of participants reported ever using emergency contraception. Bivariate analyses indicated that EC use among African American female adolescents was significantly associated with age, education level, job status, receipt of government assistance, age at first sex, knowledge of EC availability and number of average condom errors. The findings in this study are consistent with previous studies exploring social determinants and their relationship to sexual health practices among high risk populations. The findings of this study could be used to design effective pregnancy prevention initiatives including EC education and promotion targeting specific segments of the African American adolescent female population that may be at a greater risk for unintended pregnancies.

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