Family planning and contraceptive decision-making by economically disadvantaged, African–American women

Abstract

Background Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning. Study Design Structured focus groups were held with adult, low-income, non-pregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, and audio-taped and transcribed. Four, independent researchers coded the transcripts using the constant comparative method. Codes were organized into over-arching themes. Results Contraceptive knowledge was limited with formal education often occurring after sexual debut. Attitudes about contraception were overtly negative with method effectiveness being judged by the experience of side effects. Family and friends strongly influence contraceptive decisions while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible although compliance is considered a barrier. Conclusions Contraception education should occur before sexual debut, should involve trusted family and community members, and should positively frame issues in terms of achieving life goals.

A Mixed Methods Study of Contraceptive Effectiveness in a Relationship Context Among Young Adult, Primarily Low-Income African American Women

“…Ideologically, they did not support abortion but accepted that they sometimes had to terminate a pregnancy when they could not support a child, also making this value-laden and conflicted decision alone. Similar perceptions of perceived lack of social support have been described in other research with primarily low-income African American and Hispanic samples [51, 52]. This suggests a possible cultural or socioeconomic component to reproductive decision making.…”

“…Contraceptive use is lower among African American women compared to other women [8, 9], even though 60 % of African American women ages 18–29 believe pregnancy planning is important and 80 % desire to avoid pregnancy [10]. Access-related challenges that may contribute to lower contraceptive use by African American women include limited knowledge about contraceptives and available methods [11, 12], transportation difficulties [12], lack of insurance or lack of coverage for the desired contraceptive method [12], difficulty getting an appointment [13], and concerns about privacy at a community-based clinic [11]. Thus, ineffective contraceptive use is a significant risk that contributes to unplanned pregnancy, particularly for young adult African American women [1, 14].…”

Patient and provider perspectives on Bedsider.org, an online contraceptive information tool, in a low income, racially diverse clinic population

“…First, similar to other qualitative studies [15], our analysis relies on a small sample of participants at a single clinic. Findings may not be generalizable to other populations or nonstudy participants, and the hypotheses generated from focus groups should be tested in larger studies.…”

Racial/ethnic differences in contraceptive preferences, beliefs, and self-efficacy among women veterans

“…12,13 Furthermore, preliminary data suggest that minority women more frequently report views that have been linked to inconsistent use of contraception or use of less effective methods, such as fatalistic beliefs about pregnancy (ie, “when it’s my time, it will happen”), 5,9 the belief that birth control is primarily a woman’s responsibility, 7,8 and lower contraceptive self-efficacy. 8,9 …”