Pregnancy intentions in a group of remote-dwelling Australian Aboriginal women: a qualitative exploration of formation, expression and implications for clinical practice

Abstract

Background Unintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements. Methods Semi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18–49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation. Results Most (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community. Conclusion Consultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.

Women’s perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis

“…Nine studies specifically explored experiences of low-income women [ 30 , 33 , 36 , 37 , 40 , 41 , 43 , 51 , 52 ]. Two studies explored the experiences of Indigenous women in Australia [ 48 , 49 ], two studies explored perspectives of rural Hindu women in India [ 51 , 52 ], and three explored experiences of migrant women in Australia and USA [ 38 , 42 , 48 ]. Fifteen studies from the USA explored the experiences of women from different racial and ethnic backgrounds, particularly White, African American and Latina women [ 3 , 29 – 37 , 39 , 40 , 42 , 43 ].…”

“…Reproductive coercion and abuse was the primary phenomena of interest in 13 studies [ 3 , 5 , 29 , 40 – 42 , 44 , 47 , 48 , 50 , 54 , 58 ]. Reproductive coercion and abuse was a secondary phenomena of interest in the other studies, which focused on women’s experiences with intimate partner violence (IPV) particularly sexual violence [ 31 , 53 , 57 ], the effects of abuse or IPV on women’s reproduction [ 32 – 35 , 39 , 43 , 45 , 46 , 51 , 55 , 56 ], factors affecting women’s pregnancy intentions [ 30 , 36 , 49 , 52 ], barriers to contraception use [ 37 ] and son preferences [ 38 ].…”

“…Thirty two studies described women’s experiences of reproductive coercion and abuse within the three domains of pregnancy coercion, contraceptive control or control of pregnancy outcome [ 3 , 5 , 29 – 59 ]. Eighteen studies included perceived and experienced consequences of reproductive coercion and abuse [ 3 , 5 , 29 , 32 – 36 , 38 , 39 , 41 , 43 , 47 – 50 , 56 , 59 ] and 16 studies explored women’s responses [ 3 , 29 , 30 , 32 , 33 , 35 – 37 , 42 , 44 , 45 – 49 , 51 ].…”

Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom?

“…The setting was three very remote communities in the Western Desert, a remote area of the Kimberley region of Western Australia which has been described elsewhere [25,26]. The audit period was 1 January 2011-1 September 2018.…”

“…We therefore aimed to describe what components of PCC were delivered by individual pregnancy; the prevalence of key pregnancy risk factors that were identifiable in the preconception period; the type of healthcare worker delivering PCC and how PCC is being delivered over time. This report follows from previous work examining contraceptive use and reproductive decision making in participating communities [25,26].…”