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

J Racial Ethn Health Disparities. 2017 Apr;4(2):184-194. doi: 10.1007/s40615-016-0217-0. Epub 2016 Mar 22.


Background: Unintended pregnancy is an important public health issue. Rates of unintended pregnancy are disproportionately higher among women from racial and ethnic minority groups among whom rates of contraceptive use are lower. Women's multifaceted feelings about pregnancy and perceptions of their intimate relationships may influence contraceptive behavior.

Methods: We used mixed methods to examine women's perceptions of pregnancy, motherhood, and contraceptives within the context of their intimate relationships. A convenience sample of 130 primarily low-income African American women ages 18-29 completed a cross-sectional, computerized survey; 12 women provided in-depth qualitative interview data. Generalized linear mixed models were used to identify associations between study variables and contraceptive effectiveness. Interview data were analyzed using qualitative descriptive methods and integrated with quantitative data.

Results: Higher positive pregnancy attitude [odds ratio (OR) 0.78; 95 % confidence interval (CI) 0.63, 0.98], lower contraceptive attitude (OR 1.17; 95 % CI 1.01, 1.36), and more than one recent sexual partner (OR 0.03; 95 % CI <0.01, 0.60) were associated with less effective contraceptive use. Qualitative results included three themes: You get pregnant that's on you; Motherhood means everything; and Make sure you're stable. Women's qualitative reports primarily supported but occasionally diverged from quantitative findings, reflecting discrepancies from their stated ideals, personal goals, and behavior.

Conclusion: The incongruities between women's ideals and their actual contraceptive behavior demonstrate the complexity of making reproductive decisions based on existing life circumstances and challenges. Health care providers should have broad understanding of women's pregnancy goals in order to recommend the most appropriate contraceptive methods and pre-conception counseling.

Keywords: Contraceptive; Mixed methods; Motherhood; Pregnancy attitude; Relationships.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Attitude to Health*
  • Black or African American*
  • Contraception Behavior*
  • Contraception*
  • Contraceptive Effectiveness*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Interpersonal Relations*
  • Linear Models
  • Odds Ratio
  • Poverty*
  • Pregnancy
  • Pregnancy, Unplanned
  • Public Health
  • Qualitative Research
  • Young Adult