Acceptability and feasibility of the CHARISMA counseling intervention to support women's use of pre-exposure prophylaxis: results of a pilot study.

BACKGROUND: Women may need or seek male partner approval to safely and consistently use oral antiretroviral pre-exposure prophylaxis (PrEP) or vaginal microbicides. We developed CHARISMA, a counseling intervention to support women's relationships and their ability to consistently use HIV prevention products. METHODS: In a pilot study with 95 female participants in Johannesburg, South Africa, lay counselors implemented CHARISMA, assessing participants' relationship(s) with their male partner(s) and barriers or facilitators to HIV prevention method use, and then providing tailored, interactive counseling. We conducted study participant surveys and clinic staff interviews to evaluate CHARISMA's feasibility and acceptability. RESULTS: The CHARISMA pilot study indicates that a two-session relationship counseling intervention with 6-month follow-up to support women's ability to safely and effectively use vaginal microbicides was generally acceptable and feasible. Most participants thought CHARISMA was relevant, helpful, and about the right length, and that it had a positive impact on their relationships with their partners and their product use. Staff estimated that the intervention took 1.5-2 h to implement at enrollment and 45 min to an hour for the month 1 visit. They thought that overall CHARISMA was generally feasible to implement. CONCLUSIONS: Findings from this study suggest several lessons learned that may be relevant to others developing interventions supporting women's use of oral PrEP or vaginal microbicides. The use of lay counselors instead of nurses to deliver counseling appeared to be successful, but the counselors experienced significant stress from hearing about participants' traumatic experiences and required emotional support to avoid burnout. Although staff and participants felt that having multiple intervention sessions over time was valuable, a similar level of intensity may not be feasible in other settings. Further research is needed to determine an intervention delivery mode and follow-up period that optimally balances participant needs and clinic resources. Male engagement was a challenge, as it has been in previous studies of vaginal microbicides. Alternative strategies to reach men that do not require them to come to the clinic or rely on their female partners may be more effective.

Patients' and Caregivers' Experiences with the Multi-Payer Advanced Primary Care Practice Demonstration.

BACKGROUND: The patient-centered medical home (PCMH) model aims to improve primary health care using a patient-centered approach. Little qualitative research has investigated how the PCMH model affects patient experience with care. OBJECTIVE: To understand Medicaid and Medicare patient and caregiver experiences with PCMHs participating in the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration. DESIGN: Qualitative study. PARTICIPANTS: Medicare, Medicaid, and dually eligible patients who were patients in primary care practices participating in the MAPCP Demonstration and caregivers of such patients (N = 490). APPROACH: From July through November 2014, a trained facilitator conducted 81 focus groups in the eight states participating in the MAPCP Demonstration. Separate groups were held for Medicare high-risk, Medicare low-risk, Medicaid, and dually eligible beneficiaries, their caregivers, and caregivers of Medicaid children (or, in Vermont, with patients participating in the Support and Services at Home program), in two different geographical areas in each state. Focus group discussions were recorded, transcribed, and analyzed using NVivo qualitative data analysis software. RESULTS: Participants' experiences with care were generally consistent with the expectations of a PCMH, although some exceptions were noted. Medicaid only and dually eligible beneficiaries generally had less-positive experiences than Medicare beneficiaries. Most participants said their practices had not solicited feedback from them about their experiences with care. Few participants knew what the term "medical home" meant or were aware that their practices were working to become PCMHs, but many had noticed changes in recent years, primarily related to the conversion to electronic health records. CONCLUSIONS: Most participants had positive experiences with their care. Opportunities exist, however, to improve care for Medicaid and dually eligible beneficiaries, and enhance patient awareness of and involvement in PCMH practice transformation.

Patterns of preconception, prenatal and postnatal care for diabetic women by obstetrician-gynecologists.

OBJECTIVE: To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists. STUDY DESIGN: A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/ high insurance patient populations. RESULTS: Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients' ability to afford healthful food were barriers to quality care. CONCLUSION: According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Postpartum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources.

Factors influencing women's decisions about pregnancy spacing: Findings from a focus group discussion study.

OBJECTIVES: Very short interpregnancy intervals are associated with negative health outcomes for mothers and children, and pregnancies with very short interpregnancy intervals are more likely to be unintended than pregnancies that are more widely spaced. The objective of this study was to improve understanding of women's motivations regarding pregnancy spacing. METHODS: In 2017, we conducted 8 focus group discussions with 49 English- and Spanish-speaking postpartum women in central North Carolina. The groups explored participants' preferences for birth spacing and factors that influenced their decisions. We recorded, transcribed, and coded the discussions and analyzed these data for core themes. RESULTS: Participants' ideas about when and whether to have more children were fluid-some had specific ideas during pregnancy or after delivery that changed over time; others had no definite plans. The primary reason for close birth spacing was to promote their children's having a closer relationship. Reasons for wider spacing included recovery from the previous pregnancy, challenges related to having 2 babies concurrently, and desire to wait for more favorable life circumstances. Participants did not mention health risks to children of short interpregnancy intervals and said that no health care providers discussed these risks with them. They had mixed perspectives about whether this information would influence their own child-spacing preferences but agreed that it should be shared with women to promote informed decision-making. CONCLUSION: This study adds to limited research regarding the factors that women consider when determining pregnancy spacing. Better understanding of women's motivations can help inform counseling to help women achieve their desired pregnancy spacing.

Mothers, fathers, sons, and daughters: gender differences in factors associated with parent-child communication about sexual topics.

BACKGROUND: In the United States, nearly half of high school students are sexually active, and adolescents experience high rates of unintended pregnancy and sexually transmitted diseases. Parents can have an important influence on their children's sexual behaviour, but many parents do not talk with their children about sexual topics. Research has shown significant differences in parent-child communication about sexual topics depending on the gender of both the parent and the child. Little is known, however, about the reasons for these gender differences. The purpose of this paper is to describe how factors associated with parent-child communication about sexual topics differ by gender. METHODS: Data are from a nationwide online survey with 829 fathers and 1,113 mothers of children aged 10 to 14. For each of the four gender groups (fathers of sons, fathers of daughters, mothers of sons, mothers of daughters), we calculated the distribution of responses to questions assessing (1) parent-child communication about sex-related topics, and (2) factors associated with that communication. We used chi-square tests to determine whether the distributions differed and the false discovery rate control to reduce the likelihood of type I errors. RESULTS: With both sons and daughters, fathers communicated less about sexual topics than mothers did. Fathers also had lower levels of many characteristics that facilitate communication about sex (e.g., lower self-efficacy and lower expectations that talking to their children about sex would have positive outcomes). Compared with parents of sons, parents of daughters (both mothers and fathers) talked more about sexual topics, were more concerned about potential harmful consequences of sexual activity, and were more disapproving of their child having sex at an early age. CONCLUSIONS: Using a large national sample, this study confirms findings from previous studies showing gender differences in parent-child communication about sexual topics and identifies gender differences in factors that may influence parent-child communication about sexual topics. Interventions designed to support parent-child communication about sexual topics should emphasize to both mothers and fathers the importance of talking to sons as well as daughters. Fathers need particular support to overcome the barriers to communication they encounter.

Differences in contraceptive use across generations of migration among women of Mexican origin.

OBJECTIVES: To explore differences in contraceptive use among women of Mexican origin across generations of migration. METHODS: Logit models were used to assess contraceptive use among 1,830 women of Mexican origin in Cycles 5 (1995) and 6 (2002) of the National Survey of Family Growth (NSFG). Analyses were stratified by age. Initial models controlled for survey year and underlying differences across generations of migration in age and parity; subsequent models added a range of potential mediating variables. Models account for significant interactions between generation of migration and parity. RESULTS: Among women under age 30 who have not yet had any children, women in their twenties with parity 3 or more, and women 30 or older with parity 1 or 2, those born in the US are much more likely to use contraception than immigrant women. For other levels of parity, there are no significant differences in contraceptive use across generations of migration. Generational differences in marital status, socio-economic status, health insurance coverage, and catholic religiosity did little to mediate the association between generation of migration and contraceptive use. CONCLUSIONS: Among women of Mexican origin, patterns of contraceptive use among first-generation immigrants and women of generation 1.5 are similar to those of women in Mexico, with very low rates of contraceptive use among young women who have not yet had a child. Further research is needed to investigate the extent to which this pattern is due to fertility preferences, contraceptive access, or concerns about side effects and infertility. Patterns of contraceptive use appear to change more slowly with acculturation than many other factors, such as education, income, and work force participation.

Associations between low-income women's relationship characteristics and their contraceptive use.

CONTEXT: Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods. METHODS: Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods. RESULTS: Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse. CONCLUSIONS: When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.

A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices.

CONTEXT: Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. METHODS: A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. RESULTS: Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. CONCLUSIONS: Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy.

From mission to measures: performance measure development for a Teen Pregnancy Prevention Program.

The Office of Adolescent Health (OAH) sought to create a comprehensive set of performance measures to capture the performance of the Teen Pregnancy Prevention (TPP) program. This performance measurement system needed to provide measures that could be used internally (by both OAH and the TPP grantees) for management and program improvement as well as externally to communicate the program's progress to other interested stakeholders and Congress. This article describes the selected measures and outlines the considerations behind the TPP measurement development process. Issues faced, challenges encountered, and lessons learned have broad applicability for other federal agencies and, specifically, for TPP programs interested in assessing their own performance and progress.

Feasibility and acceptability of a computer-based tool to improve contraceptive counseling.

OBJECTIVE: The objective was to test the feasibility and acceptability of a computerized tool, Smart Choices, designed to enhance the quality of contraceptive counseling in family planning clinics. The tool includes (a) a questionnaire completed by patients and summarized in a printout for providers and (b) a birth control guide patients explore to learn about various contraceptive methods. STUDY DESIGN: In 2 family planning clinics, we conducted interviews with 125 women who used the Smart Choices computerized tool and 7 providers. RESULTS: Smart Choices integrated into clinic flow well in one clinic, but less well in the other, which had very short waiting times. Patients were generally enthusiastic about Smart Choices, including its helpfulness in preparing them and their providers for the counseling session and increasing their knowledge of contraceptive methods. Providers varied in how much they used the printout and in their opinions about its usefulness. Some felt its usefulness was limited because it overlapped with the clinic's intake forms or because it did not match with their concept of counseling needs. Others felt it provided valuable information not collected by intake forms and more honest information. Some found Smart Choices to be most helpful with patients who were unsure what method they wanted. CONCLUSIONS: Smart Choices is feasible to implement and well received by patients, but modifications are needed to increase provider enthusiasm for this tool. IMPLICATIONS: The Smart Choices tool requires refinement before widespread dissemination.

Postpartum contraceptive use among adolescent mothers in seven states.

PURPOSE: To describe postpartum contraceptive use among adolescent mothers and assess the hypothesis that receipt of prenatal contraceptive counseling or a postpartum checkup is associated with the use of more effective methods. METHODS: Data are from the Pregnancy Risk Assessment and Monitoring System for seven states and the city of New York for the years 2006-2008. The sample comprises 3,207 adolescent mothers aged 15-19 years. We conducted descriptive and multinomial logistic regression analyses. The outcome measure was the type of contraceptive method used at the time of the survey. RESULTS: Nineteen percent of adolescent mothers, more than half of whom were sexually active, were using no contraception at the time of the survey. The remaining 81% were using a contraceptive method. Use of long-acting reversible contraception (LARC) was low-11% were using an intrauterine device, and only 1% were using an implant. Receipt of prenatal contraceptive counseling and receipt of a postpartum checkup were both associated with a decreased likelihood of having sex without contraception. A postpartum checkup was also associated with an increased likelihood of using medium-acting contraceptives (injectables, ring, or patch) and a decreased likelihood of relying on condoms. Prenatal contraceptive counseling was also associated with an increased likelihood of pill use. CONCLUSIONS: Given the demonstrated association between LARC use and decreased rates of rapid repeat pregnancy, efforts should be made to increase adolescent mothers' access to LARC. Enhancing the scope and quality of prenatal contraceptive counseling and increasing the proportion of adolescent mothers who return for a postpartum checkup may also improve postpartum contraceptive use.

Infant feeding experiences among teen mothers in North Carolina: Findings from a mixed-methods study.

BACKGROUND: Adolescent mothers in the U.S. are much less likely to initiate breastfeeding than older mothers, and teens who do initiate breastfeeding tend to breastfeed for shorter durations. The purpose of this mixed-methods study is to investigate breastfeeding practices, barriers and facilitators among adolescent mothers ages 17 and younger. METHODS: Quantitative descriptive analyses are conducted using data from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The population-based sample comprises 389 teens ages 13-17 giving birth to a live born infant in North Carolina in 2000 - 2005 and in 2007. Qualitative analyses are based on in-depth interviews with 22 Black, White and Hispanic teen mothers residing in rural and urban areas of North Carolina conducted between November 2007 and February 2009. RESULTS: In quantitative analyses, 52% (196 of 389) of North Carolina teen mothers initiated breastfeeding, but half of those who initiated breastfeeding (92/196) stopped within the first month postpartum. Hispanic teens (44/52 or 89%) were much more likely than Black (61/159 or 41%) or White teens (87/164 or 52%) to initiate breastfeeding and to continue for a longer duration. Nearly sixty two percent (29/52) of Hispanic respondents breastfed for greater than four weeks as compared to 16% (29/159) of Black respondents and 26% (39/164) of White respondents. Common barriers to breastfeeding initiation and continuation included not liking breastfeeding, returning to school, nipple pain, and insufficient milk. Qualitative data provided context for the quantitative findings, elucidating the barriers and facilitators to breastfeeding from the teens' perspective and insight into the ways in which breastfeeding support to teens could be enhanced. CONCLUSIONS: The large number of adolescents ceasing breastfeeding within the first month points to the need for more individualized follow-up after hospital discharge in the first few days postpartum, to address common technical challenges and to provide assistance managing the transition back to school. Provision of an extra home visit or outpatient visit for teens within the first few days following hospital discharge, and advocacy to make schools more compatible with breastfeeding, could potentially help teens who desire to breastfeed to successfully continue. These interventions warrant further research to test their effectiveness among adolescents.

Adolescent mothers' postpartum contraceptive use: a qualitative study.

CONTEXT: Effective contraceptive use among first-time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents' postpartum contraceptive use. METHODS: In-depth interviews were conducted with 21 black, white and Latina adolescent first-time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants-professionals who work closely with adolescent mothers. Interviews explored adolescent mothers' health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns. RESULTS: Teenagers' use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care. CONCLUSIONS: Ongoing follow-up may help reduce adolescent mothers' risk of contraceptive discontinuation postpartum. Increasing use of long-acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.

"We're the heroes!": fathers' perspectives on their role in protecting their preteenage children from sexual risk.

CONTEXT: Parents can be an important influence on their children's sexual behavior. However, relatively little research has focused on fathers' roles in protecting children from sexual risk or on their discussions with children about sex. METHODS: Sixteen focus groups comprising 131 parents of children aged 10-12 were conducted in three U.S. cities in 2007. Separate groups were held for mothers and fathers, and for white, black, English-speaking Hispanic and Spanish-speaking Hispanic participants. Content analysis was used to identify core themes and patterns related to fathers' communications with their children about sex. RESULTS: Fathers were highly invested in ensuring that their children are safe and successful in life. Although some had not talked to their children about sex, others had discussed it frequently and openly, and nearly all agreed that fathers' perspectives are important for children to hear. Fathers reported being better suited to discussing some topics (e.g., male puberty, how young men think) than others (menstruation). Fathers also described other strategies that they use to guide their children's development, such as emphasizing future goals and monitoring children's activities and friends. Many fathers, especially Hispanic participants, reported being more protective of daughters than of sons, and some had particular difficulty talking with their daughters about sex. CONCLUSIONS: Research and interventions concerning parent-child communication about sex should not neglect the role of fathers. However, some fathers may need support to overcome barriers to effective communication, especially with their daughters.

Parents' perspectives on talking to preteenage children about sex.

CONTEXT: Although parent-child communication about sex can significantly affect children's sexual behavior, many parents do not talk to their children about sex. Qualitative research can elucidate parents' attitudes toward and experiences with communicating with their children about sex. METHODS: In 2007, 16 focus groups were conducted with 131 mothers and fathers of children aged 10-12 in three cities in different regions of the United States. Separate groups were conducted for mothers and fathers, and for black, white and Hispanic parents. Content analysis was used to identify core themes and patterns. RESULTS: Parents believed it is important to talk to their children about sex and believed that doing so can be effective, but many had not done so. Primary barriers were parents' perception that their children are too young and not knowing how to talk to their children about the subject. Parents found it easiest to talk to their children about sex if they had a good parent-child relationship, took advantage of opportunities to talk and began having the discussions when their children were very young. Some differences were noted by parents' race, ethnicity, gender and location. CONCLUSIONS: Interventions aimed at encouraging parents to talk to their children about sex should enhance parents' understanding of the stages of children's sexual development and focus on the parents of young children. In addition, interventions should support parents in a range of strategies that complement discussions about sex.

Acculturation and changes in the likelihood of pregnancy and feelings about pregnancy among women of Mexican origin.

This study explored the changes that occur with acculturation in the likelihood that women of Mexican origin in the United States get pregnant, that they considered their pregnancies intended, and that they were happy about their pregnancies. Data were from 924 women of Mexican origin in the 1995 National Survey of Family Growth. Results showed that, controlling for underlying differences in age and parity, Mexican-origin women born in the United States were less likely to conceive a pregnancy than first-generation immigrants (O.R. = 0.69, C.I. 0.56-0.83), but the pregnancies they conceived were less likely to be intended (O.R. = 0.53, C.I. 0.35-0.79), and they were less likely to be happy about them (O.R. = 0.76, C.I. 0.57-1.01). These changes were associated with the decreases in marriage, poverty, and Catholic religiosity that occurred between first-generation immigrants and women of later generations. Findings highlight the unmet need for effective family planning among women of all generations of migration, but particularly those born in the United States.

Patterns in prenatal syphilis screening among Florida Medicaid enrollees.

OBJECTIVE: The objective of this study was to assess the rate of prenatal syphilis screening and compliance with clinical guidelines on the receipt of early and repeat screening in a Medicaid population before and after implementation of the National Plan to Eliminate Syphilis. STUDY DESIGN: Rates of office- and clinic-based prenatal syphilis screening among pregnant women with Medicaid-covered deliveries in Florida in fiscal years (FYs) 1995 and 2000 are analyzed using Medicaid claims data. RESULTS: The proportions of women receiving any, early, and repeat prenatal syphilis screening increased sharply between FY 1995 and FY 2000 but remain well below recommended levels. Screening is highly correlated with timing of prenatal care and Medicaid enrollment duration. CONCLUSIONS: Further efforts to improve screening rates will need to both increase the proportion of women who receive timely prenatal care and ensure that providers comply with guidelines to provide syphilis screening as a component of prenatal care for all women.

Motivations for pregnancy planning among Mexican immigrant women in North Carolina.

OBJECTIVES: To enhance understanding of 1) Mexican immigrant women's attitudes toward planning their pregnancies and the factors that influence their fertility preferences, and 2) the effect of migration on their pregnancy planning decisions. METHODS: Qualitative in-depth interviews were conducted with 11 Mexican immigrant women living in North Carolina. Participants were recruited by means of snowball sampling. Interviews were conducted in Spanish in the women's homes. Interviewing and analysis were conducted iteratively to allow emerging themes and interpretations to be developed and validated in subsequent interviews. RESULTS: The women were strongly motivated to plan their pregnancies. Their primary considerations in pregnancy planning were their ability to give their children a good life and their ability to enjoy their families. Individual personal aspirations did not emerge as an important consideration. Migration intensified the women's felt need to plan their pregnancies. CONCLUSIONS: The Mexican immigrant women in this study had a strong familistic orientation. Far from diminishing their interest in planning their pregnancies, however, the high value they placed on family was their primary motivation for pregnancy planning. Migration to the U.S. intensified their felt need to plan their pregnancies. Understanding of the women's motivations for family planning may help health care providers better address the family planning needs of Mexican immigrant women.

The Relationship Context: Its Effects on Low-Income Women's Desire for a Baby.

Little is known about the influence of relationship characteristics on a woman's desire for a baby with her partner. This study addresses that gap, using data from a study of 1,114 low-income women in the southeast who were in a relationship. Controlling for sociodemographic factors, women who were in more established relationships, who had not had a previous child with their partner, or who had higher expectations of their partner were generally more likely to want a baby with him. In investigating women's childbearing desires, it is important to consider not only individual characteristics but also women's relationship characteristics.