A partner-specific critique of mistimed and unwanted fertility: Results from an analysis of the 2017-2019 United States National Survey of Family Growth.

CONTEXT: Despite substantial critiques of retrospective measures of fertility intentions, researchers widely use the metrics of unwanted and mistimed pregnancies as tools for monitoring patterns and trends in reproductive health. However, in focusing exclusively on the timing and numeric elements of fertility these constructs ignore partner-specific desires, which may lead to considerable measurement error and threaten their validity. METHODOLOGY: We use data on births in the last 5 years from the 2017-2019 United States National Survey of Family Growth to compare responses to the standard retrospective measure of fertility intentions with responses to a partner-specific question that asks respondents about whether they had ever desired a child with that partner. RESULTS: We find that women's responses to questions on retrospective fertility desires with and without reference to a particular partner vary in ways that suggest that women and researchers interpret these questions differently. DISCUSSION: Despite a long history in fertility research, the standard approach to measuring mistimed and unwanted fertility is both conceptually and operationally flawed. In the context of complicated sexual and reproductive lives that do not start and end with a single partner, researchers should reevaluate the usefulness of the constructs of mistimed and unwanted fertility. We conclude by offering recommendations for analysts and survey designers as well as by calling for a move away from the terms entirely to focus instead on the pregnancies that women themselves view as most problematic.

Korean mothers' career aspirations in the context of the COVID-19 pandemic: a longitudinal qualitative study.

Working mothers face challenges in pursuing their career aspirations due to work-family conflict. The recent COVID-19 pandemic has posed added challenges for working mothers by increasing care demands while also causing numerous health, economic and social disruptions. In this paper, we examine the impact of COVID-19 on Korean working mothers' career aspirations. We employ a longitudinal qualitative design by analysing 64 in-depth interviews with 32 mothers of young children in South Korea. By interviewing the same women before (2019) and during the COVID-19 pandemic (2020), we are able to document how working mothers' career aspirations were impacted by COVID-19. Findings show that all working mothers in the sample experienced increased care demands due to COVID-19. However, the influence of COVID-19 on working mothers' career aspirations hinged on gendered beliefs related to childcare responsibility. When working mothers believed or were subjected to beliefs that mothers should be the primary caregiver for children (gendered care belief), their career aspirations were tempered or relinquished. On the other hand, those who believed that mothers should not be held solely responsible for childcare (gender egalitarian care belief) continued to pursue their career aspirations or experienced career advancements during COVID-19. Findings suggest that beliefs related to care responsibilities play an important role in working mothers' pursuit of their career aspirations, and potentially their future careers.

Norms, Trust, and Backup Plans: U.S. College Women's Use of Withdrawal with Casual and Committed Romantic Partners.

This study integrates research on contraceptive prevalence with research on contraceptive dynamics in hookup culture to examine college women's use of withdrawal with sexual partners. Drawing on in-depth interviews with 57 women at a midwestern U.S. university, we analyzed women's explanations for using withdrawal for pregnancy prevention and framed our study within the research on gender norms, sexual scripts, and power dynamics. Findings showed withdrawal was normalized within collegiate hookup culture, and that women frequently relied on withdrawal as a secondary or backup method or when switching between methods. Women often followed up with emergency contraceptives if using withdrawal alone. With casual partners, women advocated for their own preferences, including for partners to withdraw. In committed relationships, women prioritized their partner's desires for condomless sex, but also linked withdrawal with trust and love. Thus, women in relationships may be disadvantaged by hookup culture norms suggesting sex is freely available, putting pressure on them to acquiesce to withdrawal. Many women used withdrawal despite acknowledging it was not the most desirable or effective method, emphasizing the need for a sexual health approach that acknowledges these tensions and strives to help women and their partners safely meet their sexual and contraceptive preferences.

Rights vs. Lived Realities: Women's Views of Gender Equality in Relationships in Rural South Africa.

South Africa's Constitution is among the world's most ambitious in promoting gender equality, but the country continues to be marked by inequality and gender-based violence. Given this context, we analyze 43 interviews with Black women aged 18-55 in rural South Africa to explore how the constitutional ideal of gender equality-or "50/50"-has been interpreted and applied in women's intimate relationships. Overall, we found that inequality and gender hierarchy were common in relationships. Women relied on two logics to explain the persistence of inequality in their relationships. First, women offered ideological support for gender norms supporting hierarchy by linking 50/50 to the abandonment of culture, tradition, and respect. Second, women viewed reaffirmation of gender inequality within relationships as a pragmatic way to avoid men's violence and infidelity, thus protecting women from abandonment and HIV. Women's views about equality in relationships were shaped by dominant gender norms, precarity in the local political economy, and the risks of violence and HIV/AIDS. Our findings expand theories of social change by highlighting how not only longstanding social norms, but also local political-economic and health conditions can influence views of equality and ultimately the local adoption or dismissal of international standards of rights and equality.

Fertility intentions and child health in India: Women's use of health services, breastfeeding, and official birth documentation following an unwanted birth.

This study examines the relationship between women's prospective fertility intentions and child health, measured via access to healthcare facilities for children and postpartum maternal behaviors that are indicative of future child health. We analyze two waves of nationally representative data (2005 and 2012) from the India Human Development Survey (IHDS). The analytic sample includes 3,442 non-pregnant, currently married women aged 18-40 in 2005 who participated in both rounds of the IHDS, and had at least one birth between 2005 and 2012. We investigate the influence of women's prospective fertility intentions on access to benefits from the Integrated Child Development Services (ICDS), indicators of breastfeeding as recommended by the World Health Organization, and official documentation of births via birth certificates or registration. We find that 58 percent of births among women in the sample were labeled as unwanted. We use an adaptation of propensity score matching-the inverse-probability-weighted regression adjustment (IPWRA) estimator-and show that, after accounting for maternal and household characteristics that are known to be associated with maternal and child health, children who resulted from unwanted births were less likely to obtain any benefits or immunizations from the ICDS, to be breastfed within one hour of birth, and to have an official birth certificate. Results from this study have direct policy significance given the evidence that women's fertility intentions can have negative implications for child health and wellbeing in the short and longer term.

Modernizing Marriage: Balancing the Benefits and Liabilities of Bridewealth in Rural South Africa.

The payment of bridewealth or lobola is a longstanding cultural practice that has persisted in South Africa despite significant societal shifts over the past two decades. Lobola has always been a complex and contested practice that both reinforces gender inequalities and, at the same time, provides status to women and legitimacy to marriages. In this paper, we describe rural South African women's perceptions of lobola, their experiences related to marriage and lobola, and how they reconfigure lobola to fit within modern life course aspirations and trajectories. We draw on interviews with 43 women aged 18-55 to examine desires related to lobola and the meanings of lobola given current social, economic, and health (HIV) conditions in rural areas. Our findings indicate that lobola offers women a complex set of benefits and liabilities. Although women value the support, social status, and respectability lobola offers, they also lament how lobola curtails their freedom to pursue education and limits their autonomy from husbands as well as in-laws. Women also view lobola as offering a sense of security amidst the uncertainty of the local political economy and the HIV/AIDS epidemic. We conclude that the way women incorporate lobola into their desires and plans reflects tension between the expectations and aspirations of "modern" women in a post-apartheid context in which rights feature prominently but economic security is not guaranteed, and cultural scripts reinforce longstanding gender norms but also ensure social support.

Fertility intentions and maternal health behaviour during and after pregnancy.

This study examines associations between fertility intentions and maternal health behaviours during and after pregnancy among a nationally representative sample of 3,442 women from India. Two waves of data (2005, 2012) from the India Human Development Survey were analyzed to investigate the influence of unwanted births on women's use of antenatal care, timely postnatal care, and the delivery setting using binary and ordered logistic regression, partial proportional odds models, and propensity score weighting. Fifty-eight per cent of sample births were unwanted. Regression results show that, net of maternal and household characteristics, women with unwanted births were less likely to obtain any antenatal care and had fewer antenatal tests performed. Unwantedness was also associated with a lower likelihood of delivering in an institutional setting and of obtaining timely postnatal care. The relationships between unwantedness and antenatal care, postnatal care, and delivery setting were robust to models accounting for propensity weighting.

Conflicting contraceptive norms for men: equal responsibility versus women's bodily autonomy.

Most research investigating how men and women in heterosexual relationships negotiate contraceptive use focuses on the women's point of view. Using a sample of 44 interviews with men attending a western US university, this study examines norms governing men's participation in contraceptive use and pregnancy prevention and their responses to those norms. The paper demonstrates how competing norms around sexual health decision-making and women's bodily autonomy contribute to unintended outcomes that undermine young people's quest for egalitarian sexual relationships. While men largely agree that responsibility for sexual health decision-making should be shared with women, they also believe that women should have power over their own bodies and sexual health. However, the coexistence of these two competing norms - which call for both equal responsibility in decision-making and women's bodily autonomy - results in a disconnect between men saying that sexual health decision-making should be equal, but not always participating equally. Thus, men largely give contraceptive decision-making power over to women, putting the burden of pregnancy prevention onto women and letting men off the hook. It is concluded that men's negotiation of these competing norms reinforces unequal power and inequality in sexual relationships.

Conceptualizing Childbearing Ambivalence: A Social and Dynamic Perspective.

Childbearing ambivalence is often conceptualized as a state of conflicting desires about having a child that is characteristic of particular individuals and/or life stages. This study proposes that childbearing ambivalence is dynamic and situational, resulting from the multiple socio-cultural frames surrounding childbearing. Using eight waves of prospective data from a population-based sample of young adults in Malawi, results show that 41% of women and 48% of men are ambivalent about childbearing at some point in the 2.5-year study. There is limited evidence that ambivalence is related to individual sociodemographic or psychosocial characteristics aside from gender; rather, ambivalence is tied to life course markers such as school enrollment and age. Additionally, life course transitions and changes in relationships, health, and economic factors are associated with the onset of ambivalence, supporting the theory that ambivalence is a dynamic state that men and women frequently pass through as their lives and circumstances change.

'Behaving well': the transition to respectable womanhood in rural South Africa.

Few studies of the transition to adulthood in Africa analyse young people's own definitions of the events that confer adult status, and how adulthood is actually attained. This paper examines the experience of transitioning to womanhood in rural Mpumalanga Province, South Africa, drawing on interviews with 18 women aged 18-39. Three primary experiences characterised this transition: puberty and emerging body awareness, spending time with boys, and having a child. More important than the timing of these experiences, however, was whether women 'behaved well' and maintained respectability as they transitioned to adulthood. Behavioural standards reinforcing ideal femininity were focused on dress, manner and talk, and were particularly stringent for mothers. Findings emphasise the value of emic models of adulthood for understanding how youth experience this transition and provide an important counter-narrative to the literature focused primarily on the risk African youth face during this period of change in the life course.

Death and Desirability: Retrospective Reporting of Unintended Pregnancy After a Child's Death.

Social scientists have long debated how to best measure pregnancy intentions. The standard measure relies on mothers' retrospective reports of their intentions at the time of conception. Because women have already given birth at the time of this report, the resulting children's health-including their vital status-may influence their mothers' responses. We hypothesize that women are less likely to report that deceased children were from unintended pregnancies, which may explain why some cross-sectional studies have shown that children from unintended pregnancies have higher survival, despite the fact that longitudinal studies have shown the opposite is true. Using Demographic and Health Survey data from 31 sub-Saharan African countries, we confirm that mothers are less likely to report that deceased children resulted from unintended pregnancies compared with surviving children. However, the opposite is true for unhealthy children: mothers more commonly report that unhealthy children were from unintended pregnancies compared with healthier children. The results suggest that mothers (1) revise their recall of intentions after the traumatic experience of child death and/or (2) alter their reports in the face-to-face interview. The study challenges the reliability of retrospective reports of pregnancy intentions in high-mortality settings and thus also our current knowledge of the levels and consequences of unintended pregnancies in these contexts.

SURPRISING RESULTS: HIV TESTING AND CHANGES IN CONTRACEPTIVE PRACTICES AMONG YOUNG WOMEN IN MALAWI.

This study uses eight waves of data from the population-based Tsogolo la Thanzi study (2009-2011) in rural Malawi to examine changes in young women's contraceptive practices, including the use of condoms, non-barrier contraceptive methods and abstinence, following positive and negative HIV tests. The analysis factors in women's prior perceptions of their HIV status that may already be shaping their behaviour and separates surprise HIV test results from those that merely confirm what was already believed. Fixed-effects logistic regression models show that HIV testing frequently affects the contraceptive practices of young Malawian women, particularly when the test yields an unexpected result. Specifically, women who are surprised to test HIV positive increase their condom use and are more likely to use condoms consistently. Following an HIV-negative test (whether a surprise or expected), women increase their use of condoms and decrease their use of non-barrier contraceptives; the latter may be due to an increase in abstinence following a surprise negative result. Changes in condom use following HIV testing are robust to the inclusion of potential explanatory mechanisms, including fertility preferences, relationship status and the perception that a partner is HIV positive. The results demonstrate that both positive and negative tests can influence women's sexual and reproductive behaviours, and emphasize the importance of conceptualizing of HIV testing as offering new information only insofar as results deviate from prior perceptions of HIV status.

Reconsidering gendered sexualities in a generalized AIDS epidemic.

Using the threat of a severe AIDS epidemic in a collection of rural villages in South Africa, we illustrate how men and women reconsider gendered sexualities through conversations and interactions in everyday life. We draw from data collected by local ethnographers and focus on the processes through which men and women collectively respond to the threat posed by AIDS to relationships, families, and communities. Whereas previous research has shown that individuals often reaffirm hegemonic norms about gender and sexuality in response to disruptions to heteronormative gender relations, we find that the threat of AIDS provokes reconsideration of gendered sexualities at the community level. That is, our data demonstrate how men and women-through the interactions and exchanges that make up their daily lives-debate, challenge, make sense of, and attempt to come to terms with social norms circumscribing gendered sexual practices in a context where the threat of a fatal disease transmitted through sex looms large. We argue that ethnographic data are particularly useful for capturing communal responses to events that threaten heteronormative gender relations and reflect on how our findings inform theories of gender relations and processes.

Premarital Births and Union Formation in Rural South Africa.

CONTEXT: In rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common. METHODS: Longitudinal data from the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa were used to examine the relationship between premarital birth and union entry among 55,158 nonmigrant women aged 10-35 who took part in at least one annual census from 1993 to 2012. Discrete-time event history models were used to determine whether the likelihood of union formation differed between women who had had a premarital first birth and those who had not. Associations between single motherhood and union type (marriages or nonmarital partnerships) were identified using logistic regression. RESULTS: Forty-five percent of women had had a premarital first birth and 25% had entered a first union. Women who had had a premarital first birth were less likely than other women to have entered a first union (odds ratio, 0.6). Women who had had a premarital birth in the past year were more likely than those without a premarital birth to have entered a union (1.5), but women had reduced odds of union formation if they had had a birth 1-2 years earlier (0.9) or at least five years earlier (0.8). Unions formed within two years of a premarital birth had an elevated likelihood of being nonmarital partnerships (1.2-1.4). CONCLUSIONS: Single motherhood is common in the Agincourt HDSS, and women with a premarital first birth face challenges in establishing committed unions with partners.

Implementing "insider" ethnography: lessons from the Public Conversations about HIV/AIDS project in rural South Africa.

We describe the conceptualization and implementation of a research methodology in which "insider" community members work with "outsider" investigators as participant observers to document everyday conversations taking place in public settings in their communities. Our study took place in a resource-poor area of rural South Africa and focused on HIV/AIDS, yet we aim here to provide a road map for those interested in implementing this approach in other contexts for various empirical ends. Because this approach is unusual, we highlight considerations in selecting a team of ethnographers, describe the training process, and offer ways to ensure the data collected are trustworthy and confidential. We describe the advantages and limitations of utilizing "insider ethnography" in contexts where being indigenous to the study site provides access to perspectives that cannot be obtained through other methods. Finally, we examine how mutuality and the positionality of the research team affect data collection and quality.

The sensitivity of measures of unwanted and unintended pregnancy using retrospective and prospective reporting: evidence from Malawi.

A thorough understanding of the health implications of unwanted and unintended pregnancies is constrained by our ability to accurately identify them. Commonly used techniques for measuring such pregnancies are subject to two main sources of error: the ex post revision of preferences after a pregnancy and the difficulty of identifying preferences at the time of conception. This study examines the implications of retrospective and prospective measurement approaches, which are vulnerable to different sources of error, on estimates of unwanted and unintended pregnancies. We use eight waves of closely-spaced panel data from young women in southern Malawi to generate estimates of unwanted and unintended pregnancies based on fertility preferences measured at various points in time. We then compare estimates using traditional retrospective and prospective approaches to estimates obtained when fertility preferences are measured prospectively within months of conception. The 1,062 young Malawian women in the sample frequently changed their fertility preferences. The retrospective measures slightly underestimated unwanted and unintended pregnancies compared to the time-varying prospective approach; in contrast the fixed prospective measures overestimated them. Nonetheless, most estimates were similar in aggregate, suggesting that frequent changes in fertility preferences need not lead to dramatically different estimates of unwanted and unintended pregnancy. Greater disagreement among measures emerged when classifying individual pregnancies. Carefully designed retrospective measures are not necessarily more problematic for measuring unintended and unwanted fertility than are more expensive fixed prospective ones.

Low-income women's navigation of childbearing norms throughout the reproductive life course.

Shifts in family structure have affected age norms about both teenage childbearing and reproductive sterilization, but we lack research examining how childbearing norms are connected across the reproductive life course. Drawing on interviews from 40 low-income women in Colorado, we explored linkages between early childbearing and the desire for early sterilization. Specifically, we examined two narratives women use to negotiate competing norms throughout the reproductive life course. The low-income women in our study characterized their teenage childbearing experiences negatively and justified them using a "young and dumb" narrative. Women also asserted that reversible contraceptives do not work for them, using a "hyper-fertility" narrative to explain both their early childbearing and their desire for early sterilization. Our results illustrate the influence of mainstream social norms about childbearing timing on low-income women's lives and provide evidence of how women use narratives to explain and justify their violation of childbearing norms.

Bundles of Norms About Teen Sex and Pregnancy.

Teen pregnancy is a cultural battleground in struggles over morality, education, and family. At its heart are norms about teen sex, contraception, pregnancy, and abortion. Analyzing 57 interviews with college students, we found that "bundles" of related norms shaped the messages teens hear. Teens did not think their communities encouraged teen sex or pregnancy, but normative messages differed greatly, with either moral or practical rationalizations. Teens readily identified multiple norms intended to regulate teen sex, contraception, abortion, childbearing, and the sanctioning of teen parents. Beyond influencing teens' behavior, norms shaped teenagers' public portrayals and post hoc justifications of their behavior. Although norm bundles are complex to measure, participants could summarize them succinctly. These bundles and their conflicting behavioral prescriptions create space for human agency in negotiating normative pressures. The norm bundles concept has implications for teen pregnancy prevention policies and can help revitalize social norms for understanding health behaviors.

The Relationship between Partners' Family-Size Preferences in Southern Malawi.

Studies of the relative influence of partners' fertility preferences on behaviors tend to treat preferences as fixed, largely independent traits despite existing theoretical arguments and empirical evidence suggesting that they are moving targets that may be jointly developed within relationships. In this study, we use couple-level panel data from married and unmarried young adults in southern Malawi to examine the relationship between partners' family-size preferences. We find evidence of assortative mating: young Malawians are more likely to partner with individuals who have similar family-size goals. Additionally, although partners' family-size preferences do not perfectly converge, changes among men's and women's preferences are significantly more likely to be "toward" than "away from" those of their partner. Our findings point to a need for studies regarding the relative influence of partners on reproductive outcomes to consider the interdependence of partners' preferences and the varied ways in which partners can influence shared reproductive behaviors.

Management of non-marital fertility in two South African communities.

In this analysis, we draw on qualitative data to examine the management of non-marital fertility among young women in two rural, Black communities situated in different provinces of South Africa: KwaZulu-Natal and Mpumalanga. While the two communities share a history of economic and social disadvantage and limited access to the labour market, there are, nonetheless, distinctive features that are evident in the management of non-marital fertility. We show that young women in both communities aspire to an ideal ordering of events that places finishing education before getting married and having children, but this is not easily attained. However, there are important differences in the ways young women and their families respond to union formation and childbearing that often occurs outside of a recognised union. In Hlabisa, KwaZulu-Natal, formal processes for legitimising non-marital pregnancies through union recognition are still in place whereas, in Agincourt, Mpumalanga, more emphasis is placed on securing support and paternal recognition for the child rather than on cementing the union between the young woman and her partner. We also find that the older generation in Agincourt at times views education as a threat to marriage while this is not common in Hlabisa. Our findings have important implications for intervention programmes that often treat Black communities as homogeneous wholes.