What a (Young) Woman Wants: Concurrent Effects of Desire to Avoid Pregnancy and Desire for Sex on Sexual Intercourse and Contraceptive Use.

Of all pregnancies among young women in the United States, more than 60% are undesired, yet explanations for this phenomenon remain elusive. While research has investigated how pregnancy desires and intentions shape pregnancy-related behavior, only recently have scholars noted that desire for sex influences these same behaviors. Many young women simultaneously experience strong desires for sex alongside a strong desire to avoid pregnancy, but few studies have considered the extent to which young women adapt their reproductive behaviors in response to these potentially competing desires. Using novel weekly panel data, this analysis assesses how desires for sex may moderate the effect of the desire to avoid pregnancy on a young woman's sexual behavior and contraceptive use. Findings suggest that when a woman strongly wants to avoid pregnancy, she is less likely to have sex and more likely to use hormonal or coital contraceptives. As her desire for sex increases, however, she is instead more likely to have sex and use hormonal contraceptives. If she does not use hormonal methods, she is less likely to use coital contraceptives when she has intercourse. These findings highlight the importance of recognizing the desire for sex as a behavioral modifier for avoiding undesired pregnancy in the transition to adulthood.

International Migration and Modern Contraceptive Use: A Research Note on African Migrants to France.

This research note presents a multisited analysis of migration and contraceptive use by standardizing and integrating a sample of African migrants in France from six West and Central African countries in the Trajectoires et Origines survey with a sample of women living in the same six African countries in the Demographic and Health Surveys. Descriptive analyses indicate that the contraceptive use of migrants more closely aligns with that of native French women than with that of women from origin countries. In particular, migrants report dramatically higher use of long-acting reversible contraceptives and short-acting hormonal methods and lower use of traditional methods than do women in the countries of origin. Although migrants differ from women in the countries of origin on observed characteristics, including education and family background, reweighting women in the origin countries to resemble migrants on these characteristics does little to explain differences in contraceptive use between the groups. Given that contraceptive use is an important proximate determinant of fertility, our results suggest that contraceptive use should feature more prominently in the dominant demographic paradigms of migrant fertility.

Obtaining buy-in for immediate postpartum long-acting reversible contraception programs in Texas hospitals: A qualitative study.

OBJECTIVE: To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs. METHODS: We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes. RESULTS: We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC. CONCLUSION: Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training. IMPLICATIONS: Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care.

Breastfeeding Initiation, Duration, and Supplementation Among Mexican-Origin Women in Texas.

BACKGROUND: Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women's breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups. METHODS: The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States. RESULTS: Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups. CONCLUSIONS: Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.

Adolescent Relationship Quality: Is There an Intergenerational Link?

OBJECTIVE: This study examines intergenerational continuities in relationship instability, general relationship quality, and intimate partner violence (IPV) between mothers and adolescents. BACKGROUND: A growing body of literature has observed similarities in relationship quality between parents and their adult offspring. Less attention has focused on whether intergenerational continuities are present in adolescent relationships. METHOD: Using age 3, 5, 9, and 15 data from the Fragile Families and Child Wellbeing birth cohort study (N=3,162), the authors examined associations between maternal reports of relationship instability, general quality, and IPV in early and middle childhood and similar adolescent reports at age 15. Variations based on timing and persistence of exposures were considered. RESULTS: In general, exposures to low-quality maternal relationships were associated with higher risk of forming adolescent partnerships and lower relationship quality. Intergenerational links in quality were predominantly construct-specific, consistent with observational learning processes. Adolescents exposed to maternal relationships of poor general quality in middle childhood were less likely to report high-quality relationships themselves, and those exposed to any maternal physical IPV victimization during childhood were more likely to perpetrate IPV in their own relationships. Exposure to maternal relationship instability in both early and middle childhood was associated with more adolescent romantic partners. CONCLUSION: The study illuminates additional pathways through which healthy and unhealthy relationships are reproduced across generations.

Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends.

PURPOSE: To examine pregnancy rates and outcomes (births and abortions) among 15- to 19-year olds and 10- to 14-year olds in all countries for which recent information could be obtained and to examine trends since the mid-1990s. METHODS: Information was obtained from countries' vital statistics reports and the United Nations Statistics Division for most countries in this study. Alternate sources of information were used if needed and available. We present estimates primarily for 2011 and compare them to estimates published for the mid-1990s. RESULTS: Among the 21 countries with complete statistics, the pregnancy rate among 15- to 19-year olds was the highest in the United States (57 pregnancies per 1,000 females) and the lowest rate was in Switzerland (8). Rates were higher in some former Soviet countries with incomplete statistics; they were the highest in Mexico and Sub-Saharan African countries with available information. Among countries with reliable evidence, the highest rate among 10- to 14-year olds was in Hungary. The proportion of teen pregnancies that ended in abortion ranged from 17% in Slovakia to 69% in Sweden. The proportion of pregnancies that ended in live births tended to be higher in countries with high teen pregnancy rates (p = .02). The pregnancy rate has declined since the mid-1990s in the majority of the 16 countries where trends could be assessed. CONCLUSIONS: Despite recent declines, teen pregnancy rates remain high in many countries. Research on the planning status of these pregnancies and on factors that determine how teens resolve their pregnancies could further inform programs and policies.

Legal abortion levels and trends by woman's age at termination.

CONTEXT: Assessments of abortion levels and trends by women's age at termination can be used to monitor trends in unintended pregnancy by age and can inform relevant programs and policies. METHODS: Legal abortion incidence data were compiled from national statistical offices and nationally representative surveys of more than 40 countries where legal abortion is generally available. Age-specific abortion rates and percentage distributions of abortions by age were computed, and trends since 1996 and 2003 were examined. Subregional and regional estimates were developed for geographic areas where the majority of the population was represented by the data. RESULTS: The median year for the most recent estimates of abortions by woman's age was 2009. Adolescents accounted for a smaller share of abortions than their share of the population in the majority of eligible countries with data. In most countries, the highest age-specific abortion rates and proportions of abortions were among women aged 20-29. Since 1996, adolescent abortion rates have increased the most in Belgium, the Netherlands and Scotland (22-42%), and have decreased the most in Estonia, Hungary, Iceland, Slovakia and Slovenia (40-55%). The proportion of abortions obtained by adolescents was higher in North America (18%) than in Europe overall (11%), although the proportion in Northern Europe (18%) was the same as that in North America. CONCLUSIONS: Higher abortion rates in particular age-groups probably reflect higher-than-average levels of unmet need for contraception or difficulty using methods consistently and effectively, and a stronger desire to avoid childbearing. Each of the patterns observed has implications for service and information needs within countries.

Legal abortion levels and trends by woman's age at termination.

CONTEXT: Assessments of abortion levels and trends by women's age at termination can be used to monitor trends in unintended pregnancy by age and can inform relevant programs and policies. METHODS: Legal abortion incidence data were compiled from national statistical offices and nationally representative surveys of more than 40 countries where legal abortion is generally available. Age-specific abortion rates and percentage distributions of abortions by age were computed, and trends since 1996 and 2003 were examined. Subregional and regional estimates were developed for geographic areas where the majority of the population was represented by the data. RESULTS: The median year for the most recent estimates of abortions by woman's age was 2009. Adolescents accounted for a smaller share of abortions than their share of the population in the majority of eligible countries with data. In most countries, the highest age-specific abortion rates and proportions of abortions were among women aged 20-29. Since 1996, adolescent abortion rates have increased the most in Belgium, the Netherlands and Scotland (22-42%), and have decreased the most in Estonia, Hungary, Iceland, Slovakia and Slovenia (40-55%). The proportion of abortions obtained by adolescents was higher in North America (18%) than in Europe overall (11%), although the proportion in Northern Europe (18%) was the same as that in North America. CONCLUSIONS: Higher abortion rates in particular age-groups probably reflect higher-than-average levels of unmet need for contraception or difficulty using methods consistently and effectively, and a stronger desire to avoid childbearing. Each of the patterns observed has implications for service and information needs within countries.