Material Hardship and Contraceptive Use During the Transition to Adulthood

Contraceptive Use and Its Associations With Social Determinants of Health Among Young Adults

BACKGROUND

Nonuse and inconsistent use of contraception in young adults can result in undesired pregnancies. Prior research on contraceptive use has primarily focused on individual influences such as attitudes, beliefs, and skills related to contraceptive use, with little consideration of the social and economic determinants.

OBJECTIVE

This study explored domains from the Healthy People 2030 Social Determinants of Health (SDH) framework and examined their cross-sectional associations with young adults' self-reported contraceptive use (ie, any use in the past year and consistent use of contraception).

METHODS

Eleven measures related to 5 SDH domains were extracted from the Add Health dataset collected from 2001 to 2002 (Wave III). The final sample included 11,172 youth with a mean age of 21.88 years (SD: 1.84) and was 53.8% female.

RESULTS

Measures associated with the past year's use of contraceptives included non-poverty status, employment, housing instability, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, and access to primary care. For consistent use of contraception, associated measures were participants' non-poverty status, employment, high school graduation, enrollment in higher education, English language spoken at home, experience of civic participation, incarceration, and access to health care.

CONCLUSIONS

Interventions that address social determinants of health can potentially promote contraceptive use.

Food Insecurity and Women's Choice of Reversible Contraceptives: Differential Effects by Maternal Age

We investigated the relationships between food insecurity (FI) and women's choice of reversible contraceptives, overall and according to the level of method effectiveness, among partnered women of reproductive age in Nigeria. This population-based cross-sectional analysis used nationally representative data from Round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria. The sample included married or in-union women aged 15-49 years who reported a live birth in the last 2 years preceding the survey (unweighted N = 8496). Survey-weighted multivariable binomial and multinomial logistic regression analyses were performed to generate estimates of the association between FI (none, moderate, and severe) and reversible contraceptive use (overall and by method effectiveness). A Bonferroni correction was used to account for multiple testing. We stratified the models by maternal age to describe the experiences of women aged 15-24 years, 25-34 years, and 35-49 years. Overall, 6438 (74.1%) of the women in the sample experienced food insecurity (moderate, n = 2559, 30.7%; severe, n = 3879, 43.4%). In the adjusted model, we observed no statistically significant association between experiencing MFI and SFI and the use of reversible contraceptives (overall and specific) after adjustment for multiple testing. The stratified analyses showed that among women aged 25-34 years in the sample, those experiencing SFI in the past 12 months, compared to their food-secure counterparts, had significantly lower odds of reporting the use of a least effective contraceptive method (OR, 0.53; 95% CI, 0.34-0.83; p = 0.0052). However, this failed to reach the significance threshold upon adjustment for multiple testing. We found no significant association between the FI levels and use of reversible contraceptives (overall and specific) among partnered women (15-49 years) in Nigeria who were 2 years postpartum following a live birth and who were at risk of pregnancy.

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.

Mechanisms Linking High Residential Mobility to Decreased Contraceptive Use: The Importance of Method Availability

While research has demonstrated that high residential mobility has negative consequences for an array of outcomes, particularly among women and young adults, the mechanisms underlying these associations are unclear. The consequences of high residential mobility may be comprised solely of a series of short-term disruptions surrounding individual moves, or there may also be long-term, cumulative effects from repeated moves. High residential mobility may diminish access to resources as individuals move to different neighborhoods, impose a cognitive burden that impairs their ability to plan ahead, or decrease the relative power they have in their relationships to limit exposure to risk behaviors. We adjudicate between these possibilities by predicting the effects of high residential mobility on sexual intercourse and contraceptive use, the proximate determinants of pregnancy, during women's transition to adulthood. Using 2.5 years of monthly address data for 882 respondents in the Relationship Dynamics and Social Life study-a random sample of young women in Genesee County, Michigan-we find that high residential mobility is associated with long-term decreases in contraceptive use. These long-term consequences are independent of the short-term effects of individual moves and attributable to diminished contraceptive access. We disentangle the effects of home-leaving, which is distinct from subsequent moves.

Declines in Non-marital Births Among Black Women Between 2004 and 2014: Are Recent Trends the Result of Increases in Contraception?

Non-marital birth rates for women in their twenties began declining in 2008, but the mechanisms driving this decline are not yet well understood. Using a proximate determinants of fertility framework and decomposition techniques, we consider the importance of changes in relationship status, contraceptive use, and other dimensions of deliberate fertility control in understanding trends in the non-marital fertile pregnancy rate between 2004 and 2014. We use data from several cycles of the National Survey of Family Growth to identify relationship and contraceptive use status at the time of conception for pregnancies that resulted or were likely to result in live births (i.e., fertile pregnancies), and focus our analysis on non-Hispanic Black women in their twenties. We find that changes in relationship status and sexual activity did not contribute to the decline in fertile pregnancy rates, nor did changes in the distribution of contraceptive method use. Instead, changing fertile pregnancy rates within contraceptive use categories, including among those who report using no method of contraception, account for the observed trend. Though contraceptive method mix is an insufficient explanation for recent trends, our results suggest that considering the sources of within-method variation in fertile pregnancy rates over time is key to understanding declines in non-marital births, and that some women not using contraception likely engaged in a form of deliberate fertility control not captured by the National Survey of Family Growth.

Past, present, and future dimensions of socioeconomic status and sexual self-efficacy of young women during the transition into adulthood

Socioeconomic disadvantages can undermine a person's ability to control their sexual lives (sexual self-efficacy) during the transition to adulthood. Most scholarship focuses on proximate circumstances, specifically how sexual self-efficacy is a result of current socioeconomic status. Yet, this sexual agency is embedded within much longer behavioral and psychological trajectories shaped by socioeconomic contexts. Therefore, I identify a novel explanation for sexual self-efficacy by connecting it to past, present, and anticipatory future conceptualizations of young adults' socioeconomic circumstances. Drawing from 2.5 years of quarterly data from the Relationship Dynamics and Social Life Study, I found significant associations between more advantaged past, present, and anticipatory future socioeconomic circumstances and greater sexual self-efficacy during the transition to adulthood. Stage-specific dimensions of socioeconomic status (SES) followed two life course patterns (pathways and accumulation). In addition, prospective SES was found to be a more powerful predictor than childhood and current SES. As such, I encourage researchers to conceptualize socioeconomic status in life course terms to illuminate the underlying causes and consequences of varying young adulthoods.