Female adolescents' perceptions of male partners' pregnancy desire

Partner's characteristics and adolescent motherhood among married adolescent girls in 48 low-income and middle-income countries: a population-based study

OBJECTIVES

The objective of this study was to examine the prevalence of adolescent motherhood among married adolescent girls and its associations with their partners' characteristics in low-income and middle-income countries (LMICs).

DESIGN

Population-based study.

PARTICIPANTS

54 285 ever married (or lived with a partner) adolescent girls (15-19 years old) were including in prevalence analysis. However, partner characteristics were assessed in a subsample of 24 433 adolescent girls who were married (or living with a partner) at the time of interview.

SETTINGS

Data from the latest available Demographic and Health Survey round during 2010-2018 in 48 LMICs across different geographic regions.

RESULTS

The overall prevalence of adolescent motherhood was 73.98% (95% CI 70.96 to 78.10) among married adolescent girls in this study. In the pooled analysis, statistically significant and positive associations were observed between adolescent motherhood and partners' desire for more children (adjusted marginal effect (AME): 2.34, 95% CI 1.21 to 3.47) and spousal age gap (AME: 1.67, 95% CI 0.30 to 3.04 for three plus age gap). However, no statistically significant association was observed between adolescent motherhood and partners' education (AME: -0.36, 95% CI -1.77 to 1.05 for primary education) and partners' agricultural occupation (AME: 1.07, 95% CI -0.17 to 2.32). Overall, there was significant variation in the associations across countries; however, the positive associations persisted between adolescent motherhood and partners' desire for more children and spousal age gap in most of the studied countries.

CONCLUSIONS

Our findings may inform policymakers about the importance of incorporating partners of married adolescent girls into the existing birth control programmes to delay age at first birth among married adolescents in LMICs. More attention should be given to the married adolescent girls who have older partners, and efforts to discourage marriages with much older partners may have a secondary benefit of reducing adolescent motherhood in LMICs.

"We Kind of Met In-Between": A Qualitative Analysis of Young Couples' Relationship Dynamics and Negotiations About Pregnancy Intentions

CONTEXT

The literature on reproductive decision making often focuses on women and neglects the role of men and the importance of relationship context. Research with couples is vital to understanding joint decision making regarding having children at various stages of a couple's relationship and an individual's life course.

METHODS

In-depth, individual interviews were conducted with a socioeconomically, racially and ethnically diverse sample of 50 young heterosexual women and their male partners in northern California in 2015-2016. A dyadic, thematic analytic approach was used to examine whether and how prospective pregnancy intentions and current pregnancy desires are negotiated at the couple level, and how relationship dynamics influence any negotiation and decision-making processes.

RESULTS

Twenty-three couples described engaging in joint pregnancy decision making, which required purposeful communication and, for some, compromise and acceptance. For nearly all of these couples, these processes led to aligned prospective pregnancy intentions, even when current pregnancy desires differed. The remaining 27 couples described individual pregnancy decision-making processes; many respondents reported intentions that aligned with their partner's by happenstance, despite some respondents having avoided communicating their desires to their partner. Some of these couples faced relationship difficulties, including poor communication, leading some participants to misinterpret or be unaware of their partner's pregnancy intentions and desires.

CONCLUSIONS

The relationship context is important in the formulation of prospective pregnancy intentions among young people. Counseling protocols, interventions and policies that attend to the complex factors that influence young couples' pregnancy decision making are needed to better help couples attain their reproductive goals.

Planned, unplanned and in-between: the meaning and context of pregnancy planning for young people

OBJECTIVE

To understand how young people conceptualize planned, unplanned and "in-between" pregnancies.

METHODS

We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned.

RESULTS

Conceptualizations of pregnancy planning were influenced by personal experiences and life circumstances, including previous unplanned pregnancies. While many participants held up planned pregnancies as an ideal, the majority of participants (n=71) also felt that a status in between planned and unplanned pregnancy existed. Many described this in-between stage occurring when someone is "not not trying" or would find an unplanned pregnancy acceptable. Notably, a few participants mentioned that pregnancy planning was not possible because either it was uncommon among their peers or they felt a general lack of control over pregnancy.

CONCLUSION

Our analysis suggests that binary operationalization of pregnancies as "planned" and "unplanned" neglects the complexity of young people's lived experiences and perspectives. Contraceptive counseling approaches that allow patients the flexibility to express their considerations and feelings toward a potential future pregnancy could improve the quality of family planning visits and patient-provider interactions.

IMPLICATIONS

The traditional binary conceptualization of pregnancies as planned and unplanned may not holistically capture the diverse perspectives of young people. Increased understanding of the complexities in young people's conceptualizion of pregnancy planning can inform family planning care that is inclusive, relevant and supportive of a variety of perspectives.

Disentangling Perceived Norms: Predictors of Unintended Pregnancy During the Transition to Adulthood

Using data from the Relationship Dynamics and Social Life Study, this study examines the role of perceived norms in predicting unintended pregnancy among young women ages 18-22. First, it compares the relative influence of the content - injunctive (approval) versus descriptive (prevalence) - and referent - parents' versus friends' - of fertility-related norms. Second, in identifying entrance into motherhood as an important life course event, particularly during the transition to adulthood, it explores how these influences vary by parity. Third, it tests two potential mechanisms: conformity via internalization and superficial conformity. Findings support injunctive norms: non-mothers' risk of unintended pregnancy is largely influenced by friends' approval, whereas parents' approval best predicts that of young mothers'. The effects are independent of respondents' own attitudes, suggesting superficial conformity. The study sheds light on how young women's perceptions of what is "normal" among important others influence a consequential early-life event: becoming a parent.

Adolescents' Responses to an Unintended Pregnancy in Ghana: A Qualitative Study

STUDY OBJECTIVE

To investigate the experiences and perceptions of adolescents who have experienced a recent pregnancy and undergone a termination of pregnancy.

DESIGN

A vignette-based focus group approach was used to have adolescents reflect on scenarios that happen to others during an unwanted pregnancy.

SETTING

The study was conducted in public health facilities in the 3 major urban areas of Ghana-Accra, Kumasi, and Tamale.

PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES

Adolescents, aged 10-19 years, who had a recent termination of pregnancy were recruited from public health facilities in the 3 sites. Fifteen focus groups were conducted and digitally recorded in English, Twi, Ga, and Dagbani. Transcripts were transcribed and translated, and thematic analysis was used for the analysis.

RESULTS

Adolescents reported that the characters in the vignettes would feel sadness, depression, and regret from an unintended pregnancy and some male partners would "deny" the pregnancy or suggest an abortion. They suggested some parents would "be angry" and "sack" their children for becoming pregnant while others would "support" them. Parents might send the pregnant girl to a distant friend or grandparents until she delivers to avoid shame and gossip. Health professionals might encourage the pregnant girl or insult/gossip about the girl.

CONCLUSION

Adolescent unintended pregnancies in Ghana are met with a range of reactions and these reactions influence the pregnancy choices young women make for continuation or termination of pregnancy.

Pregnancy intentions among expectant adolescent couples

STUDY OBJECTIVE

To examine the self-reported pregnancy intentions of the male partners of expectant adolescent mothers, the accuracy of adolescent mothers' perceptions of their partner's pregnancy intentions, and the concordance between young mothers' and fathers' pregnancy intentions.

DESIGN

This cross-sectional pilot study collected interview data from expectant adolescent mothers and their male partners.

SETTING

Data were collected in participants' homes.

PARTICIPANTS

35 expectant couples were interviewed separately. Most participants were African American (89% of mothers, 74% of fathers). 69% of mothers were 17-18 years old, and half of the fathers were ≥19.

MAIN OUTCOME MEASURES

Parents responded to survey questions adapted from the Center for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System Questionnaire.

RESULTS

44% of fathers reported wanting their partner to get pregnant. Another 15% were ambivalent. A kappa statistic of 0.12 (P = .33) indicated very little "accuracy" of mothers' perceptions of their partners' pregnancy intentions. Further, there was low concordance between the pregnancy intentions of mothers and fathers. Young fathers who wanted or were ambivalent about pregnancy were significantly more likely to use no contraception or withdrawal.

CONCLUSION

For a notable number of minority couples, adolescent mothers do not have an accurate perception of their partners' pregnancy intentions and use contraceptive methods that are not within their control. These findings indicate that teen pregnancy prevention interventions must target young males in addition to females and sexually active adolescents should be encouraged to discuss pregnancy intentions with each other.

Pregnancy desire among a sample of young couples who are expecting a baby

CONTEXT

Adolescents' desire for a pregnancy has been explored more among females than among males. A more comprehensive understanding of teenagers' pregnancy desires is needed to inform pregnancy prevention efforts and to support couples as they undergo the transition to parenthood.

METHODS

In an observational cohort study conducted in 2007-2011 at clinics in Connecticut, data were collected from 296 couples (females aged 14-21 and their partners) who were expecting a baby. The degree to which each partner had wanted the pregnancy and partners' perceptions of each other's pregnancy desires were assessed. Multilevel regression models examined associations between pregnancy desire and individual, partner, family and community characteristics, and between desire and life and relationship satisfaction.

RESULTS

Forty-nine percent of females and 53% of males reported having wanted the pregnancy. Pregnancy desire scores were positively associated with being male, expecting a first baby, perceived partner desire and parental response to the pregnancy; scores were negatively associated with being in school, being employed and parental support. Females' perceptions of their partners' pregnancy desires were slightly more accurate than males' (kappas, 0.36 and 0.28, respectively). Pregnancy desire was positively associated with both life and relationship satisfaction, particularly among males.

CONCLUSIONS

Adolescents' pregnancy desires require further attention as a possible focus of pregnancy prevention efforts, and health care providers may want to ensure that young couples with unwanted pregnancies are offered additional psychological and social services as they transition to parenthood.

[Motivations for adolescent pregnancy]

OBJECTIVES

To identify the motivations (beliefs, values) for adolescent pregnancy among girls aged less than 17 years old.

METHOD

We performed a phenomenological qualitative study with audio recording of in-depth interviews with 12 pregnant adolescents between March and September 2008. Purposive sampling of pregnant adolescents (14-16 years) in the high-risk obstetric unit of the Hospital of Jaen (Spain) was performed, using education, voluntariness of pregnancy, urban-rural setting of the family residence and family socioeconomic status as heterogeneity criteria. A content analysis was performed with coding, triangulation of categories, and extraction and verification of results.

RESULTS

The adolescent's sociocultural context was of considerable weight in sexual and reproductive decisions. Adolescents with unplanned pregnancies felt that their responsibility was relative, showing an attitude of acceptance and resignation, which later became a tendency to rationalize the events and claim that the child was wanted or even planned. Girls with a wanted pregnancy did not have a clear idea of the consequences of having a child. Previous ideas about pregnancy were mainly related to physical changes without taking into account other changes that occur during and after pregnancy.

CONCLUSIONS

The family context and socialization of girls are based on a traditional division of gender roles in which the traditional role of the female caregiver is strongly internalized. The reasons for teenage pregnancy are unclear; pregnant adolescents lacked a sense of self-determination and felt that their lives were determined by circumstances.

Adolescent pregnancy desire and pregnancy incidence

BACKGROUND

Research has suggested the importance of pregnancy desire in explaining pregnancy risk behavior among adolescent females. Much of the literature, however, uses cross-sectional study designs to examine this relationship. Because bias may strongly influence these results, more prospective studies are needed to confirm the relationship between pregnancy desire and pregnancy incidence over time.

METHODS

Nonpregnant adolescents aged 14- to 19 years (n = 208) completed baseline interviews and interviews every 6 months thereafter for 18 months. Logistic regression was used to examine demographic and psychosocial correlates of pregnancy desire. Cox regression analysis was used to determine whether pregnancy desire predicted pregnancy incidence over time after controlling for potential confounders.

RESULTS

Twenty-four percent of participants either desired pregnancy or were ambivalent toward pregnancy in the next year. Pregnancy desire was associated with older age, relationship duration of <6 months, and greater perceived stress. After accounting for potential confounders, pregnancy desire doubled the risk of becoming pregnant over the 18-month follow-up period (relative risk, 2.00; 95% confidence interval [CI], 0.99-4.02). Additionally, a heightened risk for pregnancy was found among those who expressed some desire for pregnancy and who were not in school compared with those who expressed no desire for pregnancy and who were in school (relative risk, 4.84; 95% CI, 1.21-19.31).

CONCLUSION

Our analysis reinforces the importance of evaluating pregnancy desire among sexually active adolescent females. Interventions should target young women in new romantic relationships and who are not in school to improve pregnancy prevention efforts. Additionally, improving coping abilities may help to reduce feelings of pregnancy desire among adolescent females.