All ETDs from UAB

Advisory Committee Chair

Janet M Turan

Advisory Committee Members

Robin G Lanzi

Nir Menachemi

Bulent Turan

Kari White

Martha S Wingate

Document Type

Dissertation

Date of Award

2016

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Substantial disparities are observed in rates of unintended pregnancy and the health consequences of unintended pregnancy in the United States, with these events and outcomes occurring more frequently among young adult women and women in the southern region. The contribution of social norms and stigma to these disparities is unclear. This dissertation is comprised of three manuscripts examining unintended pregnancy-related norms and stigma, and their health implications among young adult women aged 18-24 in Birmingham, Alabama. The aims of the dissertation are to (1) elucidate perceptions of norms and stigma regarding unintended pregnancy and pregnancy decisions (abortion, adoption, and parenting), and their health implications; (2) examine the association of norms and stigma with contraceptive method use; and (3) develop, assess, and explore predictors of scales to measure norms and stigma regarding pregnancy decisions. A mixed methods approach was utilized, involving the analysis of data from focus groups and cognitive interviews (N=46) to achieve Aim 1, and inform the development of measures assessed in Aim 2 (N=390) and Aim 3 (N=642). Findings indicate that young women in Alabama perceive and express norms and stigma around unintended pregnancy and each pregnancy decision, though the degree of norms and stigma reported varied by outcome (abortion and adoption were subject to more stigma than unintended pregnancy and parenting) and participant characteristics (i.e., religion, pregnancy history, etc.). These stigmas are related to likelihood of unprotected intercourse, dual method use (combined use of a hormonal or long-acting method and a condom), and nondisclosure of unintended pregnancy or pregnancy decision. Results also suggest that new measures of reproductive norms and stigma are psychometrically valid in our sample, and may be useful tools in program development and evaluation to address stigma and support reproductive autonomy. Overall, these findings may inform and be of use in future research exploring the contribution of reproductive norms and stigma to health behavior and health outcomes.

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