The Need for Social Support During Unintended Pregnancy Decision-Making: A Qualitative Analysis of In-Depth Interviews With Young People in California

Abstract

Most pregnancies among young people in the United States are unintended. Previous analyses of unintended pregnancies have typically been restricted by outcome, focusing either on those who had an abortion or those who gave birth. We conducted in-depth interviews with 25 young women in the San Francisco Bay Area who experienced at least one unintended pregnancy at or before age 25, regardless of pregnancy outcome, allowing us to identify themes across both abortion and birth. We asked participants about their decision-making process regarding the pregnancy resolution, with a focus on the role of social support. We present results from secondary analysis of interview transcripts, utilizing reflexive thematic analysis. Most, but not all, participants reported a short decision-making timeline, yet described an unmet need for social support during and after the decision-making process. Researchers and advocates should explore ways to increase support tailored to young people experiencing an unintended pregnancy.

Keywords

unintended pregnancy social support decision-making

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References

AAP Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice Kilpatrick

S. J.

Papile

L.-A.

Macones

G. A.

(Eds.). (2017). Guidelines for perinatal care. American Academy of Pediatrics.

American College of Obstetricans and Gynecologists . (2021). Texas senate Bill 8. https://www.acog.org/community/districts-and-sections/district-xi/advocacy/texas-sb8

Arnett

J. J.

(2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066x.55.5.469

Braun

Clarke

(2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(30), 328–352. https://doi.org/10.1080/14780887.2020.1769238

Braun

Clarke

(2021). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health, 13(2), 201–216. https://doi.org/10.1080/2159676x.2019.1704846

Centers for Disease Control and Prevention . (n.d.). Unintended pregnancy|reproductive health. https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/index.htm

Chou

W. Y. S.

Klein

W. M.

(2018). Addressing health-related misinformation on social media. JAMA, 320(23), 2417–2418. https://doi.org/10.1001/jama.2018.16865.

Ehrlich

J. S.

(2003). Choosing abortion: Teens who make the decision without parental involvement. Gender Issues, 21(2), 3–39. https://doi.org/10.1007/s12147-003-0014-z

Ekstrand

Tydén

Darj

Larsson

(2009). An illusion of power: Qualitative perspectives on abortion decision‐making among teenage women in Sweden. Perspectives on Sexual and Reproductive Health, 41(3), 173–180. https://doi.org/10.1363/4117309

10.

Elsenbruch

Benson

Rücke

Rose

Dudenhausen

Pincus-Knackstedt

M. K.

Klapp

B. F.

Arck

P. C.

(2007). Social support during pregnancy: Effects on maternal depressive symptoms, smoking and pregnancy outcome. Human Reproduction, 22(3), 869–877. https://doi.org/10.1093/humrep/del432

11.

Evans

(2001). The influence of significant others on Australian teenagers’ decisions about pregnancy resolution. Family planning perspectives, 33(5), 224–230. https://doi.org/10.2307/2673786

12.

Farber

N. B.

(1991). The process of pregnancy resolution among adolescent mothers. Adolescence, 26(103), 697–716.

13.

Feld

Barnhart

Wiggins

A. T.

Ashford

(2021). Social support reduces the risk of unintended pregnancy in a low‐income population. Public Health Nursing, 38(5), 801–809. https://doi.org/10.1111/phn.12920

14.

Feldman

P. J.

Dunkel-Schetter

Sandman

C. A.

Wadhwa

P. D.

(2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715–725. https://doi.org/10.1097/00006842-200009000-00016

15.

Finer

L. B.

Frohwirth

L. F.

Dauphinee

L. A.

Singh

Moore

A. M.

(2005). Reasons US women have abortions: Quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110–118. https://doi.org/10.1363/psrh.37.110.05

16.

Finer

L. B.

Frohwirth

L. F.

Dauphinee

L. A.

Singh

Moore

A. M.

(2006). Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception, 74(4), 334–344. https://doi.org/10.1016/j.contraception.2006.04.010

17.

Finer

L. B.

Zolna

M. R.

(2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 74(9), 843–852. https://doi.org/10.1056/NEJMsa1506575

18.

Guttmacher Institute . (2019, September). Induced abortion in the United States. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

19.

Guttmacher Institute . (2021). An overview of abortion laws. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws#

20.

Halldén

B.-M.

Christensson

Olsson

(2005). Meanings of being pregnant and having decided on abortion: Young Swedish women’s experiences. Health Care for Women International, 26(9), 788–806. https://doi.org/10.1080/07399330500230961

21.

Helsen

Vollebergh

Meeus

(2000). Social support from parents and friends and emotional problems in adolescence. Journal of Youth and Adolescence, 29(3), 319–335. https://doi.org/10.1023/a:1005147708827

22.

Jones

R. K.

Ingerick

Jerman

(2018). Differences in abortion service delivery in hostile, middle-ground, and supportive states in 2014. Women’s Health Issues, 28(3), 212–218. https://doi.org/10.1016/j.whi.2017.12.003

23.

Kirkman

Rowe

Hardiman

Mallett

Rosenthal

(2009). Reasons women give for abortion: A review of the literature. Archives of Women’s Mental Health, 12(6), 365–378. https://doi.org/10.1007/s00737-009-0084-3

24.

Kjelsvik

Sekse

R. J. T.

Moi

A. L.

Aasen

E. M.

Chesla

C. A.

Gjengedal

(2018). Women’s experiences when unsure about whether or not to have an abortion in the first trimester. Health Care for Women International, 39(7), 784–807. https://doi.org/10.1080/07399332.2018.1465945

25.

Long-Sutehall

Sque

Addington-Hall

(2011). Secondary analysis of qualitative data: A valuable method for exploring sensitive issues with an elusive population? Journal of Research in Nursing, 16(4), 335–344. https://doi.org/10.1177/1744987110381553

26.

Mahanaimy

Gertdts

Moseson

(2020). What constitutes a good healthcare experience for unintended pregnancy? A qualitative study among young people in California. Culture, Health and Sexuality, 1–14.

27.

Malterud

Siersma

V. D.

Guassora

A. D.

(2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444

28.

Markiewicz

Lawford

Doyle

A. B.

Haggart

(2006). Developmental differences in adolescents’ and young adults’ use of mothers, fathers, best friends, and romantic partners to fulfill attachment needs. Journal of Youth and Adolescence, 4(4), 843–852. https://doi.org/10.1007/s10964-005-9014-5

29.

McIntyre

Anderson

McDonald

(2001). The intersection of relational and cultural narratives: Women’s abortion experiences. Canadian Journal of Nursing Research Archive, 33(3), 47–62.

30.

Moreau

Trussell

Bajos

(2012). Contraceptive paths of adolescent women undergoing an abortion in France. Journal of Adolescent Health, 50(4), 389–394. https://doi.org/10.1016/j.jadohealth.2011.07.013

31.

Moseson

Dehlendorf

Gerdts

Vittinghoff

Hiatt

R. A.

Barber

(2018). No one to turn to: Low social support and the incidence of undesired pregnancy in the United States. Contraception, 98(4), 275–280. https://doi.org/10.1016/j.contraception.2018.06.009

32.

Moseson

Mahanaimy

Dehlendorf

Gerdts

(2019). … Society is, at the end of the day, still going to stigmatize you no matter which way”: A qualitative study of the impact of stigma on social support during unintended pregnancy in early adulthood. PloS one, 14(5), e0217308.

33.

Moseson

Fix

Hastings

Stoeffler

Lunn

M. R.

Flentje

Lubenskyg

M. E.

Capriottig

M. R.

Ragostaa

Forsberg

Obedin-Maliver

(2020). Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. International Journal of Transgender Health, 22(1–2), 30–41. https://doi.org/10.1080/26895269.2020.1841058

34.

Moseson

Fix

Ragosta

Forsberg

Hastings

Stoeffler

Lunn

M. R.

Flentje

Capriotti

M. R.

Lubensky

M. E.

Obedin-Maliver

(2021). Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. American Journal of Obstetrics and Gynecology, 224(4), 376e1–371e11. https://doi.org/10.1016/j.ajog.2020.09.035

35.

Nowell

L. S.

Norris

J. M.

White

D. E.

Moules

N. J.

(2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1609406917733847. https://doi.org/10.1177/1609406917733847

36.

Office of Disease Prevention and Health Promotion . (n.d.). Pregnancy and childbirth | healthy people 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth

37.

Pereira

Pires

Canavarro

M. C.

(2019). Decision-making trajectories leading to termination of an unplanned pregnancy: Specificities among adolescent and adult women. Journal of Reproductive and Infant Psychology, 37(3), 242–255. https://doi.org/10.1080/02646838.2019.1566596

38.

Pew Research Center . (2021a). Mobile fact sheet. https://www.pewresearch.org/internet/fact-sheet/mobile/

39.

Pew Research Center . (2021b). Social media use in 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/

40.

Rini

Schetter

C. D.

Hobel

C. J.

Glynn

L. M.

Sandman

C. A.

(2006). Effective social support: Antecedents and consequences of partner support during pregnancy. Personal Relationships, 13(2), 207–229. https://doi.org/10.1111/j.1475-6811.2006.00114.x

41.

Ruggiano

Perry

T. E.

(2019). Conducting secondary analysis of qualitative data: Should we, can we, and how? Qualitative Social Work, 18(1), 81–97. https://doi.org/10.1177/1473325017700701

42.

Tong

Sainsbury

Craig

(2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

43.

Tracey

S. J.

(2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative inquiry, 16(10), 837–851. https://doi.org/10.1177/1077800410383121

44.

Wang

McKee

Torbica

Stuckler

(2019). Systematic literature review on the spread of health-related misinformation on social media. Social Science & Medicine, 240, 112552. https://doi.org/10.1016/j.socscimed.2019.112552.

45.

Wiggins

Oakley

Sawtell

Austerberry

Clemens

Elbourne

(2005). Teenage parenthood and social exclusion: A multi-method study.