title: "It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning.
abstract: OBJECTIVE
  Unintended pregnancy is common and disproportionately occurs among low-income women. We conducted a qualitative study with low-income women to better typologize pregnancy intention, understand the relationship between pregnancy intention and contraceptive use, and identify the contextual factors that shape pregnancy intention and contraceptive behavior.
  
  
  METHODS
  Semistructured interviews were conducted with low-income, African-American and white women aged 18-45 recruited from reproductive health clinics in Pittsburgh, PA, to explore factors that influence women's pregnancy-related behaviors. Narratives were analyzed using content analysis and the constant comparison method.
  
  
  RESULTS
  Among the 66 participants (36 African-American and 30 white), we identified several factors that may impede our public health goal of increasing the proportion of pregnancies that are consciously desired and planned. First, women do not always perceive that they have reproductive control and therefore do not necessarily formulate clear pregnancy intentions. Second, the benefits of a planned pregnancy may not be evident. Third, because preconception intention and planning do not necessarily occur, decisions about the acceptability of a pregnancy are often determined after the pregnancy has already occurred. Finally, even when women express a desire to avoid pregnancy, their contraceptive behaviors are not necessarily congruent with their desires. We also identified several clinically relevant and potentially modifiable factors that help to explain this intention-behavior discrepancy, including women's perceptions of low fecundity and their experiences with male partner contraceptive sabotage.
  
  
  CONCLUSIONS
  Our findings suggest that the current conceptual framework that views pregnancy-related behaviors from a strict planned behavior perspective may be limited, particularly among low-income populations.
  
  
  CONCLUSIONS
  This study identified several cognitive and interpersonal pathways to unintended pregnancy among low-income women in Pittsburgh, PA, including perceptions of low reproductive control, perceptions of low fecundity and male partner reproductive coercion.
authors.affiliation: Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Electronic address: borrerosp@upmc.edu.
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
authors.affiliation: Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Cara
authors.initials: C
authors.lastname: Nikolajski
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Steinberg
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
authors.forename: Lori
authors.initials: L
authors.lastname: Freedman
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Aletha Y
authors.initials: AY
authors.lastname: Akers
authors.affiliation: VA Center for Health Equity, Research, and Promotion, Philadelphia VA Medical Center, Philadelphia, PA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Said
authors.initials: S
authors.lastname: Ibrahim
authors.affiliation: Department of Medicine, University of California, Davis School of Medicine, Sacramento, CA.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D003068:Coercion; D015331:Cohort Studies; D003268:Contraception Behavior; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D007398:Interpersonal Relations; D007407:Interviews as Topic; D010414:Pennsylvania; D011203:Poverty; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D043762:Reproductive Behavior; D020377:Self Efficacy; D012747:Sexual Partners; D019037:Urban Health Services; D055815:Young Adult
keywords: Pregnancy intention; Pregnancy planning; Race; Reproductive coercion