title: Social Norms and Stigma Regarding Unintended Pregnancy and Pregnancy Decisions: A Qualitative Study of Young Women in Alabama.
abstract: Social norms and stigma may play important roles in reproductive health behavior and decision making among young women in the U.S. South, who disproportionately experience unintended pregnancies. No research has described the presence and manifestations of social norms and stigmas associated with unintended pregnancy and related decision making from the perspective of this population.
  
  
  
  Six focus groups and 12 cognitive interviews were conducted between December 2013 and July 2014 with 46 low-income women aged 19-24 living in Birmingham, Alabama; respondents were recruited from two public health department centers and a community college. Semistructured interview guides were used to facilitate discussion about social perceptions of unintended pregnancy and related pregnancy decisions. Sessions were audio-recorded, and transcripts were analyzed using a theme-based approach.
  
  
  
  Participants described community expectations that pregnancy occur in the context of monogamous relationships, in which both partners are mature, educated and financially stable. However, respondents reported that unintended pregnancy outside of these circumstances was common, and that the community expected young women faced with unintended pregnancies to bear and raise their children. Women who chose to do so were viewed more positively than were women who chose abortion or adoption. The community generally considered these alternatives to parenting unacceptable, and participants discussed them in terms of negative labels, social judgment and nondisclosure.
  
  
  
  Findings suggest a need to reduce stigma and create a social environment in which young women are empowered to make the best reproductive decisions for themselves.
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors.forename: Whitney
authors.initials: W
authors.lastname: Smith
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors.forename: Kari
authors.initials: K
authors.lastname: White
authors.affiliation: Department of Medical Sociology, College of Arts and Sciences/ Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Stringer
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.
authors.forename: Anna
authors.initials: A
authors.lastname: Helova
authors.affiliation: Department of Pediatrics, School of Medicine, University of Alabama at Birmingham.
authors.forename: Tina
authors.initials: T
authors.lastname: Simpson
authors.affiliation: Sea Change Program, Tides Foundation, Oakland, CA.
authors.forename: Kate
authors.initials: K
authors.lastname: Cockrill
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000407:Alabama; D001294:Attitude to Health; D005260:Female; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011287:Prejudice; D036301:Qualitative Research; D020377:Self Efficacy; D066262:Social Norms; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires