Abstract
Decades of research have attempted to understand the paradox of stubbornly high unintended pregnancy rates despite widespread use of contraception. Much of this research has focused on socioeconomic disparities in rates of unintended pregnancy, finding that economically disadvantaged women tend to use less effective contraceptive methods and use them less consistently. Building on this research, this study examines how material hardship is associated with less consistent contraceptive use among women who do not desire to become pregnant. Using the Relationship Dynamics and Social Life (RDSL) Study, a weekly longitudinal survey, I find lower levels of contraceptive use and less consistent use of contraception among women experiencing material hardship, relative to those without hardship experiences. I also investigate the extent to which this association is explained by access barriers and lower contraceptive efficacy among women experiencing hardship. Using structural equation modeling, I find that these mediators significantly explain the relationship between hardship and risky contraceptive behaviors, suggesting that hardship creates mental and resource constraints that impede successful implementation of contraception. However, net of these mediators, material hardship remains associated with riskier contraceptive behaviors among young women, calling for further research on how hardship exposes women to greater risk of unintended pregnancies.
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Data Availability
All data sets are publicly available through the Inter-university Consortium for Political and Social Research. The RDSL website offers additional information about the publicly available RDSL data and requests for access to the restricted version: https://rdsl.psc.isr.umich.edu/.
Notes
In supplementary analyses (Table A1, online appendix), I also show that women who do not desire pregnancy have very similar attitudes toward pregnancy and contraception, regardless of material hardship, indicating that riskier contraceptive behaviors among women experiencing hardship are not likely due to different attitudes.
Although this study design does control for cohort and age effects, survey administration during the beginning of the Great Recession may introduce period effects. Therefore, I provide a supplementary analysis of AddHealth.
The supplement was not introduced as an explicitly poverty-focused survey but rather as an additional survey on a range of topics, including school, jobs, and finances.
The RDSL has high response rates and low rates of attrition (Barber et al. 2016b; Watson and Wooden 2009), but comparing Poverty Supplement responders and nonresponders reveals that the nonresponders are generally more disadvantaged than responders. This is consistent with prior research and nonresponse bias on surveys. Models using chained multiple imputation on the hardship measures show similar results to models presented here, as well as a small conservative bias on some contraceptive behaviors.
Each week, women were asked whether they had sexual intercourse (defined as vaginal intercourse) and to rate how much they wanted to become pregnant in the next month or to avoid becoming pregnant on a scale of 0 to 5. The sample includes only those weeks in which women were both sexually active and reported having zero desire for pregnancy and the strongest desire to avoid pregnancy.
The RDSL captures any use of contraception, regardless of reason for using, following national surveys, like the NSFG. Contraception reduces unintended pregnancy risk even when women are using it for other reasons, such as acne treatment, severe PMS, or irregular menstrual cycles.
See Table A2 in the online appendix for the distributions of the dependent variables.
This measure includes only those weeks in which a coital-specific method was the woman’s most effective form of contraception. In addition, sensitivity analyses including only condom-use weeks showed substantively similar results, but the sample was considerably smaller.
Abortion rates are higher among African American women (Jones and Jerman 2017), which may also play a role in hardship because abortion may be a result of inconsistent contraception, and the expense of an abortion may cause hardship. Unfortunately, the RDSL is not well suited to analyses of abortion.
Only one respondent failed to complete all hardship questions, and she had no experiences of material hardship on the items that she completed. She was therefore coded as experiencing zero hardships.
Table A3 in the online appendix shows the distribution of hardship separately for women experiencing one hardship and women experiencing multiple hardships. This table shows that the distribution between these two groups is quite similar, with both groups most commonly experiencing pawning belongings, food insecurity, and telephone disconnection.
Supplemental analyses using different constructions of material hardship yielded substantively similar results and supported the decision to combine women experiencing multiple hardship into one group. Models including each hardship individually also did not find that any one hardship drives the relationship between hardship and contraceptive behaviors.
The study was conducted before the implementation of the Affordable Care Act and Medicaid expansion; I elaborate on implications of these policy changes in the discussion.
Results from the polychoric factor also supported including the measure on self-control with the measures of partner control. The Chronbach’s alpha for the scale with only the three partner measures was significantly lower than that for the four-item scale.
Alternative model specifications measure independence by whether a woman was living with her family and whether there was an interaction effect between independence and hardship. Both specifications provide substantively similar results.
Only one respondent was missing from the item on being responsible for oneself, and she was imputed as the mode (“not independent”). Nine respondents (2% of sample) were missing on family income at the Poverty Supplement and at baseline; these respondents were also imputed as the mode (“high family income”).
These measures were also tested as separate controls, but nearly none of the individual measures were significant. Therefore, I use the index measure to capture family background effects.
A sensitivity analysis using a dichotomous variable for White, compared to all other racial and ethnic groups, yielded nearly identical substantive results. A supplemental analysis including an interaction between race and material hardship indicated that the effect of hardship does not vary significantly by race.
See Ela and Budnick (2017) for additional comparisons of the RDSL sample to the nationally representative NSFG.
As a sensitivity analysis, I also included a control for ever expressing a desire for pregnancy during the survey and the proportion of weeks the woman was in a romantic relationship. These controls did not change the substantive results and were excluded in favor of the presented models, which provide a clean temporal ordering.
The AddHealth survey asks about lack of phone service, missed or underpayment of rent/mortgage, missed or underpayment of a utility bill, utility shutoff in the past 12 months, and current homelessness. The hardship measure captures whether a respondent said yes to any of these items.
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
Ajzen, I., & Klobas, J. (2013). Fertility intentions: An approach based on the theory of planned behavior. Demographic Research, 29, 203–232. https://doi.org/10.4054/DemRes.2013.29.8
Barber, J. S., Kusunoki, Y., & Gatny, H. H. (2011). Design and implementation of an online weekly journal to study unintended pregnancies. Vienna Yearbook of Population Research, 9, 327–334.
Barber, J. S., Kusunoki, Y., & Gatny, H. H. (2016a). Relationship Dynamics and Social Life (RDSL) Study [Genesee County, Michigan], 2008–2012 [Public and Highly Restricted-Use]. Raleigh, NC: Inter-university Consortium for Political and Social Research [distributor]. Retrieved from https://doi.org/10.3886/ICPSR34626.v5
Barber, J., Kusunoki, Y., Gatny, H., & Schulz, P. (2016b). Participation in an intensive longitudinal study with weekly web surveys over 2.5 years. Journal of Medical Internet Research, 18(6), e105. https://doi.org/10.2196/jmir.5422
Barber, J. S., Yarger, J. E., & Gatny, H. H. (2015). Black-White differences in attitudes related to pregnancy among young women. Demography, 52, 751–786.
Biggs, M. A., Karasek, D., & Foster, J. G. (2012). Unprotected intercourse among women wanting to avoid pregnancy: Attitudes, behaviors, and beliefs. Women’s Health Issues, 22, e311–e318.
Boonstra, H. D., Gold, R. B., Richards, C. L., & Finer, L. B. (2016). Abortion in women’s lives. New York, NY: Guttmacher Institute.
Borrero, S., Nikolajski, C., Steinberg, J. R., Freedman, L., Akers, A. Y., Ibrahim, S., & Schwarz, E. B. (2015). “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception, 91, 150–156.
Clark, A. (2018). The role of residential mobility in reproducing socioeconomic stratification during the transition to adulthood. Demographic Research, 38, 169–196. https://doi.org/10.4054/DemRes.2018.38.7
Dehlendorf, C., Rodriguez, M. I., Levy, K., Borrero, S., & Steinauer, J. (2010). Disparities in family planning. American Journal of Obstetrics and Gynecology, 202, 214–220.
Desmond, M. (2012). Eviction and the reproduction of urban poverty. American Journal of Sociology, 118, 88–133.
Desmond, M. (2017). Evicted: Poverty and profit in the American city. New York, NY: Broadway Books.
Dott, M., Rasmussen, S. A., Hogue, C. J., Reefhuis, J., & National Birth Defects Prevention Study. (2010). Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997–2002. Maternal and Child Health Journal, 14, 373–381.
Edin, K., England, P., Shafer, E., & Reed, J. (2007). Forming fragile families: Was the baby planned, unplanned, or in between? In P. England & K. Edin (Eds.), Unmarried couples with children (pp. 25–54). New York, NY: Russell Sage Foundation.
Edin, K., & Kefalas, M. (2005). Promises I can keep: Why poor women put motherhood before marriage. Berkeley: University of California Press.
Edin, K., & Lein, L. (1997). Making ends meet: How single mothers survive welfare and low-wage work. New York, NY: Russell Sage Foundation.
Ela, E. J., & Budnick, J. (2017). Non-heterosexuality, relationships, and young women’s contraceptive behavior. Demography, 54, 887–909.
England, P. (2016). Sometimes the social becomes personal: Gender, class, and sexualities. American Sociological Review, 81, 4–28.
England, P., Caudillo, M. L., Littlejohn, K., Bass, B. C., & Reed, J. (2016). Why do young, unmarried women who do not want to get pregnant contracept inconsistently? Mixed-method evidence for the role of efficacy. Socius, 2. https://doi.org/10.1177/2378023116629464
Fennell, J. L. (2011). Men bring condoms, women take pills: Men’s and women’s roles in contraceptive decision making. Gender & Society, 25, 496–521.
Finer, L. B., & Zolna, M. R. (2013). Shifts in intended and unintended pregnancies in the United States, 2001–2008. American Journal of Public Health, 104(S1), S43–S48.
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 374, 843–852.
Finnigan, R., & Meagher, K. D. (2019). Past due: Combinations of utility and housing hardship in the United States. Sociological Perspectives, 62, 96–119.
Foster, D. G., Higgins, J. A., Biggs, M. A., McCain, C., Holtby, S., & Brindis, C. D. (2012). Willingness to have unprotected sex. Journal of Sex Research, 49, 61–68.
Frost, J. J., & Darroch, J. E. (2008). Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspectives on Sexual and Reproductive Health, 40, 94–104. https://doi.org/10.1363/4009408
Frost, J. J., Frohwirth, L. F., & Zolna, M. R. (2016). Contraceptive needs and services, 2014 update (Report). New York, NY: Guttmacher Institute.
Frost, J. J., Singh, S., & Finer, L. B. (2007). Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual and Reproductive Health, 39, 90–99. https://doi.org/10.1363/3909007
Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39, 18–38.
Grace, K. T., & Anderson, J. C. (2018). Reproductive coercion: A systematic review. Trauma, Violence, & Abuse, 19, 371–390.
Gunzler, D., Chen, T., Wu, P., & Zhang, H. (2013). Introduction to mediation analysis with structural equation modeling. Shanghai Archives of Psychiatry, 25, 390–394. https://doi.org/10.3969/j.issn.1002-0829.2013.06.009
Guttmacher Institute. (2008). Improving contraceptive use in the United States (In Brief 2008 Series, No. 1). New York, NY: Guttmacher Institute.
Hall, K. S., Dalton, V., & Johnson, T. R. B. (2014). Social disparities in women’s health service use in the United States: A population-based analysis. Annals of Epidemiology, 24, 135–143.
Harris, K. M., & Udry, J. R. (2018). National Longitudinal Study of Adolescent to Adult Health (Add Health), 1994–2008 [Public Use]. Chapel Hill: Carolina Population Center, University of North Carolina–Chapel Hill [distributor], Inter-university Consortium for Political and Social Research [distributor]. Retrieved from https://doi.org/10.3886/ICPSR21600.v21
Hays, S. (2003). Flat broke with children: Women in the age of welfare reform. New York, NY: Oxford University Press.
Heflin, C. M. (2006). Dynamics of material hardship in the Women’s Employment Study. Social Service Review, 80, 377–397.
Heflin, C. H., & Butler, J. S. (2013). Why do women enter and exit from material hardship? Journal of Family Issues, 34, 631–660.
Heflin, C. M., & Iceland, J. (2009). Poverty, material hardship, and depression. Social Science Quarterly, 90, 1051–1071.
Iceland, J., & Baurman, K. J. (2007). Income poverty and material hardship: How strong is the association? Journal of Socio-Economics, 36, 376–396.
Jackson, A. V., Karasek, D., Dehlendorf, C., & Foster, D. G. (2016). Racial and ethnic differences in women’s preferences for features of contraceptive methods. Contraception, 93, 406–411.
Jones, R. K., & Jerman, J. (2017). Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. American Journal of Public Health, 107, 1904–1909.
Jones, J., Mosher, W., & Daniels, K. (2013). Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995. In E. A. Thomas (Ed.), Sexual statistics: Select reports from the National Center for Health Statistics (pp. 127–173). New York, NY: Nova Science Publishers, Inc.
Karpman, M., Zuckerman, S., & Gonzalez, D. (2018). Material hardship among nonelderly adults and their families in 2017 2017: Implications for the safety net (Report). Washington, DC: Urban Institute.
Kavanaugh, M. L., & Jerman, J. (2018). Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014. Contraception, 97, 14–21.
Kost, K., & Lindberg, L. (2015). Pregnancy intentions, maternal behaviors, and infant health: Investigating relationships with new measures and propensity score analysis. Demography, 52, 83–111.
Kost, K., Singh, S., Vaughan, B., Trussell, J., & Bankole, A. (2008). Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception, 77, 10–21.
Kusunoki, Y., Barber, J. S., Ela, E. J., & Bucek, A. (2016). Black-White differences in sex and contraceptive use among young women. Demography, 53, 1399–1428.
Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35(Extra Issue), 80–94.
Longmore, M. A., Manning, W. D., Giordano, P. C., & Rudolph, J. L. (2003). Contraceptive self-efficacy: Does it influence adolescents’ contraceptive use? Journal of Health and Social Behavior, 44, 45–60.
Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013). Poverty impedes cognitive function. Science, 341, 976–980.
Martinez, G., Copen, C. E., & Abma, J. C. (2011). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006–2010 National Survey of Family Growth (Vital and Health Statistics, Series 23, No. 31). Hyattsville, MD: National Center for Health Statistics.
Mayer, S. E., & Jencks, C. (1989). Poverty and the distribution of material hardship. Journal of Human Resources, 24, 88–114.
McCarthy, B., Carter, A., Jansson, M., Benoit, C., & Finnigan, R. (2018). Poverty, material hardship, and mental health among workers in three front-line service occupations. Journal of Poverty, 22, 334–354.
Meier, A., & Allen, G. (2008). Intimate relationship development during the transition to adulthood: Differences by social class. New Directions for Child and Adolescent Development, 2008(119), 25–39.
Mirowsky, J., & Ross, C. E. (1998). Education, personal control, lifestyle and health: A human capital hypothesis. Research on Aging, 20, 415–449.
Moynihan, D., & Herd, P. (2010). Red tape and democracy: How rules affect citizenship rights. American Review of Public Administration, 40, 654–670.
Moynihan, D., Herd, P., & Harvey, H. (2015). Administrative burden: Learning, psychological, and compliance costs in citizen-state interactions. Journal of Public Administration Research and Theory, 25, 43–69.
Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. New York, NY: Macmillan.
Mulligan, K. (2015). Contraception use, abortions, and births: The effect of insurance mandates. Demography, 52, 1195–1217.
Musick, K., England, P., Edgington, S., & Kangas, N. (2009). Education differences in intended and unintended fertility. Social Forces, 88, 543–572.
Nelson, A. L., & Kakaiya, R. (2016). Prevention of unintended pregnancy among sexually active adolescents in the United States. Primary Prevention Insights, 2016(6), 1–10.
Nettleman, M. D., Chung, H., Brewer, J., Ayoola, A., & Reed, P. L. (2007). Reasons for unprotected intercourse: Analysis of the PRAMS survey. Contraception, 75, 361–366.
Potter, J. E., Hopkins, K., Aiken, A. R. A., Hubert, C., Stevenson, A. J., White, K., & Grossman, D. (2014). Unmet demand for highly effective postpartum contraception in Texas. Contraception, 90, 488–495.
Raiz, L. (2006). Health care poverty. Journal of Sociology and Social Welfare, 33(4), 87–104.
Reed, J., England, P., Littlejohn, K., Bass, B. C., & Caudillo, M. L. (2014). Consistent and inconsistent contraception among young women: Insights from qualitative interviews. Family Relations, 63, 244–258.
Ross, C. E., & Mirowsky, J. (2013). The sense of personal control: Social structural causes and emotional consequences. In C. S. Aneshensel, J. C. Phelan, & A. Bierman (Eds.), Handbook of the sociology of mental health (Handbooks of Sociology and Social Research, pp. 379–402). Dordrecht: Springer Netherlands.
Schenck-Fontaine, A., & Panico, L. (2019). Many kinds of poverty: Three dimensions of economic hardship, their combinations, and children’s behavior problems. Demography, 56, 2279–2305.
Schneider, D., Harknett, K., & McLanahan, S. (2016). Intimate partner violence in the Great Recession. Demography, 53, 471–505.
Schwartz, C. R., & Mare, R. D. (2005). Trends in educational assortative marriage from 1940 to 2003. Demography, 42, 621–646.
Shah, A. K., Mullainathan, S., & Shafir, E. (2012). Some consequences of having too little. Science, 338, 682–685.
Silva, J. M. (2013). Coming up short: Working-class adulthood in an age of uncertainty. New York, NY: Oxford University Press.
Sonfield, A., Hasstedt, K., & Gold, R. B. (2014). Moving forward: Family planning in the era of health reform (Report). New York, NY: Guttmacher Institute.
Sonfield, A., Hasstedt, K., Kavanaugh, M. L., & Anderson, R. (2013). The social and economic benefits of women’s ability to determine whether and when to have children (Report). New York, NY: Guttmacher Institute.
Sundaram, A., Vaughan, B., Kost, K., Bankole, A., Finer, L., Singh, S., & Trussell, J. (2017). Contraceptive failure in the United States: Estimates from the 2006–2010 National Survey of Family Growth. Perspectives on Sexual and Reproductive Health, 49, 7–16. https://doi.org/10.1363/psrh.12017
Watson, N., & Wooden, M. (2009). Identifying factors affecting longitudinal survey response. In P. Lynn (Ed.), Methodology of longitudinal surveys. New York, NY: John Wiley & Sons.
Wijnberg, M., & Reding, K. (1999). Reclaiming a stress focus: The hassles of rural, poor single mothers. Families in Society, 80, 506–515.
Williams, D. T., Cheadle, J. E., & Goosby, B. J. (2015). Hard times and heart break: Linking economic hardship and relationship distress. Journal of Family Issues, 36, 924–950.
Wood, G. (2003). Staying secure, staying poor: The “Faustian bargain.” World Development, 31, 455–471.
Wu, J., Meldrum, S., Dozier, A., Stanwood, N., & Fiscella, K. (2008). Contraceptive nonuse among US women at risk for unplanned pregnancy. Contraception, 78, 284–289.
Yoo, J. P., Slack, K. S., & Holl, J. L. (2009). Material hardship and the physical health of school-aged children in low-income households. American Journal of Public Health, 99, 829–836.
Zilanawala, A., & Pilkauskas, N. V. (2012). Material hardship and child socioemotional behaviors: Differences by types of hardship, timing, and duration. Children and Youth Services Review, 34, 814–825.
Acknowledgments
I am grateful to my anonymous reviewers, Jennifer Barber, Yasamin Kusunoki, Heather Gatny, Fabian Pfeffer, and the RDSL working group for their support and feedback on earlier drafts. This research was supported in part by the National Science Foundation Graduate Research Fellowship Program (DGE #1256260) and by a National Institute of Child Health and Human Development (NICHD) training grant to the Population Studies Center (PSC) at the University of Michigan (T32 HD007339). The data used in this analysis were collected with support from two research grants from the NICHD (R01 HD050329, U54 HD093540, PI Barber) and a research grant from the National Institute on Drug Abuse (R21 DA024186, PI Axinn). The author also gratefully acknowledges use of the services and facilities of the PSC, funded by the NICHD under award number P2CHD041028. The content of this publication is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the National Science Foundation. Earlier versions of this article were presented at the annual meetings of the American Sociological Association (Philadelphia, August 2018) and the Population Association of America (Austin, May 2019).
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Field, E. Material Hardship and Contraceptive Use During the Transition to Adulthood. Demography 57, 2057–2084 (2020). https://doi.org/10.1007/s13524-020-00922-3
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DOI: https://doi.org/10.1007/s13524-020-00922-3