Journal of Urban Health

, Volume 96, Issue 2, pp 171–180 | Cite as

Childbearing Motivations and Desires, Fertility Beliefs, and Contraceptive Use among Urban African-American Adolescents and Young Adults with STI Histories

  • Kamila A. AlexanderEmail author
  • Nancy Perrin
  • Jacky M. Jennings
  • Jonathan Ellen
  • Maria Trent


This study explored the influence of STI history on childbearing motivations, fertility beliefs, current childbearing desires, and contraception use among urban African-American adolescents and young adults (AYA). Secondary data were from the Neighborhood Influences on Adolescent and Young Adult Health (NIAAH) study, conducted from 2004 to 2007. Sample included 517 AYA ages 15–24 years (male: n = 199, female: n = 318). Linear and logistic regression models examined gender differences in childbearing motivations (CBM) and desires, fertility beliefs, condom, and contraception use. Logistic regression models were constructed to examine age, pregnancy history, and STI fertility knowledge as potential confounders. AYA men (3.29) and AYA women (3.23) had similar CBM mean scores. AYA women had more positive CBM and used condoms less. Condom use was not associated with CBM among AYA men (OR = 0.71, p = 0.069). Low beliefs about fertility (OR = 0.52, p = 0.003) and prior pregnancy (OR = 5.27, p = 0.002) were associated with current childbearing desires among AYA women. AYA men’s low fertility beliefs were only associated with current childbearing desires (OR = 0.56, p = 0.044). AYA men reported more contraception use (67.46 vs. 55.04%), especially with no partner pregnancy history (OR = 0.26, p = 0.017). Younger men (15 to 18 years old) reported more contraception or condom use compared to older AYA men (19–25 years old) (OR = 0.40, p = 0.016). Young men reporting a partner’s prior pregnancy used fewer condoms or contraception (OR = 0.23, p = 0.028). STI history did not influence CBM in this sample of urban youth. Prior pregnancy experiences and chronological age, however, were important milestones shaping proximal motivations and desires to bear children, beliefs about fertility, and contraception behaviors.


Adolescents Condoms Contraception Hormonal contraception Sexually transmitted diseases 



This work was supported by the National Institutes of Health [grant number 3R011NE013507-04S1].


  1. 1.
    Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health. 2014;104(S1):S43–8.CrossRefGoogle Scholar
  2. 2.
    Prevention. C for DC and. Sexually Transmitted Disease Surveillance 2016. Atlanta: U.S. Department of Health and Human Services. Published 2017. Accessed 14 Dec 2017.
  3. 3.
    Macaluso M, Blackwell R, Jamieson DJ, Kulczycki A, Chen MP, Akers R, et al. Efficacy of the male latex condom and of the female polyurethane condom as barriers to semen during intercourse: a randomized clinical trial. Am J Epidemiol. 2007;166(1):88–96. Scholar
  4. 4.
    Trent M, Haggerty CL, Jennings JM, Lee S, Bass DC, Ness R. Adverse adolescent reproductive health outcomes after pelvic inflammatory disease. Arch Pediatr Adolesc Med. 2011;165(1):49–54.CrossRefGoogle Scholar
  5. 5.
    Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40.CrossRefGoogle Scholar
  6. 6.
    Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716–9. Scholar
  7. 7.
    Kerr JC, Valois RF, Siddiqi A, Vanable P, Carey MP. Neighborhood condition and geographic locale in assessing HIV/STI risk among African American adolescents. AIDS Behav. 2014:1–9.Google Scholar
  8. 8.
    Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191(Suppl):S115–22.CrossRefGoogle Scholar
  9. 9.
    Stewart J. The mommy track: the consequences of gender ideology and aspirations on age at first motherhood. J Sociol Soc Welf 2003;30. Accessed 16 Feb 2017.
  10. 10.
    Freeman C. The missing element: incorporating culturally-specific clinical practices in HIV prevention programs for African-American females. J Cult Divers. 2010;17(2):51–5.Google Scholar
  11. 11.
    Davis S. Attitudes of young African American fathers toward early childbearing. Am J Health Behav. 2004;28(5)
  12. 12.
    Trent M, Millstein SG, Ellen JM. Gender-based differences in fertility beliefs and knowledge among adolescents from high sexually transmitted disease–prevalence communities. J Adolesc Health. 2006;38(3):282–7.CrossRefGoogle Scholar
  13. 13.
    Edin K, Kefalas M. Promises I can keep: why poor women put motherhood before marriage. University of California Press: Berkeley and Los Angeles, California 2005;2011.Google Scholar
  14. 14.
    Polis CB, Zabin LS. Missed conceptions or misconceptions: perceived infertility among unmarried young adults in the United States. Perspect Sex Reprod Health. 2012;44(1):30–8.CrossRefGoogle Scholar
  15. 15.
    Burdette AM, Haynes SH, Hill TD, Bartkowski JP. Religious variations in perceived infertility and inconsistent contraceptive use among unmarried young adults in the United States. J Adolesc Health. 2014;54(6):704–9.CrossRefGoogle Scholar
  16. 16.
    Miller WB, Trent M, Chung SE. Ambivalent childbearing motivations: predicting condom use by urban, African-American, female youth. J Pediatr Adolesc Gynecol. 2014;27(3):151–60.CrossRefGoogle Scholar
  17. 17.
    Pitts M, Bowman M, McMaster J. Reactions to repeated STD infections: psychosocial aspects and gender issues in Zimbabwe. Soc Sci Med. 1995;40(9):1299–304. Scholar
  18. 18.
    Finocchario-Kessler S, Sweat MD, Dariotis JK, Trent ME, Kerrigan DL, Keller JM, et al. Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav. 2010;14(5):1106–14.CrossRefGoogle Scholar
  19. 19.
    Pazol K, Whiteman MK, Folger SG, Kourtis AP, Marchbanks PA, Jamieson DJ. Sporadic contraceptive use and nonuse: age-specific prevalence and associated factors. Am J Obstet Gynecol. 2015;212(3):324.e1–8. Scholar
  20. 20.
    Clarke KEN, Kraft JM, Wiener JB, Hatfield-Timajchy K, Kottke M, Sales JM, et al. Factors associated with contraceptive use differ between younger and older African-American female adolescents. J Pediatr Adolesc Gynecol. 2016;29(5):448–53. Scholar
  21. 21.
    Raneri LG, Wiemann CM. Social ecological predictors of repeat adolescent pregnancy. Perspect Sex Reprod Health. 2007;39(1):39–47.CrossRefGoogle Scholar
  22. 22.
    Boardman LA, Allsworth J, Phipps MG, Lapane KL. Risk factors for unintended versus intended rapid repeat pregnancies among adolescents. J Adolesc Health. 2006;39(4):597.e1–8.CrossRefGoogle Scholar
  23. 23.
    Lampic C, Svanberg AS, Karlstrom P, Tyden T. Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics. Hum Reprod. 2006;21(2):558–64.CrossRefGoogle Scholar
  24. 24.
    Gungor I, Rathfisch G, Kizilkaya Beji N, Yarar M, Karamanoglu F. Risk-taking behaviours and beliefs about fertility in university students. J Clin Nurs. 2013;22(23–24):3418–27.CrossRefGoogle Scholar
  25. 25.
    Miller WB. Childbearing motivations, desires, and intentions: a theoretical framework. Genet Soc Gen Psychol Monogr 1994.Google Scholar
  26. 26.
    Borrero S, Nikolajski C, Steinberg JR, Freedman L, Akers AY, Ibrahim S, et al. “It just happens”: a qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception. 2015;91(2):150–6.CrossRefGoogle Scholar
  27. 27.
    Gray SC, Holmes K, Bradford DR. Factors associated with pregnancy among incarcerated African American adolescent girls. J Urban Heal. 2016:1–10.Google Scholar
  28. 28.
    Jennings JM, Taylor R, Iannacchione VG, Rogers SM, Chung SE, Huettner S, et al. The available pool of sex partners and risk for a current bacterial sexually transmitted infection. Ann Epidemiol. 2010;20(7):532–8.CrossRefGoogle Scholar
  29. 29.
    Bureau USC. State and County QuickFacts. Published 2013. Accessed 30 June 2017
  30. 30.
    Center for Sexually Transmitted Infection Prevention MD of H and MH, Baltimore City Health Department, Maryland Office of Planning. 2015 Chlamydia Distribution by Jurisdictions and Age Groups. of Chlamydia Cases by Age Group, Maryland Counties and Baltimore City, 2015.pdf. Accessed 28 Dec 2017.
  31. 31.
    Miller WB, Barber JS, Gatny HH. The effects of ambivalent fertility desires on pregnancy risk in young women in the USA. Popul Stud (NY). 2013;67(1):25–38.CrossRefGoogle Scholar
  32. 32.
    Miller WB. Childbearing motivation and its measurement. J Biosoc Sci. 1995;27(4):473–87.CrossRefGoogle Scholar
  33. 33.
    IBM Corp. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Released 2017.Google Scholar
  34. 34.
    Finocchario-Kessler S, Sweat MD, Dariotis JK, Anderson JR, Jennings JM, Keller JM, et al. Childbearing motivations, pregnancy desires, and perceived partner response to a pregnancy among urban female youth: does HIV-infection status make a difference? AIDS Care. 2012;24(1):1–11. Scholar
  35. 35.
    Herrman JW. Repeat pregnancy in adolescence: intentions and decision making. MCN Am J Matern Child Nurs. 2007;32(2):89–94. CrossRefGoogle Scholar
  36. 36.
    Gillmore MR, Lewis SM, Lohr MJ, Spencer MS, White RD. Repeat pregnancies among adolescent mothers. J Marriage Fam. 1997;59(3):536–50.CrossRefGoogle Scholar
  37. 37.
    McGhan C. Repeated acquisition of sexually transmitted infections: feelings, perceptions, and explanations of adolescent girls. 2005.
  38. 38.
    Marcell AV, Ford CA, Pleck JH, Sonenstein FL. Masculine beliefs, parental communication, and male adolescents’ health care use. Pediatrics. 2007;119(4):e966–75.CrossRefGoogle Scholar
  39. 39.
    Smith JL, Fenwick J, Skinner R, Merriman G, Hallett J. Young males’ perspectives on pregnancy, fatherhood and condom use: where does responsibility for birth control lie. Sex Reprod Healthc. 2011;2(1):37–42.CrossRefGoogle Scholar
  40. 40.
    Gordon DM, Hawes SW, Reid AE, Callands TA, Magriples U, Divney A, et al. The many faces of manhood: examining masculine norms and health behaviors of young fathers across race. Am J Mens Health. 2013;7(5):394–401. [doi].
  41. 41.
    Nowatzki N, Grant KR. Sex is not enough: the need for gender-based analysis in health research. Health Care Women Int. 2011;32(4):263–77. Scholar
  42. 42.
    Cuffee JJ, Hallfors DD, Waller MW. Racial and gender differences in adolescent sexual attitudes and longitudinal associations with coital debut. J Adolesc Health. 2007;41(1):19–26. Scholar
  43. 43.
    Dehlendorf C, Park SY, Emeremni CA, Comer D, Vincett K, Borrero S. Racial/ethnic disparities in contraceptive use: variation by age and women’s reproductive experiences. Am J Obstet Gynecol. 2014;210(6):526.e1–9. Scholar
  44. 44.
    Craig AD, Dehlendorf C, Borrero S, Harper CC, Rocca CH. Exploring young adults’ contraceptive knowledge and attitudes: disparities by race/ethnicity and age. Women’s Heal Issues. 2014;24(3):e281–9. Scholar
  45. 45.
    Gavin L, Moskosky S, Carter M, Curtis K, Glass E, Godfrey E, et al. Providing quality family planning services: recommendations of CDC and the US Office of population affairs. MMWR Recomm Rep. 2014;63(rr-04):1–54.Google Scholar
  46. 46.
    Tyler CP, Whiteman MK, Kraft JM, Zapata LB, Hillis SD, Curtis KM, et al. Dual use of condoms with other contraceptive methods among adolescents and young women in the United States. J Adolesc Health. 2014;54(2):169–75.CrossRefGoogle Scholar
  47. 47.
    Santelli JS, Warren CW, Lowry R, Sogolow E, Collins J, Kann L, et al. The use of condoms with other contraceptive methods among young men and women. Fam Plan Perspect. 1997;29(6):261–7. Scholar
  48. 48.
    Cushman LF, Romero D, Kalmuss D, Davidson AR, Heartwell S, Rulin M. Condom use among women choosing long-term hormonal contraception. Fam Plan Perspect. 1998;30(5):240–3. Scholar
  49. 49.
    Haleh S, Poindexter A. Planned condom use among women undergoing tubal sterilization: sexually transmitted diseases. Sex Transm Dis. 1998;25(7):335–41. Accessed 20 May 2017CrossRefGoogle Scholar
  50. 50.
    Higgins JA, Smith NK, Sanders SA, Schick V, Herbenick D, Reece M, et al. Dual method use at last sexual encounter: a nationally representative, episode-level analysis of US men and women: prepared for resubmission to contraception. Contraception. 2014;90(4):399–406.CrossRefGoogle Scholar
  51. 51.
    Raiford JL, Wingood GM, DiClemente RJ. Correlates of consistent condom use among HIV-positive African American women. Women Health. 2007;46(2–3):41–58.CrossRefGoogle Scholar
  52. 52.
    Lau M, Lin H, Flores G. Pleased to be pregnant? Positive pregnancy attitudes among sexually active adolescent females in the United States. J Pediatr Adolesc Gynecol. 2014;27(4):210–5. Scholar
  53. 53.
    Lanier Y, Stewart JM, Schensul JJ, Guthrie BJ. Moving beyond age: an exploratory qualitative study on the context of young African American men and women’s sexual debut. J Racial Ethn Heal Disparities. April 2017;5:1–10. Scholar
  54. 54.
    Diaz CJ, Fiel JE. The effect(s) of teen pregnancy: reconciling theory, methods, and findings. Demography. 2016;53(1):85–116. Scholar
  55. 55.
    Berrington A, Pattaro S. Educational differences in fertility desires, intentions and behaviour: a life course perspective. Adv Life Course Res. 2014;21:10–27. Scholar
  56. 56.
    Thomson E. Couple childbearing desires, intentions, and births. Demography. 1997;34(3):343–54.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  1. 1.Department of Community Public HealthJohns Hopkins School of NursingBaltimoreUSA
  2. 2.Department of PediatricsBayview Medical Center, Johns Hopkins School of MedicineBaltimoreUSA
  3. 3.Johns Hopkins All Children’s HospitalSt. PetersburgUSA
  4. 4.Department of PediatricsJohns Hopkins School of MedicineBaltimoreUSA

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