Factors Associated with Reproductive Autonomy: A Social Ecological Approach Public

Abstract

Introduction Unintended pregnancy imposes severe physical, mental and economic consequences for young women in the United States. Previous research has demonstrated associations between reproductive autonomy and coercion and increased unintended pregnancy rates. Reproductive autonomy and reproductive coercion are important indicators of women’s’ control over their reproductive health and subsequent wellbeing.

Objective This study utilizes the Social Ecological Model to explore the multi-level factors associated with high reproductive autonomy and the presence of reproductive coercion in young women living in and around Atlanta, Georgia.

Methods Women between the ages of 15-24 living in the Atlanta area were recruited to participate in the Young Women’s Stress Study (YWSS). The YWSS collected information on physical health, risk behaviors, mental health, social and physical environment, sexual health and history, family history, and reproductive health knowledge and attitudes. This study explored the baseline data of the YWSS using bivariate analyses and multivariate regressions to examine what social and cultural variables are associated with reproductive autonomy and reproductive coercion in this population.

Results A multivariate linear regression revealed that for every unit increase in age, there is a .1012 increase in reproductive autonomy scores (B=.1012, 95% CI .0196, .1828, p=.0156). The

logistic regression indicated that participants who had experienced less discrimination were more likely to experience reproductive coercion, with the data revealing that for each unit increase in discrimination (higher score equates to less discrimination), the odds of experiencing reproductive coercion increased by 1.23 (AOR=1.23, 95% CI 1.055, 1.560, p=.01). The results also indicated a significant association between the reproductive coercion outcome and income (p=.04). Participants with an income less than $9,999 are less likely to experience reproductive coercion than women with an income between $10,000 and $19,999 (AOR=.336, 95% CI .119, .954, p=.04). There were no significant differences between participants with an income less than $9,999 and participants with an income greater than $20,000 (p=.63) or participants with an income between $9,999 and $19,999 and participants with an income greater than $20,000 (p=.44).

Conclusion The results indicate that reproductive autonomy scores increase with age while experiencing discrimination and income level are important predictors of reproductive coercion in young women. Future research is needed to understand the durability of the association with age across the life course and the types of discrimination that most impact the presence of reproductive coercion in young women. 

Table of Contents

Table of Contents

Chapter 1 - Introduction ........................................................................................................................ 1

Unintended Pregnancy in the U.S .........................................................................................................................1

Defining Reproductive Autonomy and Reproductive Coercion...........................................................................3

Health Impacts of Reproductive Autonomy and Reproductive Coercion ............................................................4

Theoretical Framework .........................................................................................................................................5

Purpose of this study .............................................................................................................................................6

Chapter 2 - Literature Review............................................................................................................... 8

Use of the Social Ecological Model (SEM)..........................................................................................................8

Criticisms of Reproductive Autonomy ...............................................................................................................16

Chapter 3 – Methods ............................................................................................................................ 19

Study Design .......................................................................................................................................................19

Procedures ...........................................................................................................................................................20

Measures .............................................................................................................................................................20

Hypothesized Correlates to Reproductive Autonomy and Reproductive Coercion............................................22

Analysis Plan.......................................................................................................................................................28

Chapter 4 - Manuscript Version ......................................................................................................... 29

Introduction .........................................................................................................................................................29

Research Purpose and Aims................................................................................................................................34

Materials and Methods........................................................................................................................................36

Results .................................................................................................................................................................40

Discussion ...........................................................................................................................................................48

Chapter 5 – Public Health Implications ............................................................................................. 53 References.............................................................................................................................................. 56

Appendix I. ............................................................................................................................................ 67

Appendix II. .......................................................................................................................................... 77 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Women's Studies
Mot-clé	Reproductive Coercion Reproductive Autonomy Social Ecological Model
Committee Chair / Thesis Advisor	Kelli Stidham Hall, Emory University
Committee Members	Jessica Sales, Emory University

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