Most research that has looked at men's role in contraceptive use and unintended pregnancy has focused on adolescents and young adults, yet three‐fourths of all pregnancies ending in birth involve men who are 25 or older. Moreover, about a third of men in this age span report involvement in an unintended pregnancy, and this is more common among those with low incomes and low educational attainment. To address this relative lack of attention regarding older men, Anthony D. Campbell, David K. Turok and Kari White conducted in‐depth interviews with more than two dozen low‐income men aged 25–55 to explore their fertility intentions, contraceptive knowledge and attitudes, and engagement in contraceptive decision making (page 125). Although men reported that their main motivations to prevent a pregnancy were for age and financial reasons, they also demonstrated limited contraceptive knowledge and, regardless of method use, perceived that their risk of causing a pregnancy was low. Few respondents engaged in decisions about contraceptive use, even though most felt that partners had a shared responsibility to prevent pregnancy. The authors believe that further research could help identify how programs might better promote men's increased contraceptive involvement over their reproductive life course.
Also in This Issue
• Many individuals may be unaware of restrictions on reproductive health care at Catholic hospitals—which generally prohibit the provision of contraceptives, sterilization and abortion—and scant research has examined women's awareness of these institutions' policies. Debra B. Stulberg and colleagues sought to fill this gap by asking U.S. women aged 18–45 about their expectations for receiving reproductive services from either a hypothetical Catholic hospital or a nonreligious hospital (page 135). Respondents randomized to the Catholic group were less likely than those in the nonreligious group to expect provision of birth control pills, tubal ligation or abortion for serious fetal indications, yet substantial proportions (up to three‐fourths) believed these services would be available. Higher income level was associated with correctly identifying the Catholic hospital by name, and women who did so had reduced expectations of receiving such services. Because women may not realize the breadth of reproductive care restrictions at Catholic facilities, the researchers call for increased institutional transparency, which may help individuals make informed decisions about where to seek care.
• There is a substantial body of literature on unintended pregnancy among young women; however, their desire for pregnancy, and the ways in which this desire may change, has received less attention. To address this gap, Jennifer S. Barber and colleagues examined weekly data on intimate relationships and pregnancy desire from U.S. women aged 18–22 who were followed for several years (page 143). They employed within‐between logistic regression models to make comparisons of women's desire for pregnancy within a relationship and across different relationships. In general, the desire for pregnancy increased as relationships endured and became more serious. Notably, the odds of desiring a pregnancy were elevated in relationships that were violent or nonmonogamous. The authors conclude that young women's pregnancy desire depends on the context of their intimate relationship, across the relationships they experience, and suggest that clinicians be mindful of the potentially fast‐changing nature of pregnancy desire when providing contraceptive counseling.
• Because of increasing breast‐feeding rates and durations in the United States, women may be more likely to practice breast‐feeding during pregnancy (BDP), which has been hypothesized to elevate the risk of miscarriage. To explore this issue, Joseph Molitoris assessed data on pregnancies from waves of the National Survey of Family Growth covering the years 2002–2015 (page 153). He found that the risk of miscarriage was greater when mothers exclusively breast‐fed than when they did not breast‐feed, but no increased risk was found with complementary BDP (i.e., when the child also consumed other food). The miscarriage risk during exclusive BDP was similar to that among women who conceived when they were 40 or older. The author suggests that further research should examine whether BDP is related to other maternal, child and fetal health outcomes, and that improved understanding of these relationships can help inform health recommendations.
• Heterosexual adolescents are less likely to use contraceptives when their partners are of different backgrounds or social circles, but the reasons for this are not well understood. To explore this issue when adolescents have school‐discordant partners—that is, partners who do not attend the adolescent's school—Kate Strully and David Kennedy examined characteristics of romantic relationships and contraceptive use among respondents in the 1994–1995 and 1996 waves of the National Longitudinal Study of Adolescent to Adult Health (page 165). Among females, the likelihood of ever having used a condom with a partner was reduced when that partner had not attended her school at the start of the relationship or when he was two or more years older. However, having a school‐ or age‐discordant partner was not associated with contraceptive use for males. These researchers believe that studies employing "richer relationship measures or qualitative techniques" could deepen the understanding of "how discordance interacts with risk factors in adolescent relationships."
• Belgian law restricts abortion on request after the first trimester and mandates a six‐day waiting period after presenting for abortion care. Sarah Van de Velde and colleagues set out to better understand the circumstances and characteristics of women who sought abortion care beyond the country's legal limit, which was 13 weeks and one day at the time of the study (page 175). After assessing four years' of patient records from abortion clinics in Flanders, they identified nearly a thousand individuals who had presented beyond the legal limit—29% of whom could not obtain an abortion as a result of the waiting period. Characteristics positively associated with presenting beyond the limit rather than before included being younger than 20, having lower educational attainment and being unemployed. The authors conclude that a fuller consideration of patients' characteristics when evaluating Belgian abortion policy is necessary to ensure that the needs and rights of socioeconomically vulnerable women are addressed.