Black and white young women share similar desires to avoid pregnancy and similar pregnancy plans, but Black women were much less likely to be pronatal, advocating for a higher birth rate, than were white women, new research revealed. The unintended pregnancy rate is 2.5 times higher for Black women than for white women, which raises questions about why this difference occurs.1

Investigators wanted to look for disparities in undesired pregnancies, says Jennifer Barber, PhD, professor in the department of sociology and a senior scientist at the Kinsey Institute at Indiana University.

“We were motivated by this huge disparity in what researchers call the unintended pregnancy rate, which is sort of a misnomer, because we’re talking about whether women wanted to get pregnant when they got pregnant,” Barber explains. “I called them undesired pregnancies.”

There is a large race difference. In the study, two-thirds of Black women reported that their pregnancies were unintended, compared to 38% of white women.

“Our research was motivated by that huge difference,” Barber says. “I was interested in learning whether Black women do not want to plan pregnancies or do they know what they want.”

The investigators found that Black and white women are very similar. Both had concrete plans of what they wanted with pregnancy and contraception, she says.

LARC Not Responsible

The study took place between 2008 and 2012. Participants reported little use of long-acting reversible contraceptives (LARCs), so that was not the reason for the difference, Barber notes.

“LARC is more common now, but it was not very common among young women then,” she says. “Back in 2008 to 2012, physicians didn’t want to insert IUDs [intrauterine devices] in women who didn’t have children.”

Hypotheses Tested

Investigators assessed several hypotheses about what might cause the disparity in unintended pregnancy rates. Here are three of their hypotheses:

Hypothesis 1: Black women have more desire for pregnancy during young adulthood than do white women.

Investigators interviewed more than 900 women, multiple times. They found almost no differences in pregnancy desire between Black women and white women. That theory was not the answer.

“A little over a third of them ever, in any interview, said they had any desire for pregnancy,” Barber says.

Hypothesis 2: Young Black women are more indifferent or ambivalent about pregnancy than are young white women.

In nine out of 10 weekly interviews, women reported zero desire for pregnancy and the strongest desire to avoid pregnancy. Black and white women showed similar patterns.1 This hypothesis also was incorrect.

Hypothesis 3: Young Black women have weaker pregnancy plans or are more fatalistic than are young white women.

Investigators found Black and white women had similar plans for future pregnancies. They often reported that their plan was to undergo tubal ligation when they discontinued contraceptives or gave birth.

They also held similar plans for education and careers. Only one Black woman and two white women suggested a fatalistic attitude or lack of planning for pregnancy. This hypothesis also was wrong.

“Not one size fits all is the story about why young women who don’t want to get pregnant find themselves pregnant,” Barber says. “One aspect of the story is they may find themselves with a partner who says, ‘I want to have a baby with you.’”

Some women might become pregnant if they think their partner wants this. Another possibility is that it is difficult to maintain discipline with contraceptive methods for years.

“For women with serious partners who want a pregnancy in the next several years, they don’t want a LARC, so they end up with a method that takes serious effort,” Barber explains. “They get tired of using condoms week in, week out. If you have a messy life, it’s hard to remember to take a pill every day.”

If a woman lets down her guard, even briefly, she may become pregnant. “My advice is we need better contraceptive methods and we need to support women to use the contraceptive methods they choose,” Barber says. “I don’t think any of these conclusions are new.”

From a provider’s perspective, it is important to know that both Black and white young women have clear desires to avoid pregnancy, and they have plans for how they will avoid or delay pregnancy, Barber says.

“But for some reason, they are not able to implement those plans in all cases — especially Black women,” she adds. “It’s not that they are wishy-washy about what they want or that they’re unable to take steps, and it’s not because they want different things. Providers should ask women what they want and help them put together a contraceptive plan.”

REFERENCE

  1. Barber JS, Guzzo KB, Budnick J, et al. Black-white differences in pregnancy desire during the transition to adulthood. Demography 2021;58:603-630.