‘They are my future’: childbearing desires and motivations among women with disabilities in Ghana - implications for reproductive healthcare

Background Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. Methods A cross-sectional qualitative study was conducted with WWDs aged 18–49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. Results Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. Conclusion Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services.

Effect of Changes in Response Options on Reported Pregnancy Intentions: A Natural Experiment in the United States

Objectives The Pregnancy Risk Assessment Monitoring System (PRAMS), conducted by the Centers for Disease Control and Prevention in collaboration with state health departments, is the largest state-level surveillance system that includes a question on the intention status of pregnancies leading to live birth. In 2012, the question was changed to include an additional response option describing uncertainty before the pregnancy about the desire for pregnancy. This analysis investigated how this additional response option affected women’s responses. Methods We used the change in the pregnancy intention question in 2012 as a natural experiment, taking advantage of relatively stable distributions of pregnancy intentions during short periods of time in states. Using PRAMS data from 2009-2014 (N = 222 781), we used a regression discontinuity-in-time design to test for differences in the proportion of women choosing each response option in the periods before and after the question change. Results During 2012-2014, 13%-15% of women chose the new response option, “I wasn’t sure what I wanted.” The addition of the new response option substantially affected distributions of pregnancy intentions, drawing responses away from all answer choices except “I wanted to be pregnant then.” Effects were not uniform across age, parity, or race/ethnicity or across states. Conclusions These effects could influence estimated levels and trends of the proportion of births that are characterized as intended, mistimed, or unwanted, as well as estimates of differences between demographic groups. These findings will help to inform new strategies for measuring pregnancy and childbearing desires among women.

Effect of changes in response options on reported pregnancy intentions: Findings from a natural experiment in the United States

Objectives: The Pregnancy Risk Assessment Monitoring System (PRAMS), conducted by the Centers for Disease Control in collaboration with state health departments, is the largest state-level surveillance system that includes a question on the intention status of pregnancies leading to live birth. In 2012, the question was changed with the inclusion of an additional response option describing uncertainty about pregnancy desire prior to the pregnancy. This analysis investigates how this additional response option affected women’s responses.Methods: We use the change in the pregnancy intention question in 2012 as a natural experiment, taking advantage of relatively stable distributions of pregnancy intentions over short periods of time within states. Using PRAMS data from 2009-2014 (N=222,781), we employ a regression discontinuity design to test for differences in the proportion of women choosing each response option in the periods pre- and post-question change. Results: In the years 2012-2014, 13-15% of women chose the new answer option, “I wasn’t sure what I wanted”. The addition had a substantial impact on distributions of pregnancy intentions, drawing responses away from all answer choices except for “I wanted to become pregnant then.” Effects were not uniform across age, parity and race combined with Hispanic ethnicity, as well as across states.Conclusions: These effects could impact estimated levels and trends of the proportion of births that are characterized as intended, mistimed or unwanted, as well as estimates of differences between demographic groups. These findings will help to inform new strategies for measuring women’s pregnancy and childbearing desires.

FROM MOTIVES THROUGH DESIRES TO INTENTIONS: INVESTIGATING THE REPRODUCTIVE CHOICES OF CHILDLESS MEN AND WOMEN IN POLAND

SummaryThis study examined the potential of the theoretical model proposed by Warren Miller (the Traits/Motives–Desires–Intentions–Behaviour or TDIB model) for investigating the involuntary–voluntary childlessness continuum. The first three stages of the theoretical motivational sequence (motives to desires to intentions) were examined using a purposive sample of 314 childless Polish men and women aged 30–39 (at the time of data collection in September 2013). In Poland, this is the age range when the final decision for or against parenthood is taken. To model the motivational sequence, the Structural Equation Modelling (SEM) technique was applied. The results confirmed the hypothesized relations between the constructs for childless individuals in the analysed age group. Their childbearing desires were found to be good predictors of reproductive intentions, while negative and positive childbearing motives (independently) underpinned their desires. Moreover, positive motives appeared to have a stronger effect on desires than negative ones. The study also documented the psychometric properties of the Polish adaptation of the Childbearing Questionnaire, which was originally developed by Miller to measure childbearing motives. The advantages of using this tool for investigating the involuntary–voluntary childlessness continuum are discussed. Overall, the study validated the theoretical model as well as the adaptation of the Childbearing Questionnaire in the new research context: in the new cultural setting and for examining reproductive choices of a specific subpopulation. Directions for future research that could build on the TDIB model and allow for a deeper understanding of permanent childlessness are outlined.