State-Level Income and Racial Inequity and Pregnancy Orientation: Differential Effects By Race/Ethnicity

Background and Purpose:  In the United States, groups most affected by structural inequities are most likely to experience unplanned pregnancy. A growing body of qualitative research suggests the notion of pregnancy planning is often not salient in the context of intractable inequity. Programs and policies that promote delaying pregnancy until certain milestones are met, such as educational attainment and professional success, neglect that certain groups, including low-income women of color, may face significant barriers to achieving these milestones whether they postpone pregnancy or not. While qualitative work has highlighted the role that structural conditions play in shaping pregnancy intentions among women of color, little quantitative work has investigated this relationship. In this analysis, we investigate the impact of state-level structural inequities on current pregnancy orientation and examine differential effects for white, Black, and Latina women.

Methods: We conducted a national survey of 1681 women who were not pregnant or seeking pregnancy. Using mixed effects multilevel regression analyses, we assessed the influence of state-level measures of inequity on pregnancy orientation for the full sample and, in stratified analyses, by race/ethnicity. This analysis was restricted to participants who had not concluded childbearing and self-identified as white, Black, or Latina (n=1105). Current pregnancy orientations included “open” and “closed,” based on an earlier latent class analysis of respondents’ current pregnancy desire, pregnancy acceptability, and expectation of resolution of an unexpected pregnancy. State-level inequity measures included the Gini Index (income inequality) and the proportion of residents completing college and who were unemployed (calculated separately for the Black, Latina, and white residents). Multivariable analyses adjusted for age, relationship, parental status, race/ethnicity, education, and income.

Results: About half of the sample (52.9%) had a closed pregnancy orientation, while the other half (47.1%) had varying degrees of openness. In the overall model, a higher Gini Index score (reflecting greater state-level income inequality) was associated with an increased risk of closed pregnancy orientation. In stratified analyses by race/ethnicity, this association held only for white women. In the stratified model for Latina women, as the proportion of the Latino/a population unemployed at the state-level increases, Latina women’s pregnancy orientation becomes more closed. For Black women, state-level proportion of college completion in the Black population was significant but conversely showed that higher rates of college completion were associated with closed pregnancy orientation.

Conclusions and Implications: We find some evidence of the role of state-level measures of inequity as influencing pregnancy orientation, with differential influences for white, Latina and Black women. For white and Latina women, increases in inequity were associated with increased likelihood of closed pregnancy orientation, but for Black women, the opposite was true—increases in equity were associated with closed pregnancy orientation. Social and health services providers should take the specific structural challenges that Black, Latina, and white women each face into account when addressing pregnancy orientation and planning, as failure to do so masks important differences between the groups that have important implications for family planning and pregnancy care.