#Blackmamasmatter: A Mixed-Methods Study of African American Women's Attitudes Towards Birth Control

Background.  The maternal mortality rate in the United States has increased from 7.2 deaths per 1,000 live births in 1987, to 18.0 deaths per 1,000 in 2014 (CDC, 2018). While the reasons for this upward trend are inconclusive, research shows that African American (AA) women are most at risk for maternal mortality. Disturbingly, AA women are 3 to 4 times more likely to die of pregnancy-related causes than non-Hispanic whites (CDC, 2018).

Reducing the rate of maternal mortality will require a life course perspective, whereby women receive preconception care to address underlying health issues that may impact their health during pregnancy. Since four out of ten women become pregnant unintentionally and therefore cannot make health changes before pregnancy, an important aspect of preconception care is to help women make informed birth control decisions. This enables them to make reproductive choices that are planned and potentially beneficial to their health. Because AA have higher rates of pregnancy-related mortality, this study seeks to examine the perspectives of AA women in relation to birth control.

Methods. This was a mixed-method, secondary analysis using data from CHOICES Plus, a randomized controlled trial of a preconception intervention for women at risk of alcohol- and tobacco-exposed pregnancies. The intervention helped women understand the choice they had to either lower substance use and/or use effective birth control as a means to prevent a substance-exposed pregnancy. The quantitative data analyses examined the decisional balance scale at baseline comparing women of different race/ethnicities (n=261). Women were asked to choose how important certain reasons were in deciding to use birth control.  Items included pros for using birth control (When thinking about using birth control, how much does it matter that you would be safer from becoming pregnant?) and cons for using (How much does it matter that birth control might have negative side effects?). Only qualitative interviews of AA women discussing the “good things” and the “not so good things” of birth control use from the intervention sessions were analyzed.

Results.  There were no differences on the cons for using birth control (p=.140) between AA women and Latinas, and non-Hispanic whites; however, they scored lower on the pros for using birth control (p=.045) than women of all other race ethnicities. Qualitatively, AA women discussed that pregnancy and STI prevention were the main pros for using birth control, while the cons included side effects (e.g., weight gain, health risks) and hassles (e.g., having to keep up with birth control).

Implications.

For healthcare providers to provide delivery of culturally responsive reproductive services, it is important to understand AA women’s views of the benefits and drawbacks of using birth control as a reproductive planning tool. An understanding of AA women’s birth control health beliefs can guide discussions with the healthcare provider and serve as a catalyst for further research.