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An Exploration of the Meaning and Consequences of Unintended University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School January 2013 An Exploration of the Meaning and Consequences of Unintended Pregnancy among Latina Cultural Subgroups: Social, Cultural, Structural, Historical and Political Influences Natalie Dolores Hernandez University of South Florida, [email protected] Follow this and additional works at: http://scholarcommons.usf.edu/etd Part of the Public Health Commons Scholar Commons Citation Hernandez, Natalie Dolores, "An Exploration of the Meaning and Consequences of Unintended Pregnancy among Latina Cultural Subgroups: Social, Cultural, Structural, Historical and Political Influences" (2013). Graduate Theses and Dissertations. http://scholarcommons.usf.edu/etd/4505 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. An Exploration of the Meaning and Consequences of Unintended Pregnancy among Latina Cultural Subgroups: Social, Cultural, Structural, Historical and Political Influences by Natalie Dolores Hernandez A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Community and Family Health College of Public Health University of South Florida Major Professor: Ellen Daley, Ph.D. Julie Baldwin, Ph.D. Eric Buhi, Ph.D. Kathleen O’Rourke, Ph.D. Nancy Romero-Daza, Ph.D. Date of Approval: April 5, 2013 Keywords: Hispanic, Unplanned Pregnancy, Young Adults, Qualitative, Ecological Copyright © 2013, Natalie Dolores Hernandez DEDICATION This dissertation is dedicated to the twenty women who shared their stories for this dissertation. I admire their strength, courage, and wisdom and will always be grateful to them as they have inspired me. In addition, this dissertation is lovingly dedicated in memory of my uncle Frank Rosario, who always believed in me and supported me. I love you far more than words can say and miss you every day. I would like to give thanks and appreciation to my husband for his love, support, and encouragement throughout my doctoral process. Thank you for your patience, commitment, and unwavering support through the challenges, uncertainties, and for the sacrifices you made while completing the dissertation. Special thanks are also given to my family for your support, encouragement, and generosity during this time. I love each and every one of you so much and I am so appreciative of all you have done for me. Thank you to my niece, Miley Esme Ward, for giving me joy and laughter, when I needed it most. Titi Natty loves you so much. ACKNOWLEDGMENTS I am indebted to countless people who have been an integral part of my research and supportive throughout my doctoral studies. I am most obliged to Ellen Daley for serving as my major professor, her everlasting support and zeal, her humor and positive outlook when things did not go as intended (numerous times!), giving me the opportunities to grow as a researcher, and finally on a personal level, for being my academic mom. Without your guidance and willingness to assist me this dissertation would have not been possible. Thanks to my committee members: Eric Buhi, Julie Baldwin, Kathleen O’Rourke, and Nancy Romero-Daza for their commitment, valuable feedback, and assistance on all aspects of my dissertation research. My gratitude for your contribution to my future success as a public health researcher is immeasurable. I am also thankful for my cohort Amy, Kristy, Jamie, Melissa, Roxann and Shaista. You have been such a special part of my doctoral studies. I have learned so much for each of you and as a result become a better researcher and person. We have been through a great deal together and could not ask for a better group of women to share this experience with. Thank you to other faculty members, staff, and colleagues for your support, encouragement and faith in me through my doctoral studies. TABLE OF CONTENTS LIST OF TABLES vi LIST OF FIGURES vii ABSTRACT viii CHAPTER ONE: INTRODUCTION 1 Statement of the Problem 1 Overall Unintended Pregnancy Rates 5 Unintended Pregnancy Rates among Latinas 5 Rationale for the Inquiry 6 Research Questions 11 Delimitations 12 Limitations 12 Definition of Relevant Terms 13 CHAPTER TWO: LITERATURE REVIEW 15 Overview of Unintended Pregnancy 16 Definition and Measures of Unintended Pregnancy 17 Latino Population in the U. S 24 Latino Population in the Florida 26 Historical Context of Latinos in U. S. 28 Mexican Americans 29 Puerto Ricans 30 Cuban Americans 31 New Latino Immigrant Populations 32 Unintended Pregnancy in Florida 35 Unintended Pregnancy in Miami-Dade, Florida 37 Disparities in Unintended Pregnancy and Management 37 Social Implications of Unintended Pregnancy 39 Health Implications of Unintended Pregnancy 40 Prenatal care 40 Prenatal health behaviors 41 Preterm birth 42 Birth weight 44 Breastfeeding 45 Families and couples 46 Financial implications 47 Mental Health 47 i Factors Contributing to Unintended Pregnancy among Latinas 48 Intrapersonal Factors 49 Interpersonal Factors 57 Socio-Structural Factors 61 Cultural Factors 65 Acculturation 68 Management of Unintended Pregnancy 69 Abortion 70 Adoption 73 Strengths and Weaknesses of Previous Research 75 Purpose of the Inquiry 76 Theoretical Frameworks Informing the Inquiry 78 Ecological Model of Health Promotion 79 Theory of Gender and Power 86 The Health Belief Model 90 The Theory of Planned Behavior 92 CHAPTER THREE: METHODS 96 Research Questions 96 Overview of the Research Design 98 Pilot Study 99 Study Population 99 Location of the Study 100 Inclusion Criteria for In-Depth Interviews 101 Exclusion Criteria for In-Depth Interviews 101 Sample for In-Depth Interviews 101 Recruitment 103 Data Collection Procedures 104 Setting 105 Participant Demographic Survey 105 Individual In-Depth Interviews 106 Interview Guide 107 Technical Research Process 107 Recording Interviews 109 Transcription 109 Field Notes 110 Establishing Trustworthiness 111 Credibility 111 Member Checking 111 Transferability 112 Dependability 112 Confirmability 113 Qualitative Data Analysis 113 Data Interpretation 115 Use of Pseudonyms 115 Protection of Human Subjects 116 ii Data Management 116 CHAPTER FOUR: RESULTS 117 Demographic Information 117 Attribute Listing 124 Findings 134 Research Question 1: What are Latinas thoughts, feelings and beliefs about pregnancy, motherhood and unintended pregnancy? 134 Meaning of Pregnancy and Motherhood 134 Attitudes and Thoughts on the Term Unintended Pregnancy 136 Attitudes on Intentions and Planning 138 Pregnancy Planning and Timing 138 Feelings of Happiness about Pregnancy 140 Research Question 2: What factors (intrapersonal, interpersonal, institutional, community and public policy) influence Latinas meaning of an unintended pregnancy? 141 Intrapersonal Factors 141 Pregnancy Ambivalence 141 Timing 142 Interpersonal Factors 144 Family Influence 144 Male Partner Influence 145 Research Question 3: What are Latinas perceived consequences of an unintended pregnancy? 147 Emotional Consequences 147 Distress 147 Regret 149 Guilt 150 Social Consequences 151 Personal growth 151 Personal lifestyle choices 153 Family bonding 154 Relationship status 155 Interference with school 157 Judgment 158 Relationship with peers 159 Decision-making on pregnancy resolution outcome 160 Abortion 162 Unintended childbearing 163 Health Consequences 164 Delayed or no prenatal care 164 Research Question 4: Among pregnant Latinas who have described their pregnancy as unintended, what attitudes, subjective norms and perceived behavioral control influence their behavioral intentions (abortion, adoption or unintended birth) towards the pregnancy? 166 iii Personal Attitudes towards Unintended Childbearing 167 Familial Beliefs towards Unintended Childbearing 169 Community and Societal Attitudes towards Unintended Pregnancy 170 Personal Attitudes towards Abortion 172 Religiosity and Abortion 173 Familial Beliefs towards Abortion 174 Community Attitudes towards Abortion 175 Partner Attitudes towards Abortion 176 Surgical vs. Medical Abortion 177 Personal Attitudes towards Adoption 178 Perceived Behavioral Control 179 Research Question 5: What are the factors (intrapersonal, interpersonal, institutional, community and public policy) that influence Latinas management (abortion, adoption, or unintended birth) of an unintended pregnancy? 181 Intrapersonal Factors 181 Age 181 Relationship Status 182 Financial Status 183 Interference with Education/Future Aspirations 184 Past Pregnancy History 185 Interpersonal Factors 185 Partner Influence 185 Family Influence 186 Institutional Factors 188 Religion 188 Societal Attitudes towards Latinas and Unintended Pregnancy 189 Community Factors 191 Cultural Values and Expectations of Latina Women 191 Policy Factors 192 Lack of Information and Resources 192 Health Care Access Issues 193 Policies that Restrict Access to Abortion 195 CHAPTER FIVE: DISCUSSION 196 Section I: Summary of Major Findings 196 Section II: Analysis of Research Findings 200 Meaning of Pregnancy and Influences 200 Meaning of Unintended Pregnancy 201 Pregnancy Planning 202 Perceived Consequences of Unintended Pregnancy 204 Emotional Consequences 204 Social Consequences 205 Influences on Management of an Unintended Pregnancy 206 iv Financial Factors 207 Socio-Cultural Factors 208 Barriers to Access and Utilization
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