UMD Theses and Dissertations

Permanent URI for this collectionhttp://hdl.handle.net/1903/3

New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.

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    RACIAL DIFFERENCES IN PROTECTIONS AGAINST PREGNANCY: COMPETING GOALS AND DECISIONS
    (2018) Young Harrison, Eowna; Kahn, Joan; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Racial disparities in unintended pregnancy are largely related to differences in contraceptive practices. Black women are less likely to use an effective contraceptive and more likely to discontinue a method compared to their White counterparts. More concerning is that the Black-White gap in these protections against unintended pregnancy may have widened over time. Reasons for these racial disparities and the pathways to contraceptive practices that leave at-risk women vulnerable to unintended pregnancy are unexplained This project addresses some of the existing gaps in the literature by using a mixed-methods approach to 1) investigate the various factors contributing to Black-White differences in contraceptive practices over time and 2) explore the contraceptive decision-making of women at high risk of unintended pregnancy. Using multinomial logistic regression and a Fairlie decomposition on data from the National Survey of Family Growth 1988 and 2011-2015 survey cycles, I analyze contraceptive use and effective method choice of young adult women. Results reveal that the Black-White gap in contraceptive practices in 2011-2015 are 2-3 times larger than in 1988. Very few factors were statistically significant at explaining the 13% Black-White difference in 2011-2015. Interviews with Black women in Philadelphia were used to improve our understanding of contraceptive practices that are less effective at protecting against pregnancy. Findings highlight criteria for method selection, concern for STDs, and partner trust as key factors guiding contraceptive practices.
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    The Effect of Depression on Women's Contraceptive Behaviors and Teenage Pregnancy
    (2018) Vafai, Yassaman; Steinberg, Julia R.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Objective: The overall objective of this dissertation was to investigate the effect of depression on women’s contraceptive behaviors and teenage pregnancy. Methods: In the first study, the relationship between pre-abortion depressive symptoms and effectiveness level of contraceptive method chosen (low, moderately, or highly effective) after contraceptive counseling was examined using multinomial logistic regression in a group of women seeking abortion services. In the second study Cox proportional hazards models were used to estimate the hazard of contraceptive method discontinuation and unintended pregnancy among women experiencing any current and past elevated depressive symptoms in reproductive health settings. The third study examined the association between first depressive episode relative to age at first sex, and the hazard of first teenage pregnancy among girls participating in the National Comorbidity Survey–Adolescent Supplement. Results: More pre-abortion depressive symptoms were associated with higher odds of choosing a low contraceptive method than a moderately or a highly effective contraceptive method. Compared to non-depressed women, women exposed to baseline and a history of elevated depressive symptoms and those exposed to a history of elevated depressive symptoms had 39% and 12% increased hazards of contraceptive method discontinuation respectively; though the associations were not statistically significant when examining all contraceptive methods together. These associations were significant among patch and the injectable users. Finally, adolescent girls whose first depressive episode occurred at the same age as their sexual debut had a higher likelihood of experiencing first teenage pregnancy (HR: 2.73, 95% CI 1.07, 6.97) than those experiencing no depression onset. Conclusion: This dissertation provides evidence for the critical role of timing of depression in determining women’s contraceptive behaviors and reproductive decisions. The findings collectively suggest that not only the presence or absence of depression, but also the time the condition manifests itself during the course of women’s live can predict women’s decisions surrounding contraceptive method choice, continuation, and pregnancy. Implications: The integration of mental and reproductive health as well as a more effective patient-physician communication are warranted in an effort to optimize pregnancy outcomes in women at risk for depression.