If Things Were Different in My Life: Structural Inequity and Pregnancy Desires in Emerging Adulthood

Abstract

Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18–24) and their male partners (n=100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the “Things Will Be Different Later” theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the “I Don’t Have Everything I Need” theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the “I’ll Never Have Everything I Need” theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-a-vis emphasis on contraceptive use to ensure future economic success.

INTRODUCTION

Public health researchers and practitioners have long critiqued the pregnancy planning paradigm, which posits that women develop their pregnancy plans in accordance with their career and educational goals (Aiken et al., 2016). Critics argue that this paradigm perpetuates normative expectations for pregnancy preparedness that neglect the realities of reproductive decision-making, particularly in the context of limited educational, career, and economic opportunities (Aiken et al., 2016; Arteaga et al., 2019; Borrero et al., 2015; Callegari et al., 2017). Indeed, ample research finds that many groups, including people of color and of lower socioeconomic status, do not relate to conventional notions of pregnancy preparedness, including achieving educational and career goals and marrying before having children (Arteaga et al., 2019; Edin & Kefalas, 2005; R. K. Jones et al., 2016; Kendall et al., 2005). Yet these normative expectations are embedded in pregnancy prevention efforts (Callegari et al., 2017; Stevens, 2015). For example, researchers at the Brookings Institution have promoted the “Success Sequence,” which they argue will allow people to avoid poverty and enjoy greater economic success in life (Haskins, 2013). This approach suggests that individuals should finish school, maintain full-time employment or have a partner who does so, and be at least 21-years-old and married before childbearing. However, later research examining this sequence found that results differed by race; Black individuals who followed this sequence still had fewer economic prospects compared to whites (Reeves et al., 2015). The authors posit these differential outcomes occur because the sequence ignores the important impact of social factors, many of which share the root cause of systemic racism, on one’s ability to succeed economically.

Despite recent declines in unintended pregnancy, rates in the United States remain high compared to other high-income nations (Sedgh et al., 2015); in 2011, researchers classified 45% of all pregnancies and 62% of pregnancies among 18–24-year-olds as unintended (Guttmacher Institute, 2016). Reducing unintended pregnancy rates, particularly among emerging adults, remains a public health imperative and was once again named a national Healthy People 2030 goal (Klein & American Academy of Pediatrics Committee on Adolescence, 2005; U.S. Department of Health and Human Services, 2020). As women with the fewest years of educational attainment, women of color, low-income women, and younger women had the highest rates of pregnancies classified as unintended, these groups are frequently the focus of contraceptive promotion programs (Guttmacher Institute, 2016). However, it is important to note that traditional measures of pregnancy intentions, including those used for national estimates, lack the nuance necessary to capture the many complexities that factor into pregnancy decision-making. To that end, some research suggests that people may find unexpected pregnancies acceptable (Borrero et al., 2015) and feel happy about an unexpected pregnancy (Aiken et al., 2015; Gómez et al., 2019).

A rich body of scholarship has investigated pregnancy plans and desires among groups experiencing structural inequity (Aiken et al., 2015; Borrero et al., 2015; Edin & Kefalas, 2005; R. K. Jones et al., 2016; Kavanaugh et al., 2017; Sisson, 2012; Wise et al., 2017). We define structural inequity as the systemic disadvantage of social groups due to a confluence of unequal rights, opportunities, power, and opportunities, as well as discriminatory laws and policies. Structural inequity is shaped by historical injustice and perpetuated through contemporary structures (C. P. Jones et al., 2009; National Academies of Sciences & Medicine, 2017; World Health Organization, 2010). Some studies find that young women who do not expect educational or career opportunities may see less reason to avoid pregnancy (Borrero et al., 2015; Edin & Kefalas, 2005; Gómez, Arteaga, et al., 2018; Kendall et al., 2005; Wise et al., 2017). Indeed, one nationally representative study of women found that those with less educational advantage were less likely to report their first pregnancies as unintended, compared to those with greater educational advantage (Wise et al., 2017). Relatedly, research suggests that economic hardships can lead some to delay pregnancy beyond their true desires (Aiken et al., 2015; Gómez et al., 2018). One study of young men and women found that a pregnancy may be viewed as unacceptable, even if desired, because of lack of financial stability (Gómez et al, 2018). This body of work highlights how structural inequity, manifesting as limited educational, career, and economic opportunities, informs the circumstances under which people prefer to be pregnant (Aiken et al., 2015; Edin & Kefalas, 2005; Kavanaugh et al., 2017).

On a foundational level, pregnancy plans are rooted in childbearing desire, a person’s innermost reproductive hopes or dreams, which can include desires to have children or not to have children, as well as considerations related to birth spacing, timing, and desired number of children (Aiken et al., 2015; Arteaga et al., 2019; Callegari et al., 2017; Gómez et al., 2019). Pathways to actualizing childbearing desires are then complicated by structural realities and social norms, such as professional and educational plans, financial resources, relationships, family support, and possible social stigma (Aiken et al., 2015; Bell et al., 2018; Borrero et al., 2015; Geronimus, 2003; Kendall et al., 2005). For example, one qualitative study found that most of its female participants cited financial reasons for not wanting to have more children, despite some describing potential happiness about an unintended pregnancy (Aiken et al., 2015). The authors posit better economic circumstances could influence these participants’ pregnancy decision-making towards having another child rather than avoiding pregnancy.

Additionally, social norms that promote delaying pregnancy until certain milestones are met, such as educational attainment and professional success, undermine the fact that certain groups, including low-income women of color, may face significant barriers to achieving these milestones whether they postpone pregnancy or not (Geronimus, 2003). Research examining the impact of early childbearing has been equivocal. Some studies indicate that teen childbearing is associated with increased risk of school interruption, dropping out of school, and not attending college, all of which can limit future career opportunities (Casares et al., 2010; Hofferth et al., 2001). Other studies find that early childbearing has a greater impact on more advantaged women (Diaz & Fiel, 2016; Wilde et al., 2010). One nationally representative, longitudinal study found that adolescent childbearing had a greater negative association with educational attainment for those who had greater educational and career opportunities prior to pregnancy (Diaz & Fiel, 2016). Meanwhile, the observed association for those who had low pre-pregnancy socioeconomic prospects was significantly weaker. These results suggest that pre-existing socioeconomic context may be more influential on future prospects than childbearing itself.

Emerging adulthood (ages 18–25) is a developmental timeframe marked by identity exploration, self-focus, and feelings of possibility during which individuals often contemplate possible life trajectories, including reproductive trajectories (Arnett, 2014). Given the high social threshold for pregnancy preparedness, emerging adults of lower socioeconomic status may not envision themselves as ever having the resources necessary to successfully plan for a pregnancy (Edin & Kefalas, 2005; Kendall et al., 2005). Consequentially, these individuals may feel pressure to shift their reproductive expectations and plans. This is particularly important given that lower-income emerging adults are already impacted by structural inequity, including community violence, homelessness, housing or food insecurity, or barriers to educational and professional opportunities (Edin & Kefalas, 2005; Geronimus, 2003). In light of these intractable inequities, the pregnancy planning paradigm may appear unattainable (Aiken et al., 2015; Borrero et al., 2015; Kendall et al., 2005).

In this paper, we qualitatively investigate young people’s perspectives on future pregnancy, using data from 50 young couples (n=100). Given that a primary goal of the study was to develop new measures of pregnancy intentions, we asked participants to respond to existing survey measures to understand how they: (1) made sense of existing measurement approaches, and (2) conceptualized their pregnancy expectations. Using one such existing survey item, participants were asked the extent to which they agreed with the statement, “If things were different in my life, I would love to have a baby right now” (Kaye et al., 2009, p. 10). Through our qualitative analysis of responses to this question, we found that many participants described a gap between their current pregnancy desires (what they wanted) and their plans (what they were working towards and expected to actualize), with structural inequity emerging as a major reason for this chasm.

Our analysis is informed by reproductive justice as a guiding analytic framework. Reproductive justice is an intersectional social movement, analytic framework, praxis, and vision that understands the human right to manage one’s fertility with dignity is intrinsically connected to the right to have children and to parent with safety and dignity (Luna & Luker, 2013). As a social movement founded in the 1990s by Black women, reproductive justice stood in contrast to the conventional reproductive rights movement, which focused on individual privacy and choice in reproductive decision-making and inherently neglected the structurally- and historically-produced inequities that impeded under-resourced communities’ reproductive self-determination (Ross & Solinger, 2017). Indeed, drawing on reproductive justice as an analytic framework requires centering the experiences of individuals from these communities, including communities of color, and the ways that intersecting systems of oppression, including racism and sexism, affect self-determination (Ross & Solinger, 2017). In this study, we explored how various structural factors, including financial and housing insecurity, persistent lack of educational and career opportunities, and systemic racism, influenced young people’s ability to make decisions in line with their reproductive preferences.

METHOD

This analysis utilized qualitative data from a mixed methods study examining pregnancy planning, desire, and decision-making among 50 young, cisgender women (aged 18–24) and their cisgender, male partners (N=100) in the San Francisco Bay Area. We recruited participants via flyers at community organizations, health clinics, community college, and universities, as well as via Facebook ads and Craigslist posts. To be eligible for the study, the female partner had to identify a primary race of either Latina or Hispanic, Black or African-American, Asian, or White; be between the ages of 18 and 24; not be pregnant or actively trying to become pregnant; and identify a primary male partner with whom she had been sexually active in the last 2 months. Eligible women were invited to provide contact information for their partners or refer their partner to the study team to determine eligibility (being older than 18 for male partners). We employed theoretical sampling, wherein data collection is driven by the goal of maximizing conceptual diversity in a sample, iteratively shifting our focus to different populations in order to yield a sample with maximum diversity in racial/ethnic background, socio-economic status, educational attainment, and parenting status.

Prior to the in-person interviews, participants completed a survey to assess demographic characteristics, contraceptive history, and pregnancy preferences. Trained, same-gender interviewers conducted in-depth interviews using a semi-structured interview guide including questions about relationship dynamics, contraceptive use and decision-making, and pregnancy intentions, plans, and desires. Interviewers also probed on participants’ survey responses regarding pregnancy preferences. We interviewed partners separately and simultaneously. Each participant received an incentive of $30. Interviews averaged 77 minutes and were professionally transcribed verbatim. The Committee for the Protection of Human Subjects at the University of California, Berkeley approved the study protocol.

The average participant age was 23 years (Table 1). Most participants identified with a racial or ethnic minority group, and 24 identified as multiracial. Educational attainment ranged from 22 participants having attained at most a high school degree to 25 that were college graduates. Thirty-two participants had public insurance, and 10 were uninsured. Most participants (n=71) had been in a relationship for over a year, and 26 were married or cohabiting. Forty-one participants were parents, 65 were employed, and 52 were students. Participants used a variety of contraceptive methods, with 34 using long-acting reversible contraception (LARC) (intrauterine device (IUD), implant), 22 using short-acting, hormonal methods (contraceptive pills, ring, patch, injectable contraception), 27 using male condoms, 8 using withdrawal, and 9 not using a method.

Table 1:

Participant demographic characteristics and pregnancy intentions, Young Couples Study (N=100)

Demographic Characteristic	n
Mean age, years (SD)	22.6 (3.5)
Race/ethnicitya
Latino	45
Black	22
Asian/Pacific Islander	18
Native American	7
White	35
Multiracial	24
Educational attainment
Less than high school	3
High school	19
Vocational or technical school, associate’s degree	7
Some college	46
College graduate	25
Student	52
Employed	65
Parent	41
Has experienced an unintended pregnancy	47
Married/cohabitingb	26
In a relationship for more than one year	71
Insurance typec
Private	58
Public	32
Uninsured	10
If things were different in my life, I would love to have a baby right now.
Strongly agree	25
Agree	21
Neither agree nor disagree	24
Disagree	17
Strongly disagree	13
Social advantage
Less social advantage	54
More social advantage	46
Qualitative themes
Things will be different in my life later.	52
I don’t have what I need to have a(nother) child.	39
I’ll never have what I need to have a(nother) child.	9
Most effective method of contraception used
No method	9
Withdrawal	8
Male condoms	27
Oral contraception pills	18
Patch	2
Injectable birth control	2
Implant	16
Hormonal IUD	12
Non-hormonal copper IUD	6

Notes:

^(a)Participants could report identifying with multiple racial and ethnic groups, thus the sum of all categories exceeds 100.

^(b)Each individual participant reported their relationship status. Members of some couples discrepantly reported their relationship status, making this frequency an odd rather than even number.

^(c)One participant reported having both public and private insurance. Another participant reported not knowing what type of insurance they had.

The “Sort and Sift, Think and Shift” approach guided our qualitative analysis (Maietta, 2006). We created extensive analytic memos for each interview transcript and for each couple to capture emergent themes. This process informed the iterative development of a codebook which was finalized after all memos had been completed. The codebook focused on relationship dynamics, contraception use, pregnancy desire, expected feelings if they found out they or their partner was pregnant today, and pregnancy planning nomenclature. Following development of the codebook, we coded data utilizing a “lumping” approach, in which larger excerpts of text are coded to capture the overall topics and ideas identified during the memo writing process (Saldaña, 2016). We used Dedoose, a web-based software, for coding.

For this analysis, we focused on the coded data using a thematic analytic approach to examine the influence of structural factors, including financial and housing instability, on pregnancy desires and plans. To do so, we compared participants by level of social advantage, as determined by educational opportunity and attainment, family structure and support, access to financial resources, immigration status and housing/employment stability. Classification of social advantage was not dependent on any one factor but through participants’ qualitative descriptions of the ways in which structural inequity manifested in their lives; participants were not directly asked about their perceived level of social advantage. For example, a participant may have attained a college degree but be classified as lacking social advantage owing to their status as an undocumented immigrant, not qualifying for financial aid, and having grown up in a single-parent, low-income household. Conversely, another participant may also be an immigrant but have social advantage, emigrating at an early age from Europe and growing up in a two-income household with relative wealth. To investigate how structural inequity interacted with pregnancy plans and desires, we examined participants’ responses to the following question in the demographic survey and the reasoning for their answer choices: “How much do you agree or disagree with the following statement: If things were different in my life, I would love to have a baby right now “ (Kaye et al., 2009, p. 10). Forty-six participants agreed or strongly agreed that if things were different in their lives, they would love to have a baby right now, 30 disagreed or strongly disagreed, and 24 neither agreed nor disagreed (Table 1). To further inform our analysis, we also examined participants’ qualitative descriptions about ideal timing for pregnancy, pregnancy desire, and perceptions of pregnancy preparedness needs. We entered this information into a matrix to inform the development of emergent themes (Miles et al., 2014).

RESULTS

In our analysis, three mutually exclusive themes emerged with regards to pregnancy desires in young adulthood: “Things will be different later,” “I don’t have everything I need,” and “I’ll never have everything I need.” Notably, the distribution of these themes was stratified by social advantage. We classified 46 participants as being more socially advantaged, and 54 participants as being less socially advantaged.^a More advantaged participants typically had pregnancy plans aligned with their desires and indicated they were not ready for pregnancy. Less advantaged participants frequently had pregnancy plans that did not align with their desires or did not find pregnancy planning to be relevant to their lives; these participants described that they did not or would not ever have what they needed to become pregnant. Most individuals (n=88) appeared in the same theme as their partner.

Things Will Be Different Later

About half (n=52) of participants felt that they were not ready to become parents, 38 of whom were more socially advantaged. These participants largely described feeling as though pregnancy right now would be undesirable, though they looked forward to it later in their lives. Many of these participants were more socially advantaged and had pregnancy plans that aligned with their desires, owing to expectations of meeting future economic, experiential, educational, and relational goals. Nearly half of these participants (48%) disagreed or strongly disagreed that, if things were different in their lives, they would love to have a baby right now. For the 23% of participants who agreed they would love a pregnancy now “if things were different” in their lives, these responses were actually reflective of desiring children at a later stage in their development, when they had personal expectations of achieving milestones associated with pregnancy preparedness. For example, one 24-year-old Asian woman reflected,

“Like if things were different in my life, like if I was financially stable or if I was older or if I was married or what it meant by different, then yeah, I’d be okay having kids, but like, I don’t know, if like things were different now, I’m still kind of young, so I wouldn’t want to have kids even if I was like financially stable or married.”

This participant was a socially advantaged college graduate with high expectations of future professional success. Unlike other participants who desired pregnancy but could not actualize those desires with current resources, her pregnancy desires and plans aligned, as she fully expected to achieve important life milestones she felt were a prerequisite for becoming a parent. Similarly, a 22-year-old Latina woman noted,

“I mean if things were different, I don’t really want things to be different in my life right now, so that’s why I put neither agree nor disagree. But if I was like different in the sense that I would be already out of school and have a job, then yes.”

These participants did not desire things to be different in their lives now but rather envisioned a future in which they surely would be, by virtue of being further along a life path on which they already perceived themselves to be. Thus, they believed that they could plan for a pregnancy in accordance with their desires, and that their plans could and would be actualized.

When describing ideal timing for pregnancy, these participants overwhelmingly referenced achievement of educational or professional goals. Indeed, participants presumed attaining those goals would allow other needs to fall into place, such as home ownership or financial stability. One 22-year-old Latina woman said that 30 would be the ideal age to become pregnant: “I feel like that’s when I’ll be pretty much when I’m done with school I should actually have something going for myself, an actual career and like a job. Have some kind of stability.” Similarly, a 22-year-old white man who planned to attend medical school noted, “I definitely would like to be done with residency by the time I have a kid so I have a larger income to be able to support the child.” These participants believed that finishing school and/or professional training would inevitably facilitate financial stability and, therefore, increase their ability to parent. Many within this theme held similar perspectives about the “right” time to have a child, which took into account achieving certain milestones before childbearing. As another 22-year-old Latina woman explained, “I want to do things right, kind of like, you know, finish my school, graduate and do whatever else I’m going to do after that. And then marriage and then kids.” Thus, completing school was seen as the first essential step on the path to parenthood. Because many participants under this theme were already attending college or had recently earned degrees, these aspirations felt wholly within reach.

For many of these participants, the attainment of educational and professional goals necessitated the postponing pregnancy until these goals were met. This was reflected in participants’ contraceptive use; most (67%) were using highly effective contraception, including IUDs, implants, and oral contraceptive pills, with 49% using multiple methods. Participants’ descriptions of their contraceptive decision-making processes highlighted the importance of pregnancy prevention. Indeed, many described choosing methods affording them extra protection against pregnancy, compared to previous methods. These participants described either switching to more effective methods or using these methods simultaneously with another less effective method. For example, one 20-year-old white woman described her reasoning behind switching to the pill from the male condom: “I was like, you know, I really don’t want anything to happen or put either of us into a situation where it’ll just change our whole plan…And so that’s when I like really decided I think birth control [pills] would be really helpful. We were already really careful but just still I felt more comfortable with getting birth control [pills].” Additionally, participants described choosing methods specifically for their effectiveness, as well as those they felt comfortable using owing to prior use or lack of unwanted side effects. Many of these participants had tried numerous methods on the quest to find one that worked for them—because pregnancy prevention was important, they were therefore willing to invest significant effort to find the right method.

Notably, all eight participants using withdrawal as their most effective method fell under this theme. Like the others in this theme, these participants described the importance of avoiding pregnancy but faced contraceptive access barriers. For example, four participants described condoms or the pill as being “too expensive,” while three characterized obtaining condoms as inconvenient. For two participants, trying to abstain from sex for religious reasons led them to stop using other methods and to default withdrawal use. For these participants, withdrawal was a convenient method that was easily accessible when more effective methods were not. Here, the link between pregnancy preferences and contraceptive use was complicated by a variety of factors, including financial barriers.

I Don’t Have Everything I Need

For many participants (n=39), most of whom were less socially advantaged (n=31), pregnancy plans were delayed owing to the lack of financial, structural, and social supports they perceived to be necessary for pregnancy preparedness; 74% of these participants agreed that if things were different in their lives, they would love to have a baby right now. While these participants expressed desires for pregnancy sooner, they felt the need to delay until they could contend with structural barriers. Therefore, their pregnancy plans, shifted by way of structural inequity, were not in accordance with their expressed pregnancy desires.

These participants mentioned an array of overlapping difficulties preventing them from actualizing their pregnancy desires, including difficulty finding stable employment, affording stable housing, and overall financial instability. For example, one 24-year-old Latino man said,

“I think the bottom line, at least for me has always been like being financially set. Being financially set gives you the freedom I would say to have a kid. I know there’s a question that says like, if things were different would you be willing to have a kid now? And I said absolutely because…if I could have a kid now, man, without having to worry about, you know, finances, that’s definitely something that, I mean, I would be more than willing to do. I’ll be absolutely glad to.”

This participant was very familiar with structural inequity, having paid many years of college tuition out-of-pocket due to his inability to access financial aid as an undocumented immigrant. While he would be happy having a child now, his plans were at odds with his desires, as he felt he had to delay pregnancy until financial resources were in place. He expected overwhelming barriers on the path to accumulating the necessary resources, as he heard it can cost “over a million bucks to raise a kid.” Similarly, a 23-year-old white woman described her decision to postpone having another child, saying,

“Your money doesn’t go very far here. I pay over $2,000 a month for a very, very small 2-bedroom house that doesn’t even have a garage, versus another part of the country, you’re looking at (a) 6–7 bedroom house, pool, all that for the same cost. So I think that’s why financial responsibility is such a big thing in this area. So for being 23, we make good money, but we don’t make as good a money as the 30- and 40-year-olds…what’s holding us back at the moment is finances.”

While this participant had described herself and her husband as “pretty frickin’ stable” for their ages, she acknowledged that even their relative stability failed to provide the necessary resources for parenting another child the way she would like to (i.e., with enough financial security to stay home from work for a year after childbirth).

For many participants under this theme, lack of financial stability was closely tied to unstable housing. This lack of stable housing directly contradicted their pregnancy desires, as they could not envision raising a child in their current housing conditions. For example, one 19-year-old white man described why he felt he was not ready to have a child now:

“Like especially since like we live in a trailer, we could not raise a baby in the trailer. Like the cradle would take about half of our floor space. And then we’d either not have access to our bed, not have access to our kitchen, or not have access to our living room. Like wherever we put it, it would just be blocking most of what we use.”

This participant’s current living situation made it impossible for him to visualize raising a child. Therefore, he described the desire to delay pregnancy until he and his partner had better housing:

“Like I said, get more money, a house, get more secure and a more permanent living situation because like I’ve lived in 7 different houses. There was a period of 4 years where every year was a different house, so like the whole just getting settled in and then having to pack up and move again, that was really stressful on me, and I don’t want to do that to our kids.”

Ultimately, this participant and his partner planned to leave California for a more affordable area where the houses “are like really big with big open fields that you would own right there.” Similarly, an 18-year-old Latina woman described her hesitation to have more children due to not having her own place to live.

“We’re not ready to have a third child when we have two already, and we’re staying at someone’s house. As adults, we have two children, and we’re staying at his mother’s house, so I feel like we’re not ready to have another child at this moment.”

Other participants also described less than ideal housing circumstances, such as small living spaces or living with parents or other family members; a few participants even mentioned being currently or recently homeless. For many, having a child in the context of housing insecurity felt impossible.

Notably, one couple mentioned the difficulties associated with having a child in a society that provides little structural support for parents. These participants were parents and chose to delay having any more children until they were more financially stable.

“So if there was a system in here, like in our society that would let moms stay for the necessary amount of time to bond with their babies instead of just like, oh, hey go back to work, kind of thing I would love to have another baby…I just think a lot of reality just kind of like shapes whether I need to have a baby. I’m trying to word it correctly and try to word it so it makes sense. Because I just feel like if the system was perfect and like there wasn’t like so much stress on everybody, having a family wouldn’t be a big problem.”

-24-year-old Latina woman

Similarly, her husband described,

“We want to be able to watch our kid. We want to be able to have enough time or money or whatever to be able to take that time off. Like in France, they give you like two years or whatever, just to watch your kid. We don’t get that here. And when you do, they make you feel bad about it.”

-21-year-old multiracial man

For this couple, larger structural issues that make it difficult to parent in the U.S. while working or attending school strongly influenced their pregnancy plans. Because of this lack of support, they were delaying pregnancy beyond their true desires.

The contradiction between the need to delay pregnancy and the desire to have a child was showcased in these participants’ contraceptive decision-making. Unlike participants who felt things would be different later and used highly effective contraception, the most commonly used method under this theme was the male condom, used by 44% of participants. Like those who felt things would be different later, many had arrived at using male condoms after trying other methods that did not work for them, often because of side effects. Many described choosing their method for pregnancy prevention reasons, ease of use, and their comfort with the method. In contrast to the first theme, many participants under the “I don’t have everything I need” theme actively chose not to tolerate negative side effects even if it meant greater protection against pregnancy. One 23-year-old white woman described her journey to find the right contraceptive method, eventually landing on a mix of condoms and withdrawal:

“So I initially took birth control pills when I was really young, hormones gave me headaches. I did the NuvaRing, but I rode horses. I showed and so the Ring kept slipping. And of course we’d have intercourse, and it was all weird with a big ring in there. And then I tried the Patch, I did the Depo, I gained weight on the Depo, and I had headaches all throughout that whole time. And I realized it was from the hormones. For some reason, I just don’t do well with any kind of hormone treatment. So that’s why I used the Paragard because there were no hormones. And I thought since I was a little older at this point, my hormones had evened out a little more, and then we talked about it, and he was like, I’m not comfortable with it [Paragard], and I said, that’s fine. We’ll figure it out. You know if we get pregnant again, we’ll be fine.”

Despite avoiding pregnancy because of financial concerns, this participant also noted that she would be able to make a pregnancy work at this time, and even noting that if she and her partner were more financially stable, “I probably would have had my second [child] already.”

I’ll Never Have Everything I Need

Nine participants, all of whom were less socially advantaged and identified as people of color, expressed significant doubt about whether they would ever have everything they should to raise a child. As such, the alignment of pregnancy plans and desires was not relevant for their lives. The traditional pregnancy planning paradigm, which leans heavily on structural preparedness, appeared inapplicable, as they did not believe their lives would be dramatically different in the future. For these participants, everyday experiences of structural inequity, manifesting in financial and housing insecurity and systemic racism, meant navigating life with unmet basic needs. This lived experience strongly impacted a variety of life domains, including reproductive decision-making. For example, one 22-year-old Black woman said,

“I’ve never met anyone who was like, oh yeah, I was now prepared to have my baby. And, oh, I had a billion dollars saved up for his whole life. Like, word, no, nobody’s saying shit like that. Like people are like, oh, I hella wasn’t ready when I had my baby.”

This participant describes how no one she has ever known has had all of the resources necessary to have a child when they got pregnant. Rather, they had a child and figured it out after the fact. Because she similarly did not anticipate having all of the resources necessary for traditional pregnancy preparedness, she didn’t feel the need to plan for pregnancy and felts accepting of a pregnancy, no matter when it might occur. Therefore, the notion of normative pregnancy planning lacked relevance for her. Similarly, a 22-year-old multiracial woman described why “anytime” would be ideal for her next pregnancy, saying, “I adapt to things that happen to me…like, like when I got pregnant with (baby), I totally wasn’t prepared, but I figured it out. If shit happens, you just stay, and you deal with it.”

Importantly, two participants described constraints to their pregnancy plans because of pervasive experiences of trauma, community violence, and systemic racism.

“It’s not abnormal for a parent to bury their 12-year-old, 13-year-old son or daughter. Like it’s just not–it’s normal where I’m at right now, like in this life, it’s normal, so it’s like, I’m kind of scared to bring a kid here…Yeah, I worry about your son getting murdered, your daughter getting murdered, your daughter getting molested or something. I gotta worry about too much so it’s kind of scary, and at the same time, you know I want to bring them into the world but it’s still kind of scary for they get older. I can’t stop everything and everybody.”

24-year-old Black man

The (structurally-produced) trauma and inequity this participant has experienced in his life, including having “so many lives [taken] from me,” made him scared to bring a child into the world. However, he also does not expect these circumstances to change any time soon, and in that way, is accepting of a pregnancy despite the fact that he cannot control the world around him, saying, “It would probably be the happiest moment in my life” if he found out his partner was pregnant today. Another 22-year-old multiracial woman described how her pregnancy plans were influenced by her experiences of anti-Blackness.

“Because I feel like, because I’m Black, I have to go out of my way, even if I’m mixed with other stuff they don’t see that so it’s just like I’m an African American woman whatever. And I feel like if I have a baby, and I’m not married, I’m going to be with that a certain way, so I have to try extra harder not to be a stereotype. I have to go to college and push harder because I have to have a package behind me. I have to have a job because I don’t want to be called the Section 8 welfare girl.”

This participant highlighted the powerful impact of racism and the resulting stigma on her decision-making. Though she identified as mixed race, she felt pressured to reach certain milestones associated with pregnancy preparedness before having a child in order to avoid the stigma associated with being labeled a stereotype due to dominant narratives about Black women in U.S. society. However, while describing planned pregnancies are “best,” she simultaneously felt that “nobody is truly ready.” Despite not having completed college or established a career, she said that, if she could have it her way, she would want to have a baby now.

Under this theme, participants were generally not concerned about avoiding pregnancy; as they did not feel their circumstances would ever be ideal enough for pregnancy preparedness, the notion of pregnancy prevention was not particularly salient. Unlike participants under the two other themes, about half (44%) were not using contraception. Only one male participant described use of a highly effective method by his partner, who was in the “I don’t have what I need” theme. Notably, when asked about what influenced contraceptive decision-making, no participant mentioned choosing a method for its pregnancy prevention abilities. Rather, these participants were using methods that their partners had chosen or did not have the undesirable side effects they had experienced with hormonal methods. Those not using contraception described doing so because they would find an unexpected pregnancy acceptable. For example, one 24-year-old Black man described the joint decision to stop using contraception: “Yeah, like, it started with condoms and then I’m like, ‘I don’t want to use condoms no more,’ and then [she’s] like, ‘Okay, you gotta pull out then.’ And so I was probably like, ‘Why do I need to pull out? Do you care about getting pregnant?’ ‘Oh not really.’ So it’s like, I’m not pulling out no more.” Like others, he did not feel that he and his partner could attain the conditions needed to plan a pregnancy and therefore did not feel the need to use contraception.

DISCUSSION

This analysis indicates that structural inequities influence the trajectory from envisioning to actualizing reproductive desires in emerging adulthood. In our sample, less advantaged individuals reasoned that they did not or would never have what they needed to actualize their pregnancy desires. These participants navigated these barriers in two ways; some chose to postpone pregnancy beyond their preferred desires, while others forewent traditional notions of pregnancy planning altogether and adapted to pregnancy regardless of current circumstances. In contrast, more advantaged participants held normative timelines for pregnancy that were supported by their educational and professional trajectories. These findings align with previous research that suggests pregnancy planning lacks universal relevance, particularly for emerging adults (Aiken et al., 2016; Arteaga et al., 2019; Borrero et al., 2015; Edin & Kefalas, 2005; Geronimus, 2003; Kendall et al., 2005), and highlights the importance of social and economic context vis-à-vis reproductive decision-making. Additionally, despite differences in participants’ perceptions of their ability to actualize pregnancy plans, advantaged and disadvantaged participants alike described the importance of financial stability, steady employment, and having one’s own home in order to be prepared for childbearing. These findings support previous research indicating that young peoples’ ideal circumstances for pregnancy differ very little by socioeconomic status (Bell et al., 2018; Geronimus, 2003; Gibson-Davis et al., 2005). However, when young people have few educational and professional prospects to look forward to, the perceived costs of early childbearing may not seem as high compared to those who expect to attend college and launch successful careers (Edin & Kefalas, 2005; Kendall et al., 2005; Sisson, 2012).

In our study, nine participants, all of whom identified as people of color and were socially disadvantaged, expressed they would never have what they needed to be prepared for pregnancy, and therefore did not consider it beneficial to postpone pregnancy, as they did not envision that their life would be dramatically different in the future. These participants often faced multiple barriers to meeting their basic needs, including persistent financial and/or housing insecurity, neighborhood violence, and lack of educational and career opportunities that coalesced in a perpetual state of instability. Because of this, they did not expect a pregnancy to drastically alter their lives and felt they could adapt. These findings are notable in light of research indicating that early childbearing may have less cataclysmic effects on the lives of disadvantaged individuals. Indeed, some research has found that pregnancy can be a positive outcome for young parents, offering them with a means of transition into adulthood when other milestones, such as attending college or owning a home, are unavailable (Edin & Kefalas, 2005; Gubrium et al., 2016; Kendall et al., 2005; Minnis et al., 2013). Notably, nearly all participants under this theme described being in a serious relationship with their partners for at least a year or longer. These relational factors may contribute to their sense of capacity for parenting and pregnancy acceptability. A 2018 study found that the perceived opportunity costs of childbearing appeared weaker among individuals in stronger relationships, as these costs could potentially be shared between both partners (Bell et al., 2018).

While contraceptive use patterns mostly aligned with participants’ pregnancy desires and plans, differences in use emerged by social advantage; among those in the “Later” theme, there was generally a strong link between life goals and plans and contraceptive use. Yet eight participants used withdrawal as their primary contraception, despite avoiding pregnancy until achieving educational and career goals. Of these participants, half cited economic hardship as the reason for withdrawal use. Furthermore, all participants under the “I’ll never have what I need” theme were people of color and had lower socioeconomic status; about half were not using contraception, while the others described choosing methods based on characteristics other than pregnancy prevention effectiveness. Other research describes age, socioeconomic and racial and ethnic differences in contraceptive use (Daniels & Abma, 2018; Kavanaugh & Jerman, 2018; Lyons et al., 2018; Wright, In Press). An analysis of the relationship between financial strain and contraceptive use found that, after adjusting for income level, emerging adult women experiencing financial strain were less likely to use LARC methods (Lyons et al., 2018). Another recent study found that socioeconomically disadvantaged individuals were less likely to use IUDs compared to those with socioeconomic advantage, while Black-identified respondents were more likely to use injectable birth control compared to other racial groups (Wright, In Press). These differences are attributed to a multitude of factors, including the U.S.’s history of reproductive oppression (Gamble, 1997; Haider et al., 2013; Roberts, 1997; Washington, 2006), distrust of the medical system (Benkert et al., 2009), experiences of discrimination (Bird & Bogart, 2001; Sorkin et al., 2010), and pressure to use contraception or limit family size (Becker & Tsui, 2008; Downing et al., 2007; Gómez & Wapman, 2017; Yee & Simon, 2011). Indeed, studies show that Black and Latina women express a lack of trust towards a medical care system that has historically constrained their reproductive self-determination, perhaps undergirding preferences for user-controlled methods that provide greater agency (Gómez, Mann, et al., 2018; Jackson et al., 2016). This lack of trust often leads women of color to be uninterested in highly-effective methods of contraception, like LARC methods, because of the need for provider intervention to discontinue use (Gómez et al., 2020; Gómez & Wapman, 2017). Additionally, there is evidence to suggest that women of color may prioritize certain contraceptive method attributes over effectiveness, such as low side effects, the ability to stop using the method at any time, and protection against sexually transmitted infections (Gómez, Mann, et al., 2018; Jackson et al., 2016). Indeed, participants in our sample who were not as concerned about avoiding pregnancy used condoms in an effort to avoid unwanted side effects from hormonal contraception.

Our study is one of the few to examine how structural factors affect the expression and actualization of pregnancy desires in emerging adulthood. A strength of this analysis involves the use of qualitative methods, which facilitated a deep and rich understanding of these processes in our sample. Additionally, the notable diversity of our sample enabled us to examine a range of perspectives and compare pregnancy plans among more and less advantaged individuals. However, there are limitations. While it is not a goal of qualitative inquiry to be representative, our analysis is limited to heterosexual, cisgender men and women in the San Francisco Bay Area. Structural inequity may manifest differently for queer, transgender, and non-binary people and should be explored in future research (Carpenter et al., 2020). Furthermore, these findings may be compounded by the extremely high costs of living, shrinking housing market, and highly competitive employment market in this area. Additionally, all participants were in partnered relationships, which may affect their pregnancy desires and plans (Carter et al., 2013). Lastly, we did not collect information on income or ask participants about their perceived level of social advantage. Instead, we classified levels of social advantage based on descriptions of factors that are important components of the pregnancy planning paradigm: educational and career opportunities, family support, access to financial resources, and housing/employment stability. Though this limits our ability to describe the sample, it is important to note that traditional measure of socioeconomic status are often not appropriate for young adults (Svedberg et al., 2016).

Our results suggest that intractable structural inequity limits the reproductive self-determination of emerging adults. While public health narratives emphasize the importance of pregnancy planning (with some arguing that pregnancy planning is a poverty prevention approach; Sawhill, 2014), it is important to consider the ways in which experiencing poverty, structural racism, and related forms of social disadvantage (e.g., housing and employment instability) can affect a young person’s prospects for the future and, ultimately, their pregnancy desires and plans (Edin & Kefalas, 2005; Geronimus, 2003; Sisson, 2012). In our study, many less advantaged individuals were delaying pregnancy beyond their true desires due to lack of structural supports. Advocacy efforts that focus on increasing access to structural supports, such as paid family leave, can increase the capacity of all individuals to make reproductive choices that align with their desires and life goals. Furthermore, research focusing on the measurement of unintended pregnancy should shift focus to individuals who experience truly unwanted pregnancies, or who experience pregnancy as a negative event in their life, as research suggests there may be many pregnancies captured in current measures of “unplanned” or “unintended” pregnancies that occur in individuals for whom the pregnancies themselves were acceptable but circumstances were not ideal due to structural inequity (Aiken et al., 2016; Borrero et al., 2015; Gómez et. al, 2018). Additionally, family planning providers, who may base their counseling approaches on normative notions of pregnancy preparedness, should strive to recognize the ways that structural inequity undermines family planning in order to better support young people’s contraceptive and reproductive preferences (Callegari et al., 2017; Downey & Gómez, 2018; Stevens, 2015). While expanding access to resources and opportunities for those with less social and economic advantage remains critical, it is similarly important to recognize and support childbearing desires in all contexts (Aiken et al., 2016; Borrero et al., 2015; Gómez et al., 2020). Until these supports are in place, socially disadvantaged young people will continue to experience inequity throughout the reproductive life course, including postponing pregnancy beyond their true desires and parenting in conditions that undermine their well-being and reproductive self-determination.