Is violence related to unintended pregnancy or is it just a coincidence? That’s the question Temple University researcher Deborah B. Nelson hopes to answer in a study funded by a $500,000 grant from the National Institutes of Health.

While advances in birth control in the past 50 years have made it easier to prevent pregnancy, about half of the 6.7 million pregnancies each year in the U.S. are unintended. Rates of unintended pregnancies are particularly high among unmarried women, minority or urban women, women with limited education, women living in poverty, younger women and women who have experienced interpersonal violence. 

Nelson's study will be conducted in North Philadelphia — a community with particularly high rates of teen pregnancy, violence and infant mortality — and will explore how a woman’s experience with violence can affect her ability to negotiate regular birth control usage.

“We’re encountering women who don’t want to get pregnant, but are not using contraception. Where is the gap?” said Nelson, an associate professor of public health, and obstetrics, gynecology and reproductive sciences, and director of the Maternal and Child Health Wellness Lab at Temple University.

“Women who have experienced childhood violence usually suffer from long-term consequences such as lower self-esteem, higher rates of depression and the inability to regulate their emotions as effectively. In turn, this could affect a woman’s sexual self-efficacy — whether it’s maintaining consistent contraceptive use such as the pill, or insisting her partner use a condom,” said Nelson.

“We want to determine how strong the relationship is between high levels of violence and unintended pregnancies in these communities, and if attributes such as high self-esteem, high levels of family and peer support help young women take charge of their sexual health,” she said.

Nelson’s research for the past decade has focused on what causes early pregnancy and adverse pregnancy outcomes among urban women, including preterm delivery and miscarriage. She is currently studying how bacterial vaginosis, or BV, a vaginal infection caused by an imbalance of bacteria, predicts complications during pregnancy such as preterm delivery. Pregnant women with BV more often have babies who are born premature or with a low birth weight of less than 5.5 pounds.

Unintended pregnancy is associated with an increased risk of problems for the mom and baby. If a pregnancy is not planned before conception, a woman may not be in optimal health for childbearing. For example, women with an unintended pregnancy could delay prenatal care that may affect the health of the baby.

Nelson’s newly funded NIH study will be begin by enrolling 300 sexually active women between the ages of 18 to 30 at Temple’s Family Planning Clinic next month. At the clinic, women will complete a questionnaire about prior and current experiences with violence such as childhood violence or current violence with their partner, measures of self esteem, and susceptibility to depression. 

The survey — designed by the Institute of Survey Research at Temple — will let participants answer these sensitive questions on a tablet as they hear the questions on a headset. Interviewers will provide referrals to women who report that they have or are currently experiencing violence, said Nelson.

In a follow-up survey nine months later, the same women will answer questions about their sexual health, including whether they have had sex since the initial questionnaire, if so how many times and if they used birth control and how consistently.  

The surveys will reveal if women who initially reported violence in their lives were more likely to be inconsistent birth control users. Also, researchers want to know what skills women possess who regularly use birth control, said Nelson.

“If we discover that young women are lacking in the confidence and ability to discuss contraception, then we aren't doing a good job educating young, urban women on their reproductive health," she said. "If we find that low self-esteem is a factor contributing to unintended pregnancy, we need to find ways to build self-esteem among these young women before they become sexually active.

“The overall goal is to make women more resilient so they are more able to take control of their sexual health, and empower them with the skills to use contraception effectively and choose partners who will also use contraception consistently.”

— Anna Nguyen