EDUCATIONAL ADVANTAGE AND UNINTENDED PREGNANCY by Akilah M. Wise A dissertation ...

196 Pages·2015·1.68 MB·English

by  Akilah Wise

EDUCATIONAL ADVANTAGE AND UNINTENDED PREGNANCY

by

Akilah M. Wise

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Health Behavior and Health Education)
in The University of Michigan
2015

Doctoral Committee:

Professor Arline T. Geronimus, Chair
Professor Larry M. Gant
Professor Pamela J. Smock
Associate Professor Rachel C. Snow
© Akilah M Wise

2015
Acknowledgements

This dissertation reflects a journey that I could not have taken without the support,
guidance, and encouragement of many. Everyday I wondered if I made a mistake - leaving
California, full of sunshine, love, and beauty, to Michigan, full of promise and potential for my
growth. I felt like an interloper but this dissertation is proof that I thrived and made it, thanks to
the help of my incredible support system. There were those who kept me grounded – the family
and friends who reminded me of far I had come. There were those who kept me lifted – the
friends who shared in good times, love, support, and laughter, keeping my heart and mind open
to the beauty of life’s gifts. And those who led me forward in the right direction - the teachers
and advisors who provided advice and guidance that I needed to navigate this program. Truly,
this dissertation is a product of a group effort.

Those who guided me forward…
I would like to acknowledge the intellectual support of Dr. Arline Geronimus, my advisor
and committee chair. I thank Arline for her patient and thoughtful guidance throughout the
conceptualization and completion of this dissertation project. My grounding in this field and
confidence as a new scholar is largely owed to her.
I also want to thank my committee: Dr. Larry Gant, Dr. Rachel Snow, and Dr. Pamela
Smock. Dr. Gant encouraged me to approach my qualitative project with nuance but he also
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provided supportive advice for my long-term plans. Dr. Rachel Snow invigorated me with her
astute guidance, energy, and confidence in my capability as a scholar. And Dr. Pamela Smock
provided leadership and support during my most vulnerable state and restoring my confidence in
the analytic approach of the quantitative study.
I am very grateful for the Population Studies Center pre-doctoral traineeship. This
interdisciplinary community provided a tremendous amount of assistance during my time at
Michigan. I give huge thanks to Lisa Neidert and Cathy Sun for showing me the ins and outs of
programming and data analysis when this project was in its infancy. Furthermore, I am grateful
for the generous support from the Population Studies Center’s Small Grants Fund for allowing
me to pursue the qualitative project.
Thank you, Maggie Hicken, Annie Ro, Erin Linnenbringer, and Danya Keene for pulling
me to the finishing line with your invaluable mentorship, moral support, and stellar guidance.
For reading through the rough drafts and listening to the clueless questions - thank you. I would
also like to thank Dr. Carla Stokes for trusting me with her girls and being an inspiration.
I am grateful for Dr. Amy Schulz who validated this project with her guidance when it
was just a kernel of an idea. Thank you Drs. Gilbert Gee and Anne Pebley for recognizing my
potential and encouraging me to pursue a Ph.D.

Those who kept me grounded….

I want to thank my family, including my father and mother, Fritz and Rhonda, who
instilled the value of education and intellect, even though they did not receive any formal
education beyond that of high school. Thank you, Omari, my little brother who has grown to be
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my confidant and partner in the struggle to be better people and do great things. I would also like
to thank my Uncle J.W. who was a rock to lean on when I felt the decision to pursue graduate
education was a financial mistake. He always reminded me that I was doing something valuable
and noble.
I thank my grandparents, Elray and Johnella Wise and Benny and Marjorie Colon, who
left their roots in Texas and Louisiana nearly fifty years ago to find better work and education
prospects in Los Angeles. Their migration served as a constant reminder that self-improvement
comes from sacrifice and geographic boundaries are no match for one’s determination to forge
their own path for betterment and opportunity.

Those who kept me lifted…
To my closest girls Megan, Jo-Issa, Andunett, Mienah, Uchechi, Elinam, Abenet, and
those who are unnamed here, thank you for supporting my choice to leave for Michigan and your
long-distance emotional support throughout the years. My girls are my family. To my Michigan
crew: Kimberly, Keon, Linnea, Jamie, Marvin, Nelson, and Veronica, for their laughter, the late
nights, the tears, deep commiseration, and friendship.
I could not have done this without you all.

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Table of Contents

Acknowledgements………………………………………………………………………… ii

List of Tables………………………………………………………………………………. vi

List of Appendices…………………………………………………………………………. viii

Chapter

1. Introduction 1

2. Critical Literature Review of Unintended Pregnancy and Theoretical Overview of 3
Educational Advantage and Fertility Intention

3. Educational Advantage in Youth and Pregnancy Intention of First Births 21

4. Unintended Pregnancy and Educational Advantage: The experiences of pregnancy 64
anticipation among a diverse group of women

5. Conclusion: A New Approach to Pregnancy Intention 148

Appendices 160

References 176

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List of Tables

Table 3.1 Questions used to assess pregnancy intention in major US surveys 52
Table 3.2 National Longitudinal Survey of Youth 1979 Example Pregnancy Intention Items 53
Table 3.3 Educational Advantage Variables and Corresponding Items 54
Table 3.4 Independent Effects of Educational Advantage Indicators on 55
College Degree Attainment by Age 25

Table 3.5 Pairwise Correlations of Continuous Education Measures and Educational 56
Advantage Index
Table 3.6 Mean and Standard Error of Indicators Included in the Index of Advantage 56
Table 3.7 Levels and Significance of Sample Characteristics (Column 1) and Index of 57
Advantage (Columns 2 and 3) by Socio-demographic variables
Table 3.8 Levels and Significance of non-Hispanic Black Sample Characteristics (Column 58
1) and Index of Advantage (Columns 2 and 3) by Socio-demographic variables

Table 3.9 Levels and Significance of non-Hispanic white Sample Characteristics (Column 59
1) and Index of Advantage (Columns 2 and 3) by Socio-demographics variables

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Table 3.10 Relative Risk Ratios of Pregnancy Intention Status of First Birth and 60
Educational Advantage, n = 2570
Table 3.11 Relative Risk Ratios of Pregnancy Intention Status of First Birth by 60
Educational Advantage and Educational Attainment, Total Sample N = 2570
Table 3.12 Relative Risk Ratios of Pregnancy Intention Status of First Birth and 61
Educational Advantage, non-Hispanic Black women N=903
Table 3.13 Relative Risk Ratios of Pregnancy Intention Status of First Birth by 61
Educational Advantage, and Educational Attainment, non-Hispanic Black women
N=903
Table 3.14 Relative Risk Ratios of Pregnancy Intention Status of First Birth by 62
Educational Advantage, non-Hispanic white women N=1947
Table 3.15 Relative Risk Ratios of Pregnancy Intention Status of First Birth by 62
Educational Advantage and Educational Attainment, non-Hispanic white women
N=1947
Table 3.16 Predicted Probabilities of Pregnancy Intention as a Function of Educational 63
Advantage
Table 4.1 Demographic Characteristics of Study Sample, n=17 147

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List of Appendices

Appendix 4-A Interview Guide 160

Appendix 4-B Recruitment Flyer 165

Appendix 4-C Statement of Consent 166

Appendix 4-D IRB Approval Letter 169

Appendix 4-E Open Coding to Focused Coding 170

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Chapter 1

Introduction

This dissertation combines quantitative and qualitative approaches to examine the role of
educational advantage and disadvantage in contributing to the social patterning of pregnancy
intention status in the U.S. This project is comprised of three papers: 1) Critical Literature
Review and Theoretical Overview, 2) a Quantitative Analysis, 3) a Qualitative Analysis. The
critical literature review and theoretical overview examine the contextual influencers of fertility,
pathways between educational advantage and fertility patterns, validity of pregnancy intention
status measures, and empirical evidence on the association between unintended pregnancy and
adverse maternal, infant, and child health outcomes.
The quantitative analyses examine how educational advantages relate to the incidence
and prevalence of unintended births in the United States. These analyses will use the National
Longitudinal Survey of Youth – 1979, which is a nationally representative sample of youth who
were between the ages of 14 and 22 in 1979. This survey has a longitudinal design, detailed
information on respondents’ youth background, and detailed fertility schedules for female
respondents, which makes it ideal for this type of analyses.
The qualitative study examines data collected from semi-structured interviews with
women about their youth background, including educational experiences, and fertility histories. I
interview a non-representative sample of non-institutionalized, English-speaking women who
1