Graduation Year

2015

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Anthropology

Degree Granting Department

Anthropology

Major Professor

Nancy Romero-Daza, Ph.D.

Committee Member

Elizabeth Bird, Ph.D.

Committee Member

Eric Buhi, Ph.D.

Committee Member

Heide Castañeda, Ph.D., M.P.H.

Committee Member

Ellen Daley, Ph.D., M.P.H.

Keywords

Adolescent health, Applied medical anthropology, Contraception, Public health, Sexual and reproductive health, Teen pregnancy

Abstract

In the United States, concerns about adolescent childbearing and its perceived corollaries – negative health outcomes for mother and child, the disintegration of the nuclear family, and “over-dependence” on public resources – began to circulate widely in policy spheres and popular media in the 1970’s, resulting in a proliferation of policies, programs, and services designed to address its prevention. Although national birth rates among adolescents are currently at their lowest since peaking in the early 1990’s, this decline masks persistent and significant disparities between groups of young people by race, ethnicity, geography, and poverty level. The concomitant existence of social and economic inequities that contribute to these differences is particularly striking in New York City; an urban center of vast extremes in health, wealth, and opportunity, but which boasts extensive reproductive health services for young people, including confidential care and availability of free or low-cost contraception. Within this setting, the promotion of hormonal and long-acting reversible contraceptive methods, specifically aimed at young women deemed at high risk of pregnancy and with less access to health care, has emerged as a key primary prevention strategy to reduce both overall adolescent pregnancy rates and disparities between adolescent groups. Using ethnographic methods, this research examined the promulgation and interpretation of this strategy by reproductive health leaders and healthcare workers as well as contextualized these perspectives with the reproductive decisions and fertility desires of female youth for whom this strategy is intended. As a result, this study elucidates broader political and socio-cultural contexts in which young women negotiate intimate relationships and contraceptive use. Recommendations are subsequently offered for clinical practices attuned to female youths’ lived experiences, educational programs for healthcare workers, and reproductive health policies reflective of the broader factors that influence contraceptive behaviors.

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