Doctor of Philosophy (Ph.D.)
Degree Granting Department
Community and Family Health
Stephanie L. Marhefka, Ph.D.
Ellen M. Daley, Ph.D., MPH
Cheryl A. Vamos, Ph.D., MPH
Adetola Louis-Jacques, M.D.
contraception, cultural health capital, African American, psychological reactance, reproductive justice
Introduction: Black women in the U.S. disproportionately experience unintended pregnancy, particularly as compared to their white counterparts. When racial and ethnic disparities in reproductive health are combined with other marginalized identities, such as low social status and young age, Black women’s risk of negative health outcomes may increase and further produce disadvantage.
Objective: The overall objective of this research was to understand the family planning care experiences of young Black women.
Methods: This study used a transformative mixed methods design to understand young Black women’s most recent family planning care experience in the last 12 months through Intersectionality, Psychological Reactance, and Cultural Health Capital. Intersectionality provided an overarching framework for the study conceptualization and informed the development of the interview guides. Psychological Reactance was used in the quantitative analysis and re-emerged during the interviews. The Cultural Health Capital framework emerged as a fit for data and provided a unifying framework for this research. The first phase of this research included an online quantitative survey (n=185). Those who were eligible and completed the online survey were asked to participate in a two-interview sequel. Interviews (n=22) were conducted in-person or via Zoom. The interviewing techniques were informed by phenomenology wherein interview one collected a life story and interview two co-constructed women’s health care visit to talk about starting, stopping or switching birth control. Quantitative analyses included bivariate and mediation analysis using the PROCESS macro in SPSS. Qualitative analysis approaches included inductive and deductive coding schemes. The modified van Kaam method of phenomenological analysis informed inductive approaches. Further refinement and reduction of the data were achieved once findings were compared to concepts in the Cultural Health Capital Framework. Qualitative analysis was conducted using MaxQDA.
Results: Overall women rated their family planning care experiences positively. Women’s experiences were most influenced by the patient-provider interaction at their most recent visit to talk about starting, stopping or switching birth control. Although women considered other factors when describing their experiences overall, such as wait times and interactions with other health care providers, the patient-provider relationship was most important. From women’s life stories, connections were made between early life experiences and current sexual health. Additionally, experiences during women’s formative years created opportunities for risk and resilience that produced or diminished their cultural health capital. Positive experiences between women and providers helped cultivate and sustain cultural health capital such that they felt prepared to engage in future family planning care and manage their sexual health.
Conclusion: Results show that young Black women’s family planning care experiences are dynamic and include positive and negative aspects of care delivery. Young Black women’s family planning care experiences were informed by their life story, previous health care experiences, reactance, and patient-provider interactions. Women obtained cultural health capital, such as skills, information and ability to navigate the FPC visit, through personal and vicarious experiences within and external to the health system. The patient-provider dynamic was best when women and providers engaged in relationship building together, when providers demonstrated respect for patients, and when women felt comfortable enough to share their thoughts, perceptions, and feelings with providers. The potential implications of provider investment include women having comfort in making future health decisions, feeling equipped to find information and resources, make decisions that work best for them and their health and work with health care providers in the future considering their family planning options and navigating health care encounters. Positive family planning care experiences can cultivate young Black women’s cultural health capital and address persistent family planning care inequities.
Scholar Commons Citation
Logan, Rachel G., "Understanding the Family Planning Care Experiences of Young Black Women Using an Intersectionality Mixed Methods Approach" (2019). Graduate Theses and Dissertations.