Doctor of Philosophy (PhD)
Health Promotion and Disease Prevention Research
Large bodies of evidence document the importance of sexual and reproductive health (SRH) in the lives of individuals and among populations. Of particular interest are sexually transmitted diseases (STDs), due to their potential for long-term health consequences, and unintended pregnancy because of its association with social and economic outcomes for women and families.
This dissertation addressed three distinct but related areas of reproductive health and family planning: counseling for condom use following an STD test, counseling for contraception following a pregnancy test in a clinical setting, and the effect of abortion on having and achieving long-term plans. These topics are especially timely in a political context in which funding for public health programs is in decline, when policies which would support the well-being of women and their families are not prioritized, and there is a systematic attempt to remove funding from the provision of reproductive health services, particularly in specialized family planning clinics.
The first study evaluated the proportion of women who received condom use counseling following an STD test according to clinical setting and individual-level factors. This analysis used the National Survey of Family Growth (NSFG), a nationally representative survey of the US household population aged 15 to 44, and was limited to women who received an STD test in the previous year. Women who attended family planning and Planned Parenthood clinics had higher odds of receiving counseling for condom use relative to both women who attended community health clinics, community clinics, or public health clinics and women who attended other clinical settings. There were also significant social disparities in receiving counseling for condom use.
The second study evaluated differences in counseling for contraception following a pregnancy test in a clinical setting among women not desiring a(nother) birth in the subsequent two years according to clinical setting and individual-level characteristics. Data for this study also came from the NSFG. Multivariate results suggest that women who attended family planning and Planned Parenthood clinics did not differ from those who attended a community health clinic, community clinic, or public health clinic in terms of being counseled for contraceptive use; however, they were more likely to have received counseling compared to women who attended other settings. In addition, younger women were more likely to have received counseling for contraception.
The findings from these two studies indicate that there is a missed opportunity for providing patient education following clinical encounters that address some aspect of SRH. That specialized family planning and Planned Parenthood clinics are more consistent than other clinical settings in providing patient education following a visit for reproductive health services suggests that it may be useful to adapt the aspects of service delivery which are effectively meeting the reproductive health needs of their patient population for use in other clinical settings.
The third study in this dissertation addressed goal setting and achievement among women who sought an abortion for an unwanted pregnancy. Support for abortion rights is often based on the idea that having an abortion helps women define for themselves which opportunities in life they would like to pursue. Prior research suggests that women who do not receive a wanted abortion are much less optimistic about their short-term futures and less likely to attain their short-term goals. However, there is a gap in knowledge related to whether there is an association between receiving a wanted abortion and long-term goal setting and/or achievement. This five-year longitudinal cohort study evaluated the effect of abortion on (a) having and (b) having and achieving aspirational five-year plans among a sample of women who sought abortions, some of whom received them and some who were turned away due to gestational limits.
Across all study groups, most plans were aspirational. Multivariate results indicate that women who were turned away from abortion were less likely to have aspirational five-year plans than women who received an abortion in the first trimester or within two weeks of the facility’s gestational limit. However, they did not differ in their odds of having and achieving aspirational five-year plans relative to either not having an aspirational plan, or having one and not achieving it. The findings from this study suggest that access to abortion care may help women have a bright outlook about their long-term future. Second, this study found that women are resilient. While women turned away from abortions were less likely to have and achieve their aspirational one-year plans than women who received an abortion, they did not differ in terms of their aspirational five-year goal setting and achievement. Support for low-income mothers and women raising children alone could help women achieve their goals within a shorter time frame.
Policies and programs should seek to improve the lives of women and their families by ensuring access to a wide range of sexual and reproductive health care available in different clinical settings. In particular, ensuring that women can access SRH care may help reduce disparities in health and help women achieve pregnancies if and when they want to. This, in turn, can improve women’s lives by helping them to set and achieve aspirational goals for the futures.
McCarthy, Molly, "Public Health Perspectives on Sexual Health and Family Planning" (2017). Theses & Dissertations. 247.