Family planning and contraceptive decision-making by economically disadvantaged, African-American women.

BACKGROUND: Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning.

STUDY DESIGN: Structured focus groups were held with adult, low-income, nonpregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, audio-taped and transcribed. Four independent researchers coded the transcripts using the constant comparative method. Codes were organized into overarching themes.

RESULTS: Contraceptive knowledge was limited, with formal contraceptive education often occurring after sexual debut. Attitudes about contraception were overtly negative, with method effectiveness being judged by the presence of side effects. Family and friends strongly influence contraceptive decisions, while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible, although compliance is considered a barrier.

CONCLUSIONS: Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals.