The Impact of Structural Determinants on Pregnancy Intention and Reproductive Decision-Making Among African American Women

African American women face significant reproductive health inequities rooted in structural and social factors, though few studies have directly engaged them to examine how such factors play a role in their reproductive decision-making. This study draws from a methodology underused in reproductive health research to understand how African American women of different socioeconomic groups approach reproductive decision-making.

The study employed group concepting mapping (GCM), a participatory, mixed-methods design that integrates qualitative processes with multivariate analyses. Twenty-four African American women between 18 and 44 years were recruited into lower (n = 12) and higher (n = 12) income groups. Based on GCM methods, each group engaged in the participatory data collection analysis process across three sessions. GCM software was used to generate visualizations, such as pattern match maps and go-zones, to identify themes.

Participants described experiences with trauma, depression, stress, and everyday interaction with discrimination. Three themes emerged from the GCM process: inward reflection (autonomy in reproductive decision-making, prioritizing career and education, and pressure to push through adversity), relational reflection (expectations of sexual partners in reproductive trajectories), and outward reflection (judgement from providers, reproductive coercion in healthcare systems). Each theme influenced participants' pregnancy trajectories and reproductive decision-making.

Participants reported high importance of self-reflection, career and education, and low importance of male partners, when considering whether to pursue pregnancy, prevent pregnancy, and/or use contraception. Findings illustrate participants' reproductive health experiences were impacted by structural and social determinants. Results help document opportunities for policies and practices to attend to structural determinants versus individuals' reproductive trajectories.