Combining Quantitative Measurement Tools with Theoretical Frameworks to Examine Structural Determinants on Reproductive Decision Making Among African American Women

Racial disparities in sexual and reproductive health are an ongoing injustice in the US, affecting pregnancy and maternal and infant health. This exploratory study sought to use Intersectionality and Critical Race Theory as theoretical frameworks to examine a sample of African American women's experiences with trauma, stress, depression, discrimination, and reproductive decision-making, and to examine their experiences relative to income level.

This cross-sectional community survey study included African American women from lower and higher income strata and compared their scores in key measures of mental health and discrimination: Adverse Childhood Experiences Questionnaire (ACE), the Patient Health Questionnaire-2 (PHQ-2), the Perceived Stress Scale-10 (PSS-10), and the Everyday Discrimination Scale (EDS), and their experiences with pregnancy and birth control and demographic data collected from the Family Planning Study of African American Women (FPSAAW) questionnaire used in this study.

The mean ACE, PHQ-2, and PSS-10 scores were higher for the lower income group, and the EDS mean score was higher for the higher income group, though none of these differences reached between-group statistical significance. The FPSAAW found non-significant differences in contraceptive preferences and use and decision-making agency between income groups.

African American women's reproductive decisions are shaped by the intersection of micro-level and macro-level factors. Examining context, including mental health history, discrimination, and the intersection of their identities and social context provides important insight for reproductive planning. It is necessary to examine the needs of African American women using theoretical frameworks that center their experiences, particularly related to their mental health and reproductive health care.