pmc10115926230202J Womens Health (Larchmt)J Womens Health (Larchmt)Journal of women's health (2002)1540-99961931-843X396052101195792910.1089/jwh.2024.0535HHSPA2039631ArticleNonuse of Contraception at Conception Due to Partner Objection and Pregnancy-Related Health Care Utilization, Postpartum Health, and Infant Birth OutcomesD’AngeloDenise V.MPH1BombardJennifer M.MSPH2BasileKathleen C.PhD1LeeRosalyn D.PhD1RuvalcabaYanetPhD1ClaytonHeatherPhD1RobbinsCheryl L.PhD2Division of Violence Prevention, National Center for Injury Prevention & Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Authors’ Contributions

All authors contributed to the study conception and design. Writing: original draft preparation was done by D.V.D. Analysis: formal data analysis was performed by J.B. Writing: review and editing was done by all authors. All authors read and approved the final article.

Address correspondence to: Denise V. D’Angelo, MPH, Division of Violence Prevention, National Center for Injury Prevention & Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop S106-10, Atlanta, GA 30341, USA, DDAngelo@cdc.gov212202442025271120240142025344525538Objective:

Reproductive coercion has been associated with adverse reproductive health experiences. This study examined the relationship between nonuse of contraception due to partner objection, one aspect of reproductive coercion, and selected pregnancy-related outcomes.

Methods:

We used 2016–2020 data from the Pregnancy Risk Assessment Monitoring System in 22 jurisdictions to assess the prevalence of nonuse of contraception due to a partner objection by select characteristics among individuals with a recent live birth who reported an unintended pregnancy. We calculated adjusted prevalence ratios (aPRs) to understand associations with health care utilization, postpartum behaviors and experiences, postpartum contraceptive use, and infant birth outcomes.

Results:

Among people with a recent live birth in the study jurisdictions (n = 29,071), approximately 5% reported nonuse of contraception due to a partner objection and unintended pregnancy. This experience was associated with lower prevalence of attending a health care visit before pregnancy (aPR 0.8, 95% confidence interval [CI] 0.7–0.9), first trimester prenatal care, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6–0.9 for both). Higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1–1.6) and partner objecting to using birth control postpartum (aPR 2.8, 95% CI 2.1–3.9).

Conclusions:

Nonuse of contraception due to a partner objection at conception was associated with poor mental health and lower health care utilization around the time of pregnancy. Prevention efforts may include strategies that ensure provider screening for intimate partner violence, and evidence-based approaches that teach about healthy relationships, enhance self-efficacy, and address underlying drivers of violence.

reproductive coercionintimate partner violencepregnancycontraceptive usePRAMSIntroduction

Intimate partner violence (IPV) is a widespread public health problem that is associated with health consequences across the lifespan, including physical injury, poor mental health, chronic health problems, and substance use.1 Psychological aggression, including control of reproductive or sexual health, is one type of IPV that may include reproductive coercion or efforts, successful or unsuccessful, to get someone pregnant when they do not want to be.2 Reproductive coercion can also include contraceptive sabotage when a partner limits access to or use of contraceptives, or deliberately damages or secretly takes the condom off, as well as emotional manipulation and tactics such as pressure, threats, or lies that can interfere with autonomous decisions about reproduction.3,4

Studies have found estimates of reproductive coercion ranging from 8% to 16%5,6 and have identified racial and ethnic disparities in the experience of reproductive coercion, with non-Hispanic Black women experiencing the highest prevalence5,7–9 and Latina and multiracial women disproportionately affected, as well.7 Experiencing reproductive coercion has been associated with physical and sexual IPV,6,10–12 sexually transmitted infections,6,13,14 unintended pregnancy,6,15–17 and rape-related pregnancy.18 A systematic review of 27 studies provides a description of reproductive coercion, pregnancy coercion, abortion coercion, and birth control sabotage, as well as characteristics associated with these experiences and the intersection with IPV.7 A separate scoping review found coercive condom use resistance to be associated with interpersonal violence, emotional stress, diagnosis of sexually transmitted infections, and to be more common among people with a perceived lower ability to say “no.”19 However, information on the association between reproductive coercion or condom use resistance and pregnancy and infant health outcomes is limited.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is an important source of population-based information on pregnancy-related experiences and outcomes that can be used to study the impact of violence. One study using PRAMS Phase 7 data (2012–2015) from six states that asked a question about contraceptive sabotage (i.e., ever having a partner try to keep the respondent from using birth control when they did not want to be pregnant) found a prevalence of 1.1% and that the experience was associated with physical IPV.12 A more recent study using the same PRAMS Phase 7 data examined the relationship between experiencing contraceptive sabotage and contraceptive use at the time of conception finding an association with a higher prevalence of contraceptive use.20 However, neither study examined pregnancy-related health or infant health outcomes, and the question on contraceptive sabotage was only used by one PRAMS site in the more recent Phase 8 version of the PRAMS survey (2016–2022). Given the limitations described above, we used a nontraditional approach to assess one aspect of reproductive coercion. We analyzed the question on reasons for not using contraception at the time of conception used by 22 PRAMS sites on the Phase 8 survey. We hypothesized that people who said they did not want a pregnancy, yet reported that the only reason they were not doing something to avoid a pregnancy was because their partner objected, may have been experiencing coercive control by their partner. The PRAMS sample only includes people who became pregnant and had a live birth, so this provides a unique opportunity to look at pregnancy and birth outcomes for people whose pregnancy resulted from potentially coercive contraceptive behavior by their partner.

We examined this experience by respondent demographic characteristics, health care provider screening, and partner relationship factors. Recognizing the structural factors and history of oppression that lead to a disproportionate risk of violence for some marginalized racial and ethnic groups, we also examined differences in the nonuse of contraception due to a partner objection by race and ethnicity. We looked at the association with substance use, depression, health care utilization, postpartum contraceptive practices, and infant birth outcomes.

Material and MethodsStudy population

We analyzed PRAMS 2016–2020 data from 22 jurisdictions that asked a standard (optional) question on reasons for nonuse of contraception at the time of conception on their PRAMS survey during the study years (Alabama, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Louisiana, Kentucky, Massachusetts, Maine, Michigan, Missouri, North Carolina, Nebraska, New Jersey, New York State, New York City, Oregon, Tennessee, and Washington). Jurisdictions were included for each year in which they met the target response rate threshold (2016–2017 ≥55%; 2018–2020 ≥50%).21 There were 29,071 individuals with a recent live birth and complete information on the reasons for nonuse of contraception in our sample in the 22 jurisdictions during the study period.

PRAMS is a jurisdiction-specific, population-based surveillance system conducted by the Centers for Disease Control and Prevention (CDC) in collaboration with state, city, and territorial health departments. Using a standardized data collection protocol, each participating jurisdiction draws a stratified random sample from birth certificate records every month. Individuals are sampled 2–6 months after a live birth and are mailed up to three surveys. Nonrespondents are contacted to complete the survey by telephone. Data are weighted to account for the PRAMS complex survey design prior to release for analysis. Details of the PRAMS methodology have been described previously.22 The PRAMS study protocol was approved by the institutional review boards of the CDC and each participating jurisdiction.

Measures

We examine one aspect of reproductive coercion in this study, which is nonuse of contraception at the time of conception due to partner objection among respondents who reported an unintended pregnancy. It is measured based on respondent reports that they were not doing anything to avoid the pregnancy at the time of conception because their partner did not want to use anything. Since partner objection to contraception alone doesn’t indicate coercion, we further limited our measure to respondents who also reported an unintended pregnancy. Those who reported that they wanted to be pregnant then or sooner were considered to have an “intended pregnancy,” and those who reported that they wanted the pregnancy later, never, were grouped together as having an “unintended pregnancy.” We also included with the “unintended” group those who reported that they were “unsure” what they wanted. This inclusion was based on results from a previous study using PRAMS data that found the prevalence of physical IPV and health indicators for the “unsure” group to be similar to those with “unwanted” and “mistimed” pregnancies.23

A separate series of questions was used to assess nonuse of contraception at the time of conception due to partner objection (see Fig. 1). Respondents were asked if they were trying to get pregnant when they got pregnant with their new baby. If they answered “no,” they were directed to a question about whether or not they were doing anything to avoid a pregnancy. If they also answered “no” to this question, they were asked a question about their reasons for not doing anything (Phase 8 standard question E7). Respondents could check multiple responses, including “my husband or partner didn’t want to use anything.” Individuals who selected only this option (and reported an unintended pregnancy) were classified as having experienced nonuse of contraception at the time of conception due to partner objection, one aspect of reproductive coercion. We restricted the measure to those with only this single response because other reason response options were not suggestive of coercion (side effects, problems getting birth control, etc.).24

The question about reasons for not doing anything to avoid a pregnancy included an open-ended response option “other, please tell us.” To make sure we did not miss any respondents with coercive experiences, we reviewed free-text responses to this response option. Similarly, we analyzed these free-text responses among respondents who reported an unintended pregnancy (n = 3,521). Responses were divided among four independent coders who classified each response as “experienced coercion” or not. Coders met to discuss results and came to a consensus on all classifications. For example, write-in responses that were categorized as coercion included “he wanted a baby, but I didn’t,” “he was uncooperative about using condoms,” and “extremely controlling husband.” Those with free-text responses coded as coercion were included with the group experiencing nonuse of contraception at the time of conception due to partner objection, with or without also answering “yes” to the partner “didn’t want to use anything” response option (n = 77) (Fig. 1).

The following information came from the linked birth certificate data: respondent age, race/ethnicity, marital status including acknowledgment of paternity for unmarried individuals (e.g., presence of documentation adding father’s name to the birth record), education, and health insurance coverage for delivery. Other indicators from the PRAMS questionnaire included: self-reported disability status (report of one or more functional restrictions from a list of six conditions) available in 10 of the 22 jurisdictions,25 health care providers asking if someone was hurting the respondent emotionally or physically, and relationship factors such as physical IPV before and during pregnancy.

Statistical analysis

To describe our sample, we calculated weighted prevalence estimates and 95% confidence intervals (CIs) for nonuse of contraception due to partner objection overall and by respondent characteristics and infant outcomes. We used chi-square tests to compare select characteristics and experiences of respondents with nonuse of contraception at the time of conception due to partner objection to respondents without this experience (p-value <0.05). For variables that had more than two levels (e.g., age and education level), we also reviewed 95% CIs of the weighted prevalence to identify those that were nonoverlapping as a way to assess differences among the various levels. This typically conservative approach might fail to note differences between estimates more often than formal statistical testing. Overlap between CIs does not necessarily mean that there is no statistical difference between estimates. We used the same procedures to examine these characteristics by race and ethnicity among individuals who experienced nonuse of contraception due to partner objection to extend what has been documented in the literature about disparities among groups.

To examine associations with outcomes of interest, we calculated adjusted prevalence ratios (aPRs) to examine the relationship between nonuse of contraception due to partner objection and respondent behaviors and conditions before, during, and after pregnancy including substance use (smoking, alcohol use, and use of marijuana or illicit substances), depression, attendance at health care visits (prepregnancy visit, first trimester prenatal care, and attendance at a postpartum care visit), postpartum contraceptive practices (any use, use of long-acting reversible contraception [intrauterine device or contraceptive implant], use of postpartum female sterilization, and report of husband or partner not wanting to use a method), and infant birth outcomes (low birth weight: <2,500 g; preterm birth: gestational age <37 weeks; small for gestational age: weight below 10th percentile for age). All analyses were conducted using SUDAAN (version 11.0; RTI International).

Results

There were 29,701 respondents in our final sample. About 1 in 20 individuals with a recent live birth, or 4.8%, reported nonuse of contraception at the time of conception due to partner objection and unintended pregnancy (n = 1,356). We found higher prevalence (p-value <0.0001 and nonoverlapping CIs) among those who were 20–24 years of age compared with those 25 years and older; those who were non-Hispanic Black compared with those who were non-Hispanic White, non-Hispanic Asian/Pacific Islander, and Hispanic; unmarried respondents compared with married respondents; those who had a high school education (HS) or less compared with those with more than an HS education; and those who were Medicaid recipients at the time of delivery compared with those who had private insurance. The prevalence of nonuse of contraception due to partner objection was also higher among those who reported experiencing physical IPV before or during pregnancy (Table 1).

We looked at these same characteristics by race and ethnicity specifically among individuals who experienced nonuse of contraception due to partner objection and unintended pregnancy (n = 1,343). Approximately 4% were non-Hispanic White (4.0%, 95% CI 3.5–4.6), non-Hispanic Asian/Pacific Islanders (4.0%, 95% CI 3.0–5.4), and Hispanic (3.7%, 95% CI 2.9–4.7); 6.5% were non-Hispanic Black (95% CI 5.7–7.4); 7.5% were non-Hispanic multiracial (95% CI 5.2–10.9); and 7.6% were non-Hispanic American Indian/Alaska Native (95% CI 3.4–16.2) (data not shown). Among all respondents who experienced nonuse of contraception due to partner objection, a higher proportion of non-Hispanic Asian/Pacific Islander respondents were married (80.1%, 95% CI 66.9–88.9) compared with respondents from all other racial and ethnic groups and had more than an HS compared with non-Hispanic White, non-Hispanic Black, and Hispanic respondents. Compared with non-Hispanic White and non-Hispanic Asian/Pacific Islander respondents, a lower proportion of non-Hispanic Black respondents were married (19.2%, 95% CI 14.5–24.9) and a higher proportion were Medicaid recipients (80.8%, 95% CI 75.5–85.2) (Table 2).

Experience of nonuse of contraception due to partner objection and unintended pregnancy was associated with lower prevalence of attending a health care visit in the 12 months before pregnancy (aPR 0.8, 95% CI 0.7–0.9), entering prenatal care in the first trimester, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6–0.9, for both) compared with the prevalence for individuals who did not experience nonuse of contraception due to partner objection and unintended pregnancy. A higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1–1.6) and reports of their partner not wanting to use a birth control method postpartum (aPR 2.8, 95% CI 2.1–3.9) compared with the prevalence among those who did not experience nonuse of contraception due to partner objection and unintended pregnancy. There was no association found with substance use (cigarette, alcohol, marijuana), depression before or during pregnancy, any use of postpartum contraception, long-acting reversible contraception, or postpartum female sterilization. In addition, there were no associations found with infant birth outcomes (birthweight, preterm birth, small for gestational age) (Table 3).

Discussion

In our study, about 5% of individuals with a recent live birth and unintended pregnancy reported nonuse of contraception due to partner objection as the only reason for not doing anything to avoid a pregnancy at the time of conception when they did not want to get pregnant. While this is not a complete or traditional measure of reproductive coercion, it includes aspects of contraceptive sabotage and coercive control where respondents experienced a partner limiting the use of contraception against their wishes. Using this measure, our estimate is slightly lower than estimates for reproductive coercion from nationally representative data for all adult women (that use additional items to capture reproductive coercion), as well as other estimates from other studies that range from 8%−16%.5,6 The estimates are higher than those from the PRAMS studies using the indicator specific to contraceptive sabotage (around 1–2%), potentially due to capturing a broader range of coercive experiences.12,20 Nevertheless, characteristics of individuals who reported nonuse of contraception due to partner objection and an unintended pregnancy were similar to those identified with reproductive coercion or contraceptive sabotage in other studies, including younger age, lower education, and lower socioeconomic status.5,12,26 Like other studies on reproductive coercion, we also found a higher prevalence of IPV among people who reported nonuse of contraception due to partner objection.6,10

Overall, there was a higher prevalence of nonuse of contraception due to a partner objection reported by non-Hispanic Black respondents. This finding is consistent with other studies on reproductive coercion.5,8,27 Social and structural factors, including racial discrimination, may result in lower access to resources and may shape how women and men experience social and sexual networks; this may explain in part the disproportionate rates of reproductive coercion reported by women from some marginalized racial and ethnic groups.8,28

In our examination of respondent characteristics and experiences by race and ethnicity among the subgroup of people who reported nonuse of contraception due to partner objection, we found differences in marital status and health insurance status. A higher proportion of non-Hispanic Asian/Pacific Islander respondents were married compared with all other groups, and a higher proportion of non-Hispanic Black respondents were unmarried without an acknowledgment of paternity compared with non-Hispanic White and non-Hispanic Asian/Pacific Islander respondents. Our Asian/Pacific Islander category did not distinguish between the many groups that it may encompass; however, studies among South Asian women have cited strong patriarchal cultural norms as being linked to IPV.29,30 While race and ethnicity are not necessarily related to immigration status, for some women from this population, immigrant status may contribute to challenges in identifying resources and assistance, resulting in difficulty obtaining a divorce or otherwise leaving an abusive marriage.29,31 For Black women, lower marriage rates compared with White women have been known to exist for decades and, while not fully understood, some research suggests that there is a smaller pool of marriageable partners due to higher levels of incarceration and unemployment among Black men compared with other men,32–34 circumstances that are rooted in structural inequities and discriminatory practices and policies35,36 Scarcity of partners and stigmatizing race-based stereotypes may influence rates of reproduction coercion among Black women via lowered sense of empowerment which in turn may influence lowered efficacy around negotiating reproductive choices.34,37,38

In our study, health insurance status could be considered a proxy for income, and we found that a higher proportion of respondents who were Medicaid recipients at delivery experienced nonuse of contraception due to partner objection. A lower income may put individuals at increased risk due to challenges accessing IPV prevention resources or health care services (transportation, childcare, time off work) that could limit options to leave abusive relationships or access highly effective contraceptives. In the subgroup analysis by race/ethnicity, we noted a higher proportion of non-Hispanic Black respondents experiencing nonuse of contraception due to partner objection coercion were Medicaid recipients compared with non-Hispanic White or non-Hispanic Asian/Pacific Islander respondents. Lower median incomes and social and structural factors that result in a higher likelihood of having precarious employment for Black women may be among the drivers of these differences.39–41

We found no association between the nonuse of contraception due to partner objection and substance use before, during, or after pregnancy. Our measure was from the time of conception, and while we hypothesized that people may have been at risk of experiencing violence and stressors that might lead to substance use before the incident, there were no differences found for substance use before pregnancy. Furthermore, we may not have observed an association during pregnancy or postpartum because the use of cigarettes, marijuana, and alcohol has been found to decrease during pregnancy and not fully rebound to prepregnancy levels in the early postpartum period.42–44 We also did not have information about lifetime experiences of coercion or other interpersonal violence that may be more strongly associated with substance use.45

We found that the prevalence of self-reported postpartum depressive symptoms was significantly higher among respondents who reported nonuse of contraception due to partner objection compared with those who did not. Other research has identified a relationship between reproductive coercion and depression. For example, an association of reproductive coercion with depression and posttraumatic stress disorder was found among a community-based convenience sample of Black adolescent and young adult women.46 In general, exposure to IPV around the time of pregnancy has been linked with poor mental health.47

We found a significant association with a reduced likelihood of attending a prepregnancy visit, entering prenatal care in the first trimester, and attending a postpartum care visit. Other studies of reproductive coercion among the general population have found the experience associated with frequent clinic visits for pregnancy tests, emergency contraception, and testing for sexually transmitted infections.48 However, individuals in our study were already pregnant and would no longer need some of these services. Aligning with our findings, experiencing IPV, in general, has been associated with reduced access to health care services, and individuals may face other challenges seeking services in the context of a relationship with a controlling partner.49

The strongest association in our study was between the nonuse of contraception due to partner objection at the time of conception and reports that the husband or partner was still objecting postpartum. If the respondent’s circumstances and partner are the same after the pregnancy, it is not surprising that the partner’s behavior persists in the postpartum period. A study of undergraduate women found that those who experienced reproductive coercion had a reduced rate of self-efficacy and contraception use,50 which may also be relevant in our study population. This may be an area of opportunity for intervention.

This study has several limitations. Data represent individuals from the 22 jurisdictions included in the analysis and are not generalizable beyond the study sites. PRAMS respondents are individuals who had a live birth, so these findings do not represent individuals who experienced pregnancy outcomes such as stillbirth, abortion, or miscarriage. Information is self-reported in the postpartum period and may be subject to recall and social desirability biases and may lead to underreporting. Although the data are weighted to be representative of the population of people with a live birth in each jurisdiction, we had a small sample for some racial and ethnic groups that limited the ability to calculate reliable estimates and may have limited our ability to identify disparities in experiences, in particular American Indian/Alaska Native, Asian/Pacific Islander, and multiracial respondents.

Our measure of nonuse of contraception due to partner objection and unintended pregnancy was not a traditional or validated measure of reproductive coercion and differs from measures used in other studies. However, this study is not unlike other studies in capturing only select aspects of reproductive coercion, such as potential contraceptive sabotage. Also, while other studies have documented adverse outcomes among people experiencing mistimed, unwanted (unintended), and unsure pregnancies compared with those reporting intended pregnancies,23,51 we recognize the complex nature, historical context, and challenges with measurement of this concept which may not resonate with all respondents and could be particularly problematic for respondents from marginalized racial and ethnic groups.52 Given these various limitations, our estimates likely underestimate experiences of potentially coercive contraceptive behaviors by partners at the time of conception among people with a recent live birth. Nevertheless, the study provides valuable insight into health outcomes around the time of pregnancy among a large, population-based sample of individuals with a recent live birth.

Prevention of reproductive coercion may be addressed using evidence-based strategies. For example, programs that teach about healthy sexuality and healthy relationships can promote communications skills and help with setting expectations for respectful relationships starting with adolescents and young adults.53,54 Other approaches to promoting adult and adolescent sexual and reproductive health include comprehensive sexual education,55–57 economic support programs,58 strategies that address social norms changes, and the creation of protective environments.53,54 It is encouraging that empowerment-based programs have shown promising results on sexual health outcomes and have been implemented in diverse populations, including youth, college students, individuals with intellectual disabilities, and justice-involved women.59–62

Screening and referrals by health care providers are important first steps to identifying individuals who are experiencing IPV or reproductive coercion and connecting them with services.3 Consistent with another study using PRAMS data, we found that about one in four women in our study were not asked about IPV during prenatal care visits.63 Universal screening is recommended during prenatal care,64 and there may be missed opportunities for this population.4 Health providers may also promote sexual and reproductive health through supportive conversations about contraceptive use.65 Training for health care providers on available screening tools and information on available resources may facilitate more widespread screening.66

Conclusions

Findings from this study shed light on the relationship between nonuse of contraception due to partner objection as one aspect of reproductive coercion and lower prevalence of health care utilization, higher postpartum depressive symptoms, and higher prevalence of nonuse of contraception due to partner objection in the postpartum period. Prevention efforts may include strategies that increase awareness about reproductive coercion and the use of evidence-based approaches that help create protective environments, teach about healthy relationships, and empower individuals to enhance self-efficacy related to reproductive choices and reproductive autonomy.

Acknowledgments

The authors thank the PRAMS Working Group, which includes the PRAMS sites in this analysis: Alabama, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Louisiana, Kentucky, Massachusetts, Maine, Michigan, Missouri, North Carolina, Nebraska, New Jersey, New York State, New York City, Oregon, Tennessee, and Washington, and the PRAMS Team in CDC’s Division of Reproductive Health. The authors also thank Isabella V. Hernandez for graphics assistance.

Funding Information

The authors received no funding for this research.

Disclaimer

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author Disclosure Statement

The authors have no financial conflicts of interest to disclose.

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Reasons for nonuse of contraception at time of conception flowchart.

Prevalence of Nonuse of Contraception Due to Partner Objection and Unintended Pregnancy Among Individuals with a Recent Live Birth by Selected Characteristics, Pregnancy Risk Assessment Monitoring System, 2016–2020a

Nonuse of contraception due to partner objection and unintended pregnancy (n = 1,356)
Did not experience nonuse of contraception due to partner objection (n = 27,715)
nb % c 95% CI % c 95% CI Chi-square p-value
Overall29,0714.84.4–5.295.394.9–95.6
Demographics
Age
 <201,9715.74.5–7.294.392.8–95.50.0000
 20–247,0746.25.3–7.293.892.8–94.7
 25–3415,1674.54.0–5.095.595.0–96.0
 ≥354,8592.92.3–3.797.196.3–97.7
Race/ethnicity
 White, non-Hispanic10,0164.03.5–4.696.095.4–96.50.0000
 Black, non-Hispanic10,0556.55.7–7.493.592.6–94.3
 American Indian/Alaskan Native, non-Hispanic5107.63.4–16.292.483.8–96.6
 Asian/Pacific Islander, non-Hispanic1,9154.03.0–5.496.094.6–97.0
 Multiracial, non-Hispanic1,5237.55.2–10.992.589.1–94.8
 Hispanic4,7953.72.9–4.796.395.3–97.1
Marital status
 Married11,3923.63.1–4.196.495.9–96.90.0000
 Unmarried with acknowledgment of paternity10,3994.74.2–5.495.394.6–95.8
 Unmarried without acknowledgment of paternity5,7187.86.6–9.192.290.9–93.4
Education level (years)
 Less than high school4,5695.64.7–6.894.493.2–95.30.0000
 High school9,4435.85.1–6.694.293.4–94.9
 More than high school14,8543.73.3–4.296.395.8–96.7
Disabilityd
 Yes5753.41.9–6.096.694.0–98.10.3127
 No5,5334.63.6–5.795.494.3–96.4
Health care
Health insurance at delivery
 Private10,3242.82.4–3.397.296.7–97.60.0000
 Medicaid17,2936.15.5–6.793.993.3–94.5
 None7863.72.1–6.396.393.7–97.9
 Other4764.12.2–7.795.992.3–97.8
Health care provider asked about emotional or physical abuse before pregnancye
 Yes8,6113.83.3–4.596.295.5–96.70.3504
 No7,3514.33.6–5.095.795.0–96.4
Health care provider asked about emotional or physical abuse during pregnancye
 Yes21,8314.64.2–5.195.494.9–95.80.2899
 No6,1195.14.4–6.094.994.0–95.6
Relationship factorsExperienced physical intimate partner violence before pregnancy
 Yes1,3069.97.5–13.090.187.0–92.50.0002
 No26,8354.54.1–4.995.595.1–95.9
Experienced physical intimate partner violence during pregnancy
 Yes88611.08.3–14.589.085.5–91.70.0001
 No27,1984.64.2–5.095.495.0–95.8

Twenty-two jurisdictions: Alabama, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Louisiana, Kentucky, Massachusetts, Maine, Michigan, Missouri, North Carolina, Nebraska, New Jersey, New York State, New York City, Oregon, Tennessee, and Washington.

Unweighted n.

Weighted row percentage.

Respondent indicated having “a lot of difficulty” or “cannot do at all” on one or more six functional types of disability: remembering, seeing, hearing, communicating, walking/climbing stairs, and self-care. Disability data collected included Georgia 10/2018–12/2020; Louisiana 8/2018–12/2020; Massachusetts 10/2018–12/2020; Maine 4/2019–12/2019; Michigan 9/2018–12/2020; Missouri 10/2018–12/2020; Nebraska 9/2018–12/2020; New York 1/2019–12/2019; Oregon 10/2018–6/2019, 3/2020–12/2020; and Tennessee 1/2020–12/2020.

Among individuals who attended a health care visit.

CI, confidence interval.

Selected Characteristics of Individuals with a Recent Live Birth Who Reported Nonuse of Contraception Due to Partner Objection and Unintended Pregnancy by Race and Ethnicity, Pregnancy Risk Assessment Monitoring System, 2016–2020a

White, non-Hispanic (n = 380)
Black, non-Hispanic (n = 593)
Asian/Pacific Islander, non-Hispanic (n = 84)
Multiracial, non-Hispanic (n = 84)
Hispanic (n = 180)
% b 95% CI % 95% CI % 95% CI % 95% CI % 95% CI
Maternal demographics
Age
 <208.05.2–12.08.86.3–12.31.20.3–4.612.44.7–29.18.24.5–14.4
 20–2433.828.0–40.130.124.0–37.014.66.7–28.745.127.1–64.639.228.1–51.6
 25–3450.844.4–57.251.644.8–58.457.042.1–70.734.018.8–53.640.129.1–52.1
 >=357.54.6–11.89.56.6–13.527.316.0–42.48.42.9–22.012.67.1–21.4
Marital status
 Married39.333.2–45.719.214.5–24.980.166.9–88.928.414.1–49.030.420.6–42.4
 Unmarried with acknowledgment of paternity37.831.7–44.442.135.4–49.118.810.2–32.139.923.0–59.741.330.1–53.5
 Unmarried without acknowledgment of paternity22.917.8–28.938.732.1–45.71.10.4–3.531.616.6–51.928.317.3–42.5
Education level (years)
 <1215.211.2–20.211.88.6–15.817.68.9–31.829.916.2–48.642.330.6–54.9
 1243.136.8–49.646.539.8–53.414.76.8–28.836.419.5–57.533.423.6–45.0
 >1241.735.5–48.241.735.3–48.467.752.5–79.933.718.7–53.024.317.0–33.6
Disabilityc
 Yes6.81.9–21.66.12.9–12.3n/adn/adn/adn/ad10.7e3.7–27.3
 No93.278.4–98.193.987.7–97.1n/adn/adn/adn/ad89.3e72.7–96.4
Health care Health insurance at delivery
 Private26.121.0–32.016.712.7–21.854.639.7–68.828.913.8–50.918.411.6–28.0
 Medicaid69.663.4–75.180.875.5–85.243.129.1–58.370.548.7–85.874.363.7–82.6
 None2.91.2–7.01.10.4–2.80.30.1–0.80.10.0–0.53.31.3–8.1
 Other1.40.5–4.11.40.5–4.42.00.4–8.70.50.1–3.24.01.2–12.9
Health care provider asked about emotional or physical abuse before pregnancyf
 Yes46.838.3–55.549.740.5–59.042.8e21.3–67.444.4e20.5–71.252.236.7–67.3
 No53.244.5–61.750.341.0–59.557.2e32.6–78.755.6e28.8–79.547.832.7–63.3
Health care provider asked about emotional or physical abuse during pregnancyf
 Yes71.865.6–77.278.972.9–83.972.357.4–83.472.851.8–86.973.561.4–82.8
 No28.222.8–34.421.116.1–27.127.816.6–42.627.213.1–48.226.517.2–38.6
Relationship factors Experienced physical intimate partner violence before pregnancy
 Yes10.47.2–14.97.04.5–10.83.80.6–19.813.34.1–35.37.51.9–25.6
 No89.685.1–92.893.089.2–95.596.280.2–99.486.764.7–95.992.574.5–98.1
Experienced physical intimate partner violence during pregnancy
 Yes6.34.0–9.77.14.6–11.03.60.6–20.412.53.6–35.21.50.7–3.3
 No93.790.3–96.092.989.0–95.496.479.6–99.587.664.8–96.498.596.7–99.3

Twenty-two jurisdictions: Alabama, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Louisiana, Kentucky, Massachusetts, Maine, Michigan, Missouri, North Carolina, Nebraska, New Jersey, New York State, New York City, Oregon, Tennessee, and Washington; unweighted n = 1,343.

Weighted row percentage.

Respondent indicated having “a lot of difficulty” or “cannot do at all” on one or more six functional types of disability: remembering, seeing, hearing, communicating, walking/climbing stairs, and self-care. Disability data collected included Georgia 10/2018–12/2020; Louisiana 8/2018–12/2020; Massachusetts 10/2018–12/2020; Maine 4/2019–12/2019; Michigan 9/2018–12/2020; Missouri 10/2018–12/2020; Nebraska 9/2018–12/2020; New York: 1/2019–12/2019; Oregon 10/2018–6/2019, 3/2020–12/2020; and Tennessee 1/2020–12/2020.

Estimates not shown, denominator <30.

Estimates potentially unreliable, denominator >30 to <60.

Among individuals who attended a health care visit.

CI, confidence interval.

Association Between Partner Objection to Contraceptive Use and Unintended Pregnancy and Pregnancy-Related Behaviors, Experiences, and Outcomes Among Individuals with a Recent Live Birth, Pregnancy Risk Assessment Monitoring System 2016–2020a

Behavioral risk factors and health conditions Prevalence
Nonuse of contraception due to partner objection and unintended pregnancy versus Did not experience nonuse of contraception due to partner objection and unintended pregnancy
nb % c 95% CI aPR d 95% CI
Cigarette smoking during the 3 months before pregnancy
 Yes7,09624.323.6–25.01.21.0–1.4
 No21,48975.775.0–76.41.0
Cigarette smoking during the last 3 months of pregnancy
 Yes3,91712.812.2–13.41.21.0–1.5
 No24,69687.286.7–87.81.0
Postpartum cigarette smoking
 Yes5,16117.216.6–17.91.21.0–1.5
 No23,42682.882.1–83.41.0
Heavy drinking during the 3 months before pregnancye
 Yes8163.02.7–3.31.20.8–1.9
 No27,65897.196.7–97.31.0
Binge drinking during the 3 months before pregnancyf
 Yes1,18937.435.0–39.90.90.5–1.6
 No1,89162.660.1–65.01.0
Any drinking during the last 3 months of pregnancyg
 Yes9976.96.3–7.61.30.8–2.1
 No13,43993.192.4–93.71.0
Use of marijuana or illicit substances before pregnancyh
 Yes75715.714.2–17.31.00.6–1.6
 No2,37084.382.7–85.81.0
Use of marijuana or illicit substances during pregnancyi
 Yes66110.89.6–12.10.80.4–1.6
 No4,81489.388.0–90.41.0
Prepregnancy depression
 Yes4,98516.816.2–17.51.10.9–1.3
 No23,76083.282.5–83.81.0
Depression during pregnancy
 Yes5,07216.816.2–17.51.21.0–1.5
 No23,38483.282.5–83.81.0
Postpartum depressive symptoms
 Yes5,03116.315.7–16.91.31.1–1.6
 No23,16883.783.1–84.31.0
Health care access/utilization Prepregnancy health care visit
 Yes16,03756.655.7–57.50.80.7–0.9
 No12,58543.442.5–44.31.0
First trimester prenatal care
 Yes22,86781.681.0–82.30.70.6–0.9
 No5,35818.417.7–19.11.0
Postpartum checkup
 Yes24,19986.485.8–87.00.70.6–0.9
 No4,13013.613.0–14.21.0
Postpartum contraceptive practicesAny use of postpartum contraception
 Yes19,78871.270.4–72.00.90.8–1.1
 No8,44228.828.0–29.61.0
Postpartum long-acting reversible contraception (IUD or implant)
 Yes4,68015.514.9–16.20.90.7–1.2
 No24,39184.583.9–85.11.0
Postpartum female sterilization
 Yes3,12610.610.1–11.21.31.0–1.6
 No25,94589.488.8–89.91.0
Husband or partner didn’t want to use a postpartum methodj
 Yes97812.111.1–13.32.82.1–3.9
 No7,05787.986.8–88.91.0
Birth outcomesBirthweightk
 Low birth weight5,3398.17.8–8.41.00.8–1.2
 Normal birth weight22,92591.991.6–92.21.0
Pretermk
 Yes4,6529.38.9–9.70.80.7–1.0
 No23,58590.790.3–91.11.0
Small for gestational agek
 Yes4,04310.810.3–11.31.00.8–1.3
 No24,17889.288.7–89.71.0

Twenty-two jurisdictions: Alabama, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Louisiana, Kentucky, Massachusetts, Maine, Michigan, Missouri, North Carolina, Nebraska, New Jersey, New York State, New York City, Oregon, Tennessee, and Washington.

Unweighted n = 29,071; may vary by indicator due to missing data.

Weighted row percentage.

Adjusted for age, race, marital status, and health insurance at delivery.

Heavy drinkers drank eight or more drinks per week, all states.

Binge drinkers drank four or more drinks on one or more occasion; jurisdictions included Hawaii, Iowa, Maine, Nebraska, and New Jersey.

Jurisdictions included: Connecticut, Georgia, Hawaii, Louisiana, Maine, Missouri, North Caroline, Nebraska, New Jersey, New York State, Tennessee, and Washington.

Jurisdictions included Louisiana, Kentucky, and Maine.

Jurisdictions included Alabama, Connecticut, Florida, Georgia, Iowa, Illinois, Louisiana, Kentucky, Massachusetts, Missouri, New York State, Oregon, Tennessee, and Washington.

Among women not using a method of postpartum contraception.

Restricted to singleton deliveries; low birth weight: <2,500 g, preterm: <37 weeks gestation; small for gestational age: weight <10th percentile for age. aPR, adjusted prevalence ratio; CI, confidence interval; IUD, intrauterine device.