Reproductive Health Projects

Interagency Collaboration on Maternal and Child Wellbeing

Principal Investigator / Mentor: Robert Crosnoe
Co-Principal Investigator /  Mentee:
Haley Stritzel
Funded by: National Science Foundation

The majority of child maltreatment reports received by child protective service agencies in the United States come from professionals such as teachers, healthcare providers, and social workers. Data sharing between the child welfare system and other institutions thus facilitates the investigation of and intervention in cases of child maltreatment. One consequence of this collaboration, however, is that families may avoid institutions that provide necessary resources out of fear of coming into contact with the child welfare system. This project analyzes under what circumstances institutional engagement is associated with a greater likelihood of child protective services involvement, as well as how child protective services involvement is related to future institutional engagement. This project utilizes both quantitative and qualitative methods. The quantitative portion of project will analyze data from the Fragile Families and Child Well-being Study (FFCWS). Currently available FFCWS data follow nearly five thousand children and their families from the focal child's birth to age fifteen, with an oversampling of children born to unmarried mothers. Statistical techniques such as generalized linear models will be used to estimate associations between child welfare system involvement and service utilization. In addition, the project involves in-depth, semi-structured interviews with 40 social service employees.

Contraception in Community Colleges in Texas: A Randomized Control Trial

Prinicpal Investigator: Kristine Hopkins
Funded by: University of California

In the US, young women aged 18–25 experience high rates of unintended pregnancy and
have limited knowledge of contraception or their pregnancy risks. UT Austin will subcontract with UCSF to conduct the Texas component of a cluster randomized trial to test an intervention to increase awareness of contraception and health protective behaviors among students in this age group in community colleges. During the subcontract period, UT Austin will recruit 6 community colleges in Texas to serve as study sites, which will be randomly assigned to intervention or control groups. The intervention group will receive: 1) a one-day, CME-accredited training on contraception for staff and clinicians at the campus health center (if applicable) and at network referral partners, and 2) student education on birth control. The control group will receive student nutritional education on the impacts of sugar on health. UT Austin will recruit 75 students at each site for a total of 450 student participants. Students will be eligible to participate if they are female, aged 18–25, enrolled in the first year of community college, at risk of pregnancy (sexually active, not pregnant and not sterilized), do not want to become pregnant in the next year, and willing to be contacted for follow-up data collection. UT Austin will collect data from student participants through self-administered questionnaires at baseline and will support follow-up data collection efforts, including online surveys every 3 months and home pregnancy tests every 6 months following baseline. UT will also facilitate provider surveys made available by the UCSF team. The UT team will follow up with providers to encourage high response rates.

Reproductive Responses to the Zika Virus Epidemic in Brazil

Principal Investigator: Leticia Marteleto
Funded by: National Institutes of Health

The objective of the proposed research is to provide one of the first in-depth analyses of how the Zika virus (ZIKV) epidemic has affected and potentially continues to affect reproductive processes in Brazil. These analyses will include investigations into how different types of physical and social exposure to the virus shape women’s desires for pregnancy and contraception, contraceptive use and sexual frequency, prenatal healthcare use, abortion, and pregnancy and birth outcomes. Understanding women’s reproductive responses to ZIKV exposure is key to developing a nuanced understanding of the effects of population health shocks on family health and health disparities more broadly, and is especially important to consider in a developing country context where vast inequalities in healthcare access, unintended pregnancy, and morbidity and mortality persist. The specific aims of this project will be to: (1) collect longitudinal data on physical and social ZIKV exposure, reproductive processes, and potential mediators; (2) estimate the extent to which sociodemographic, municipal, and state characteristics affect women’s physical and social experiences of ZIKV exposure; and (3) investigate how and why reproductive intentions, behaviors, and outcomes vary with ZIKV exposure. 

The Effects of Stressful Exposures on Pregnancy Among Late Adolescents

Principal Investigator: Abigail Weitzman
Funded by: National Institutes of Health

The proposed research will be one of the first in-depth investigations of the effects of an extreme form of neighborhood violence, specifically homicide exposure, on adolescent pregnancy in the United States. The analysis will examine how homicide exposure affects the risk of pregnancy and will further identify underlying mechanisms including changes in aspirations for and expectations about the future, perceived behavioral control, relationship dynamics, and sexual behavior and contraceptive use. The specific aims of this project will be to: (1) assess how young women’s aspirations, expectations, and perceived behavioral control evolve alongside their exposure to homicide (2) examine how young women’s relationship dynamics, sexual activity, and contraceptive use, evolve with homicide exposure and (3) investigate how the risk of adolescent pregnancy changes following homicide exposure. To achieve these aims, the proposed study will integrate geo-referenced administrative data on the date and location of homicides with time-varying information from RDSL panel data on young women’s aspirations for and expectations about future education, employment, and family formation; relationship dynamics; sexual activity and contraceptive use; and pregnancy status.

Fertility Trends, Changing Maternal Characteristics, and Children’s Health

Principal Investigator: Shannon Cavanagh
Funded by: National Institute of Child Health and Human Development

Today, mothers of young children in Western societies “look” different than they did in the past—in terms of their age, how many children they have, and whether they are married. Amidst all this change, one thing that remains the same is mothers’ primary responsibility for managing their children’s early health and development. The stakes of this responsibility are growing, given evidence illuminating the critical role of early childhood in lifelong health and the associated efficacy of early interventions. The interplay of these two trends—changes in fertility-related maternal characteristics, increased recognition of the importance of early childhood health disparities—has clear implications for children’s futures. The purpose of this project, therefore, is to test a life course-influenced conceptual model of the linkages among key characteristics of individual mothers, population trends in those characteristics in their home countries, their management of children’s early health, and their children’s physical health in six English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom, United States). This comparative approach is valuable because, despite some similarities, these countries vary across a variety of fertility trends and social supports. Consequently, they are diverse contexts in terms of the relative standing of different types of mothers within their societies as well as differences in the public scaffolding available in these countries to reduce the intergenerational transmission of inequality.

Sexual Behavior during the Transition to Adulthood and Associated Health Outcomes

Principal Investigator: Abigail Weitzman
Funded by: National Institutes of Health

The objective of the proposed research is to provide one of the first in-depth analyses of sexual concurrency among young adult women in the United States. These analyses will include investigations into how childhood and adolescent experiences, changes in personal circumstances during the transition to adulthood, and the relationship dynamics of intimate partnerships each contribute to this behavior. Understanding the determinants of sexual concurrency is a key step toward understanding variation in sexual risk-taking more broadly, and is especially important to consider during late adolescence and the transition to adulthood, when risk-taking behaviors and sexual experimentation are concentrated. The specific aims of this project will be to: (1) determine which childhood and adolescent experiences affect the likelihood of sexual concurrency and why (2) investigate how changes in personal circumstances such as enrolling in college or experiencing a pregnancy affect young women’s changing likelihood of concurrency over time and (3) examine the relationship dynamics that contribute to young women’s likelihood of concurrency. To meet these aims, the proposed study will draw on data from the RDSL study to combine time-varying information on young adults’ sexual behavior, relationships, education, employment, and fertility, and static information on their childhood and adolescent experiences and on their attitudes toward sex and perceptions of sexual norms and risk. Fixed and random effects regression models will be used to assess how the probability of sexual concurrency differs both within and across women over a two and a half year period.

Demography, Health, and Contraceptive Use of Repeat Teenage Mothers

Principal Investigator: Julie Maslowsky
Funded by: National Institutes of Health

Nearly 1/5 of the 230,000 annual births to teen mothers in the US are repeat births (births to a teen mother   who already has one or more children), the large majority of which are unintended. Repeat teen mothers are a high-risk group of adolescents; they are more likely to drop out of high school, are less likely to be employed, and more likely to have mental health problems, and start prenatal care later or receive no prenatal care more frequently compared to first-time teen and older mothers. They also experience higher incidence of preterm birth, low infant birth weight, and infant mortality compared to both first time teen mothers and older mothers. Despite the vulnerability of these mothers and their children, they have been notably understudied compared to first-time teen mothers. The demographic composition of this population, their health profile, their knowledge and attitudes toward contraceptive are not well documented. We also lack understanding of the processes by which teens choose their contraception, knowledge that is necessary to inform appropriate education and facilitate uptake of effective contraception among teen mothers wishing to prevent a repeat birth. The proposed research has 3 aims: 1. Characterize the US repeat teenage mother population with regards to demographic characteristics, reproductive health, and contraceptive use and compare this population to first time teen mothers and older mothers (ages 20-25). 2. Identify individual factors that influence teens’ desire to use long acting reversible contraceptives (LARCs) in high- and low-access states, Colorado and Texas. 3. Identify knowledge, attitudes, intentions, and perceived accessibility regarding postpartum contraception, particularly LARCs, among teens.

Undue? Quantifying the Burden of a Restrictive Abortion Law on Texas Women

Principal Investigator: Abigail Aiken
Additional Investigators: Vinita Goyal and Joseph Potter, Co-Investigators
Funded by: Society of Family Planning

Texas House Bill 2 (HB2), enacted in 2013, placed targeted abortion restrictions on abortion providers which resulted in closure of more than half of the state's abortion clinics. Using patient-level data from approximately 30,000 patients seeking care at eight abortion clinics in the state in the year before and after passage of HB2, we will evaluate differences in travel distances and time, the proportion of low-income and racial / ethnic minority women receiving care, gestational age at the time of abortion, and type of abortion procedure obtained by women in Texas during the two time periods. We will use geospatial maps to demonstate the effects of this law on hypothesized outcomes, including: increased length of travel; later gestational age at the time of care; decreased use of medication abortion particularly among rural women; and relative inaccessibilty of care among low-income and minority women since passage of this law. Our results may be used by the general public to understand the implications of this law, including geographical and social inequities in the distribution of abortion services in Texas, by researchers and public health officials as evidence of the harmful effects of this law regarding access to safe and timely abortion care, and by policymakers to caution against future restrictive abortion legislation.

Texas Policy Evaluation Project

Principal Investigator: Joseph E. Potter
Additional Investigators: Kristine Hopkins, Co-Investigator; Daniel Powers, Co-Investigator; Daniel Grossman, Principal Investigator, Ibis Reproductive Health Subcontract; Kari White, Principal Investigator, Unversity of Alabama at Birmingham subcontract
Funded by: Anonymous foundation

Begun in Fall 2011, Texas Policy Evaluation Project (TxPEP) is a collaborative group of investigators who evaluate the impact of legislation in Texas related to women’s reproductive health passed in the 82nd and 83rd legislative sessions. Study areas include policy changes related to the provision of family planning and abortion care in Texas. Our current research projects include studying the impact of the Supreme Court decision on abortion access in Texas, the effects of HB 3994 in restricting judicial bypass for teens seeking abortion care without parental consent, as well as the impact of the new and reorganized state family planning programs and the Medicaid rule change permitting reimbursement for immediate postpartum provision of long-acting reversible contraception.

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    University of Texas at Austin
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    Austin, Texas 78712-1699