Numerous measures of pregnancy ambivalence have been developed to capture the nuances and complexities that are often overlooked by conventional, binary measures of pregnancy intention. Yet the concept of ambivalence varies widely and, in particular, may not adequately account for young people’s experiences. To address this situation, Anu Manchikanti Gómez and her team examined the accuracy of a half dozen pregnancy ambivalence measures in a mixed-methods study that collected both quantitative and qualitative data from 50 young women and their male partners. Following thematic analysis of in-depth interviews, all but two of the 80 individuals who would be considered ambivalent by at least one measure were deemed to have been misclassified. Several themes regarding the misclassification of ambivalence were identified: the conflation of current pregnancy desires with expected postconception emotional responses, the acceptability of an undesired pregnancy and the perceived lack of control regarding pregnancy. The researchers believe that current approaches to measuring ambivalence "may fail to capture the intricacies of pregnancy intentions," and they suggest that a shift toward assessing pregnancy acceptability "may offer a rich pathway for understanding the nuance" of intentions and might better encapsulate  individuals’ experiences.

Also in This Issue

• Black females in the United States have disproportionately high rates of STDs, including HIV, and a better understanding of the relationship between sociocultural conditions and STD risk during their sexual development is essential to designing effective and culturally relevant prevention programs. To explore this relationship, Natasha Crooks and colleagues interviewed 20 black women aged 19–62 about their STD experiences, sexuality and sexual development. They identified three phases of becoming a sexual black woman: Girl, when participants reported beginning to understand their sexuality; Grown, marking a transition to adulthood, when participants began to feel more self-sufficient yet still grappled with their emerging sexuality; and Woman, when participants developed a strong sense of self and took ownership of their bodies. Two sociocultural elements that affected sexual development were stereotype messaging (from both the media and the black community itself) and protection (both self-protection and protecting others). After noting black females’ reports of "the powerful influence of sociocultural conditions on their self-image, intimate relationships and sexual health," the authors conclude that interventions throughout the life course may help reduce STD risk in this population. 

• Human papillomavirus (HPV) can be acquired from sexual partners of any sex or gender, yet some sexual minority women believe themselves to be at low risk for infection. To explore these risk perceptions, Madina Agénor and colleagues conducted interviews with 29 sexual minority individuals who were assigned female at birth (AFAB) and identified as women or nonbinary. Participants mistakenly linked the risk of HPV infection to the exchange of genital fluids, and a hierarchy of perceived risk emerged: Interviewees believed that individuals who engage in penile-vaginal sex with partners assigned male at birth (AMAB) were at highest risk for HPV infection, whereas lesbians and individuals with only AFAB partners were at low risk. Moreover, participants in these last two groups perceived having sex with bisexual women or with AFAB individuals who have AMAB partners as a risk factor. The authors suggest that tailored interventions are needed to "provide sexual minority AFAB individuals with comprehensive and accurate information about their risk of acquiring HPV."

• Although obesity is not related to an increased risk of abortion complications, anecdotal evidence suggests that obese women seeking services at abortion clinics are often referred for hospital-based care and hence experience delays. Given the fact that advancing gestational age is associated with complications and increased procedure costs, Alhambra Frarey and colleagues collected data on 201 women who had obtained abortions at a hospital clinic in Philadelphia to examine the relationship between obesity and referral. While they found no difference in rates of complications among patients in different weight groups, they did find that severely obese patients (body mass index of at least 40 kg/m2) were more likely than normal-weight patients to be referred from a freestanding clinic than to report other paths to care. Moreover, referred patients waited twice as long as other patients and paid two-thirds more in up-front costs. The authors call for further research to determine whether obese women seeking abortions are being referred despite not requiring hospital-based care and, if needed, for the development of strategies to ameliorate such delays.

• A positive relationship has been found between country-level gender equality and contraceptive use among adults, but few studies have explored this relationship among adolescents. Using 2014 Global Gender Gap Index scores and data from 33 countries that participated in the 2013–2014 Health Behaviour in School-Aged Children study, Margaretha de Looze and colleagues assessed associations between gender equality and the use of condoms only, the pill only and dual methods (both of these) at last intercourse among 14–16-year-olds. Gender equality was found to be positively associated with all three approaches among young women, and with reliance on the pill and dual methods among young men. Overall, associations were stronger for females than for males, and remained significant for pill use and dual method use in analyses controlling for national wealth and income inequality. The researchers conclude that further studies are needed to identify pathways by which gender equality and adolescents’ contraceptive use are linked.

—The Editors