Research Projects: 3[iii] Qualitative research in adult women

Research Brief 3[iii]

Qualitative research in adult women

This study aims to explore the meanings which sexually active women between ages 20 to 30 attach to their fertility and fertility decisions such as contraceptive use and sexual risk-taking. These meanings will be examined within personal psychological contexts as well as broader relationship and contemporary social contexts.

Background to research:
Contrary to popular opinion and media stereotyping, abortion and crisis pregnancy is not an experience specific to unmarried teenagers. There is an assumption that crisis pregnancy is a teenage problem, yet Irish data identify young women aged between 20 and 25 years as a particularly vulnerable group in terms of crisis pregnancy. Small scale studies (e.g. Dean 1984; Burke, 1983) have examined the characteristics of Irish women seeking abortion in the UK. Findings revealed a consistent trend, indicating that the greatest number of abortions occurs for women between the ages of 20 and 24 years, mainly originating from urban areas. More recent figures (2001), show that of a total of 6,673 abortions, 2,404 (36%) were to women within the 20 - 24 age range. 1, 685 women between the ages of 25 and 29 gave Irish addresses at UK abortion clinics. In 2001, 22.4% of pregnancies among women aged 20 - 24 were aborted. In addition, the greatest proportion of unmarried births is to women under the age of 25. While various policy documents have identified teenage pregnancy as a cause for concern (e.g. 'Developing a Policy for Women's Health (Dept. of Health), 'The Voice of Women' (Southern Health Board)), there is a clear lack of emphasis on factors relating to risky sexual behaviour among women, other than teenagers. The present study aims to fill this knowledge gap by exploring fertility and contraceptive practice in women aged 20 - 30 years, and the psychological, relationship and societal influences on sexual risk-taking and fertility decision-making.

Psychological influences on fertility decision-making may include factors such as attitudes of fertility denial and wishful thinking, which can lead to feelings of impregnability among single women and failure to use effective contraception (Greene et al., 1989). Hyde (1996) carried out a qualitative analysis of unmarried pregnant women's accounts of their contraceptive practices and found that study participants could be categorised according to their risk taking behaviour. Results demonstrated that women can invoke a series of rationales to justify their sexual risk-taking, e.g. destiny dependence, where women are relatively unconcerned about what happens to them, fertility denial and unrealistic optimism ('it will never happen to me'). Hyde's sample consisted of un-married pregnant women aged between sixteen and thirty-six. The extent to which these psychological factors specifically influence fertility decisions of non-pregnant women aged 20 - 30 needs to be explored. Additional relevant psychological factors which warrant exploration in this population include life aspirations and personal goals and the extent to which they are perceived to be compatible with motherhood. Also, subconscious motivations for pregnancy have been addressed in literature on teenage pregnancy (Adler and Tschann, 1993). The extent to which this may apply to older women and influence their fertility decisions has not yet been explored.

An understanding of women's fertility decisions must take into account broader relationship and societal influences. Previous research, both nationally and internationally, indicates that relationships appear to make sexual risk-taking more acceptable (e.g. Mahon et al., 1998; Hyde, 1996). Long-term relationships may encourage 'progressive remissness', or increased risk-taking as the relationship develops (Hyde, 1996). The effectiveness with which women manage their fertility and contraception can vary according to the relationship they are in (Greene et al., 1989). For example, to avoid connotations of sexual promiscuity, women in Mahon et al.'s (1998) study confined their use of the pill to established relationships, where it is clear they are only having sex with one man to whom they are committed. In addition, the study also reported that male resistance to using condoms, affected women's control over when they did or did not use a condom. Mahon et al. (1998) also noted that effective contraception was compromised when women feared objections from their partners and they feared insistence would threaten the relationship. It is inferred from such data that communication skills and self-efficacy play a role in the ability to negotiate condom use. Negotiation skills have been found to be particularly important for women, especially young women who do not have a monogamous relationship (Richards & Van Der Plight, 1991).

Research has shown that women's use of contraceptives is also constrained by social attitudes to women's sexual behaviour (Mahon, Conlon & Dillon, 1998). A woman seeking or using contraception is acknowledging that she is sexually active, and may therefore be perceived to be defying socially defined moral code. Social opposition to non-marital sexual activity can be experienced at different levels. Fear of parental disapproval of sexual activity outside marriage may prevent young women from seeking contraceptive advice from parents. Merrigan-Feegan (1995) carried out research with 100 unmarried women attending a Dublin antenatal clinic (average age 20 years). Although 74% of respondents said they had a good relationship with their parents, only 33% said that their parents were aware that they were sexually active. At the service level, women have given accounts of doctors as 'moral gatekeepers' by refusing to prescribe contraception by conveying to women their disapproval of their non-marital sexual activity. This restricted access to contraception (Mahon, Conlon & Dillon, 1998). Catholic social teaching, which deems sexual intercourse outside marriage to be sinful and immoral, also influences the social stigma attached to sexual activity outside marriage. Social and parental stigma also extends to lone motherhood, despite the fact that different types of family are emerging in Irish society. Quinney (1991) reported that negative social attitudes towards single motherhood were the most common reason for women seeking abortion.

Social norms and perceived gender roles and expectations also influence women's decisions regarding contraception and risk-taking. In a study by Mahon, Conlon & Dillon (1998), women revealed that using the pill was influenced by social norms; being on the pill was seen as being prepared for sex or 'sexually available,' and constituted 'unfeminine behaviour'. The same social norms also discouraged women from purchasing and using condoms. These constraints on women's effective use of contraception often resulted in pregnancy risk-taking. The present study aims to explore the specific relevance of such constraints in the context of young women's fertility decisions.

Research aim:
To achieve a greater understanding of fertility issues of young unmarried women aged between 20 and 30 years, particularly those issues relating to contraception and sexual risk-taking.

Research objectives:
1. To explore the meanings Irish women aged 20 - 30 attach to their fertility and fertility-related decisions.

2. To explore factors which may influence the ways in which these women manage their fertility and the extent to which they engage in sexual risk-taking. These factors include:

Deliverables of research:

Methodology and sampling considerations:
Due to the exploratory nature and sensitive subject-matter of this study a qualitative methodology is appropriate. The perspectives of the young women themselves are central to the present study. It is hoped that a qualitative research approach will allow for respondents' own experiences to be centralised in the data collection process. Possible data collection methods include focus groups and/ or individual interviews.

The sampling frame for this study will be Irish heterosexual women between the ages of 20 and 30, without children, who are sexually active. Respondents will be un-married. The sample should contain variation in relationship status of respondents (e.g. single, in long-term relationship, casual relationship) and in geographical origin of respondents (urban/ rural).

Budget guidance:
The budget available for this study is in the region of €40, 000 - €50,000, inclusive of VAT.

Timetable:
A suggested timeframe for this study is 6 months.
Please refer to the Invitation to Tender letter for information relating to expected outputs, reporting arrangements, ethical consideration, terms of reference, contacts and details for submission and content of tender bids. This information is elaborated in section 2.2 of the Invitation to Tender letter.

References: