Date of Award

Summer 2022

Degree Type


Director of Thesis

Dr. Emily S. Mann

Second Reader

Christiana Johnson


Low-income women and women of color experience adverse birth outcomes at disproportionately higher rates in the United States than most people who give birth. This thesis examines individual interviews conducted with 30 low-income women whose most recent birth was covered by Medicaid, the United States’ largest means-tested public health insurance program. The aim of this thesis is to examine how the women in the study thought about pregnancy, and how they described their intentions to become or avoid becoming pregnant at various times in their life. While public health researchers often frame pregnancy as an event that is either intended or unintended, this thesis argues that pregnancy intentions and reactions to pregnancy among low-income women are much more complex, with various interpersonal, social, and economic factors shaping the way study participants thought about their chances of becoming pregnant, and the acceptability of their pregnancy. The attitudes and beliefs of pregnancy-capable people is deeply intertwined with their social contexts, including their experiences with gynecological and obstetric care, as well as their interpretations of the experiences of their friends and family members. As such, these findings can enhance researchers’ and clinicians’ understandings of the diverse factors that can contribute to positive and negative experiences during pregnancy and childbirth among low-income women and contribute to ongoing efforts to better support patient autonomy and person-centered gynecological and obstetric care and reduce pregnancy-related health inequities. Additionally, this thesis provides insight for policymakers and wider general audiences alike, in understanding the complex pregnancy experiences and desires of publicly insured women in the United States, and best supporting the autonomy and needs of their peers, constituents, and loved ones who may be capable of pregnancy. I hope that my thesis may be able to contribute to the burgeoning field of research on pregnancy desires, in shifting discussions away from the narrow view of unintended pregnancy as a problematic source of risk.

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