Strickland Denson Jill
Prevention Research Center, University of Wisconsin, Madison, WI, USA.
J Racial Ethn Health Disparities. 2025 May 19. doi: 10.1007/s40615-025-02459-w.
African American women face significant reproductive health inequities rooted in structural and social factors, though few studies have directly engaged them to examine how such factors play a role in their reproductive decision-making. This study draws from a methodology underused in reproductive health research to understand how African American women of different socioeconomic groups approach reproductive decision-making.
The study employed group concepting mapping (GCM), a participatory, mixed-methods design that integrates qualitative processes with multivariate analyses. Twenty-four African American women between 18 and 44 years were recruited into lower (n = 12) and higher (n = 12) income groups. Based on GCM methods, each group engaged in the participatory data collection analysis process across three sessions. GCM software was used to generate visualizations, such as pattern match maps and go-zones, to identify themes.
Participants described experiences with trauma, depression, stress, and everyday interaction with discrimination. Three themes emerged from the GCM process: inward reflection (autonomy in reproductive decision-making, prioritizing career and education, and pressure to push through adversity), relational reflection (expectations of sexual partners in reproductive trajectories), and outward reflection (judgement from providers, reproductive coercion in healthcare systems). Each theme influenced participants' pregnancy trajectories and reproductive decision-making.
Participants reported high importance of self-reflection, career and education, and low importance of male partners, when considering whether to pursue pregnancy, prevent pregnancy, and/or use contraception. Findings illustrate participants' reproductive health experiences were impacted by structural and social determinants. Results help document opportunities for policies and practices to attend to structural determinants versus individuals' reproductive trajectories.
非裔美国女性面临着源于结构和社会因素的重大生殖健康不平等问题，尽管很少有研究直接让她们参与进来，以考察这些因素在她们的生殖决策中如何发挥作用。本研究采用了生殖健康研究中未充分利用的一种方法，以了解不同社会经济群体的非裔美国女性如何进行生殖决策。
该研究采用了群体概念映射法（GCM），这是一种参与式混合方法设计，将定性过程与多变量分析相结合。招募了24名年龄在18至44岁之间的非裔美国女性，分为低收入组（n = 12）和高收入组（n = 12）。基于GCM方法，每个组在三个阶段参与了参与式数据收集分析过程。使用GCM软件生成可视化结果，如图案匹配图和可行区域，以识别主题。
参与者描述了创伤、抑郁、压力以及日常遭遇歧视的经历。GCM过程中出现了三个主题：向内反思（生殖决策中的自主性、优先考虑职业和教育以及克服逆境的压力）、关系反思（性伴侣在生殖轨迹方面的期望）和向外反思（来自医疗服务提供者的评判、医疗系统中的生殖胁迫）。每个主题都影响了参与者的怀孕轨迹和生殖决策。
在考虑是否怀孕、预防怀孕和/或使用避孕措施时，参与者报告自我反思、职业和教育非常重要，而男性伴侣的重要性较低。研究结果表明，参与者的生殖健康经历受到结构和社会决定因素的影响。研究结果有助于记录政策和实践关注结构决定因素而非个人生殖轨迹的机会。
