Pregnancy Intentions, Contraceptive Knowledge And Educational Aspirations Among Community College Students.

CONTEXT: Community college students, representing more than one-third of U.S. undergraduates, are a diverse population of young people motivated to seek higher education who are at elevated risk of unintended pregnancy. However, it is unknown how well prepared they are to prevent pregnancy and what they think about it in terms of their educational aspirations. METHODS: In-depth interviews were conducted with 57 students aged 18-25, inclusive of all genders, in three community colleges in California in 2015. Content analysis was used to code data and identify themes. RESULTS: All participants reported strong desires to prevent pregnancy in the next year and perceived their pregnancy risk as low, but many reported unprotected sex with opposite-sex partners. Participants had specific timelines for completing their degrees and believed pregnancy would make that far more challenging, but would not ultimately prevent them from achieving their goals. Female students expressed concern about the risks of exacerbated poverty, housing instability and unachieved career goals. Participants had little knowledge of their pregnancy risks and of the health benefits, side effects or effectiveness of contraceptives. They held negative beliefs about hormonal contraception (including emergency contraception, IUDs and the implant), fearing long-lasting effects and infertility. Gay or bisexual students shared concerns about contraceptives, although several were using methods for noncontraceptive reasons. CONCLUSION: Many community college students not desiring pregnancy have limited awareness of pregnancy risk and prevention.

Making Sense of Advice About Drinking During Pregnancy: Does Evidence Even Matter?

Women have been told not to drink during pregnancy for decades; last year, the Centers for Disease Control and Prevention (CDC) extended that advice to all women who were at risk for experiencing a pregnancy. This commentary puts the recent CDC guidelines in historical perspective and considers the unintended consequences of public health messages that extend beyond what is supported by evidence.

Commentary on the Consensus Statement-Centering the Norm: Let's Make "Normal Birth" Usual Again.

In this column, Elizabeth Mitchell Armstrong provides expert commentary on the article "Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM." The consensus statement on normal physiologic birth points the way to recenter social norms and expectations around birth.

Blueprint for action: steps toward a high-quality, high-value maternity care system.

Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care.

Home birth matters-for all women.

Although it remains rare in the United States, planned home birth has drawn increasing attention and criticism in the mainstream media and has come under attack from organized medicine. Yet, recent peer-reviewed studies contribute to the evidence base supporting home birth as a safe option for low-risk women attended by skilled midwives. The author of this editorial argues that home birth is an important cultural touchstone in the landscape of American maternity care.

Risk and the pregnant body.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, not evidence.