The "abortion imaginary": Shared perceptions and personal representations among everyday Americans.

Drawing upon 217 in-depth interviews and the concept of the "social imaginary," we introduce the "abortion imaginary"-a set of shared understandings regarding abortion and abortion patients. We identify four interrelated facets of the U.S. abortion imaginary pertaining to who gets an abortion and why: maternal inevitability, economic decision-making, relationship precarity, and emotional fragility. We then show how shared perceptions of abortion patients diverge into polarized opinions, revealing how those who know someone who has had an abortion differ from those who do not. Centering personal "exemplars," we integrate conceptual work on social imaginaries with contact theory to illuminate how divergent opinions coexist with shared cultural understandings.

The heterogeneous associations of universal cash-payouts with breastfeeding initiation and continuation.

Existing health literature documents the benefits of breastfeeding for the first six months of life. Prior research on barriers to breastfeeding has focused on the role of hospital initiatives, return to work, and individual mothers' characteristics. This study uses data from Alaska's Pregnancy Risk Assessment Monitoring System and the Alaska Permanent Fund Dividend, to investigate whether universal income support shapes mothers' breastfeeding behaviors. We find that payouts are associated with increases in breastfeeding initiation and short-term continuation (three months) among a sample of urban Alaskan mothers. These associations differ across mothers' socioeconomic and demographic characteristics (i.e., education, economic status, race, marital status). We contend that this type of income intervention may complement existing efforts to promote breastfeeding by removing financial barriers to breastfeeding.

Pregnancy intentions' relationship with infant, pregnancy, maternal, and early childhood outcomes: Evidence from births in Alaska, Missouri, and Oklahoma.

OBJECTIVES: Much of reproductive health care policy in the United States focuses on enabling women to have intended pregnancies. Investigating whether the association between pregnancy intention and adverse outcomes for mothers and children in the immediate and longer term is due to intention or a mother's demographics provides valuable context for policy makers aiming to improve maternal and child outcomes. METHODS: We investigated relationships between pregnancy intention and pregnancy, infant, early childhood, and maternal outcomes using data from the Pregnancy Risk Assessment Monitoring System survey, conducted 2-8 months after the child's birth, and follow-up surveys from three states (Alaska, Missouri, and Oklahoma), administered at age 2-3 years old. We used logistic regressions with inverse propensity weights to measure associations, accounting for potential confounding factors. RESULTS: After inverse propensity weighting, pregnancy intention was associated with adverse maternal pregnancy behaviors but not most infant outcomes. Mothers who reported an unwanted pregnancy were associated with increased odds of the child receiving a developmental delay diagnosis. Among those who did not report depression prior to pregnancy, mothers with unwanted pregnancies were more likely to experience persistent depression, and mothers with pregnancies mistimed by two or more years had a higher likelihood of experiencing depression postpartum or in the follow up period. CONCLUSIONS: Our findings suggest that pregnancy intention is less consequential for maternal and child well-being than socio-economic disadvantage, suggesting that re-orienting policy toward social conditions and reproductive autonomy will serve better individual and population health.

Discordant benevolence: How and why people help others in the face of conflicting values.

What happens when a request for help from friends or family members invokes conflicting values? In answering this question, we integrate and extend two literatures: support provision within social networks and moral decision-making. We examine the willingness of Americans who deem abortion immoral to help a close friend or family member seeking one. Using data from the General Social Survey and 74 in-depth interviews from the National Abortion Attitudes Study, we find that a substantial minority of Americans morally opposed to abortion would enact what we call discordant benevolence: providing help when doing so conflicts with personal values. People negotiate discordant benevolence by discriminating among types of help and by exercising commiseration, exemption, or discretion. This endeavor reveals both how personal values affect social support processes and how the nature of interaction shapes outcomes of moral decision-making.

Do Pregnancy Intentions Matter? A Research Note Revisiting Relationships Among Pregnancy, Birth, and Maternal Outcomes.

The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause adverse maternal and child outcomes is limited. In this research note, we examine these relationships using recent large-scale data and inverse propensity weights estimated from generalized boosted models. We find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth-both of which are consistent with prior research. In an addition to the literature, we show that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.

Willing but unable: Physicians' referral knowledge as barriers to abortion care.

Abortion care is a crucial part of reproductive healthcare. Nevertheless, its availability is constrained by numerous forces, including care referrals within the larger healthcare system. Using a unique study of physician faculty across multiple specialties, we examine the factors associated with doctors' ability to refer patients for abortion care among those who were willing to consult in the care of a patient seeking an abortion (N = 674). Even though they were willing to refer a patient for an abortion, half (53%) of the physicians did not know how and whom to make those referrals, though they care for patients who may need them. Those with the least referral knowledge had not been taught abortion care during their medical training and were in earlier stages of their career than those who had more knowledge. This research exposes another obstacle for those seeking an abortion, a barrier that would be overcome with a clear and robust referral system within and across medical specialties.

Secrets and social networks.

Secrets are information kept from others; they are relational. They shape the intimacy of our relationships, what we know of others and what we infer about the world. Recent research has promoted two models of voluntary secret disclosure. The first highlights deliberate and strategic disclosure to garner support and to avoid judgment. The second maintains strategic action but foregrounds that disclosures are made in contexts which shape who is in one's social network and who may be the recipient of a disclosure. Work outside of this main vein examines the mechanisms and motivations to share others' secrets as well as the potential consequences of doing so. The final avenue of inquiry in this review considers how keeping secrets can change (or avoid changing) the size and composition of the secret-keeper's social network and what information is shared within it. Understanding how secrets spread within and form social networks informs work from public health to criminology to organizational management.

Enacted abortion stigma in the United States.

RATIONALE: Abortion is a common medical procedure at the center of political debate. Yet, abortion stigma at the individual level is under-researched; the nascent research on abortion stigma has not yet documented enacted (experienced) stigma instead capturing anticipated or internalized stigma. OBJECTIVE: This study documents how women and men who disclosed abortions perceived others' reactions and determinants of those perceptions. METHOD: The study uses the American Miscarriage and Abortion Communication Survey, a survey representative of American-resident adults. Data from the sub-sample who had personal experience with abortion were analyzed (total sample, N = 1640; abortion disclosure sub-sample, n = 179). The survey captured each disclosure of the most recent abortion. Respondents had eight possible choices for articulating how the listener reacted. Cluster analyses grouped these reactions. Multinomial logistic regression identified predictors of the perceived reactions. Ordinal logistic regression revealed which disclosers perceived exclusively negative reactions, exclusively positive reactions, and a mix of negative and positive reactions. RESULTS: Each disclosure fell into one of three clusters: negative reaction, supportive reaction or sympathetic reaction. The majority of abortion disclosures received largely positive reactions (32.6% were characterized as supportive and 40.6% were characterized as sympathetic). A substantial minority of disclosures received a negative reaction (26.8%). The perceived valence of the reaction is predicted, in part, by to whom the disclosure was made and why. Across all their disclosures, most people disclosing an abortion history perceived only positive reactions (58.3%). A substantial minority of people perceived either exclusively negative reactions (7.6%) or a mix of negative and positive reactions (34.1%). Ordinal logistic regression (with people as the unit of analysis) showed perceived reactions are predicted by the number of disclosures made and the revealer's race and income. CONCLUSION: Whereas most people disclosing an abortion received support or sympathy, a substantial minority received stigmatizing reactions, which could plausibly have a negative impact on health.

"When you're in a crisis like that, you don't want people to know": mortgage strain, stigma, and mental health.

OBJECTIVES: We analyzed experiences of stigmatization, concealment, and isolation among African American homeowners who were experiencing mortgage strain. METHODS: We conducted semistructured interviews between March 2012 and May 2013 with 28 African American homeowners in a northeastern US city who were experiencing mortgage strain. We coded all of the transcripts and reviewed data for codes relating to stigma, sharing information, social support, social isolation, and the meaning of homeownership. RESULTS: Our data showed that mortgage strain can be a concealable stigma. Participants internalized this stigma, expressing shame about their mortgage situation. Additionally, some participants anticipated that others would view them as less worthy given their mortgage trouble. In an effort to avoid stigmatization, many concealed their mortgage trouble, which often led to isolation. This stigmatization, concealment, and isolation seemed to contribute to participants' depression, anxiety, and emotional distress. CONCLUSIONS: Stigma may exacerbate stress associated with mortgage strain and contribute to poor mental health, particularly among upwardly mobile African Americans who have overcome significant structural barriers to home ownership. Reducing stigma associated with mortgage strain may help to reduce the health consequences of this stressful life event.

Secrets and Misperceptions: The Creation of Self-Fulfilling Illusions.

This study examines who hears what secrets, comparing two similar secrets-one that is highly stigmatized and one that is less so. Using a unique survey representative of American adults and intake forms from a medical clinic, I document marked differences in who hears these secrets. People who are sympathetic to the stigmatizing secret are more likely to hear of it than those who may react negatively. This is a consequence of people not just selectively disclosing their own secrets but selectively sharing others' as well. As a result, people in the same social network will be exposed to and influenced by different information about those they know and hence experience that network differently. When people effectively exist in networks tailored by others not to offend, then the information they hear tends to be that of which they already approve. Were they to hear secrets they disapproved of, then their attitudes might change, but they are less likely to hear those secrets. As such, the patterns of secret hearing contribute to a stasis in public opinion.