Pregnancy Intentions' Relationship with Infant, Pregnancy, Maternal, and early Childhood Outcomes: Evidence from Births in Alaska, Missouri, and Oklahoma

Hobby, Erica, Nicholas Mark, Alison Gemmill, & Sarah K. Cowan

Published in Perspectives on Sexual and Reproductive Health 55, 2023

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. 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. 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. 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.

Category: Pregnancy

The Heterogeneous Associations of Universal Cash-Payouts with Breastfeeding Initiation and Continuation

Amorim, Mariana, Erica Hobby, Anna Zamora-Kapoor, Katherine A. Perham-Hester & Sarah K. Cowan

Published in Social Science and Medicine - Population Health 22, 2023

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.

Category: Cash Transfers

Stasis and Sorting of Americans’ Abortion Opinions: Political Polarization Added to Religious and Other Differences

Hout, Michael, Stuart Perrett & Sarah K. Cowan

Published in Socius 8, 2022

Americans disagree on legal abortion now about as much as they did in the 1970s, but their attitudes now sort much more according to political identity. Differences of opinion by religion, gender, race, and work that were key to understanding abortion attitudes in the 1970s persisted through 2021. The General Social Survey shows that first conservatives increased their opposition to legal abortion rights; their mean score dropped 1.1 points (on a 6-point scale) from 3.8 to 2.7 from 1974 to 2004. As conservatives’ opinions leveled off, liberals increased their support of abortion rights from 4.7 in 2004 to 5.3 or 5.4 in 2021 (because of Covid-19, survey mode changed, creating uncertainty about the sources of change). Women were significantly more divided by political ideology than men were throughout the time series, but gendered political differences did not displace or reduce religious, educational, racial, or work-life differences.

Category: Abortion, Public Opinion, Political Sociology

Do Pregnancy Intentions Matter? Revisiting Relationships With Pregnancy, Birth, and Maternal Outcomes

Mark, Nicholas* & Sarah K. Cowan

Published in Demography, 2021

Preventing unplanned or unintended pregnancies continues to be a cornerstone of American reproductive health policy and infrastructure, but the evidence that these pregnancies cause adverse maternal and child outcomes is limited. We test these relationships on recent large-scale data using inverse propensity weights estimated from generalized boosted models. Consistent with prior research, we find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth. In an addition to the literature, we find evidence 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.

Category: Pregnancy

Examining the Effects of a Universal Cash Transfer on Fertility

Cowan, Sarah K. & Kiara Wyndham Douds*

Published in Social Forces, 2022

Childbearing is at once deeply personal and shaped by social structure. It is also a site of profound inequality in the United States. Income inequality is an upstream cause of childbearing inequality, yet the evidence of the effect of income on reproduction is inconclusive. Previously, scholars primarily examined the introduction of means-tested relief to families with children. This limits analysis to families in poverty and provides insight only into the presence or absence of a policy. We analyze the Alaska Permanent Fund Dividend, which has provided all Alaskan residents with a substantial annual cash payment since 1982. The amount of the payment varies annually and is exogenous to individual Alaskans’ behavior and the state’s economy. We examine the effect of the cash transfers on fertility and abortion among a large and diverse population that has received varying amounts of money over time. We find the payments increase short-term fertility rates 1 and 2 years after disbursement, particularly among socioeconomically disadvantaged populations. Standardized to the 2010 household size distribution, two average payments relative to two minimum payments would result in a predicted fertility rate increase from 80.03 to 86.53 per 1,000 women age 15–44. The effect is largest for first births. The payments have no effect on the abortion rate. These results indicate the additional income removes economic constraints to reproductive health and autonomy and reduces reproductive inequality.

This research was covered in New York Times and KCBS.

Category: Cash Transfers, Pregnancy

Disclosure among youth stopped by the police: Repercussions for mental health

Turney, Kristin, Amanda Geller & Sarah K. Cowan

Published in Social Science and Medicine - Mental Health 2 (2022)

Police contact is a common and consequential experience disproportionately endured by youth of color living in heavily surveilled neighborhoods. Disclosing police contact to others (including parents, siblings, or friends) may buffer against the harmful mental health repercussions of police contact, but little is known about the relationship between disclosure of police contact and mental health. We use data from the Fragile Families and Child Wellbeing Study, a cohort of urban children born around the turn of the 21st century and followed through age 15, to examine the relationship between disclosure of police contact and mental health among youth. Results suggest three conclusions. First, youth who experience police contact (regardless of whether they disclose this contact) report more depressive symptoms and anxiety than youth who do not experience police contact. Second, among youth who experience police contact, disclosure is associated with significantly less anxiety (but is not significantly associated with depressive symptoms). Third, this protective nature of disclosure is concentrated among Black youth and boys. Taken together, these findings suggest that disclosing police contact, particularly for groups most likely to experience it, may ameliorate some of the harmful mental health repercussions of this contact for youth.

Category: Secrets, Stigma

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

Anderson, Elizabeth M.*, Sarah K. Cowan, Jenny A. Higgins, Nicholas B. Schmuhl & Cynthie K. Wautlet

Published in Social Science and Medicine - Population Health 17 (2022)

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.

Category: Abortion

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

Cowan, Sarah K. , Tricia C. Bruce, Brea L. Perry, Bridget Ritz*, Stuart Perrett* & Elizabeth M. Anderson*

Published in Science Advances 8 (7), 2022

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.

Category: Abortion, Public Opinion, Political Sociology, Social Networks

Updating A Time-Series of Survey Questions: The Case of Abortion Attitudes in the General Social Survey

Cowan, Sarah K., Michael Hout & Stuart Perrett*

Published in Sociological Methods & Research, 2022

Long-running surveys need a systematic way to reflect social change and to keep items relevant to respondents, especially when they ask about controversial subjects, or they threaten the items' validity. We propose a protocol for updating measures that preserves content and construct validity. First, substantive experts articulate the current and anticipated future terms of debate. Then survey experts use this substantive input and their knowledge of existing measures to develop and pilot a large battery of new items. Third, researchers analyze the pilot data to select items for the survey of record. Finally, the items appear on the survey-of-record, available to the whole user community. Surveys-of-record have procedures for changing content that determine if the new items appear just once or become part of the core. We provide the example of developing new abortion attitude measures in the General Social Survey. Current questions ask whether abortion should be legal under varying circumstances. The new abortion items ask about morality, access, state policy, and interpersonal dynamics. They improve content and construct validity and add new insights into Americans' abortion attitudes.

Category: Abortion, Measurement, Public Opinion, Political Sociology

COVID-19 Vaccine Hesitancy Is the New Terrain for Political Division among Americans

Cowan, Sarah K., Nicholas Mark* & Jennifer A. Reich

Published in Socius 7 (2021)

Politically conservative Americans are less likely than those who identify as liberal to report a willingness to get a vaccine against coronavirus disease 2019. Using data from the Axios/Ipsos Coronavirus Survey from November 2020 to February 2021, the authors find that this partisan divide in vaccine hesitancy has increased over time. Recent scholarship has suggested that these differences can be attributed to personal characteristics, including varying levels of trust in institutions. The authors find that although the data supported this hypothesis in mid-November, by early February differences in demographics, concern about the pandemic, and institutional trust no longer explained the partisan gap. The authors explain the deepening divide by turning to recent evidence that political party affiliation has become a source of identity that shapes personal decision making.

Category: Public Opinion, Political Sociology

Low perceived susceptibility to pregnancy as a reason for contraceptive nonuse among women with unintended births

Gemmill, Alison & Sarah K. Cowan

Published in Demographic Research 44 (2021)

Background: While low perceived susceptibility (PS) to pregnancy is a common risk factor for having sex without contraception among women susceptible to unintended pregnancy, little research has examined the correlates of low PS, and none have investigated whether low PS predisposes women to later pregnancy discovery and prenatal care initiation among women with unintended births.

Methods: We use data from the 2004‒2011 Pregnancy Risk Assessment Monitoring System and limit our sample to women in the United States with unintended births who were not using contraception at the time of the index pregnancy (n = 55,940). Women were classified as having low PS if they indicated they could not get pregnant at the time the index pregnancy occurred or they or their partner were sterile. We use logistic regression to identify correlates of low PS and determine whether low PS is associated with timing of pregnancy recognition and prenatal care initiation.

Results: Over one-third of women with unintended births cited low PS as a reason for contraceptive nonuse. Maternal age and disadvantage are correlated with low PS. Among women with unintended births, those with low PS had lower odds of early pregnancy recognition (adjOR = 0.88; 95% CI: 0.82, 0.94) and prenatal care initiation (adjOR = 0.86; 95% CI: 0.79, 0.94) compared to those who did not hold these beliefs.

Contribution: Although research remains focused on other barriers to contraceptive use, low perceived susceptibility to pregnancy is critical to understanding the high rates of unintended pregnancies and births in the United States and may affect prenatal health.

This research is the winner of the Editor’s Choice Designation from Demographic Research.

Category: Pregnancy

Secrets and Social Networks

Cowan, Sarah K.

Published in Current Opinion in Psychology 31 (2020)

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.

Category: Secrets, Social Networks

Estimating Personal Network Size with Non-random Mixing via Latent Kernels

Sahai, Swupnil, Timothy Jones*, Sarah K. Cowan & Tian Zheng

Published in Aiello L., Cherifi C., Cherifi H., Lambiotte R., Lió P., Rocha L. (eds) Complex Networks and Their Applications VII. Complex Networks 2018. Studies in Computational Intelligence, vol 812. Springer.

A major problem in the study of social networks is estimating the number of people an individual knows. However, there is no general method to account for barrier effects, a major source of bias in common estimation procedures. The literature describes approaches that model barrier effects, or non-random mixing, but they suffer from unstable estimates and fail to give results that agree with specialists’ knowledge. In this paper we introduce a model that builds off existing methods, imposes more structure, requires significantly fewer parameters, and yet allows for greater interpretability. We apply our model on responses gathered from a survey we designed and show that our conclusions better match what sociologists find in practice. We expect that this approach will provide more accurate estimates of personal network sizes and hence remove a significant hurdle in sociological research.

Category: Social Networks

“It could turn ugly”: Selective Disclosure of Political Views and Biased Network Perception

Cowan, Sarah K., and Delia Baldassarri

Published in Social Networks 52 (2018)

This article documents individuals selectively disclosing their political attitudes and the consequences for social influence and the democratic process. Using a large, diverse sample of American adults, we find Americans keep their political attitudes secret specifically from those with whom they disagree. As such, they produce the experience of highly homogeneous social contexts, in which only liberal or conservative views are voiced, while dissent remains silent, and often times goes unacknowledged. This experience is not the result of homogeneous social contexts but the appearance of them. Pervasive selective disclosure creates a gap between the objective social network and the perceived social network in which political agreement is over-estimated. On the micro-level, the processes of social influence on the formation and modification of political attitudes that occur when people converse with those with whom they disagree are thwarted and on the macro-level, this mechanism of selective disclosure leads to the perception of a greatly polarized public opinion.

Category: Public Opinion, Secrets, Social Networks

Bystander Interventions on Behalf of Sexual Assault and Intimate Partner Violence Victims

Weitzman, Abigail, Sarah K. Cowan & Kate Walsh

Published in Journal of Interpersonal Violence 35(7-8), 2017

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.

Category: Secrets, Social Networks

Enacted Abortion Stigma in the United States

Cowan, Sarah K.

Published in Social Science and Medicine 177 (2017)

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 experienced (enacted) 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 plausibly negatively impact on health.

This research was covered in Glamour.

Category: Abortion, Stigma

Alternative Estimates of Lifetime Prevalence Of Abortion from Indirect Survey Questioning Methods

Cowan, Sarah K., Lawrence Wu, Susanna Makela*, Paula England

Published in Perspectives on Sexual and Reproductive Health 48 (2016)

Abortion is a frequent medical procedure undergone by diverse women in the United States with profound demographic and political implications yet we do not know how many American women alive today have had abortions. We do not know this basic fact because women under-report their abortion histories in surveys. There are a number of well-established techniques to elicit more accurate survey responses to sensitive items. In this comment, we propose that lifetime prevalence estimates for abortion in the United States could be improved through use of these techniques, in particular the double list experiment. We report on a pilot double list experiment we conducted which shows promising results. We also provide unique formulae for determining the appropriate sample sizes needed to detect that the double list experiment has improved accuracy of estimates over those obtained from asking women directly whether they have had an abortion.

Category: Abortion, Measurement

Periodic Discordance Between Vote Equality and Representational Equality in the United States

Cowan, Sarah K.

Published in Sociological Science 2 (2015)

American democracy has two central values that are often in tension: vote equality, that each vote has equal influence, and representational equality, that each elected official represents equal numbers of people. The electoral standard of “one person, one vote” ensures representational equality, and that often ensures vote equality. This relationship fails, however, under certain demographic conditions, namely, when a large, non-enfranchised population resides unevenly across jurisdictions. Then, representational equality is preserved and vote equality is violated. Prior to women’s suffrage, for example, western states had relatively fewer women than the remainder of the country, contributing to gross vote inequality, though rectified through extension of the franchise. Given recent high rates of immigration to some states, I ask whether the two values are in tension. I find that they are, and quantify the electoral consequences of this disjuncture at 13 House seats in 2010.

This work was cited in the Democratic National Committee’s amicus brief to the Supreme Court in the case Evenwel v. Abbott. This research is also covered by Huffington Post.

Category: Political Sociology

“When you’re in a crisis like that, you don’t want people to know”: Mortgage Strain, Stigma and Mental Health

Keene, Danya E., Sarah K. Cowan, and Amy Castro Baker*

Published in the American Journal of Public Health 105 (5), 2015

Objectives: Mortgage strain can have severe consequences for mental health, but the specific mechanisms underlying this relationship have yet to be revealed. Stigma represents one unexplored pathway. We analyze experiences of stigmatization, concealment and isolation among African-American homeowners who were experiencing mortgage strain.

Methods: We conducted semi-structured interviews with 28 African-American homeowners who were experiencing mortgage strain.

Results: Our data show 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 experiences of isolation. This stigmatization, concealment and isolation seemed to contribute to participants’ depression, anxiety and emotional distress.

Conclusions: Stigma may exacerbate the 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.

This research was covered in the Yale Alumni Magazine.

Category: Secrets, Social Networks, Stigma

Secrets and Misperceptions: The Creation of Self-Fulfilling Illusions

Cowan, Sarah K.

Published in Sociological Science 1 (2014)

This study examines who hears what secrets, comparing two similar secrets — one which is highly stigmatized and one which 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 not just of people 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 to not offend then the information they hear tends to be that of which they already approve. Were they to hear secrets they disapprove 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.

This research has been covered by The New York Times, Salon, National Public Radio, RH Reality Check , Daily Kos (twice — see the more recent one here), LifeSite, Minnesota Post, The New Republic, The Daily Beast, Huffington Post, PSMag and ThinkProgress among other news sources.

This research won the Robert K. Merton Prize for Analytical Sociology from the International Network of Analytical Sociologists, and the Honorable Mention for Best Paper from the Communication, Information Technologies and Media section of the American Sociological Association.

Category: Abortion, Secrets, Social Networks

Cohort Abortion Measures for the United States

Cowan, Sarah K.

Published in Population and Development Review 39(2), 2013

Demographers interested in abortion in the United States have thus far focused on cross-sectional and synthetic cohort measures, due to data availability. We now have cohorts that have completed their entire reproductive years after the Roe v. Wade decision legalizing abortion nationwide. For women who are in the midst of their childbearing years at the conclusion of data collection, I apply the Lee-Carter forecasting technique – its first application in abortion research – to complete their age-specific abortion rates. Using true cohort measures reveals markedly different abortion experiences by cohort. I find stasis in the distribution of abortion by abortion order and the racial composition of abortion incidences. In addition to the substantive findings, cohort measures shift the focus of quantitative abortion research from incidence rates to women’s lives over their reproductive years.

Category: Abortion, Measurement

* indicates student co-author