Contraception xx (2016) xxx – xxx Original research article Describing abortion attitudes among young, African American men Elisabeth J. Woodhams a, b,⁎, Brandon J. Hill a, c , Camille Fabiyi a , Melissa Gilliam a, c a Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL b Boston University School of Medicine, Boston, MA c Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, Chicago, IL Received 24 November 2015; revised 9 March 2016; accepted 14 March 2016 Abstract Objectives: This paper describes African American teenaged males' attitudes and perspectives on abortion. Methods: Data were derived from a larger cross-sectional survey of African American males aged 14–19, living in the south side of Chicago. Results: Acceptability of abortion varied by partner type, such that 60% of teenagers felt abortion was acceptable with a casual partner while 37% found it acceptable with committed partners (p b .001). Acceptability also varied by sociocontextual factors, and with overarching uncertainty or inconsistency. Conclusions: Teenaged African American males have uniquely complex attitudes toward abortion. © 2016 Elsevier Inc. All rights reserved. Keywords: African American; Men; Adolescents; Abortion; Attitudes 1. Introduction More than 600,000 teenagers between the ages 15 and 19 become pregnant every year, and 26% of these pregnancies end in abortion [1]. Adolescent women commonly report that parents and male partners are influential when deciding whether to obtain an abortion [2,3]. Among young women seeking abortion, one study found that roughly 78% involve their male partner in the decision [4]. Thus, understanding attitudes and perceptions of young men may be critical in fully understanding how adolescents consider abortion. Currently, much of the literature examining male partners' perspectives on pregnancy outcomes is largely focused on adult men. Evidence to date describes the influence of responsibility, fatherhood and other psychological factors [5,6]. Few studies specifically focus on African American teenage men's attitudes toward abortion and circumstances regarding its acceptability. Accordingly, this study describes abortion attitudes among a cohort of urban, African American teenagers and examines how sociocontextual factors may modify these attitudes. ⁎ Corresponding author. Tel.: +1-617-414-3821; fax: +1-617-414-5798. E-mail address: Elisabeth.woodhams@bmc.org (E.J. Woodhams). http://dx.doi.org/10.1016/j.contraception.2016.03.008 0010-7824/© 2016 Elsevier Inc. All rights reserved. 2. Methods 2.1. Participants and procedures Data were derived from the African American Adolescent Male Perceived Responsibility for Pregnancy Prevention Study, a large mixed-method, cross-sectional study of teenage males in Chicago (n = 348). Participants were recruited from four charter schools on the south side of Chicago; eligibility criteria included being (a) male; (b) African American; and (c) between the ages of 14 and 19 years. Pen-and-paper surveys, approximately 20 min in length, were administered by investigative team members between February 2013 and April 2014. Parental consent was obtained from participants under age 18; adolescents gave informed assent if they were under age 18 and informed consent if they were 18 years or older. This analysis was limited to participants with complete data on our measures of interest. All study procedures were reviewed and approved by the university's institutional review board. 2.2. Measures Sociodemographic measures included age (years), grade, use of public assistance (yes or no), familial composition (members with whom the participant lived) and religiosity 2 E.J. Woodhams et al. / Contraception xx (2016) xxx–xxx (how frequently they attended church). Sexual health history measures included whether they had ever had penile vaginal intercourse (PVI), current number of partners and their preferred gender of partner. Participants were also asked whether they knowingly had gotten a sexual partner pregnant. 2.2.1. Abortion attitudes Questions regarding abortion attitudes were developed with the University of Chicago Survey Lab, as validated measures were not available. Participants were asked, “If you got a committed sexual partner/casual sexual partner pregnant right now, would you consider abortion to be an option?” Participants could respond to each hypothetical situation with either a “yes” or “no.” In addition, participants were asked to what extent they viewed abortion as “okay” in nine sociocontextual scenarios. All items began with the stem questions, “In your opinion, is it OK for a woman to get an abortion if…” followed by each scenario ranging from “she was raped” or “her parents want her to” (see Fig. 1). Response options included “never okay,” “sometimes okay,” or “always okay.” 2.3. Data analysis Descriptive statistics were used to describe the sample, and McNemar chi-square tests were used to compare proportions for each abortion attitude. All data were analyzed using SPSS (Statistical Package for the Social Sciences) 21.0 (Chicago, IL, USA). 3. Results A total of 338 teenagers had complete data on the measures of interest (93.5%). Sample characteristics are described in Table 1. More young men (60%) reported that they would consider an abortion as an option right now if a casual sexual partner was pregnant than if a committed sexual partner was pregnant (37%; pb .001). Approximately one third (33%) reported that they would consider abortion an option for both types of partners, and 36% reported that they would not consider abortion an option for either partner type. Participants' attitudes toward abortion ranged across sociocontextual scenarios (Fig. 1). Participants were most likely to report that abortion is “always okay” if a woman had been raped (48%), whereas they were least likely to report that abortion is “always okay” if she is 3 to 5 months pregnant (11%). Indecision toward abortion was also apparent; approximately, 40% reported abortion was “sometimes okay” in 6 of the 9 scenarios. Only 4% reported that abortion is “always okay,” and 15% reported abortion is “never okay” across all scenarios. The median number of scenarios for which it was “never okay” was 3. 4. Discussion Results suggest that teenage African American males demonstrate a broad range of attitudes toward abortion. First, their attitudes differed significantly by relationship type, with abortion being an option more frequently in a causal relationship than in a committed relationship. Second, abortion attitudes were amenable to different sociocontextual factors (e.g., rape, ability to afford a child), and these factors are anchored in a social hierarchy with some sociocontextual factors deemed more acceptable for opting for abortion than others. Notably, a distinction between what were perceived as acceptable versus unacceptable abortions was missing. Attempting to conceptualize abortion attitudes as a single indicator (e.g., for or against) might not accurately reflect the plasticity of young men's abortion attitudes. 70% Is it OK for a woman to get an abortion if… 60% Never OK 50% Sometimes OK Always OK 40% 30% 20% 10% 0% she is she is less she has she is 3 to her her she has she can’t she’s still another 5 months parents partner afford in school? pregnant than 3 been child? pregnant? raped? another and she months want her doesn’t want her doesn’t pregnant? child? to? to have a want to baby? be? Fig. 1. Young African American men's attitudes toward abortion (N = 330). E.J. Woodhams et al. / Contraception xx (2016) xxx–xxx Table 1 Participant characteristics of young African American males (n =330) 1 n (%) Age Grade 9th 10th 11th 12th Public assistance Yes No Don't know Lives with Mother Father Stepmother/Stepfather Brother/Sister Other Frequency attend religious services ≥ 1 a week 1–3 times a month Less often Ever had PVI Number of current partners 2 0 1 2 or more Ever been involved in a pregnancy 2 Preferred gender of partner Women only Both men and women Men only Abortion an option Casual sexual partner Committed sexual partner 1 2 M (SD) 16.1 (1.23) 91 (28.3) 75 (23.3) 104 (32.3) 52 (16.1) 167 (52.4) 102 (32.0) 50 (15.7) 293 (88.8) 124 (37.6) 54 (16.4) 213 (64.5) 103 (31.2) 106 (32.7) 73 (22.5) 145 (44.8) 197 (62.1) 64 (34.0) 84 (44.7) 40 (21.3) 29 (14.6) 301 (92.3) 24 (7.4) 1 (0.3) 199 (60.3) 123 (37.3) Missing values ranged from 0 to 13. Among participants who reported ever having had vaginal intercourse. 3 Ambivalence and indecision, also identified here, suggest that providers may need to anticipate additional distress or confusion from African American male teenagers when counseling young couples. Our findings suggest African American male teenagers may be less accepting of abortion than population-level estimates; however, given different survey measures, this conclusion may not be accurate [7]. A few notable study limitations include enrollment from charter schools and obtaining parental consent which might present selection biases. Additional research is needed to determine the counseling and support needs of young couples seeking abortion and additional sociocontextual factors, including partner attitudes and perceptions, that may influence pregnancy termination. References [1] Kost K, Henshaw S. U.S. Teenage Pregnancies, Births and Abortions. 2010: National and state trends and trends by age, race and ethnicity. New York: Guttmacher Institute; 2014. [2] Biggs M, Gould H, Foster D. Understanding why women seek abortions in the US. BMC Womens Health 2013;13:29–42. [3] Chibber K. M Biggs, S Roberts, et al. The role of intimate partners in women's reasons for seeking abortion. Womens Health Issues 2014;24:e131–8. [4] Henshaw S, Kost K. Parental involvement in minors' abortion decisions. Fam Plann Perspect 1992;24:196–207 [+13]. [5] Corkindale C, Condon J, Russell A, et al. Factors that adolescent males take into account in decisions about an unplanned pregnancy. J Adolesc 2009;32:995–008. [6] Condon J, Corkindale C, Russell A, et al. Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. J Youth Adolesc 2006;35:423–34. [7] Boggess S, Bradner C. trends in adolescent males' abortion attitudes, 1988–1995: differences by race and ethnicity. Fam Plann Perspect 2000;32:118–23.