Reproductive decision-making under uncertainty: exploring the relationship of economic preferences and reproductive health

Little research has examined how economic uncertainty and preferences affect decision-making surrounding fertility intention, contraceptive behavior and pregnancy outcomes –an area where intention-behavior inconsistencies are widely acknowledged. Risk preference are defined as a person’s willingness to assume risk, and time preference as a person’s degree of present bias. Measures of risk and time preferences that underlie decision-making have been linked to health behaviors, especially substance use. There is a long history in social science of examining how these preferences correlate with financial decision-making and behavior, and measures have therefore been included in population surveys to examine economic behavior. Far less frequent are analyses that examine how economic preferences may extend beyond financial behavior to explain behavior in other domains, such as health behavior. Sexual and contraceptive behaviors are influenced by uncertainty surrounding pregnancy risk, pregnancy intention, access to methods, sexual and reproductive control, as well as perception of STI risk. Decision-making theory may therefore be especially helpful to shed light on disparities in unintended pregnancy and contraceptive use.Drawing on behavioral economics, this dissertation expands understanding of uncertainty and reproductive health decision-making in several steps. My three papers examine if there are general decision-making constructs, including risk-taking propensity and degree of present bias that may extend beyond financial decisions to health behavior and ultimately reproductive health outcomes. In the first paper, I review the state of the literature on temporal and risk preferences and sexual and reproductive health. Next, I examine how risk preferences are related to sexual behavior and contraceptive use in the National Longitudinal of Youth (NLSY97). Finally, I examine the relationship between national economic uncertainty and pregnancy intentions and outcomes in the National Survey of Family Growth (NSFG). This work draws on economics, psychology, and social epidemiology.The goal of this research is to contribute to understanding the context of reproductive decision-making and behavior. This work deepens our understanding of the mechanisms underlying choices that drive health behavior. This is an important step towards predicting who will be at highest risk of adverse outcomes and develop models for intervention