Unintended Pregnancy in the Native Hawaiian Community: Key Informants’ Perspectives

CONTEXT

Native Hawaiians experience the highest reported rate of unintended pregnancy of any ethnic group in Hawaii. Understanding the context in which they make decisions that influence pregnancy and pregnancy planning is essential to reducing this rate.

METHODS

A qualitative study was carried out in partnership with a community health center serving a large Native Hawaiian population to explore how Native Hawaiians conceptualize pregnancy and pregnancy planning. Between August and October 2013, semistructured interviews were conducted with 10 diverse key informants from the Hawaiian community. Content analysis was used to identify themes and patterns that emerged from the interviews.

RESULTS

Core Hawaiian values of children and family strongly affect how Native Hawaiians view pregnancy, pregnancy planning and unintended pregnancies. ‘Ohana (families) are large and characterized by tremendous support, which is perceived to lessen the burden of an unintended pregnancy. Pregnancies, whether planned or not, are seen as blessings because children are highly valued. Because of these concepts, there is an expectation for women to continue unplanned pregnancies. Although Hawaiians ascribe value to planning pregnancies and hope that children are born under what they identify as ideal circumstances, they acknowledge that these circumstances are not necessary and often do not occur.

CONCLUSION

The concepts of family and children serve as core values to Native Hawaiians and are linked to the ways in which they view pregnancy and pregnancy planning.

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By:   

Reni Soon¹, 

Jennifer Elia², 

Nina Beckwith³, 

Bliss Kaneshiro⁴ and

Timothy Dye⁵

1. 1
   Assistant professor, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
2. 2
   Junior researcher, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
3. 3
   Medical student, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
4. 4
   Associate professor, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
5. 5
   Professor, Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 

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Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. 

Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. 

Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. 

Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales.

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By:  Ka'opua LS1, Cassel K2, Shiramizu B3, Stotzer RL4, Robles A4, Kapua C5, Orton M5, Milne C4, Sesepasara M5.

• 1University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA lskaopua@hawaii.edu.
• 2University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 3University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 4University of Hawai'i-Ma-noa, Honolulu, HI, USA.
• 5Life Foundation of O'ahu, Honolulu, HI, USA. 

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HIV Diagnoses among MSM, 2005-20014, U.S.

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