PROJECT SUMMARY Despite the existence of guidelines from the World Health Organization and the American College of Obstetricians and Gynecologists recommending an optimal interpregnancy interval (IPI) of at least 18 to 24 months, nearly one-third of non-first births in the US are conceived within 18 months of the end of a preceding pregnancy. Short IPI is a significant problem due to the associated adverse pregnancy and birth outcomes, most of which are concentrated in vulnerable populations, including immigrants. Specifically, African immigrants have 1.5 to 3 times higher risk of IPI of less than six months compared to US-born Black and US-born white people, respectively. Despite the rapid growth in African immigration to the US in recent years, the population is underrepresented in reproductive health research and programs. Hence, the risk factors for short IPI are not well understood. Studies in sub-Saharan Africa suggest that social and cultural norms about reproductive health and abortion, infant mortality, and social support influence fertility and contraceptive behaviors and practices. However, it is unknown if these norms and practices persist through after immigration and integration, and whether they play a role in short IPIs in the African immigrant population. The purpose of this R15 proposal is to use an exploratory sequential mixed methods design to understand the social and cultural norms and demographic factors related to short IPI in African immigrants living in the US. The specific aims are: 1) to describe, using qualitative methods, social and cultural norms about optimal birth spacing, including how cultural beliefs and practices related to fertility and family planning, intimate relationship factors, and stigma shape these norms among African immigrant women and men; and 2) to develop and evaluate the psychometric properties of a culturally-sensitive measure of underlying sociocultural constructs related to birth spacing and IPI, using quantitative methods. We propose to conduct in-depth interviews with women aged 18-49 years and men aged 18-60 years, born in Ghana, Liberia, Nigeria, or Sierra Leone, living in Greater Philadelphia, home to one of the most distinct African immigrant communities in the US. A quantitative measure will be developed from a) qualitative findings from in-depth interviews and b) a scoping review of existing sociocultural norms measures with relevance to IPI that may be modified. This measure will be refined and validated with a sample of African- born women of reproductive age. The research team for this project has a strong background and relevant experience in conducting community-engaged research in reproductive health, interpregnancy intervals, contraceptive use, immigrant research in development and humanitarian contexts, and measurement development and validation. The long-term goals of this study are to 1) develop culturally acceptable and clinically relevant interventions to optimize IPI in African immigrants; 2) enrich the research environment at Arcadia University; and 3) enhance career development opportunities for students through mentoring in research.

PROJECT NARRATIVE Short interpregnancy interval is associated with adverse maternal and infant outcomes. Little is known about the sociocultural and demographic factors associated with short interpregnancy intervals in African immigrant women living in the US. The proposed mixed methods study is designed to elucidate a community-informed understanding of social and cultural norms and demographic factors related to birth spacing and short interpregnancy intervals, which will inform the modification of existing relevant measures or the development of a new measure, if needed, and validation of a measure of underlying sociocultural constructs related to birth spacing and interpregnancy intervals in African immigrant women in the US.