National Survey Of Family Growth Research Articles

Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011–2017 National Survey of Family Growth

Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.

IMPACT survey: IMpaired fecundity in Physicians and Association with Clinical Time.

ObjectiveStudies suggest female physicians experience higher rates of infertility than the general population. The overall objective of this study was to determine the rate of impaired fecundity in a sample of female emergency physicians and compare it to the Centers for Disease Control and Prevention (CDC) National Survey of Family Growth (NSFG) data. Impaired fecundity is defined as physical difficulty in getting pregnant or carrying a pregnancy to live birth.MethodsWe performed a cross‐sectional survey of female emergency physicians to determine the rate of impaired fecundity. Survey questions were adapted from the NSFG to allow comparison to the general population. Statistical comparisons were made using contingency tables (with chi‐square and tau‐c assessments), 1‐sample t tests, and independent samples t tests, as appropriate.ResultsA total of 2072 women completed the survey with a mean (SD) current age of 38.9 (7.2) years. Data were analyzed for women of childbearing years (15–44 years old as defined by the CDC; n = 1705 [82% total responses]). The rate of impaired fecundity in emergency physicians was 24.9% as compared to the NSFG cohort (12.1%; P < 0.001). Female emergency physicians with impaired fecundity reported working 9.8 overall more clinical hours (95% CI 2.5–17) and 4.5 more night hours (95% CI 0.8–8.2) than those with normal fecundity.ConclusionFemale emergency physicians have increased rates of impaired fecundity when compared with a general population cohort. Clinical workload and night shifts are greater in female emergency physicians with impaired fecundity. Research is needed to elucidate work‐related impaired fecundity risk factors.

Use of contraception among reproductive-aged women in the United States, 2014 and 2016

ObjectiveTo examine current levels, correlates of, and changes in contraceptive use among reproductive-age women in the United States between 2014 and 2016.DesignWe conducted simple and multivariable logistic regression analyses to identify associations between user characteristics and contraceptive use, with specific attention to methods requiring a visit to a health care provider.SettingNot applicable.Patient(s)All self-identified female respondents to the surveys. Secondary analysis of two rounds of the National Survey of Family Growth, an in-home, nationally representative survey of people ages 15–44 years (2013–2015) and 15–49 years (2015–2017).Intervention(s)None.Main Outcome Measure(s)Current use of a contraceptive method, including use of individual methods and grouped method use in 2016, and change in use from 2014.Result(s)Contraceptive use remained steady between 2014 and 2016 among sexually active females not seeking pregnancy (88%). Among users, use of long-acting reversible contraceptive (LARC) methods increased from 14% to 18%, as use of short-acting reversible contraceptive (SARC) methods fell from 32% to 28%. Implant use among 15- to 19-year-olds rose from 6% to 16% and represents one of the largest increases observed. Access to sexual and reproductive health care was strongly associated with use of all LARC and SARC methods except for the implant (adjusted odds ratios ranged from 3.21 to 13.53).Conclusion(s)Contraceptive users are shifting primarily among the most and moderately effective method groups, and not from contraceptive nonuse to use. Reductions in access to sexual and reproductive health care could have implications for individuals’ ability to use their preferred contraceptive methods.

Adult offspring of lesbian parents: How do they relate to their sperm donors?

To study how adult offspring in planned lesbian-parent families relate to their unknown or known donors. Qualitative analyses of the sixth wave of online surveys from a longitudinal study of adult offspring in planned lesbian families, enrolled at conception. Community-based United States national study. The 76 participants were 25-year-old donor insemination (DI) offspring whose lesbian parent(s) enrolled in a prospective longitudinal study when these offspring were conceived. None. Offspring were asked about donor type, feelings about permanently unknown donor, satisfaction with and role of known donor, whether relationship with known donor was ongoing, and age of meeting open-identity donor. This cohort (n = 76) of DI offspring with lesbian parents was among the first generation to reach adulthood. Thirty participants had permanently unknown donors and most participants felt comfortable about not knowing them. Sixteen participants had open-identity donors they had not met. Thirty had currently known donors-met in childhood (n = 22) or after open-identity donor disclosure (n = 8)-of whom two thirds had ongoing relationships with donors, half considered their donors as acquaintances, and nearly half had good feelings about their relationship, although a minority expressed conflicted feelings. This study of adult DI offspring from planned lesbian families shows that those who knew their donors mainly felt positively about these relationships. Qualitative analyses offered insight into offspring-donor relationships, whose numbers are increasing due to historical and demographic trends.

Investigating the Relationship Between Fatherhood and Provider Weight-Related Practices and Counseling in Clinical Settings

ObjectiveTo assess whether weight-related practices and counseling between men and their medical providers are associated with the patient's fatherhood status. MethodsUsing the 2015–2017 National Survey of Family Growth, logistic regression models were constructed to examine the odds of men being weighed, told a weight status, or referred for nutrition/exercise counseling during a medical visit in the previous year. ResultsThe sample included 2,562 men and 1,272 fathers. Overall, 90%, 76%, and 49% of fathers were weighed by a provider, told their weight status, and referred for nutrition/exercise counseling, respectively. There were no associations between fatherhood status and being weighed or provider weight status communication. Fathers were more likely to be referred for nutrition/exercise counseling compared with those without children during a medical (adjusted odds ratio, 1.61; 95% confidence interval, 1.003–2.583) or routine visit (adjusted odds ratio, 1.81; 95% confidence interval, 1.04–3.16). Conclusions and ImplicationsThe increased likelihood of nutrition or exercise counseling referrals among fathers presents an opportunity to address obesity within families.

HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011-2017 National Survey of Family Growth.

Although there has been significant progress in reducing perinatal human immunodeficiency virus (HIV) transmission, the United States is yet to meet the proposed elimination goal of less than one infection per 100,000 live births. Failure to screen all pregnant women for HIV as recommended by the Centers for Disease Control and Prevention can result in missed opportunities for preventing vertical transmission of HIV with antiretroviral drugs. Using the 2011-2017 National Survey of Family Growth, this study examined HIV testing among pregnant women during prenatal care. We estimated the weighted proportion of self-reported HIV testing among women whose last pregnancy ended within 12 months prior to the interview. Logistic regression models were used to determine the factors associated with HIV testing. Of the 1566 women included in the study, 76.4% (95% confidence intervals [CI] = 72.8-80.0) reported receiving an HIV test during prenatal care. In the multivariable regression model, high school diploma (adjusted odds ratio [aOR] = 1.9, 95% CI = 1.1-3.1), two completed pregnancies (aOR = 1.7, 95% CI = 1.1-2.7), health insurance coverage in the last 12 months (aOR = 1.6, 95% CI = 1.0-2.6), Hispanic race/ethnicity (aOR = 2.8, 95% CI = 1.8-4.4), and non-Hispanic black race/ethnicity (aOR = 2.2, 95% CI = 1.3-3.8) were associated with higher odds of reporting being tested for HIV. However, household income of 300% or more of the federal poverty level (aOR = 0.6, 95% CI = 0.3-0.9) and urban residence (aOR = 0.5, 95% CI = 0.3-0.9) were associated with lower odds of reporting HIV testing. These findings suggest that HIV testing among pregnant women during prenatal care is not universal and may affect achieving the goal of elimination of mother-to-child transmission of HIV in the United States.

1347-P: Contraception Preferences in Women with Diabetes

Objective: Effective contraception use in women with diabetes until glucose control is achieved is one of the key factors for optimizing pregnancy outcomes in this high-risk population. The objective of this analysis was to examine whether contraception utilization varied by presence of maternal diabetes. Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women age 18-44 were included in the analysis. Maternal diabetes was defined as either the presence of pre-gestational diabetes or diagnosis of gestational diabetes. Bivariate and multivariable logistic regression analyses were run to evaluate the association between the use of contraception by contraception type (sterilization, long-acting reversible contraception (LARC), other hormonal method, barrier method and none) and maternal diabetes status. Results: A total of 28,454 women were included in the analysis, with 3,003 (10.5%) women with diabetes during pregnancy. Women with diabetes were less likely to use LARC (7.2% vs. 10.7%) or barrier methods (14.4% vs. 17.6%) compared to controls (p&amp;lt;0.001 for both comparisons). The utilization rates of sterilization and other hormonal methods did not differ between the groups. In multivariable logistic regression, controlling for maternal age, race/ethnicity, body mass index, insurance, education, marital status, family income and diagnosis of sexually transmitted infection, maternal diabetes remained to be significantly associated with lower utilization rates of LARC (aOR=0.73, 95% CI 0.55-0.97) and barrier methods (aOR=0.76, 95% CI 0.59-0.97). Conclusions: In this cohort, women with diabetes were less likely to choose LARC and barrier methods for contraception. As LARC is one of the more effective and safest options of contraception in this high-risk population, further research is required to understand the causes behind this variation in contraception utilization. Disclosure S.L. Walker: None. R. Anguzu: None. L.E. Egede: None. A. Palatnik: None.

1348-P: Social Adaptability Index and Pregnancy Outcomes in Women with Diabetes during Pregnancy

Objective: The social adaptability index (SAI) is a composite indicator capturing an individual’s social adaptability within society and socioeconomic status in order to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women whose pregnancy is complicated by diabetes. Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women with a singleton gestation age 18-44 were included. Maternal diabetes was defined as either presence of pre-gestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: education level, employment status, income, marital status and substance abuse. Higher score indicates lower risk. Multivariable logistic regression models were run to assess the association between SAI and pregnancy outcomes associated with diabetes, including cesarean delivery, macrosomia (birthweight &amp;gt;4000g) and preterm delivery (&amp;lt;37 weeks), stratified by maternal diabetes. All analyses were weighted. Results: A total of 18,304 women were included in the analysis, with 1,965 (10.7%) having diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy, compared to controls (6.7±0.2 vs. 7.2±0.1, p&amp;lt;0.001). In the univariable analysis, the SAI had a significant association with the outcomes of preterm delivery (OR=0.94, p&amp;lt;0.001) and was not significantly associated with cesarean delivery or macrosomia. In adjusted multivariable analysis, controlling for maternal race/ethnicity, insurance status, body mass index, age and partner support of the index pregnancy, SAI remained to be independently associated with preterm delivery among women with diabetes during pregnancy (aOR=0.83, 95% CI 0.77-0.94). Conclusion: Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm delivery. Disclosure A. Palatnik: None. M.Y. Thakkar: None. R.J. Walker: None. L.E. Egede: None.

Changing Educational Differentials in Female Sterilization.

Female surgical sterilization is widely used in the United States. Educational differentials in sterilization are large, but poorly understood. Improved understanding of these differences is important to ensure that all women have access to the full range of contraceptive methods. Data from the National Survey of Family Growth (1973-2015) from 8,100 women aged 40-44 were used to describe trends in sterilization and other contraceptive methods by educational attainment. Demographic standardization was employed to examine how compositional changes in marital status and age at first birth contribute to aggregate changes in sterilization prevalence. In 1982, women with a high school diploma and those with at least a bachelor's degree reported similar levels of sterilization use (38% and 32%, respectively), but by 2011-2015, prevalence had declined to 19% among college-educated women and had increased to 44% among those with a diploma. The trend among college graduates was largely attributable to delayed fertility; all other things being equal, if their age at first birth had not increased, the prevalence of sterilization would have declined by approximately 3% instead of 14% between 1982 and 2002. Increased use of sterilization among women with a high school diploma was only weakly related to changes in birth timing and marital status. Among women with a high school diploma, elements other than childbearing and marital status-such as contraceptive preferences and access-appeared to influence their contraceptive behavior. Sterilization differentials between high school and college graduates may reflect or exacerbate other socioeconomic disparities that affect women's health and well-being.

Abortion Reporting in the United States: An Assessment of Three National Fertility Surveys

Despite its frequency, abortion remains a highly sensitive, stigmatized, and difficult-to-measure behavior. We present estimates of abortion underreporting for three of the most commonly used national fertility surveys in the United States: the National Survey of Family Growth, the National Longitudinal Survey of Youth 1997, and the National Longitudinal Study of Adolescent to Adult Health. Numbers of abortions reported in each survey were compared with external abortion counts obtained from a census of all U.S. abortion providers, with adjustments for comparable respondent ages and periods of each data source. We examined the influence of survey design factors, including survey mode, sampling frame, and length of recall, on abortion underreporting. We used Monte Carlo simulations to estimate potential measurement biases in relationships between abortion and other variables. Underreporting of abortion in the United States compromises the ability to study abortion—and, consequently, almost any pregnancy-related experience—using national fertility surveys.

Unintended Childbearing and Marital Instability: An Emphasis on Couples’ Intentions

ABSTRACT The birth of a child can negatively impact relationship functioning, especially if one or both partners did not intend to have a child. As such, unintended or disagreed-upon births may elevate the risk of dissolution. In this paper, we use the National Survey of Family Growth to consider how married couples characterize the intendedness of their first birth and examine its linkage with dissolution. Nearly one-third of first marital births are unintended by at least one parent. When fathers do not intend the birth, regardless of whether or not mothers do, couples report an elevated risk of dissolution.

Racial Disparities in Emotional Well-Being during Pregnancy.

In light of persistent racial disparities in maternal and child health, it is important to understand the dynamics shaping outcomes for black mothers. We examine racial patterns in women's emotional well-being regarding pregnancy (i.e., women's reported happiness to be pregnant), which has been shown to have health consequences. Using the 2002-2017 National Survey of Family Growth (N = 6,163 pregnancies ending in birth), we find that black women are less happy about their pregnancies than white women both for intended and mistimed pregnancies. The happiness gap in intended pregnancies is partially attributable to differences in economic strain and partner support. In addition, child gender shapes happiness differently by race: Black women who previously had sons are unhappier about current intended pregnancies than those who did not (with no difference for white women). We argue there are pregnancy- and parenthood-related stressors that disproportionately impact black women, with potential implications for mothers and children.

Prevalence of and Factors Associated With Receiving a Pelvic Examination or Pap Testing Under the Age of 21 Years

PurposeCurrent guidelines recommend that individuals receive their first Pap test at age 21 years and only receive a pelvic examination before age 21 years for clinical indications. We sought to determine the prevalence and associated covariates of receiving a pelvic examination or Pap test before 21 years of age. MethodsWe analyzed the 2013–2015 National Survey of Family Growth. We conducted bivariate analyses comparing individuals who had and had not had a pelvic examination or Pap test and multivariable logistic regression to identify factors associated with having a pelvic examination or Pap test under 21 years. ResultsThis study included 1,170 individuals. Of respondents, 30.8% received a pelvic examination and 25.1% received a Pap test before 21 years of age. Receiving a pelvic examination was associated with being sexually active (adjusted odds ratio [aOR]: 6.6, 95% confidence interval [CI]: 3.8–11.7), having ever taken contraceptive pills (aOR: 2.6, 95% CI: 1.6–4.1) compared with no contraceptive method, and being screened for sexually transmitted infections in the past 12 months (aOR: 12.6, 95% CI: 7.3–21.8). Receiving a Pap test was also associated being sexually active (aOR: 7.2, 95% CI: 3.7–14.0), having ever taken contraceptive pills (aOR: 3.0, 95% CI: 1.9–4.7) compared with no contraceptive method, and being screened for sexually transmitted infections in the past 12 months (aOR: 8.94, 95% CI: 5.12–15.61). ConclusionsContrary to contemporary guidelines, a notable proportion of individuals under the age of 21 years continues to receive pelvic examinations and Pap testing.

Condom Use at First Vaginal Intercourse Among Adolescents and Young Adults in the United States, 2002–2017

PurposeThe purpose of this study was to describe trends in vaginal intercourse (VI) and condom use during first VI from 2002 to 2017 among never-married 15- to 24-year-olds in the United States. MethodsData come from the National Survey of Family Growth. We used logistic regression and Stata's margins package to estimate the percentage reporting VI and condom use at first VI and to conduct statistical comparisons across time. ResultsVI was stable for 20- to 24-year-old men, but their condom use increased after 2002. For 15- to 19-year-old men, VI declined after 2011-2015 but condom use increased (83%). Among women, the overall percentage reporting VI and partner's condom use was stable, despite a significant increase in condom use among 15- to 19-year-olds between 2006–2010 and 2011–2015 (69%–75%). ConclusionsCondom use at first intercourse increased among young men, but a similar pattern was not observed for young women. Understanding why is crucial to the formulation of strategies to increase condom uptake.

Sociodemographic Trends in Long Acting Reversible Contraception vs. Female Sterilization, 2006-2017 [33I

INTRODUCTION: Historically, female sterilization (FS) has been disproportionately concentrated among racial minorities and women with lower education and income. Given increasing popularity of long-acting reversible contraception (LARC), we examined changing socio-demographic patterns of FS and LARC usage. METHODS: We used data files from the National Survey of Family Growth 2006-2010 (earlier) and 2015-2017 (later) survey waves. We analyzed all women of reproductive age not seeking pregnancy, with a sub-analysis of FS and LARC, and extracted socio-demographic information. RESULTS: We included 11,073 respondents. From the earlier to later cohort, the prevalence of LARC increased 3-fold (7% to 20%), while FS dropped (25% to 22%). In our sub-analysis comparing LARC vs FS users (n=3918), the adjusted likelihood of LARC use was greater in the later cohort (OR 2.3 [1.6, 3.4]). When comparing LARC to FS in both cohorts, there were non-significant trends of reduced LARC use in black women (OR 0.51 [0.3, 1.1]), while Hispanic women emerged as more likely to use LARCs in the later cohort (OR 1.5 [0.9, 2.7]). Overall, the most significant predictors of LARC use in the later cohort remained younger age (&gt;35), higher income ($75,000), and more education (OR 3.6 [1.9, 6.6], 5.3 [1.8, 15.9], and 4.5 [2.1, 9.7], respectively). Living in a metropolitan area emerged as a new predictor of LARC use over FS in the later cohort (OR 3.0 [1.3, 7.3]). CONCLUSION: Although LARC use increased and FS decreased, the most significant predictors of LARC over FS include higher income, more education and metropolitan residence, suggesting inequities in access.

Trends in Contraceptive Methods Among Substance Abusers Reveals Unmet Need [36I

INTRODUCTION: Female substance abusers are a vulnerable population facing numerous barriers to care, especially gynecological health. Access to contraception is a crucial part of women’s health; however, research on contraceptive use in substance abusers is limited. Our aim was to investigate contraceptive methods in a women’s substance abuse rehabilitation facility. METHODS: Data was taken from 697 intake surveys of reproductive-aged women between 2013 and 2019. Analysis examined contraceptive use by sociodemographic variables. Trends were compared with data from 2015-2017 National Surveys of Family Growth and 2017 state-level data from the CDC. RESULTS: The majority of women did not use contraceptives (40.3%), were sterilized (22.7%) or used condoms (21.1%). Compared to national and Louisiana-specific rates, this data reveals significantly higher proportions of no contraception and sterilization; conversely, there were lower rates of hormonal and long-acting reversible contraceptive methods (6.9; 4.9%). Substance-abusing women reported sterilization at a younger age (37) compared to national averages. 64.8% reported Medicaid enrollment; education and insurance were independent of contraceptive choice (X2=5.76, P=.22; X2=3.15, P=.53; P&lt;.05). CONCLUSION: Women in rehabilitation reported both a high rate of sterilization, and limited use of reversible contraceptives. Lack of variability in method could include amenorrhea from chronic substance use, mistrust of the healthcare system, and inadequate education on gynecological health. Residential rehabilitation facilities provide a unique opportunity for providers to deliver contraceptive education in a positive, encouraging environment, while women are focused on making positive lifestyle changes. Addressing this need would give these women greater autonomy over their health and fertility.

Prematurity and breastfeeding initiation: A sibling analysis.

Studies suggest breastfeeding initiation is less common for premature infants. This association may be confounded by socio-economic characteristics that correlate with the risk of premature birth. We compared premature and term-born children to determine whether prematurity independently predicted likelihood of breastfeeding continuation and duration. Data were obtained from women ages 15-44years reporting at least two live pregnancies on the 2011-2017 National Survey of Family Growth. Participants completed a pregnancy and breastfeeding history. Breastfeeding initiation was defined as breastfeeding for at least 1week, and duration of exclusive breastfeeding was recorded in months. Sibling fixed effects regression models were used to evaluate the impact of prematurity. Among families with some children who were breastfed and others who were not (n=2848 children), preterm birth was not associated with breastfeeding initiation (odds ratio=1.11; P=.468). Among children who were ever breastfed, exclusive breastfeeding lasted 5% fewer months among children born preterm, compared with term-born siblings (incidence rate ratio=0.95; P=.060). Using sibling-group analysis to control for confounding, we found no independent association between prematurity and likelihood of breastfeeding initiation. This suggests interventions supporting breastfeeding for premature infants may need to address external barriers to breastfeeding not specifically preterm birth.

Refining assessment of contraceptive use in the past year in relation to risk of unintended pregnancy

ObjectivesHealthy People 2020 establishes objectives for reducing the proportion of pregnancies in the United States that are unintended and for improving contraceptive use. This analysis describes ways to more closely align measurement of contraceptive use with periods of risk for unintended pregnancy using the National Survey of Family Growth (NSFG). MethodsUsing the 2011–2015 NSFG we constructed two measures of contraceptive use for women we defined as at risk of an unintended pregnancy: (1) we augmented a measure of recent contraceptive use by recoding non-users according to their method use during their last month of sex in the past 12 months; (2) we augmented use at last sex in the past 12 months by excluding women who were pregnant at last sex. Estimates were compared overall and within 5-year age groups. ResultsThe augmented measure of recent contraceptive use found fewer women to be using no contraception than the standard measure (7.3% vs 15.4%; p < .001); greater differences were found between the two measures for younger women. When considering contraceptive use at last sex, the augmented measure identified fewer women as using no contraception (15.8% vs 21.0%; p < .001) than the standard measure and more women to be using a most effective method (33.3% vs 31.1%; p = .04) than the standard measure. ConclusionsAligning periods of unintended pregnancy risk with contraceptive use assessment reduced estimates of no contraceptive use; changes in estimates by method type varied by age. ImplicationsWhen assessing contraceptive use for the purpose of unintended pregnancy prevention, researchers may consider the methods described here to further align contraceptive use measurement with periods of unintended pregnancy risk.

Re: Estimates of Donated Sperm Use in the United States: National Survey of Family Growth 1995-2017.

Re: Estimates of Donated Sperm Use in the United States: National Survey of Family Growth 1995-2017.

Gender Differences in the Marital Plans and Union Transitions of First Cohabitations

In an era of changing relationship norms, plans for marriage are an increasingly complex yet important indicator of the link between cohabitation and marriage. Despite qualitative evidence on this complexity, little is known about the nuances of marital plans and gender differences at the population level. This study introduces the concept of “informal” marital plans—cohabitations beginning with some intentions to marry that had yet to be formalized. Drawing on data of heterosexual cohabitors in their first coresidential union from the National Survey of Family Growth (2011–2015, n = 5545), I examine the sociodemographic correlates of marital plans as well as their consequences for men’s and women’s union transitions. The results show significant gender differences in reports of marital plans at the time of moving in together, with women more likely to report engagement and men more likely to report informal marital plans. Although having any marital intentions is positively associated with transitioning to marriage for both genders, engagement is a significantly stronger predictor of marriage than informal marital plans. Pronounced gender differences are found with respect to the dissolution of first cohabitations, as both informal and formal marital plans are more protective against dissolution for men than for women. Distinguishing informal marital plans from engagement provides meaningful new insights into the role of cohabitation in modern American union formation.