O14Pregnancy and abortion: A longitudinal study of the predictive ability of people's desire to avoid pregnancy

Abstract

<h3>Objectives</h3> Understanding the relationships between people's pregnancy desires and outcomes is essential to guiding patient-centered reproductive healthcare and measuring attainment of reproductive preferences. <h3>Methods</h3> We used longitudinal data from participants aged 15–34 recruited in 2019–2022 from 23 healthcare facilities in the Southwestern US (n=1,792, n=11,246) to investigate how pre-pregnancy Desire to Avoid Pregnancy (DAP) scale scores predict new pregnancies, post-pregnancy feelings, and abortion. At baseline and quarterly for 13.5 months, participants responded to the DAP scale, a validated pregnancy preferences measure. Those with incident pregnancies responded to modified DAP scale items assessing feelings about the current pregnancy and were followed through birth or abortion. We used mixed-effects models to examine the scale's predictive associations. <h3>Results</h3> Mean quarterly DAP scale scores were 2.27 (SD:1.08, range:0-4, 4=higher preference to avoid pregnancy, α=0.96). Pregnancy preferences strongly predicted pregnancy (OR=0.37 [0.28-0.51] per point): the predicted three-month probability of pregnancy was 17.2% for DAP=0, 5.3% for DAP=2, and 1.2% for DAP=4. Those who were open to pregnancy beforehand (DAP≤2) generally expressed similarly positive feelings post-pregnancy (mean:0.76, SD:0.61, α=0.95), but those who had higher desire to avoid pregnancy (DAP>2) expressed broad ranges of feelings post-pregnancy (mean:2.08, SD:1.05). 24% of pregnancies ended in abortion. DAP scores strongly predicted abortion (OR=2.21 [1.56-3.15]), but participants at every DAP level had abortions (predicted 6.3% for DAP=0, 27% for DAP=2, 68% for DAP=4). <h3>Conclusions</h3> People's reproductive preferences can change after pregnancy discovery, particularly if they desired to avoid one. Although DAP scores strongly predict abortion, people across the spectrum of preferences may choose to have an abortion.