Abstract
ContextStandard pregnancy intentions measures do not always align with how people approach pregnancy. Studies that have investigated beyond a binary framework found that those with “ambivalent” feelings towards pregnancy are less likely to use contraception consistently, but the reasons for this are unclear. We sought to gain a nuanced understanding of pregnancy desires, and how perceptions about pregnancy are associated with contraceptive use.MethodsWe used non-probability quota sampling based on sex, age, and geographic region for a web-based survey of heterosexual men and women, aged 21–44 years, who could become pregnant/impregnate and were not currently pregnant (n = 1,477; 51% female). The survey was created using unique items informed by recent literature. Bivariate and multivariable analyses explored relationships between various perceptions about pregnancy with pregnancy desires categorized as: wanting a pregnancy, not wanting a pregnancy, and not trying but would be okay with a pregnancy. We conducted a sub-group analysis of those who were not trying but would be okay with a pregnancy (n = 460), using descriptive statistics to examine how consistent contraceptive use was associated with emotions and beliefs about avoiding pregnancy.ResultsAfter adjustment, those who felt that pregnancy may not always be avoidable, but instead determined by fate/higher power, or a natural process that happens when it is meant to, were significantly more likely (aOR: 1.83, 95% CI: 1.05–3.36; aOR: 2.21, 95% CI: 1.29–3.76, respectively) to report not trying but being okay with pregnancy, whereas those with negative feelings about a pregnancy were less likely to feel okay about a pregnancy (aOR: 0.11, 95% CI: 0.08–0.15), versus not wanting a pregnancy. In the sub-group analysis, those who felt pregnancy was determined by fate/higher power or a natural process were more likely to report not using contraception consistently (70%, 68%, respectively).ConclusionsThose who state they are not trying but would be okay with pregnancy may not use contraception consistently because of beliefs that pregnancy is predetermined. Our findings support less categorical and more multidimensional approaches to measuring fertility intentions, with important implications for reproductive health service provision.
Highlights
Demographers and other public health researchers have measured pregnancy intentions for nearly 80 years in order to understand fertility-related behaviors and trends [1]
Those who felt that pregnancy may not always be avoidable, but instead determined by fate/higher power, or a natural process that happens when it is meant to, were significantly more likely to report not trying but being okay with pregnancy, whereas those with
The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Demographers and other public health researchers have measured pregnancy intentions for nearly 80 years in order to understand fertility-related behaviors and trends [1]. Clinicians use measures to gauge fertility intentions prospectively in clinical encounters, in an effort to determine patients’ need for contraception or preconception care [3, 4]. This intentions-oriented framework assumes that a planned approach to becoming pregnant or avoiding pregnancy is universal. Research has focused on investigating how sociodemographic characteristics, such as race/ethnicity and income level, are associated with pregnancy intentions [6] This does little, though, to help identify if and what areas of need exist, beyond labeling sub-groups as being “at risk” of unintended or unplanned pregnancies
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