Pregnancy Intendedness Research Articles

Defining dimensions of pregnancy intendedness.

The classification scheme used by the National Survey of Family Growth (NSFG) is a well-established system for defining the intendedness of pregnancy, but its clinical relevance is uncertain. The purpose of this study was to explore how women conceptualize the intention status of their pregnancies and how their concepts relate to the classification scheme used by the NSFG. This qualitative study used in-depth, semistructured, open-ended interviews with 27 pregnant women seeking prenatal care or abortion. Sampling was based on ethnicity (Caucasian or Hispanic), education, religiosity, and NSFG intention status (intended, mistimed, or unwanted). Five qualitative dimensions of pregnancy intendedness emerged: preconception desire for pregnancy, steps taken to prepare for pregnancy, fertility behavior and expectations, postconception desire for pregnancy, and adaptation to pregnancy and baby. The relationship of these qualitative dimensions to the NSFG categories was varied and complex, particularly for the NSFG mistimed category. Women indicated that their partners had a strong influence on preconception and postconception desire for pregnancy. Further research is needed to develop measures of pregnancy intendedness that accurately reflect the needs and priorities of women. Research that addresses male perspectives and influence is of particular importance.

Pregnancy Intentions May Not be a Useful Measure for Research on Maternal and Child Health Outcomes

The findings of three researchers about pregnancy intendedness as a measure for understanding maternal and child health outcomes were evaluated. Studies have linked unintended pregnancy to some behaviors and to negative birth weight. Several issues undermine the validity of intendedness as it is presently measured, such as recall bias implicit in retrospective queries about intention; and pregnancy intention as a complex concept. Moreover, discrepancies between the stated and actual contraceptive practice of women also complicated the issue of intention status. Also, the issue of mistimed versus unwanted pregnancy presented another problem. Thus, intendedness may be too complex to quantify and measure accurately.

The Correspondence Between Intention to Avoid Childbearing and Subsequent Fertility: A Prospective Analysis

Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.

Pregnant women's perspectives on intendedness of pregnancy

This study examined whether intendedness is a valued characteristic of pregnancy and what factors influence women to risk unintended (unwanted or mistimed) pregnancy. Study participants were 24-34 weeks pregnant, White or Black, aged 18-30, and receiving prenatal care from a publicly funded clinic in North Carolina. Information gathered from 8 focus group sessions (14-15 participants each) revealed that: 1) the concept of a planned pregnancy had no meaning to many of the women; 2) religious beliefs helped people accept unintended pregnancy; 3) planning for pregnancy is a stressful concept because of potential disappointment; 4) unprotected intercourse without pregnancy leads to assumptions of infertility; 5) attitudes of male partners, friends, and family members influence women to risk pregnancy; 6) women adapt to unintended pregnancy very readily; 7) there are no uniform situational risks for unintended pregnancy; and 8) unintended pregnancies are more advantageous than not for some women. These results question the assumption that intendedness of pregnancy is preferred among low-income women or that the pregnancies are "subintended." While interventions to increase intendedness focus on access to contraception, study participants reported no barriers to access as a reason for conception. Health educators should consider the ramifications of teaching that pregnancy can result from a single act of unprotected intercourse without also teaching that pregnancy can occur after several acts of unprotected intercourse. These findings suggest hypotheses that should be explored with further research.

The Impact of a Preconceptional Health Promotion Program on Intendedness of Pregnancy

The objective for this study was to determine whether a brief preconceptional health promotion program for low-income women attending family planning clinics impacts on intendedness of pregnancy. In this prospective study, we examined data on 1378 women presenting for prenatal care at three local health departments. Each of the departments offers a standardized preconceptional health promotion program in its family planning clinics. Comparisons were undertaken for 456 women who had been exposed to the family planning preconception program, 309 women who had attended the family planning clinics but had not been exposed to the program, and 613 women who were unknown to the health department before beginning prenatal care. Women exposed to information on preconceptional health during routine family planning visits, the experimental group, had a 51.8% (p = 0.064) greater likelihood of identifying their pregnancies at intended than a group known to the local health departments' family planning programs but unexposed to the intervention. Furthermore, the experimental group had a 64.2% (p = 0.0009) greater likelihood of intendedness than a comparison group not known to the health departments before the initiation of prenatal care. Our study indicates that an introductory program of preconceptional health promotion which is targeted to women not planning a pregnancy in the immediate future is associated with a higher rate of intendedness in subsequent pregnancies. Expansion of similar preconceptional programs in family planning clinics may prove a useful approach for promoting intendedness of pregnancy in low-income women.

The relationship between pregnancy intendedness and physical violence in mothers of newborns

To determine if pregnancy intendedness is associated with physical violence, and to identify factors that modify this association. Three to 6 months after delivery, we mailed a questionnaire to a population-based sample of 12,612 mothers of infants born during 1990 and 1991 in four states. We used multiple logistic regression to compute odds ratios. The state-specific prevalences (+/- standard error) of physical violence ranged from 3.8 +/- 0.5 to 6.9 +/- 0.8%; the prevalences of unwanted or mistimed pregnancies ranged from 36.9-46.3%. In each state, higher rates of physical violence were reported by women who had fewer than 12 years of education, lived in crowded conditions, participated in the Special Supplemental Food Program for Women, Infants, and Children, received no or delayed prenatal care, or were of races other than white, under 20 years old, or not married. Regardless of other attributes, women with unwanted or mistimed pregnancies reported higher rates of physical violence than women with intended pregnancies and accounted for 70% of women who reported physical violence. Overall, women with unwanted pregnancies had 4.1 (95% confidence interval 2.7-6.2) times the odds of experiencing physical violence than did women with intended pregnancies. This association was weaker for women with few social advantages than for those with more advantages. Physical violence toward women during the periconceptional and antenatal periods occurs in all sociodemographic groups. Women with unwanted or mistimed pregnancies are at an increased risk for violence by their partners compared with women with intended pregnancies.

Perceptions of Single vs. Partnered Adult Gravidas in the Midtrimester

Perceptions of the pregnancy experience, pregnancy intendedness, and partner status were compared in a sample of 30 women in the midtrimester. Half of the sample defined themselves as single and half as partnered. Interview data showed a full range in pregnancy intendedness and partner status, and shared areas of concern among the sample as a whole and areas of concern specific to single women. Single women's concerns clustered into four categories: decision-making, disclosure, social support, and legal issues.