Considering planning salience in women's pregnancy intentions: Table 1

Abstract

Despite widespread availability of and knowledge about contraception in the USA, nearly half of all pregnancies are unintended.1 Recent evidence suggests that many women are ambivalent about avoiding or trying for pregnancy.2 With ambivalence about getting pregnant linked to inconsistent contraceptive use, 3 scholars have called for greater understanding of the complex dimensions of pregnancy intentionality in order to reduce negative outcomes associated with unintended pregnancy.4 Extant research has not explored the importance of pregnancy intentions or planswhat we defi ne as 'planning salience'.Using data from structured interviews and surveys of pregnancy intentions and behaviours of 56 women of childbearing age in a South-central city, we examined women's opinions about the importance of planning their pregnancies and the factors that infl uenced pregnancy intentions and behaviours. Participants discussed the importance of pregnancy planning in three distinct ways. A slight majority of the women (n=29, 52%) reported that planning their pregnancies was very important. These women discussed the importance of planning other major life events in addition to pregnancy or framed the importance of planning in terms of being in control of their lives. One woman said "I'd like to plan it; I'd like to be in control. I'm kind of a control freak when it comes to, you know, just almost everything".Other women (n=15, 27%) reported that planning their pregnancies was moderately important to them. These women had some plan for pregnancy and childbearing, but it was vague or involved a loose timeline. One woman said "Who cares? What's 3 or 4 months? … It isn't that big of a deal".A smaller but substantial number of women (n=12, 21%) reported that planning pregnancies was of very little or no importance. These women made statements such as "We haven't been actively trying, but we haven't not tried either. It was kinda [sic] if we get pregnant kind of thing" and "I'm just like, 'If the universe wants me to have a kid, then I'll have a kid'". A descriptive analysis of our sample shows higher percentages of multiple unplanned pregnancies and living in or near poverty among women with low planning salience (Table 1).These fi ndings suggest that women's planning salience may be critical to explaining the frequent mismatch between pregnancy intentions and behaviours. Given that unintended pregnancies are associated with negative maternal and child outcomes, 5 this study suggests a need for practitioners to initiate discussions about pregnancy intentions with women of childbearing age in order to improve maternal and child health outcomes. Practitioners and policymakers should be aware that some women do not believe that planning for pregnancy is very important, as this might have notable implications for contraceptive and healthrelated behaviours. Policies or programmes aimed at reducing unintended pregnancies should go beyond making contraception affordable and available and perhaps offer information about how women and families...

Prospective Attitude about the Importance of Planning Pregnancies Is Associated with Retrospective Attitude toward a Specific Pregnancy

“…As noted above, one quarter of the women (25 percent) in the sample disagreed or disagreed strongly that it is important to plan pregnancies. This finding challenges the assumption sometimes made by fertility researchers that virtually all women endorse the planning schema and supports the claim made by many that women differ in the importance they attribute to the idea of planning pregnancies (Barrett and Wellings 2002;Borrero et al 2015;Fortier and Foster 2017;Geist et al 2019;Gomez et al 2018;Hernandez et al 2020;Jones 2018;Kendall et al 2005;Rocca et al 2013;Shreffler et al 2012). The results also demonstrate that, contrary to assumptions in much research on "unintended pregnancies," a substantial minority of women are not planful, but rather nearly a third described themselves as okay either way at the time of their pregnancies.…”

Pregnancy intentions—a complex construct and call for new measures

“…We relaxed three assumptions, with each change based on prior evidence as outlined below (20, 30–34, 38, 47–50). First, we classified pregnancies to women who responded that they did not want another child but were not using birth control, and did not stop using contraception to become pregnant, but did not mind becoming pregnant as intended in the new construct.…”

“…First, we classified pregnancies to women who responded that they did not want another child but were not using birth control, and did not stop using contraception to become pregnant, but did not mind becoming pregnant as intended in the new construct. Much prior research has noted that in many cases women express ambivalence about their pregnancy intention (30–33, 38, 47). This ambivalence may stem from several reasons including expressing that planning is a not a salient concept (47), childbearing plans may not be fully formed, many women may not feel that they have reproductive control (34), having both positive and negative pregnancy desires (33), or their partners may also express ambivalence (30).…”

“…Much prior research has noted that in many cases women express ambivalence about their pregnancy intention (30–33, 38, 47). This ambivalence may stem from several reasons including expressing that planning is a not a salient concept (47), childbearing plans may not be fully formed, many women may not feel that they have reproductive control (34), having both positive and negative pregnancy desires (33), or their partners may also express ambivalence (30). It is becoming increasingly apparent that there is a need to evaluate the role of paternal intention in reproductive decisions as well (20, 30, 48, 49).…”

Variation in Pregnancy Intendedness Across U.S. Women’s Pregnancies

“…Many pregnancies may be neither planned nor unplanned; nearly a quarter of American women identify themselves as ''okay either way'' when asked if they are trying to get pregnant [11]. A study of the complexity of pregnancy intentions revealed an ambivalent (''don't care'') dimension [12], and a qualitative study suggests that some women report difficulty identifying their pregnancies as ''planned'' or ''unplanned'' because planning their pregnancies is not a salient concept for them [13].…”