CONTEXT-Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire.METHODS-Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings.
RESULTS-The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness.CONCLUSIONS-Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods.Unintended pregnancy is a persistent public health issue in the United States: An estimated 51% of pregnancies each year are unintended-a figure that has changed little since 1994. 1 Unintended pregnancies are associated with an increased risk of adverse maternal and neonatal outcomes. 2 Yet, much debate still surrounds the measurement and interpretation of women's pregnancy intentions, particularly in relation to their feelings about pregnancy. 3,4 According to Trussell et al.'s examination of contraceptive failures reported in the 1995 National Survey of Family Growth (NSFG), women frequently professed happiness about pregnancies that they classified as unintended. 5 The NSFG relies on women's retrospective reports of their pregnancy intentions and feelings (i.e., reports made after the pregnancy or birth has already occurred), which are susceptible to recall bias. 6 However, the same incongruence between intentions and feelings has been demonstrated with data measured prospectively (i.e., based on a hypothetical future pregnancy or birth). 7 This incongruence has been found to be more common among Latina women than among non-Hispanic whites. 8,9 In the current literature, happiness about pregnancies that would be or were unintended is commonly interpreted as a reflection of ambivalence about avoiding conception. [10][11][12] Yet, an alternative explanation is that intentions and feelings are ...