Critiquing the Unintended Pregnancy Framework

Abstract

The unintended pregnancy framework, a central tenet of sexual and reproductive health care delivery and research, has been depicted as an adverse outcome that should be prevented. There is growing criticism of the inadequacies of this framework, although little modification in public health guidelines, measurement, or clinical practice has been seen. This article critically reviews the literature on unintended pregnancy to encourage reflection on how this framework has negatively influenced practice and to inspire the advancement of more patient‐centered care approaches. We begin by outlining the historical origins of the unintended pregnancy framework and review how this framework mischaracterizes patients’ lived experiences, fails to account for structural inequities, contributes to stigma, and is built upon weakly supported claims of a negative impact on health outcomes. We close with a discussion of the relationship between health care provision and unintended pregnancy care and the implications and recommendations for realigning clinical practice, research, and policy goals.

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study

“…This suggests that mental health during pregnancy is an important influence on maternal health later in life, which is in line with previous studies. 68 Hence, in line with recent recommendations from other researchers in the field, 69 current results imply that the circumstances around the pregnancy might be more important than the actual amount of pregnancy intendedness to explain maternal psychological distress later in life.…”

Research and Professional Literature to Inform Practice, March/April 2024

“…Most reproductive health organizations in the United States define abortion as “an intervention (or medication) intended to terminate a pregnancy so that it does not result in a live birth.” 1 However, in public conversation, what constitutes an abortion and how we talk about abortion are deeply intertwined with abortion stigma 2 , 3 . How people understand and define abortion, as well as other reproductive health outcomes, is critical for collecting accurate data and ensuring individuals have access to the evidence‐based, supportive health care that they need 4 , 5 . In a post‐ Dobbs world, the public is growing increasingly more aware of the many reasons a person may need or want abortion care.…”

“…Long‐acting reversible contraception (LARCs) were once heralded as helping usher in the end of unplanned pregnancy. Increasingly, researchers, activists, and patients have highlighted how the emphasis on a particular method or clinical outcome (eg, planned vs unplanned pregnancy) can come at the expense of patient autonomy and agency 1 . However, the promotion of LARC methods over other contraceptive methods, especially to individuals from marginalized groups, continues to be well documented 2–4 .…”

Providing Inpatient Contraception Care Within a Reproductive Justice Framework

“…9 Furthermore, the unintended pregnancy framework has led to the categorization of people of color as high risk and encourages providers to prioritize contraception efficacy over individual client goals and autonomy. 12 Many of these practices and biases perpetuate stratified reproduction in current contraceptive counseling of Black and Latina women who report feeling pressured into methods which did not align with their reproductive goals and were heavily focused on LARC options. 9 These historical and recent practices have greatly contributed to the distrust people have toward medical systems and health care providers, underscoring the importance of contraceptive care based on the principles of reproductive justice.…”

“…Documented accounts of coercive contraceptive care leading to sterilization and placement of LARCs occurred as recently as 2010 and 2017 9 . Furthermore, the unintended pregnancy framework has led to the categorization of people of color as high risk and encourages providers to prioritize contraception efficacy over individual client goals and autonomy 12 . Many of these practices and biases perpetuate stratified reproduction in current contraceptive counseling of Black and Latina women who report feeling pressured into methods which did not align with their reproductive goals and were heavily focused on LARC options 9 .…”