Pregnancy intentions—a complex construct and call for new measures

Abstract

Objective To estimate the prevalence of unintended pregnancies under relaxed assumptions regarding birth control use compared with a traditional constructed measure. Design Cross-sectional survey. Setting Not applicable. Patients Nationally representative sample of U.S. females aged 15–44 years. Intervention(s) None. Main Outcome Measure(s) The prevalence of intended and unintended pregnancies as estimated by 1) a traditional constructed measure from the National Survey of Family Growth (NSFG), and 2) a constructed measure relaxing assumptions regarding birth control use, reasons for non-use, and pregnancy timing. Results The prevalence of unintended pregnancies was 6% higher using the traditional constructed measure as compared to the approach with relaxed assumptions (NSFG: 44%, 95% confidence interval [CI] 41, 46; new construct 38%, 95% CI 36, 41). Using the NSFG approach only 92% of women who stopped birth control to become pregnant and 0% of women who were not using contraceptives at the time of the pregnancy and reported that they did not mind getting pregnant were classified as having intended pregnancies, compared to 100% using the new construct. Conclusion Current measures of pregnancy intention may overestimate rates of unintended pregnancy, with over 340,000 pregnancies in the United States misclassified as unintended using the current approach, corresponding to an estimated savings of $678 million in public health care expenditures. Current constructs make assumptions that may not reflect contemporary reproductive practices and improved measures are needed.

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women

“…In contrast, we assessed utility among currently pregnant women close to the time of pregnancy diagnosis, and controlled for potential confounders in multivariable analysis. Further, use of multidimensional context measures beyond traditional measures of planning and intention are integral to improving our understanding of individual pregnancy perspectives and essential for evaluating impact of various strategies for addressing women’s reproductive healthcare needs [11,12]. However, there has been a lack of data on utility with respect to different pregnancy contexts in the literature.…”

“…As perspectives on hypothetical health states differ from individuals’ actual experiences [10], research is needed to better characterize the utility of pregnancy in unfavorable pregnancy contexts using more relevant study populations. Furthermore, recent literature has called for awareness of the limitations of considering only whether a pregnancy was intended or planned when evaluating the effects of the pregnancy on a woman’s life and health [11,12], Multidimensional pregnancy perspectives may be relevant to women’s perceived utility of pregnancy as well.…”

Pregnancy context and women’s health-related quality of life

“…NSFG data provide large sample sizes, however retrospective pregnancy assessments (questions about pregnancy are asked after a woman has given birth) are subject to recall and social desirability bias [18,20]. NSFG focuses on “timing-based” measures of unintended pregnancy including whether women wanted a baby/another baby, and if they did, whether they wanted that baby sooner or later than the referenced pregnancy actually occurred, and assumes that contraceptive use reflects pregnancy intentions.…”

“…By evaluating pregnancy contexts that include both assessments of pre-pregnancy perceptions and women’s assessments after pregnancy diagnosis, we aimed to address multidimensional aspects of unintended pregnancy [18] and incorporate ideas about the ways in which “women’s preconception desires and emotional orientations toward pregnancy may evolve after conception has occurred [19]. ” This approach also addresses criticisms of previously overly simplistic and dichotomous characterization of pregnancies as intended or unintended [20], which may not be relevant to some women [21]. …”

Preconception stress and the secondary sex ratio in a population-based preconception cohort

“…Our findings await corroboration before a more complete interpretation of the findings is possible in light of our important study limitations and uncertain external validity, if couples planning pregnancy have unique mood or stress profiles relative to unplanners. Still, the majority of births in the United States are reported planned (67). Some unique but unmeasured characteristics of our study cohort may be an explanation for a slightly higher age among men who fathered boys than among those who fathered girls noted in our study, which is contrast to existing literature (51, 54).…”