Public reproductive health and ‘unintended’ pregnancies: introducing the construct ‘supportability’

Macleod, Catriona

doi:10.1093/pubmed/fdv123

Cited by 67 publications

(13 citation statements)

References 22 publications

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“…Potter et al suggest querying women and men about not only the contraceptive method they are using, but what they would ideally like to be using, as a means of evaluating if they have access to their preferred method. MacLeod also suggests we reconsider intentions altogether and instead measure pregnancy "supportability" [36]. Her model highlights the micro-and macro-level supports available or lacking for having a pregnancy; researchers and policy makers can expand this framework to include preventing a pregnancy.…”

Section: Discussionmentioning

confidence: 99%

The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions

Manze

Romero

et al. 2021

PLoS ONE

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Context Standard pregnancy intentions measures do not always align with how people approach pregnancy. Studies that have investigated beyond a binary framework found that those with “ambivalent” feelings towards pregnancy are less likely to use contraception consistently, but the reasons for this are unclear. We sought to gain a nuanced understanding of pregnancy desires, and how perceptions about pregnancy are associated with contraceptive use. Methods We used non-probability quota sampling based on sex, age, and geographic region for a web-based survey of heterosexual men and women, aged 21–44 years, who could become pregnant/impregnate and were not currently pregnant (n = 1,477; 51% female). The survey was created using unique items informed by recent literature. Bivariate and multivariable analyses explored relationships between various perceptions about pregnancy with pregnancy desires categorized as: wanting a pregnancy, not wanting a pregnancy, and not trying but would be okay with a pregnancy. We conducted a sub-group analysis of those who were not trying but would be okay with a pregnancy (n = 460), using descriptive statistics to examine how consistent contraceptive use was associated with emotions and beliefs about avoiding pregnancy. Results After adjustment, those who felt that pregnancy may not always be avoidable, but instead determined by fate/higher power, or a natural process that happens when it is meant to, were significantly more likely (aOR: 1.83, 95% CI: 1.05–3.36; aOR: 2.21, 95% CI: 1.29–3.76, respectively) to report not trying but being okay with pregnancy, whereas those with negative feelings about a pregnancy were less likely to feel okay about a pregnancy (aOR: 0.11, 95% CI: 0.08–0.15), versus not wanting a pregnancy. In the sub-group analysis, those who felt pregnancy was determined by fate/higher power or a natural process were more likely to report not using contraception consistently (70%, 68%, respectively). Conclusions Those who state they are not trying but would be okay with pregnancy may not use contraception consistently because of beliefs that pregnancy is predetermined. Our findings support less categorical and more multidimensional approaches to measuring fertility intentions, with important implications for reproductive health service provision.

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Section: Discussionmentioning

confidence: 99%

The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions

Manze

Romero

et al. 2021

PLoS ONE

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“…In light of our findings, we clearly need enhanced language to more accurately capture the different ways in which people conceptualize getting pregnant. Recent suggestions have been to assess measures of reproductive autonomy as the desired outcome of interest, as opposed to intentions [40], or pregnancy “supportability,” that is, the extent to which a woman’s pregnancy is supported by her health, partner, family, health care team, and more structural social and health care policies [41].…”

Section: Discussionmentioning

confidence: 99%

A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study

2019

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Background Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy. Methods We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18–35, in the United States. Data were analyzed using grounded theory methodology. Results Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that ‘just happens.’ The third group represented a blending of both notions. Conclusions Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined . These findings can be used to improve measurement, health services, and better direct public health resources.

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“…Instead, the lens for considering pregnancy intention statistics would benefit from a focus on the structural inequities that condition a woman’s opportunities throughout her life course and frame the trade-offs she faces in fulfilling multiple social roles. The desire and ability to control the various domains of life needed to “intend” a pregnancy are sensitive to social inequities which produce differential socioeconomic opportunities, support systems, levels of academic preparation, and barriers to reproductive autonomy and maternal and child well-being (Macleod, 2015). We also suggest that clinicians who see women -- particularly young or disadvantaged women -- develop structural competency and humility, or the recognition of structural constraints in their lives (Metzl & Hansen, 2014), and adopt an approach that prioritizes young women’s socially-situated family planning and health priorities and is sensitive to disparities in the structural challenges and opportunities women face in a multicultural and unequal society (Gubrium et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

The Best of Intentions: A Structural Analysis of the Association between Socioeconomic Disadvantage and Unintended Pregnancy in a Sample of Mothers from the National Longitudinal Survey of Youth (1979)

Wise

Geronimus

Smock

2017

Women's Health Issues

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Objectives Births to less-educated women are more likely to be classified as unintended than other births. We question a common interpretation that this association reflects lack of contraceptive knowledge or self-efficacy among less-educated women. We theorize that differences in early life educational advantages structure pregnancy desires and the salience and opportunity costs of precise fertility timing. We hypothesize that net of covariates indicative of early educational disadvantage, mothers with less education are not more likely to report births as unintended compared to mothers who have attained higher levels of education before becoming mothers. Methods Using multivariate regression, we analyze a sample of women in the National Longitudinal Survey of Youth 1979 who had their first births by 1994. We test whether an index measure of educational advantage in youth predicts unintended first birth. Results Unadjusted results confirm well-documented associations between educational disadvantage and greater likelihood of unintended pregnancy. However, once covariates are controlled, those with high educational advantage in youth are more likely to report their first birth as mistimed (RRR: 1.57). Discussion Educational advantage captures expectations about how much education a young woman will obtain before giving birth and is a structural dynamic that precedes proximate factors related to family planning access and behaviors. These findings highlight the need to incorporate structural factors that condition perceptions of pregnancy intention in the study of unintended pregnancy and to critically re-evaluate the conceptualization and interpretation of pregnancy intention measures.

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Public reproductive health and ‘unintended’ pregnancies: introducing the construct ‘supportability’

Cited by 67 publications

References 22 publications

The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions

The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions

A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study

The Best of Intentions: A Structural Analysis of the Association between Socioeconomic Disadvantage and Unintended Pregnancy in a Sample of Mothers from the National Longitudinal Survey of Youth (1979)

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