The Relationship Between Ambivalent and Indifferent Pregnancy Desires and Contraceptive Use Among Malawian Women

Abstract

Ambivalent and indifferent pregnancy desires are common in Malawi and are associated with modern contraceptive use in different ways. Understanding the complex nature of pregnancy desires may be valuable in improving family planning programs.

The relationship between attitudes towards pregnancy and contraceptive continuation: Results from a longitudinal study of married women in India

“…Results demonstrate that approximately one quarter of contraceptive users who would like to have children in the future were either positively or negatively ambivalent about pregnancy (23%), and that both cognitive (beliefs and knowledge) and affective (feelings and emotions) attitudes toward pregnancy were significantly associated with method-specific contraceptive continuation 9 months later. These results support a growing body of research, largely from the United States, demonstrating that women's attitudes towards pregnancy are multifaceted, that cognitive and affective attitudes can contradict each other, and that more nuance is warranted in the measurement of pregnancy and fertility desires and intentions [14][15][16].…”

“…Adapting the approach and terms from prior research [14][15][16], a 4-category measure of attitudes toward pregnancy was constructed by combining the measures of cognitive and affective attitudes: pro-pregnancy (would be happy if she found out she was pregnant/not important to avoid pregnancy), anti-pregnancy (would be unhappy if she found out she was pregnant/ important to avoid pregnancy), positive ambivalent (would be happy if she found out she was pregnant/ important to avoid pregnancy) and negative ambivalent (would be unhappy if she found out she was pregnant/not important to avoid pregnancy) ( Table 1).…”

“…However, the constructs of unintended pregnancy and unmet need rely on the assumptions that pregnancy intentions are concrete and binary, and that women who have an unmet need or are at risk of an unintended pregnancy will use contraception if given the opportunity. This is often not the case, which has sparked many efforts to examine how to better measure fertility preferences [10][11][12][13] and understand their relationship with contraceptive use [14][15][16][17][18][19], with the goal of being able to better meet the family planning needs of women.…”

“…Frost et al [19] similarly found that ambivalence was associated with both nonuse of contraception and gaps in contraceptive use. Outside of the United States, Huber et al [14] asked a cohort of rural Malawian women two questions about pregnancy desires: how strongly a woman wanted to become pregnant in the next year and how strongly a woman wanted to avoid a pregnancy in the next year. Results showed that those who had a reported desire to become pregnant but also wanted to avoid a pregnancy (which they categorized as ambivalent) did not differ from those who were concordantly pro-pregnancy in terms of contraceptive use, while those who did not desire to become pregnant but also did not want to avoid pregnancy (indifferent) were more likely to use contraception.…”

Conceptualizing Childbearing Ambivalence: A Social and Dynamic Perspective

“…The majority of this research has focused on the health implications of ambivalence. Studies have shown, for example, that ambivalence about childbearing is linked to reduced and inconsistent contraceptive use (Campo, Askelson, Spies, & Losch, 2012; Frost, Lindberg, & Finer, 2012; Higgins et al, 2012; Huber, Esber, Garver, Banda, & Norris, 2017; Miller, Trend, & Chung, 2014; Yoo et al, 2014), low birth weight for the resulting child (Mohllajee et al 2007), and a higher likelihood of miscarriage (Santelli, Lindberg, Orr, Finer, & Speizer, 2009). In an effort to identify those most likely to express ambivalence about childbearing, much of this research has implicitly treated ambivalence as a static state that is associated with an individual’s sociodemographic or psychosocial characteristics or with particular stages of life (e.g., Higgins et al, 2012; Layte, McGee, Rundle, & Leigh, 2006; Miller, Jones, & Pasta, 2016; Schwarz, Lohr, Gold, & Gerbert, 2007; Withers, Tavrow, & Adinata, 2011; Yoo et al, 2014).…”