Challenging unintended pregnancy as an indicator of reproductive autonomy: a response

Abstract

(K. Kost). 1 We recognize that many trans men, gender-nonbinary and gender-nonconforming people also often need reproductive health care to either prevent or support pregnancy. Unfortunately, most data sources with pregnancy intentions measures do not allow researchers to identify these populations; some data sources do not even include these individuals. Because of these data limitations, we generally use the term "women" to describe the group of individuals for which we have data, but recognize that this does not necessarily include the experiences of everyone who is able to become pregnant. 2 While the issues raised throughout are relevant to ongoing discussions of how we approach research work globally, the extent of the expertise of the authors of this response necessarily limits our perspective to the body of research work focused on unintended pregnancy in the United States.

Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017

“…The unintended pregnancy rate in the U.S. has hovered around 50% for the last 20 years, suggesting new efforts must be considered to reduce unintended pregnancy [ 1 ]. Pregnancies defined as unintended, which include mistimed or unwanted pregnancies, have long been considered to be associated with negative public health outcomes [ 2 , 3 ].…”

Psychosocial status and prenatal care of unintended pregnancies among low-income women

“…In our study, 30.8% of women had not received primary care within a year before initiating prenatal care. The lack of access and engagement may perpetuate feelings of stress and depression and influence when prenatal care is initiated [34]. Massachusetts has had universal health coverage since 2006 and a majority of women in our study were insured, thereby suggesting other factors besides lack of insurance coverage impacted women's primary care engagement and timing of prenatal care.…”

“…In addition, our study population does not include women with unintended pregnancies who may have either miscarried, terminated their pregnancy before initiating prenatal care, or never sought prenatal care. We acknowledge the importance of these topics and the ongoing discussions in the field on how to best measure pregnancy intention and reproductive autonomy [34,37], but the data examined in this study still provides important information about pregnancy intentions in specific populations.…”

Pathways to Parenthood in Social and Family Contexts: Decade in Review, 2020

“…As in other industrialized countries, unintended pregnancy and birth rates in the United States declined during the past decade (Bearak, Popinchalk, Alkema, & Sedgh, ). (Unintended pregnancies and births are those that occur earlier than desired [“mistimed”] or among those who want no [more] children [“unwanted.”] Kost and Zolna [] note that these pregnancies and births would be more appropriately labeled as “undesired” rather than “unintended” because the questions that measure them ask about what women wanted, not what they intended; the latter generally entails actions or plans. We follow the convention of most current research and policy literature and use the term unintended .).…”

“…These findings have led to suggestions for other ways to measure women's desires, intentions, and plans for childbearing at both the individual and aggregate levels (e.g., Finer, Lindberg, & Desai, ; Kost & Zolna, ). It is not clear whether current approaches over‐ or understate the clarity of intentions; a recent mixed‐methods study shows that ambivalence may be overestimated with certain survey measurement approaches (Gómez, Arteaga, Villaseñor, Arcara, & Freihart, ).…”