Perceived likelihood of becoming pregnant and contraceptive use: Findings from population-based surveys in Côte d'Ivoire, Nigeria, and Rajasthan, India

Abstract

Objective: Advancing reproductive autonomy requires targeted strategies and interventions that address barriers to contraceptive use. The primary objective of this study is to investigate whether perceptions of low pregnancy likelihood are associated with lower likelihood of using contraception among presumably fecund, sexually active women. Study design: We used population-based survey data of reproductive age women at risk of pregnancy collected in 2018 from Côte d'Ivoire (N = 1447), Nigeria (N = 4110), and Rajasthan, India (N = 1994). To assess one's perceived biological likelihood of pregnancy, we used 2 measures: likelihood following a single act of sex without contraception and likelihood following 1 year of regular sex without contraception. Response options included: definitely yes, maybe yes, maybe no, definitely no, and do not know. We conducted multivariable logistic regression to assess the relationship between each perception measure with odds of contraceptive use separately by country. Results: Perceived chance of definitely or maybe becoming pregnant after one act of sex without contraception ranged from 54.0% to 55.0% in Nigeria and Rajasthan to 80.0% in Côte d'Ivoire, while it was higher for regular sex without contraception (76.0%-85.1%). Multivariable results indicate that perceptions of pregnancy likelihood were associated with contraceptive use among presumably fecund women, with a stronger relationship observed in relation to cumulative likelihood (odds ratio 0.1-0.6) than likelihood after one act (odds ratio 0.4-0.8) and a dose-response pattern by strength of perceived chance. Conclusions: Results indicate that women's use of contraception in low-resource settings is associated with their perceived likelihood of becoming pregnant after unprotected sex. Implications: Findings suggest that understanding women's perceived likelihood of pregnancy may aid in the development of interventions to help women achieve their reproductive goals.

Pregnancy recognition trajectories: a needed framework

“…For example, believing that a contraceptive has failed might be the “start” of a pregnancy recognition trajectory for someone who knows there is an increased likelihood of having become pregnant, while a lower frequency of sex without contraception can lead to lower perceptions of risk of pregnancy. 8 In contrast, a person’s perception that they are infertile or unable to conceive could mean that they “start” their pregnancy recognition trajectory later. 8 The endpoint of a trajectory could be a live birth, stillbirth, miscarriage, or abortion.…”

“… 8 In contrast, a person’s perception that they are infertile or unable to conceive could mean that they “start” their pregnancy recognition trajectory later. 8 The endpoint of a trajectory could be a live birth, stillbirth, miscarriage, or abortion. For example, a person might not experience bodily changes during a pregnancy and not recognise they were pregnant until they experience a miscarriage or live birth.…”

Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi

“…Perceived fecundity represents a person's own assessment of their likelihood of becoming pregnant if they do not use a method of contraception. Perceived fecundity has been demonstrated to influence contraceptive use across settings, including in Malawi, such that lower perceived fecundity is associated with contraceptive nonuse (Bell and Gemmill 2021;Bornstein et al 2021;Polis et al 2020).…”

“…2019). Such factors include exposure to the possibility of pregnancy (e.g., sexual activity or frequency) and one's perception of their biological risk of pregnancy (e.g., perceived fecundity) (Bell and Gemmill 2021; Bornstein et al. 2021; Gemmill and Cowan 2021; Moreira et al.…”

“…Of note, additional factors, beyond pregnancy desires and intentions, have a demonstrated influence on people's contraceptive use and nonuse among those who do not wish to become pregnant (Moreira et al 2019). Such factors include exposure to the possibility of pregnancy (e.g., sexual activity or frequency) and one's perception of their biological risk of pregnancy (e.g., perceived fecundity) (Bell and Gemmill 2021;Bornstein et al 2021;Gemmill and Cowan 2021;Moreira et al 2019;Polis et al 2020). People may choose not to use a modern method of contraception, regardless of a counseling protocol that indicates their need, and this is a choice that must be respected (Senderowicz 2019).…”