Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts?

Aiken, Abigail R.A.; Borrero, Sonya; Callegari, Lisa S.; Dehlendorf, Christine

doi:10.1363/48e10316

Cited by 203 publications

(214 citation statements)

References 30 publications

Supporting

Mentioning

197

Contrasting

Unclassified

Order By: Relevance

“…However, two findings from this study provide support for the idea that positive feelings about a pregnancy do not contradict a desire to avoid conception; rather feelings and intentions may be distinct concepts for many women [5,10,11,15]. A majority of women reported “consistent” attitudes insofar as their cognitive and affective outlooks corresponded with one another.…”

Section: Discussionmentioning

confidence: 50%

Change and consistency in US women's pregnancy attitudes and associations with contraceptive use

Jones

2017

Contraception

View full text Add to dashboard Cite

Objectives This study examines the cognitive and affective dimension of pregnancy attitudes in order to better recognize the role of each in pregnancy ambivalence as well as the relative importance of each in understanding contraceptive use. Study Design Data from a national sample of 2,894 women aged 18–39, gathered at baseline and six months later, was used to examine a measure of pregnancy avoidance (cognitive) and a measure of happiness about pregnancy (affective), both separately and jointly. I used bivariate and multivariate analysis to examine associations between attitudinal measures and consistent contraceptive use. I also examined changes in attitudes over time and associations between changes in attitudes and changes in consistent contraceptive use. Results While a majority of women, 53%, indicated it was very important to avoid pregnancy, a substantially lower proportion, 23%, would have been very unhappy to be pregnant. In logistic regression models that included both measures, only pregnancy avoidance was associated with consistent contraceptive use. Cognitive attitude was less likely than affective attitude to change over time; additionally, change in pregnancy avoidance, but not happiness, was associated with changes in consistent contraceptive use. Conclusion(s) Pregnancy avoidance appears to play a more important role in understanding consistent contraceptive use. Findings from this study provide support for the idea that positive feelings about a pregnancy do not contradict a desire to avoid conception and that feelings and intentions may be distinct concepts for many women. Implications Health care providers should assess patients’ pregnancy avoidance attitude but also recognize that this can change over short period of time for some women and should be evaluated regularly.

show abstract

Section: Discussionmentioning

confidence: 50%

Change and consistency in US women's pregnancy attitudes and associations with contraceptive use

Jones

2017

Contraception

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Lundsberg

Schwarz

et al. 2017

Contraception

View full text Add to dashboard Cite

Objective: To contribute to decision analysis by estimating utility, defined as an individual’s valuation of specific health states, for different pregnancy contexts. Study design: Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014–June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women’s sociodemographic and health characteristics. Results: Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28–0.91), PROMIS GSF-derived utility (0.66–0.75), SG (0.985–1.00) or TTO (0.9990–0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. Conclusions: Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. Implications: Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.

show abstract

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

OBJECTIVE To quantify the association of pregnancy context and health-related quality of life (HRQoL). STUDY DESIGN English- or Spanish-speaking women, aged 16–44, with pregnancies <24 weeks gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy “context,” including: timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form (PROMIS-GSF). Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables. RESULTS We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic, 37% Black, non-Hispanic, and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy, or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL. CONCLUSIONS After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL. IMPLICATIONS The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.

show abstract

Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts?

Cited by 203 publications

References 30 publications

Change and consistency in US women's pregnancy attitudes and associations with contraceptive use

Change and consistency in US women's pregnancy attitudes and associations with contraceptive use

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

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

Contact Info

Product

Resources

About