The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building

Abstract

STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.

Stimulating fertility awareness: the importance of getting the language right

“…Getting the message right also means that custom-made and personalized approaches are needed as people have different desires regarding family building which can change through the life course. Grace et al (2022) recently drew up a typology to distinguish between different categories of people according to their reproductive intention, thus identifying what they labelled as Avoiders, Betweeners, Completers, Desirers, Expectants, and Flexers. People in these different categories have different reproductive health information needs.…”

What does ‘preconception health’ mean to people? A public consultation on awareness and use of language

“…This suggests language and educational messages about the relevance and importance of preconception health need to be inclusive of the multiple phases that people move through during their reproductive years in relation to their goal to become, or not become, a parent. [30][31][32] Information on all aspects of preconception health should be communicated through research study participant materials and public health messages, to ensure it resonates with people of reproductive age. Public contributors in our consultation concluded that general messages and recruitment text that are relevant to 'everyone' of reproductive age would be important to raise widespread awareness and normalise the concept of preparing for pregnancy and parenthood in the community.…”

A mixed methods study investigating sources of fertility and reproductive health information in the UK

“…Respondents cited occupational settings as a good environment for providing support and education. For example, young professionals who are yet to start a family, would be the ideal target audience for information on family building within the workplace [39] as the acceptance of, previously perceived as taboo topics continues to increase as people's reproductive health needs evolve over time [40]. For example, in recent times, previously taboo topics like mental health issues and mindfulness are being widely discussed in the professional environment [41,42].…”