Prevalence and correlates of ambivalence towards pregnancy among nonpregnant women

doi:10.1016/j.contraception.2006.12.002

Contraception

Volume 75, Issue 4, April 2007, Pages 305-310

https://doi.org/10.1016/j.contraception.2006.12.002 Get rights and content

Abstract

Background

Ambivalence towards pregnancy is rarely acknowledged in policy discussions.

Methods

We surveyed 441 nonpregnant women who consecutively presented to two urgent care clinics in California about their current intentions to conceive using a five-point scale. We examined the association between ambivalence towards pregnancy, sociodemographic characteristics and use of contraception.

Results

Almost one third of women (29.0%; 95% CI=25–33%) expressed ambivalence about their intentions to become pregnant. In multivariable modeling, being older than 30, being nonwhite and having a personal or religious objection to abortion were significantly associated with ambivalence towards pregnancy. Compared with women who stated they were trying to avoid pregnancy, women who expressed ambivalence were significantly less likely to have used a barrier or hormonal form of contraception at last intercourse (OR=0.36, 95% CI=0.23–0.57) and more likely to use the natural family planning (NFP) method (OR=3.31, 95% CI=1.39–7.90) or withdrawal (OR=1.61, 95% CI=0.98–2.65).

Conclusion

Ambivalence towards pregnancy is common and is associated with use of less effective contraceptive methods.

Introduction

In research and policy discussions, pregnancies are frequently represented using dichotomous constructs built around terms such as “planned,” “wanted,” or “intended.”

However, ambivalence toward pregnancy that is not captured by these dichotomous measures may have both clinical and policy implications. If, as some have proposed [1], [2], [3], ambivalence towards pregnancy contributes to less effective contraception use, it may be important for clinicians, researchers and policymakers to address.

In most studies to date, women's feelings about their pregnancies have been assessed retrospectively, either after women became pregnant or gave birth [4], [5], [6], [7], [8]. For example, a retrospective study of 250 low-income women in Baltimore found that 30–56% of women were ambivalent about childbearing at the time of their last pregnancy [9]. However, it is known that retrospective data collection can introduce bias. Data from the National Survey on Family Growth highlight the discordances between women's happiness and unhappiness on learning they were pregnant and assessments of pregnancy intention and contraceptive failure [10]. In addition, the more time that passes since a child's birth, the less likely parents are to describe the birth as resulting from an unintended pregnancy [11]. If clinicians and policy makers are to be successful in helping women to appropriately use contraception, methods to prospectively assess women's desires for pregnancy must be developed.

In one of the few prospective studies available, investigators reported that 14% of nonpregnant adolescent African Americans recruited from community locations were ambivalent about pregnancy [12]. However, information about the prevalence of ambivalence towards pregnancy among women from other racial/ethnic and socioeconomic backgrounds would be helpful in many settings. The goal of this study was to prospectively estimate the prevalence and correlates of ambivalence towards pregnancy among a diverse group of women who were neither currently pregnant nor pursuing family planning services.

Section snippets

Methods

We surveyed women about their pregnancy intentions as part of a larger study of the ability of a computer program to provide preventive health information to women of reproductive age. This study was approved by the Committee on Human Research at the University of California, San Francisco, and by the Institutional Review Board of the University of Pittsburgh. Details of this study have been reported previously [13], [14].

English-speaking women were recruited for this study from the waiting

Results

The 441 women included in this analysis formed an ethnically diverse sample; 44% were white, 17% were black, 15% were Latina and 12% were Asian. Most were US born, while 24% were foreign born (Table 2). The average age of participants was 29±6 years with a range from 18 to 45. Close to half (48%) had a college degree. Most (63%) were working outside of their homes. Eighty-six women were accompanying someone who was seeking health care, while 355 women were personally seeking healthcare for

Discussion

When asking women about pregnancy intentions, we found the number of response options offered affects women's willingness to acknowledge ambivalence. When provided with five response options spanning varying levels of decisiveness, three of every 10 nonpregnant women surveyed expressed ambivalence about avoiding or achieving pregnancy. While we found ambivalence towards pregnancy to be more prevalent among older women, one of every four women younger than 30 expressed ambivalence towards

Acknowledgment

The UCSF/Mt Zion Health Fund and a Veteran's Administration Fellowship in Women's Health provided funding for this study. Duramed, the manufacturer of Plan B emergency contraception, donated 250 packs of Plan B which were offered as incentive to participants who completed the survey. No funding organization was involved in the design or conduct of the study, collection, management, analysis or interpretation of the data, or preparation of the manuscript.

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Original research articlePrevalence and correlates of ambivalence towards pregnancy among nonpregnant women

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgment

Contraception

Lancet

Am J Obstet Gynecol

Contraception

Contraception

Contraception

Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy

Perspect Sex Reprod Health

Original research article
Prevalence and correlates of ambivalence towards pregnancy among nonpregnant women