Defining and measuring unintended pregnancy: Issues and concerns

doi:10.1016/S1049-3867(97)00009-1

Women's Health Issues

Volume 7, Issue 4, July–August 1997, Pages 234-240

https://doi.org/10.1016/S1049-3867(97)00009-1 Get rights and content

Summary

This article of the past and current measures of unintendedness of pregnancy has been offered in the hope that investigation into this area can be expanded. Current information available from available national surveys is not comparable due to different survey questions, inclusion criteria, and timing of interviews. What are often reported as rates of unintendedness may be rates of unwantedness—a completely different concept. Many studies fail to delineate the distinction between those unintended pregnancies that are indeed unintended versus those that were mistimed. Potentially, these existing data sets could be reanalyzed by using specific inclusion criteria for unintendedness, maternal age, and marital status. This information might be helpful in improving the comparability between the surveys and in assessing trends in unintendedness.

In the future, to accurately measure unintendedness of pregnancy, we must use a consistent definition that takes into account the complexities of the issue. Valid and reliable scales that reflect the value of unintendedness from the mother's perspective need to be developed to reflect the potential change in intendedness over time. The adequate measurement of unintendedness of pregnancy is the first step in addressing the Healthy People 2000 goal and measuring progress in addressing the nation's reportedly high rate in the long-term goal of addressing the risk factors of unintended pregnancy.

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Cited by (61)

Challenging unintended pregnancy as an indicator of reproductive autonomy: a response
2019, Contraception
The Best of Intentions: A Structural Analysis of the Association between Socioeconomic Disadvantage and Unintended Pregnancy in a Sample of Mothers from the National Longitudinal Survey of Youth (1979)
2017, Women's Health Issues
Births to less educated women are more likely to be classified as unintended than other births. We question a common interpretation that this association reflects a lack of contraceptive knowledge or self-efficacy among less educated women. We theorize that differences in early life educational advantages structure pregnancy desires and the salience and opportunity costs of precise fertility timing. We hypothesize that net of covariates indicative of early educational disadvantage, mothers with less education are not more likely to report births as unintended compared with mothers who have attained higher levels of education before becoming mothers.
Using multivariate regression, we analyze a sample of women in the National Longitudinal Survey of Youth (1979) who had their first births by 1994. We test whether an index measure of educational advantage in youth predicts unintended first birth.
Unadjusted results confirm well-documented associations between educational disadvantage and greater likelihood of unintended pregnancy. However, once covariates are controlled, those with high educational advantage in youth are more likely to report their first birth as mistimed (relative risk ratio, 1.57).
Educational advantage captures expectations about how much education a young woman will obtain before giving birth and is a structural dynamic that precedes proximate factors related to family planning access and behaviors.
These findings highlight the need to incorporate structural factors that condition perceptions of pregnancy intention in the study of unintended pregnancy and to critically reevaluate the conceptualization and interpretation of pregnancy intention measures.
Pregnancy intentions—a complex construct and call for new measures
2016, Fertility and Sterility
To estimate the prevalence of unintended pregnancies under relaxed assumptions regarding birth control use compared with a traditional constructed measure.
Cross-sectional survey.
Not applicable.
Nationally representative sample of U.S. women aged 15–44 years.
None.
Prevalence of intended and unintended pregnancies as estimated by [1] a traditional constructed measure from the National Survey of Family Growth (NSFG), and [2] a constructed measure relaxing assumptions regarding birth control use, reasons for nonuse, and pregnancy timing.
The prevalence of unintended pregnancies was 6% higher using the traditional constructed measure as compared with the approach with relaxed assumptions (NSFG: 44%, 95% confidence interval [CI] 41, 46; new construct 38%, 95% CI, 36, 41). Using the NSFG approach, only 92% of women who stopped birth control to become pregnant and 0 women who were not using contraceptives at the time of the pregnancy and reported that they did not mind getting pregnant were classified as having intended pregnancies, compared with 100% using the new construct.
Current measures of pregnancy intention may overestimate rates of unintended pregnancy, with over 340,000 pregnancies in the United States misclassified as unintended using the current approach, corresponding to an estimated savings of $678 million in public health-care expenditures. Current constructs make assumptions that may not reflect contemporary reproductive practices, so improved measures are needed.
A self-assessment efficacy tool for spermicide contraceptive users
2016, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Most existing data on risk factors for unintended pregnancy and contraceptive effectiveness are derived from the National Survey of Family Growth. This survey relies on recall of behaviors around the time of pregnancy and recall of the classification of the pregnancy as intended or unintended, (modified by social-desirability bias18-20). Although this retrospective survey has produced important estimates over decades, prospective data provide us with more accurate risk-estimates to develop a clinical tool to aid in self-assessment and contraceptive decision-making.
Easily accessible contraceptive methods, such as chemical and barrier methods, are used currently by approximately 1 in 6 women who use contraception in the United States. Even in the face of suboptimal effectiveness, coitally dependent methods likely will always have a role in fertility management. Because most contraceptive efficacy stratifications use population-based data, for women to make informed decisions about the individual fit of a contraceptive method, better evidence-based, user-friendly tools are needed.
Spermicides are a readily available, over-the counter, woman-controlled contraceptive method, but their effectiveness is user-dependent. Patient-decision aids for spermicides and other barrier methods are not well-developed, and overall failure rates could be improved by aids that account for individual characteristics. We sought to derive a prediction rule for successful use of spermicides for pregnancy prevention and to convert those data to a point-of-care instrument that women can use when they are considering spermicide use during contraceptive decision-making.
We pooled local data from 3 randomized clinical trials that were published in 2004, 2007, and 2010 that tested spermicide efficacy. We constructed a prediction rule for unintended pregnancy using bootstrap validation and developed a scoring system.
Data from 621 women showed a mean age of 29 years; 49% of the women were African American, and 43% were white. The overall pregnancy rate was 10.3% (95% confidence interval, 7.9–12.7) over 6 months. In adjusted logistic regression, age >35 years was protective against pregnancy (odds ratio, 0.19; 95% confidence interval, 0.06–0.58; P = .003), and multigravidity was associated with high failure rates (odds ratio, 7.24; 95% confidence interval, 3.04–17.3; P < .001). These risk factors (together with frequency of unprotected sex) were used in a model that maximized sensitivity for pregnancy prediction to compute the predicted probability of unintended pregnancy for each woman. This model was 97% accurate in predicting women who had a <5% pregnancy risk while using spermicides.
Using prospectively collected data, we built a simple risk calculator for contraceptive failure that women can consult when considering spermicide use. This instrument could support patient-centered contraceptive decision-making.
Are pregnancy planning and timing associated with preterm or small for gestational age births?
2015, Fertility and Sterility
Citation Excerpt :
Although these two assessments are standard measures, they have been criticized as being imprecise. For example, many find fault with the assumption that pregnancy is a conscious and deliberate decision for women (2,52–56) and point out that a dichotomous response option does not account for the approximately 30%–60% of women who may be ambivalent about pregnancy planning (52, 57). Therefore, this analysis may have been enriched by more in-depth questions, such as whether pregnancy was unplanned but desired or unplanned and undesired, and by including questions about prenatal preparation and whether pregnancy was discussed with and agreed upon by the male partner (55, 58).
To investigate whether unplanned or poorly timed pregnancies (self-reported at enrollment) are associated with preterm or small for gestational age births.
Prospective cohort study.
Not applicable.
Two thousand six hundred fifty-four pregnant women <18 weeks estimated gestational age with a singleton pregnancy.
None.
Preterm and small for gestational age births.
In adjusted analyses, pregnancy planning was not statistically significantly associated with preterm (odds ratio [OR] 1.18; 95% confidence interval [CI], 0.85–1.65) or small for gestational age birth (OR 1.17; 95% CI, 0.69–1.97). Similarly, poorly timed pregnancies were not statistically significantly associated with preterm (OR 0.85; 95% CI, 0.53–1.38) or small for gestational age birth (OR 0.92; 95% CI, 0.65–1.29). Combining pregnancy planning (yes/no) and timing (yes/no) into a 4-level category showed no statistically significant association with preterm birth or small for gestational age.
In a large cohort with antenatally assessed pregnancy planning and timing, outcome data collected from medical record abstraction, and robust analysis adjusting for multiple confounding factors including maternal demographics, medical conditions, and other risk factors, neither pregnancy planning nor pregnancy timing showed a statistically significant association with preterm or small for gestational age infants. This study improves upon previous analyses that lacked adjustment for confounding and used retrospective self-reporting to assess pregnancy planning and timing, and preterm and small for gestational age births. Findings may differ in higher risk populations with higher prevalence of preterm or small for gestational age births.
Development and Psychometric Testing of the Attitude Toward Potential Pregnancy Scale
2014, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
To develop and test a comprehensive tool for measuring women's attitudes toward the possibility of becoming pregnant.
Cross‐sectional mixed methods study.
Two obstetric/gynecologic (OB/GYN) clinics and one family planning clinic in Baltimore, Maryland.
One‐hundred thirty (130) nonpregnant, primarily African American women (84%) age 18 to 29.
Participants completed a computer‐based survey as part of a larger retrospective mixed‐methods study. The Attitude Toward Potential Pregnancy Scale (APPS) was assessed using exploratory factor analysis and hypothesis testing.
Cronbach's alpha for internal consistency for the APPS was 0.86. Item‐total correlations ranged from 0.56 to 0.75. All items loaded on one factor. Support for construct validity was demonstrated using logistic regression, where the odds of being a highly effective contraceptive user decreased by 8% with each one‐point increase in score on the APPS (odds ratio = 0.92; confidence interval [0.87, 0.98]).
This study provides support for reliability and validity of the APPS. The APPS may be a useful tool for understanding pregnancy attitude in future studies and in clinical practice. Further research is needed to assess the usefulness of the scale with other groups of women, its utility in the clinical practice setting, and its potential predictive validity for unintended pregnancy.

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ArticleDefining and measuring unintended pregnancy: Issues and concerns

Summary

J Pediatr

Healthy people 2000: national health promotion and disease prevention objectives—full report, with commentary

Unwanted pregnancy

Relationship between the intendedness of conception and the wantedness of pregnancy

J Nerv Ment Dis

The Pregnancy Risk Assessment Monitoring System: design, questionnaire data collection, and response rates

Pediatr Perinat Epidemiol

National Maternal and Infant Health Survey: 1988

Unintended childbearing: pregnancy risk assessment monitoring system — Oklahoma, 1988–1991

MMWR

Contraceptive failure rates based on the 1988 NSFG

Fam Planning Perspec

Article
Defining and measuring unintended pregnancy: Issues and concerns