Pregnancy intentions—a complex construct and call for new measures

Current constructs measuring pregnancy intention may not reflect contemporary reproductive practices and the percentage of unintended pregnancies varies across approaches; improved measures are needed for accurate estimation of unintended pregnancy.

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Volume 106, Issue 6, Pages 1453-1462

Authors:

Sunni L. Mumford, Ph.D., Katherine J. Sapra, Ph.D., Rosalind B. King, Ph.D., Jean Fredo Louis, M.I.M., Germaine M. Buck Louis, Ph.D.

Abstract:

Objective

To estimate the prevalence of unintended pregnancies under relaxed assumptions regarding birth control use compared with a traditional constructed measure.

Design

Cross-sectional survey.

Setting

Not applicable.

Patient(s)

Nationally representative sample of U.S. women aged 15–44 years.

Intervention(s)

None.

Main Outcome Measure(s)

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.

Result(s)

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.

Conclusion(s)

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.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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