Dynamic pregnancy intentions

"When we think about whether or when people would like become pregnant, people often assume that there is one big life plan," said Claudia Geist, associate professor and associate Dean for Research in the University of Utah's School for Cultural and Social Transformation and lead author of the study. "However, we know that things shift across the lifespan."

While some studies have identified potential factors that influence pregnancy decisions, few studies have assessed how these decisions may change or shift over time and which personal circumstances are associated with the change. This study aimed to support providers in being more flexible and responsive to contraceptive clients' needs. Understanding how much pregnancy intentions can change in just one year adds to ongoing efforts to de-stigmatize and support the common practices of switching and ending various contraceptive methods.

The researchers followed a cohort of people who participated in the HER Salt Lake Contraceptive Initiative, a prospective study that recruited participants from four family planning clinics in Salt Lake County, Utah between September 2015, and March 2017. Eligible participants were between ages 18 and 45 and either initiating a new contraceptive or switching to a different contraceptive method. In addition, they needed to be intending to prevent pregnancy for at least one year.

The analysis includes 2,825 participants who provided pregnancy intention data at both the time of enrollment and the 12-month follow-up. Participants were asked to respond to the question, "What are your future pregnancy plans?" Response options included:

1. "I am currently trying to get pregnant" (only available at 12-month follow-up)
2. "I would like to get pregnant in the next year"
3. "I would like to get pregnant in the next 2-5 years, but not in the next year"
4. "I would like to get pregnant in the next 5-10 years, but not before then"
5. "I am uncertain if or when I would like to become pregnant" (only available at enrollment)
6. I do not plan on getting pregnant at any time in the future
7. "Other"

At the 12-month follow up, the majority (79%) of participants maintained their pregnancy timing intention, while just under 20% reported a change. Among those who initially said they never wanted a pregnancy, 22% changed their mind over the course of a year. About 10% of participants shifted their pregnancy timing to desire a pregnancy earlier than at the time of enrollment.

"I expected change, but I didn't expect as much change as we found," said Geist. "We found that economic stability, including more household income and/or full-time employment, seems to put people in a frame of mind where they consider a pregnancy after previously stating to never want a pregnancy."

In addition to economic stability, researchers considered relationship status, sexual identity and educational status and aspiration. Exploring the associations between changes in personal circumstances and shifts in pregnancy intentions, researchers hope to offer insight to clinicians who provide contraception.

"The rapid changes we found over 12 months are a stark reminder that health care providers need to check in frequently about the pregnancy desires of their patients," said Geist.