Unintended conceptions leading to wanted pregnancies - an integral perspective on pregnancy acceptance from a mixed-methods study in Germany

Experiences and life circumstances of unintentionally pregnant women affected by intimate partner violence-stress factors, resources, healthcare structures and needs: a scoping review protocol

This scoping review outlines the current understanding, challenges, available resources, and healthcare needs of women affected by intimate partner violence (IPV) who experience unintended pregnancy (UP). UPs are defined as unwanted, unplanned, or mistimed pregnancies. The impact of UP is multifaceted and carries several additional risks, particularly for women who experience IPV. The experiences and living conditions, including (mental) burdens, resources, care structures, and the needs of unintentionally pregnant women who have experienced IPV, remain mostly unexplored. The review will include the following criteria: (i) reproductive-aged women who have experienced IPV and UP; (ii) publications that provide detailed accounts of the experiences, circumstances, and/or needs of women with UP who have experienced IPV. This study will utilize the JBI methodology for scoping reviews and follow the PRISMA Protocol for Scoping Reviews (PRISMA-ScR). A total of 2,325 papers and gray literature published from 2000 to the present were identified. 1,539 literature items were included in the title and abstract screening. Two researchers will independently choose studies, perform data extraction, and perform data synthesis. Quantitative data will be narratively summarized and qualitative data will be analyzed using thematic analysis. The findings will identify research gaps and provide insights into an important topic of reproductive healthcare and the (mental) health situation of a particularly vulnerable group. This will be useful in defining indications for researchers, professionals, and policymakers in public, mental, and reproductive health to conceptualize interdisciplinary and empirical healthcare support for affected women.

Systematic review registration

Open Science Framework: https://doi.org/10.17605/OSF.IO/ZMVPE.

Cohort profile: the ADAPT study, a prospective study of pregnancy preferences, pregnancy, and health and well-being in the southwestern USA

PURPOSE

Significant methodological shortcomings limit the validity of prior research on pregnancy decision-making and the effects of 'unintended' pregnancies on people's health and well-being. The Attitudes and Decisions After Pregnancy Testing (ADAPT) study investigates the consequences for individuals unable to attain their pregnancy and childbearing preferences using an innovative nested prospective cohort design and novel conceptualisation and measurement of pregnancy preferences.

PARTICIPANTS

This paper describes the characteristics of the ADAPT Study Cohort, comprised of 2015 individuals aged 15-34 years, assigned female at birth, recruited between 2019 and 2022 from 23 health facilities in the southwestern USA.

FINDINGS TO DATE

The cohort was on average 25 years old. About 59% identified as Hispanic/Latine, 21% as white, and 8% as black, 13% multiracial or another race. Over half (56%) were nulliparous. About 32% lived in a household with income <100% of the federal poverty level. A significant minority (37%) reported a history of a depressive, anxiety or other mental health disorder diagnosis, and 30% reported currently experiencing moderate or severe depressive symptoms. Over one-quarter (27%) had ever experienced physical intimate partner violence, and almost half (49%) had ever experienced emotional abuse. About half (49%) had been diagnosed with a chronic health condition, and 37% rated their physical health as fair or poor. The 335 (17%) participants who experienced incident pregnancy over 1 year were similar to selected non-pregnant matched comparison participants in terms of age, racial and ethnic identity, and parity but were more likely to live with a main partner than comparison participants.

FUTURE PLANS

We will continue to follow participants who experienced incident pregnancy and non-pregnant comparison participants until 2026. Analyses will examine pregnancy decision-making and investigate differences in health and well-being by prepregnancy pregnancy desires and feelings after the discovery of pregnancy, offering new insights into the consequences of not attaining one's reproductive preferences.

TRIAL REGISTRATION NUMBER

NCT03888404.

Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data

BACKGROUND

The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access.

OBJECTIVE

We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users.

METHODS

We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric.

RESULTS

Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex.

CONCLUSIONS

Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

Welcomed Pregnancies: Characteristics and Patterns of Adjusting to Unwanted, Unplanned, Untimely or Otherwise Difficult Pregnancies

Background Women facing problematic pregnancies, defined as "unplanned, mistimed, unwanted, or otherwise difficult," either have abortions or make adjustments to welcome these pregnancies. These adjustments are understudied. Pregnancy resource centers that provide counseling and services to assist in the process of welcoming pregnancies have been the focus of controversy due to their refusal to counsel or refer for abortions. This survey of a national population of women seeks to quantify changes in attitudes toward problematic pregnancies that are not aborted and to gauge levels of contact with pregnancy help centers and perceptions of harm or benefits attributed to those contacts. Methodology A national research firm was enlisted to obtain 1,000 surveys completed by female residents of the United States aged 41-45, inclusive. Women reporting a history of abortion were surveyed along one path. For those who did not have abortions but reported a problematic pregnancy, questions were presented to assess changes in attitude toward their pregnancy from the date they first learned they were pregnant to 90 days later, their considerations of abortion, whether they had contact with a pregnancy help center, and their assessment of that contact on either harming or improving their lives. Results Among 275 respondents who had no history of abortion but had ultimately welcomed a problematic pregnancy, 112 (40.7%) had been at higher risk of abortion. Positive attitudes toward their pregnancies increased most rapidly for women who had been at higher risk of abortion but were lower on the day they first learned they were pregnant. Overall, 34 (12.4%) reported they had contacted a pregnancy help center that did not refer for abortions. Another 37 (13.5%) were uncertain if they had contacted an organization fitting that description. Both groups reported the contact improved their lives, on average. Negative assessments were uncommon and all were of a small degree. Conclusions Women facing problematic pregnancies who did not choose abortion experienced rapid improvements in feelings of wantedness, timeliness, acceptance, welcoming, and desirability toward the pregnancy. The rate of improvement was most rapid among those who had investigated and considered abortion. Women reporting contact with pregnancy help centers almost always assess it as having improved their lives.

Assessment of person-centeredness in healthcare and social support services for women with unintended pregnancy (CarePreg): protocol for a mixed-method study

INTRODUCTION

For women with unintended pregnancy, access to high-quality care has been found limited due to social stigma and legal restrictions, especially when seeking abortion. To foster person-centeredness (PC), recognising the experiences and needs of women is the first premise. This study aims to (1) identify relevant dimensions of PC (2) evaluate PC in healthcare and social support services, (3) develop recommendations for further actions in healthcare and social support services for women with unintended pregnancy.

METHODS AND ANALYSIS

We will use a mixed-methods approach. Phase 1: expert workshops with 10-15 healthcare professionals and counsellors and semistructured interviews with 15-20 women with unintended pregnancy will be conducted to assess the relevance of PC dimensions. Phase 2: quantitative assessment of PC dimensions within healthcare and support services will be conducted. We aim to include 600 women with an unintended pregnancy (1) until 24 weeks of pregnancy or (2) who sought abortion within the past 8 weeks, over three measurement points within 12 months. To deepen the results, semistructured interviews will be conducted. Phase 3: a workshop with 10-15 experts and an online survey with 100-150 experts will be used to indicate recommendations. Participants will be gained through relevant care facilities. An ethical advisory board and an advisory board of affected women will be involved throughout the study.

ETHICS AND DISSEMINATION

The study will be carried out in accordance to the latest version of the Helsinki Declaration of the World Medical Association and principles of good scientific practice. The study was approved by the Local Psychological Ethics Committee of the University Medical Center Hamburg-Eppendorf, Germany (LPEK-0260). Written informed consent will be sought prior to study participation. The study results will be disseminated in scientific journals, through collaboration partners and plain language press releases.

["Risk it"-why women who do not intend to get pregnant do not use contraception : Results of the BZgA study "Women's lives 3. Family planning in women's lives"]

Hintergrund

Trotz allgemein bekannten Verhütungsmethoden und flächendeckendem Zugang zu Verhütungsmitteln lässt sich beobachten, dass Frauen in westlichen Industriegesellschaften auch bei fehlender Schwangerschaftsabsicht oftmals nicht verhüten und schwanger werden.

Ziel der Arbeit

Die in diesem Beitrag durchgeführten Analysen zielen darauf ab, die Verbreitung des Phänomens der Nichtanwendung von Verhütung für Deutschland einzuschätzen und ein besseres Verständnis für die Gründe zu gewinnen, warum Frauen eine unbeabsichtigte Schwangerschaft riskieren.

Material und Methoden

Anhand von quantitativen Befragungsdaten zu 17.400 Schwangerschaften und von 116 offenen qualitativen Interviews aus der im Auftrag der Bundeszentrale für gesundheitliche Aufklärung (BZgA) durchgeführten Studie „frauen leben 3. Familienplanung im Lebenslauf von Frauen“ sind Aussagen zur Verbreitung der Nichtverwendung von Verhütungsmethoden trotz fehlender Schwangerschaftsabsicht und zu den dahinterliegenden Gründen möglich.

Ergebnisse

Die angegebenen Gründe für die Nichtverwendung von Verhütung lassen sich 3 sehr unterschiedlichen Motivlagen zuordnen: a) Spielen mit einem Kinderwunsch, was von knapp einem Drittel genannt wird, b) individuelle und strukturelle Hürden, wie z. B. gesundheitliche Vorbehalte oder zu hohe Kosten, und c) irrtümliche Annahme, nicht schwanger werden zu können. Es zeigt sich, dass diese Motive je nach biografischer Situation unterschiedlich verbreitet sind.

Diskussion

Die Ergebnisse weisen auf die Notwendigkeit eines differenzierteren Verständnisses unbeabsichtigter Schwangerschaften und zwar sowohl in der Forschung als auch der Prävention hin.

Als Limitation und damit als Bedarf für künftige Forschungen erweist sich, dass im Rahmen der Studie der Einfluss des (Sexual‑)Partners auf das Verhütungsverhalten der Frauen und auf die Gewolltheit der Schwangerschaft anhand der erhobenen Daten nicht untersucht werden kann.