Rethinking the pregnancy planning paradigm: unintended conceptions or unrepresentative concepts?

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by Abigail RA Aiken, Sonya Borrero, Lisa S Callegari, Christine Dehlendorf

Perspectives on Sexual and Reproductive Health 2016; 48(3/Sept) DOI: 10.1363/48e10316

Excerpts

Approximately half of pregnancies occurring each year in the United States are unintended: They either occurred too soon or were not intended at any time. This commonly cited statistic is testament to the dominance of unintended pregnancy as a public health benchmark for measuring and improving women’s reproductive health. In addition to its use as a public health metric, this timing-based definition of unintended pregnancy is reflected in pregnancy planning paradigms in clinical practice. According to these paradigms, women are expected to map out their intentions regarding whether and when to conceive, and to formulate specific plans to follow through on their intentions.

We propose, however, that public health and clinical efforts focused on reducing unintended pregnancy and improving pregnancy outcomes solely by promoting planning are subject to several important limitations. First, implicit in the planning ideal is the assumption that all women hold clear and unequivocal timing-based intentions. Second,…standard timing-based definitions of unintended pregnancy fail to capture the trade-offs of a possible pregnancy [in which the positives outweigh the negatives or vice versa]. Third, conventional planning paradigms are imbued with the normative belief that unintended pregnancies are uniformly negative events that necessarily result in adverse consequences. Finally… research has revealed a tension between the ideal of planning and the reality that for many women, planning may be irrelevant or unattainable…

The relationship between acceptability and measurable outcomes will vary depending on whether the pregnancy results in birth or abortion, which in turn depends on individual preferences and available options. We hypothesize that a woman who judges her pregnancy to be acceptable, regardless of whether it was planned, and goes on to give birth is more likely to experience positive personal and social outcomes than a woman who judges her pregnancy to be unacceptable. Our model also accommodates the fact that women who find having an ongoing pregnancy unacceptable and are able to choose abortion may experience more positive outcomes than those whose unacceptable pregnancy results in birth.

VISUAL: Figure 2 from this article.