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A YEAR OF MAGICAL THINKING LEADS TO…UNINTENDED PREGNANCY

Qualitative Study Explores Women's Perceptions of Pregnancy Risk

In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to "Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions," by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response.

The most common reason women gave for their perceived low risk of pregnancy was perceived invulnerability to pregnancy. Study participants understood that pregnancy could happen, but for reasons they couldn't explain, thought they were immune or safe from pregnancy at the time they engaged in unprotected sex. One reported that she "always had good luck," while another said, "…It's like you believe something so much, like 'I just really don't want children,' [and] for some reason, I thought that would prevent me from getting pregnant." This type of magical thinking—that pregnancy somehow would not happen despite acknowledged exposure—suggests a disconnect between the actual risk of pregnancy incurred by an average couple who does not use contraceptives (85% risk of pregnancy over the course of a year) and a woman's efforts to protect herself from unintended pregnancy.

Equal proportions (one-third) of respondents thought they or their partners were sterile, said the possibility of pregnancy "never crossed my mind" and reported that (often incorrect) contraceptive use was the reason they thought they were at low risk. Perceptions of infertility were not based on medical advice, but rather on past experiences (e.g., the respondent had unprotected sex and didn't get pregnant) or family history. Among those who thought they were protected by their contraceptive method, most women reported inconsistent or incorrect method use. For example, one woman felt a few missed pills did not put her at risk: "I just thought…they were like magic. If I missed it one day, it wouldn't really matter."

The authors suggest that further research is needed to quantify the proportion of women at risk of pregnancy who believe they are not at risk, and reasons why they hold that belief, in order to better address misconceptions around pregnancy risk with the goal of preventing unintended pregnancy. Additionally, they suggest that health care providers should seek to better understand patients' beliefs regarding their ability to get pregnant and the efficacy of contraception so as to address these topics, and that public health campaigns should dispel myths, address magical thinking, and call attention to the general problem of low health literacy.

"Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions" is currently available online and will appear in a forthcoming issue of Social Science & Medicine.

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