One in four sexually active U.S. women aged 25–45 are neither trying to become pregnant nor trying to avoid pregnancy, but would be “okay either way,” according to analyses based on data from the 2004–2006 National Survey of Fertility Barriers.1 Women who would be okay either way differ from those intending to conceive in a number of respects; for example, they attach less importance to motherhood and are less likely to say that they are infertile. They also differ from women who are trying to avoid conceiving—for instance, by feeling more confident that they will become pregnant and considering a larger number of children the ideal. Women’s pregnancy intentions vary somewhat according to whether they have ever been pregnant.

The telephone survey was conducted among a nationally representative sample of women aged 25–45. Questions covered women’s social and demographic characteristics, fertility- and lifestyle-related attitudes, and pregnancy intention (whether they currently were “pregnant, trying to get pregnant, trying not to get pregnant, or…okay either way”). The analytic sample consisted of the 3,771 women who were sexually active and answered the question about pregnancy intention. Researchers conducted chi-square tests, analyses of variance and multinomial logistic regression to assess differences in women’s characteristics by pregnancy intention.

Seventy-one percent of respondents were trying to avoid conceiving, 6% were trying to get pregnant and 23% were okay either way. In bivariate analyses, the three groups differed significantly on most characteristics examined, and women who were okay either way often occupied the middle position. For example, the proportions of women who were childless and who said that having children was very important to their partner were lowest among those trying not to conceive, intermediate among those who were okay either way and highest among those trying to conceive. By contrast, women who were okay either way reported the largest ideal number of children and the highest degree of religiosity. They resembled those trying to avoid pregnancy more than they did those seeking it with regard to the importance they attached to motherhood, but they were more similar to those who were trying not to conceive on other measures (ideal number of children and trust that they will conceive).

Analyses restricted to the 831 women who had never been pregnant revealed that in this population, too, one-quarter of women were ambivalent about conceiving. Findings for never-pregnant women were largely similar to those for the overall sample, but some differences were striking. Attitudes toward career and leisure time, which did not differ by intention in the larger sample, varied among never-pregnant women: Women trying to avoid pregnancy were the most likely to say that being successful in work and having leisure time were very important, and those seeking pregnancy were the least likely to give these responses. Additionally, two types of social pressure that were not significant in the overall sample distinguished the three groups of never-pregnant women: Those who were trying not to get pregnant were the least likely to feel pressured by their parents’ wish for a grandchild and to report that most of their friends and family have children; those seeking pregnancy were the most likely to give these replies.

Results of the multivariate analysis indicate that the more certain a woman was that she would like to have a baby and the greater value she placed on being a mother, the more likely she was to be trying to conceive rather than to be okay with either conceiving or not (odds ratio, 1.8 for each). Women who said that they were infertile and black women also had elevated odds of reporting trying to become pregnant (3.4 and 2.7, respectively). The likelihood of trying to conceive was inversely related to women’s age (0.6) and was reduced among women who had already had children (0.2–0.5). For the attitudinal variables, but not others, findings for never-pregnant women were similar to those for the full sample.

In the overall sample, the odds that women were trying to avoid pregnancy, rather than being okay either way, were inversely associated with their ideal number of children, intentions and desire to have a baby, trust that they will conceive, self-assessment as infertile and relationship satisfaction (odds ratios, 0.3–0.9). They were elevated among women who had had two or three births, and among those who had experienced economic hardship (1.3–2.1), and were reduced among Hispanics, blacks and Asians (0.4–0.6). Results were largely similar for never-pregnant women. However, ideal number of children, fertility intentions, relationship satisfaction and being Asian were not significant in this subgroup. The importance of a career, on the other hand, which did not predict trying to avoid pregnancy in the full sample, was significant for never-pregnant women (1.8).

The researchers contend that policies and public health interventions that assume that women have clearly defined fertility intentions “are unlikely to be effective with women who are…ambivalent.” They acknowledge that the survey’s response categories do not provide a complete picture of women’s pregnancy intentions and that the survey lacked measures of potentially important attitudes and experiences. Nevertheless, they conclude that women who wish to conceive, those who do not and those who are ambivalent have distinct profiles. Understanding the differences may help service providers “guide women toward making pregnancy decisions, enabling those who become pregnant to better prepare for pregnancy.”—D. Hollander