New qualitative research suggests that many women hold complex views regarding the power they have over when they become pregnant, feeling simultaneously that it is out of their control, but also that contraception could help prevent pregnancy. This combination of fatalism and agency likely informs women’s family planning decisions, according to “‘If I know I am on the pill and I get pregnant, it’s an act of God:’ women’s views on fatalism, agency and pregnancy,” by Guttmacher Institute researcher Rachel K. Jones and colleagues.

The authors interviewed 52 U.S. women aged 18–30 about their views on and experiences with contraception and their attitudes toward pregnancy. Jones et al. also examined the relationship between women’s beliefs about their ability to control pregnancy and the consistency of their contraceptive use over the past year.

A majority of the women interviewed (37 of 52) expressed some degree of fatalism about pregnancy, believing that they cannot control whether or when they become pregnant. For example, some thought that forces outside their control—such as fate, destiny or God—determine when they become pregnant, and some expressed the idea that pregnancy “just happens” and cannot be planned. However, a majority of the respondents (42 of 52) also believed that pregnancy can be prevented by using contraceptives and by regulating or controlling sexual activity.

“Many members of the public health community assume that women who believe pregnancy is out of their control will use contraceptives inconsistently or not at all,” says Jones. “However, the experiences of the women we interviewed suggest that the relationship between fatalistic attitudes toward pregnancy and contraceptive use is often far more complex than that.”

In fact, Jones concludes, fatalistic beliefs about pregnancy were not strongly linked to inconsistent contraceptive use for women in the study: Half of the interviewees (26 of 52) reported using contraceptives consistently during the previous year, including some women who believed pregnancy is beyond their control. During the interviews, some women also pointed out that there is no guarantee they can get pregnant when they want to.

The authors suggest that some degree of fatalism about fertility—including doubts about the ability to get pregnant or to completely avoid pregnancy—can be logical and pragmatic, given that the process itself is not completely within women’s control. They recommend that health care professionals engage in nonjudgmental conversations with patients regarding their concerns about pregnancy and contraception. The authors also suggest that health care providers not assume that women who believe pregnancy is outside of their control will be resistant to practicing contraception or will have problems doing so consistently.

‘If I know I am on the pill and I get pregnant, it’s an act of God:’ women’s views on fatalism, agency and pregnancy,” by Rachel K. Jones et al. of the Guttmacher Institute, is currently available online and will appear in a forthcoming issue of Contraception.