How Do You Measure Intent?

At first glance, it makes sense to assume that all pregnancies among women using contraceptives are unintended. After all, why would a woman who wants to become pregnant use a contraceptive? Not so fast: A 1999 article in Perspectives questioned that assumption and launched a vigorous, long-lasting debate. 

Using data from the 1995 National Survey of Family Growth, the authors found that approximately seven of every 10 contraceptive failures should be classified as unintended pregnancies, mainly because a substantial minority of women who became pregnant while using contraceptives said the timing of the pregnancy was “about right.” Just six of 10 reported feeling unhappy or very unhappy about their pregnancy. That finding pointed to many women’s ambivalence about becoming pregnant, the authors wrote, which translated into an imperfect use of contraceptives.

In the same issue, the journal hosted a forum of responses to the original article. The reactions contextualized and added nuance to the research, and suggested ways to address the problem:

  • One response argued that the NSFG questions about pregnancy intention were outdated. The questions had been created after World War II to measure “surplus” fertility among older mothers, but the women now taking the survey were, on average, younger—and many were deciding whether they were ready to become mothers.
  • Several responses expanded on the hypothesis that the NSFG measure failed, in particular, to capture the complexity of the issue and the concept of pregnancy ambivalence. The “unconscious wish to become pregnant—even if one doesn’t really want a baby” is a powerful complicating force, one author wrote. Another response noted that unintended pregnancy is likely on a continuum “from truly unintended, through unplanned, to intended, and finally, deliberately planned.” As a result, a third response argued, “the measure traditionally used by our field is a case of misplaced concreteness” in a muddy situation.
  • The last response addressed how future cycles of the NSFG could ask about the issue. This essay focused on the need to inquire about motivation and desire for avoiding pregnancy, factors that might indicate pregnancy ambivalence and reasons for unintended pregnancies.

The journal discussion heralded a debate that changed the way surveys asked about unintended pregnancy: Some now include a measure of ambivalence, such as “wasn’t sure,” as an answer choice.

Cover illustrations of Margaret Sanger © Matthew and Eve Levine