Measuring Unintended Pregnancy

A commonly used benchmark for measuring women’s reproductive health is the proportion of pregnancies that are unintended—that is, that occurred too soon or were unwanted. In the U.S., about half of all pregnancies each year are unintended. Implicit in current measures of intendedness is the notion that women must decide whether and when to become pregnant, and then create a plan to achieve their goals. Furthermore, this paradigm assumes that an unintended pregnancy is necessarily a negative event. But is this the way it works for all women? And if it isn’t, what is being ignored?

Abigail R.A. Aiken tackled the issue of measuring unintended pregnancy in the September 2016 issue of Perspectives. In a comment, Aiken and her coauthors described the limitations of programs and interventions trying to reduce levels of unintendedness by focusing on pregnancy planning. This planning paradigm, they suggested, is inadequate for several reasons, including that it fails to accommodate women who are ambivalent about getting pregnant or those for whom planning is neither relevant nor possible. The authors proposed a new framework, one that considered women’s “perceptions of pregnancy”—their intentions, desires and feelings about a pregnancy—and the idea of “pregnancy acceptability,” because not all women view an unintended pregnancy negatively. Aiken and her colleagues characterized the new framework as taking a “reproductive justice approach, which places individuals at the forefront and prioritizes the complexity and diversity in women’s perceptions of pregnancy.”

Putting theory into practice, Aiken conducted original research with a second set of colleagues that compared the results of three measures of intendedness or planning among a group of women awaiting pregnancy test results. Under examination were the standard time-based U.S. measure, which assesses whether a woman intended to become pregnant when she did; the London Measure of Unplanned Pregnancy, which explores pregnancy planning and related behaviors; and a measure that combined the U.S. measure with additional information about a woman’s feelings of happiness related to the pregnancy. The results were revealing, with broad implications—the researchers showed that the U.S. measure and the London measure were not comparable. Also, they found that the measure combining women’s intentions and feelings did a better job of predicting actual pregnancy outcomes than either the U.S. or the London measure, thus providing evidence of the potential benefits of the reproductive justice approach described in the comment.

Cover illustrations of Margaret Sanger © Matthew and Eve Levine