Changes in pregnancy desire after a pregnancy scare in a random sample of young adult women in a Michigan county

Make It or Break It? Pregnancy Scares and Romantic Relationship Dissolution

Young adult romantic relationships have undergone significant changes in recent decades, resulting in such distinct demographic trends as rising rates of relationship dissolution. Union dissolution during young adulthood can influence future relationship stability, financial well-being, and health. Reproductive experiences are an important factor that can shape relationship stability. Much of past research, however, has focused on the impact of childbearing on relationship stability while less attention has been paid to other reproductive experiences that could also shape relationship stability, such as pregnancy scares. A pregnancy scare is when a woman suspects she has an undesired pregnancy but later discovers she is not pregnant. This experience might increase or decrease relationship stability. Drawing on data collected from young women in the Relationship Dynamics and Social Life study, this analysis examines the association between pregnancy scares and union dissolution. Results suggest that pregnancy scares are negatively associated with union dissolution, and this relationship persists over time; however, this association varies by relationship type, with serious dating relationships experiencing the most protective benefits.

A Multidimensional and Longitudinal Exploratory Study of the Stability of Pregnancy Contexts in the United States

Objective

Evaluate the longitudinal stability of six pregnancy contexts, including intention, in a diverse cohort of individuals experiencing delivery, abortion, or miscarriage.

Methods

We enrolled individuals 16-44 years of age with pregnancies <24 weeks gestation in this longitudinal study between June 2014 and June 2015 in four US urban clinics. We assessed six pregnancy contexts (intention, wantedness, planning, timing, desirability, and happiness) at enrollment and 3-month follow-up. We constructed three-level categorical measures for each context defined as favorable, ambivalent, or unfavorable. We used Wilcoxon sign tests to evaluate changes in paired observations between pregnancy context measures over time and by pregnancy outcome.

Results

Among 121 participants at median gestational age of 7 weeks and 3 days, we found intention, wantedness, planning, timing, and happiness remained unchanged from enrollment in early pregnancy to 3-month follow-up. Individuals demonstrated changes in desirability; pregnancy assessments shifted toward less desirable from enrollment to follow-up (p = 0.01) (i.e., desired to ambivalent, or ambivalent to undesired). Among participants choosing delivery (57%), assessments shifted toward more favorable planning (i.e., unplanned to ambivalent, or ambivalent to planned) (p < 0.01), and less favorable desirability (i.e., desired to ambivalent or ambivalent to undesired) (p < 0.01) at follow-up. Among participants choosing abortion (28%), assessments shifted toward more unfavorable planning (i.e., planned to ambivalent, or ambivalent to unplanned) at follow-up (p < 0.01).

Conclusion

In multidimensional, longitudinal assessment, pregnant participants' perspectives on five of six pregnancy contexts remained unchanged between enrollment and 3-month follow-up; only desirability shifted. Pregnancy planning perspectives differed by pregnancy outcome.Human Research Subjects Protection Program: 1310012926.

Pregnancy scares, pregnancy uncertainty, and abortion attitude change

Women's attitudes towards abortion are often assessed infrequently in their lives. This measurement may not capture how lifetime events, such as reproductive experiences, potentially influence attitudes towards abortion. Although reproductive attitudes can fluctuate with life's circumstances, there is little research on how abortion attitudes may change when a woman suspects she might be pregnant. Using an intensive longitudinal dataset collected in Michigan, the Relationship Dynamics and Social Life (RDSL) study (2008-2012), we test the relationship between the timing of pregnancy scares and uncertainty and abortion attitudes using hybrid effects models. We find that women become less supportive of abortion while experiencing a pregnancy scare or uncertainty; however, this association exists only during a scare or uncertainty. These findings highlight that abortion attitudes may change when a woman suspects she might be pregnant. However, attitudinal change may not last past this period.

Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling

There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.