Objectives Retrospective assessment of pregnancy intention may be unreliable as women’s perceptions of a past conception can change over time. We compared the stability of retrospective pregnancy intention reporting over 5 years among women who sought and either received, or were denied, an abortion. Methods We recruited women from 30 abortion facilities across the United States in 2008–2010. Participants, some who received abortions and others who were denied care because they presented beyond facilities gestational limits, were followed prospectively for 5 years (n = 827). At enrollment and semiannually from year-2 to year-5, women completed the London Measure of Unplanned Pregnancy (LMUP), a six-item measure (scored 0–12), regarding the index pregnancy. We used multivariable mixed-effects models to assess the stability of retrospective reports of index pregnancy intendedness and compared trajectories by group, accounting for site and participant clustering. Our hypotheses were that intention would tend towards “more intended” over time among women denied abortions, who carried the pregnancies to term, and remain stable among women who received the abortion. Results Baseline LMUP scores were low (mean: 2.8) and similar by study group. Scores increased among women denied the abortion by year-2 (from 2.9 to 3.5; p < 0.001) and were steady through year-5. For women having near-limit abortions, reported intentions were steady between baseline (mean: 2.7) and year-2 (2.8), and declined thereafter through year-5 (to 2.5; p < 0.001). Conclusions Women somewhat shifted their perceptions of their intentions in correspondence with the pregnancy outcome. Retrospective estimates may underestimate the degree to which births result from unintended pregnancy.
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At baseline, study interviewers perceived that participants incorrectly understood item-6 regarding pregnancy preparatory behaviors. Although the item asks only about behaviors conducted specifically to prepare for pregnancy, participants were reporting whether they had engaged in the behavior for any reason. As a result, we added an interviewer prompt to clarify the item’s meaning. We excluded from analysis responses to item-6 prior to the addition of the prompt.
We modeled summed LMUP score as the outcome, rather than using a latent growth model examining latent scores to items, due to the complexity of our longitudinal model. Modeling a Generalized Linear Latent and Mixed Model with three-category outcomes, three study groups, group-by-time interactions, a spline, three levels of hierarchy, and a random time effect was too computationally intensive. Our approach of using summed LMUP scores likely produced very similar results as would have the more complex approach.
Aiken, A. R. A., Dillaway, C., & Mevs-Korff, N. (2015). A blessing I can’t afford: Factors underlying the paradox of happiness about unintended pregnancy. Social Science and Medicine, 132, 149–155.
Bankole, A., & Westoff, C. F. (1998). The consistency and validity of reproductive attitudes: evidence from Morocco. Journal of Biosocial Science, 30(4), 439–455.
Barrett, G., Smith, S. C., & Wellings, K. (2004). Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. Journal of Epidemiology and Community Health, 58(5), 426–433.
Barrett, G., & Wellings, K. (2002). What is a ‘planned’ pregnancy? Empirical data from a British study. Social Science and Medicine, 55(4), 545–557.
Biggs, M. A., Upadhyay, U. D., McCulloch, C. E., & Foster, D. G. (2017). Women’s mental health and well-being 5 years after receiving or being denied an abortion: A prospective, longitudinal cohort study. JAMA Psychiatry, 74(2), 169–178.
Borrero, S., Nikolajski, C., Steinberg, J. R., Freedman, L., Akers, A. Y., Ibrahim, S., et al. (2015). “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception, 91(2), 150–156.
Casterline, J. B., & El-Zeini, L. O. (2007). The estimation of unwanted fertility. Demography, 44(4), 729–745.
Dobkin, L. M., Gould, H., Barar, R. E., Ferrari, M., Weiss, E. I., & Foster, D. G. (2014). Implementing a prospective study of women seeking abortion in the United States: Understanding and overcoming barriers to recruitment. Women’s Health Issues, 24(1), e115–e123.
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 374(9), 843–852.
Foster, D. G. (2016). Unmet need for abortion and women-centered contraceptive care. Lancet, 388(19941), 216–217.
Foster, D. G., Biggs, M. A., Ralph, L., Gerdts, C., Roberts, S., & Glymour, M. M. (2018). Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. American Journal of Public Health, 108(3), 407–413.
Guttmacher Institute. (2018). “An overview of abortion laws.” State Laws and Policies. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws. Accessed 3 Mar 2019.
Guzzo, K. B., & Hayford, S. R. (2014). Revisiting retrospective reporting of first-birth intendedness. Maternal and Child Health Journal, 18(9), 2141–2147.
Jatlaoui, T. C., Shah, H., Mandel, M. G., Krashin, J. W., Suchdev, D. B., Jamieson, D. J., et al. (2017). Abortion surveillance—United States, 2014. Morbidity and Mortality Weekly Report, 66(24), 1–48.
Jones, R. K. (2017). Change and consistency in US women’s pregnancy attitudes and associations with contraceptive use. Contraception, 95(5), 485–490.
Joyce, T., Kaestner, R., & Korenman, S. (2000). The stability of pregnancy intentions and pregnancy-related maternal behaviors. Maternal and Child Health Journal, 4(3), 171–178.
Kendall, C., Afable-Munsuz, A., Speizer, I., Avery, A., Schmidt, N., & Santelli, J. (2005). Understanding pregnancy in a population of inner-city women in New Orleans: results of qualitative research. Social Science and Medicine, 60(2), 297–311.
Moreau, C., Hall, K., Trussell, J., & Barber, J. (2013). Effect of prospectively measured pregnancy intentions on the consistency of contraceptive use among young women in Michigan. Human Reproduction, 28(3), 642–650.
Morof, D., Steinauer, J., Haider, S., Liu, S., Darney, P., & Barrett, G. (2012). Evaluation of the London measure of unplanned pregnancy in a United States population of women. PLoS ONE, 7(4), e35381.
Mumford, S. L., Sapra, K. J., King, R. B., Louis, J. F., & Louis, G. M. B. (2016). Pregnancy intentions-a complex construct and call for new measures. Fertility and Sterility, 106(6), 1453–1462.
National Center for Health Statistics. (2018). National Survey of Family Growth 2015–2017. http://www.cdc.gov/nchs/nsfg/. Accessed 1 Jan 2019.
Poole, V. L., Flowers, J. S., Goldenberg, R. L., Cliver, S. P., & McNeil, S. (2000). Changes in intendedness during pregnancy in a high-risk multiparous population. Maternal and Child Health Journal, 4(3), 179–182.
Rabe-Hesketh, S., & Skrondal, A. (2005). Multilevel and longitudinal modeling using Stata. College Station, TX: StataCorp LP.
Rocca, C. H., Hubbard, A. E., Johnson-Hanks, J., Padian, N. S., & Minnis, A. M. (2010). Predictive ability and stability of adolescents’ pregnancy intentions in a predominantly Latino community. Studies in Family Planning, 41(3), 179–192.
Rocca, C. H., Kimport, K., Gould, H., & Foster, D. G. (2013). Women’s emotions 1 week after receiving or being denied an abortion in the United States. Perspectives on Sexual and Reproductive Health, 45(3), 122–131.
Rocca, C., Ralph, L. J., Wilson, M., Gould, H., & Foster, D. G. (2019). Psychometric evaluation of an instrument to measure prospective pregnancy preferences: The desire to avoid pregnancy scale. Medical Care, 57(2), 152–158.
Rosenzweig, M. R., & Wolpin, K. I. (1993). Maternal expectations and ex pos-t rationalizations: the usefulness of survey information on the wantedness of children. Journal of Human Resources, 28(2), 205–229.
Santelli, J., Rochat, R., Hatfield-Timajchy, K., Gilbert, B. C., Curtis, K., Cabral, R., et al. (2003). The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health, 35(2), 94–101.
Wellings, K., Jones, K. G., Mercer, C. H., Tanton, C., Clifton, S., Datta, J., et al. (2013). The prevalence of unplanned pregnancy and associated factors in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet, 382(9907), 1807–1816.
Williams, L., & Abma, J. (2000). Birth wantedness reports: A look forward and a look back. Social Biology, 47(3–4), 147–163.
Williams, L., Piccinino, L., Abma, J., & Arguillas, F. (2001). Pregnancy wantedness: Attitude stability over time. Social Biology, 48(3–4), 212–233.
The authors thank Rana Barar, Heather Gould, and Sandy Stonesifer for study coordination and management; Mattie Boehler-Tatman, Janine Carpenter, Undine Darney, Ivette Gomez, Selena Phipps, Brenly Rowland, Claire Schreiber and Danielle Sinkford for conducting interviews; Michaela Ferrari, Debbie Nguyen and Elisette Weiss for project support; Jay Fraser and John Neuhaus for database and statistical assistance; and all the participating providers for their assistance with recruitment.
This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Office of Research on Women’s Health, Building Interdisciplinary Research Careers in Women’s Health Grant #K12 HD052163; the Wallace Alexander Gerbode Foundation; an anonymous foundation; and the David and Lucile Packard Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Rocca, C.H., Wilson, M.R., Jeon, M. et al. Stability of Retrospective Pregnancy Intention Reporting Among Women with Unwanted Pregnancies in the United States. Matern Child Health J 23, 1547–1555 (2019). https://doi.org/10.1007/s10995-019-02782-9
- Pregnancy intention
- Retrospective measurement
- Unintended pregnancy