Original research articlePlanned, unplanned and in-between: the meaning and context of pregnancy planning for young people
Introduction
The dichotomous concepts of “planned” and “unplanned” pregnancy are widely used to guide family planning practice and research, despite evidence suggesting that these terms may not accurately reflect some women's experiences of or feelings toward pregnancy [1], [2], [3], [4]. This mismatch between patient and provider conceptualizations of unplanned pregnancy likely constrains reproductive health care interactions and decision making, as providers may perpetuate normative notions of pregnancy planning that alienate some patients [5], [6], [7]. Because access to contraceptive care plays a critical role in supporting individuals in achieving their reproductive goals [8], it is imperative that providers avoid perpetuating normative ideals of pregnancy planning and support their patients' diversity of attitudes toward pregnancy [5]. The traditional pregnancy planning paradigm posits that women determine if and when they want to have children based on important life goals, such as career or education, and then develop a plan for how to achieve their fertility goals [9]. Incorporating socioeconomic, contextual and relationship influences into dialogues on how women and their partners understand family planning and related decision-making processes moves toward a more inclusive and nuanced conceptualization of pregnancy planning [10].
There is a growing body of evidence regarding the limitations of “planned” and “unplanned” pregnancy concepts and terminology. Prior studies have shown that women's perceptions of pregnancy planning are multidimensional [2], [11], [12]. For example, a qualitative study in a New Orleans clinic found that some women in their sample both reported a desire to avoid pregnancy and were not using contraception regularly. While these participants understood the concept of pregnancy planning, they also expressed that avoiding pregnancy was not a priority because they might never realistically reach a point where planning one would be possible [11]. Moreover, recent studies have demonstrated that additional factors, such as relationship dynamics, desire for a baby with a specific partner and current life circumstances, significantly influence how women conceptualize pregnancy planning [2], [12]. Taken together, the literature highlights the context-dependent, multifaceted and fluid nature of pregnancy planning. Yet limited research exists on how individuals' lived experiences influence their conceptualization of planned and unplanned pregnancy, and the gray areas in between [3].
Efforts to understand the context of pregnancy planning have historically neglected men's perspectives or examined them within limited contexts. For example, recent qualitative studies have examined low-income, inner-city fathers' perspectives on childbearing but not on pregnancy planning [13], [14]. Additionally, these two studies did not include married and/or nonparenting men. Furthermore, some studies only examine male partners' desire or intention for pregnancy rather than pregnancy planning [15], [16], [17], which, in addition to desire and timing, includes the preparatory behaviors an individual takes in anticipation of pregnancy [3], [18]. These studies also rely on women's report of their male partners' intentions or use women's intentions as a proxy for their partners' intentions, neglecting that women may be unaware of or have misperceptions about their partner's perspectives [19]. While these studies provide valuable perspectives on feelings toward pregnancy intention among certain groups, they provide limited insight into the diversity of men's understanding of pregnancy intentions and do not examine their views on pregnancy planning.
To date, few studies have investigated the concept of pregnancy planning from the perspectives of both women and men. An increasing emphasis has been placed on employing qualitative approaches to examine these term's connotations, as these methods allow for better understanding of the nuances of existing definitions for patients [3], [12], [20]. Given the gaps in existing research, our work sought to further the understanding of how young people conceptualize planned and unplanned pregnancy, as well as any “in-between” areas that may be neglected by this binary. In so doing, we investigated how these definitions differ based on lived experiences.
Section snippets
Materials and methods
This analysis utilized qualitative data from the Young Couples Study, a mixed-methods study examining pregnancy desires, planning and decision making among young women and their male partners in the San Francisco Bay Area. The aim of this study was to inform development of new prospective approaches to conceptualization and measurement of pregnancy intentions and related concepts, and to understand these concepts within the context of relationships. Therefore, we sampled couples to examine the
Results
Table 1 describes demographic and relationship characteristics of the 50 couples interviewed for this study (individual n=100). The average participant age was 23 years (SD=4). Participants were racially and ethnically diverse, with about one third (n=35) of participants identifying as white. Forty-one participants were parents, 52 were students, and 65 were employed full- or part-time. Most participants (n=70) had been in a relationship with their main partner for more than a year, with a
Discussion
Researchers have long acknowledged the problematic nature of binary definitions of pregnancies as either planned or unplanned, particularly in informing contraceptive counseling practices [2], [3], [34], [35], [36], [37]. Indeed, we found that while many participants held up planned pregnancies as an ideal, the majority of our sample also felt that a status in between planned and unplanned pregnancy existed. Although the concept of a status in between planned and unplanned pregnancy did not
Acknowledgments
Research reported in this publication was supported by the Berkeley Population Center and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Numbers R00HD070874 and R24HD073964. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors extend their thanks to the Research Staff Elodia Villaseñor, Miguel Alcala,
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