The negative consequences of unintended pregnancies are well documented in the literature. Research also has shown it is possible to improve women’s lives through easier and more affordable contraception access. This leaves the question: Why are half of pregnancies in the United States unplanned and/or undesired?
The answer could be partly due to patients’ lack of access to their desired form of contraception. Cost or affordability is one of several access barriers.1
“Using a preferred contraceptive method predicted more family planning,” says Laura E.T. Swan, PhD, LCSW, a postdoctoral research associate in the department of population health sciences at the University of Wisconsin — Madison. If patients receive the contraceptive method of their choice, they are more likely to be using effective contraception, making unintended pregnancy less likely, she says.
Three Predictors
Three important predictors of family planning outcomes are health insurance, provider engagement, and contraceptive knowledge. The same three items also are important predictors of access to a person’s preferred contraception.1
“The fact that those three things were significant predictors of being able to access your preferred contraceptive method was most important to me,” Swan says. “I was trying to connect access to a preferred contraception and a more patient-centered family planning outcome.”
This is where engagement with providers proved important. “Folks who were reporting being engaged with their healthcare provider were more likely to report being able to get their preferred method,” Swan adds. More research is needed to support the statement that patient-centered care works best, but Swan’s study begins to make those connections.
Measuring unintended pregnancy and outcomes is challenging. Providers should think about whether unintended pregnancy is an undesirable outcome.
“It’s difficult to measure unintended pregnancy, and it kind of ignores abortion as a completely valid pregnancy outcome and way of exercising reproductive autonomy,” Swan says. “Some unintended pregnancies end in birth, and some end in abortion. This study did not take that into consideration.”
Researchers and clinicians can measure reproductive care success by whether patients receive their preferred contraceptive method, even if that method is not as effective as providers might consider ideal.
“A more accurate reflection of reproductive autonomy is whether the patient says, ‘I’m using my preferred contraceptive’ vs. ‘I’m not,’” Swan explains. “A person who experiences an unintended pregnancy but is able to have a successful abortion has exercised their reproductive autonomy.”
For some patients, particularly those who live in states with safe and legal abortion access, using condoms could be their desired contraception, with abortion as a back-up plan.
“Or maybe they choose to use no contraception, which is a valid choice,” Swan says. “They should still have the option to get an abortion or not.”
The research also found some additional variables that could affect unintended pregnancy. These include pregnancy fatalism, which was measured by asking participants if they agree with the statement: “It doesn’t matter whether I use birth control, when it is my time to get pregnant, it will happen.”
Other factors include:
- Whether people lived in a state with family planning Medicaid expansion;
- If they could obtain their preferred contraceptive method.
“I would focus on the importance on someone’s use or non-use of preferred contraceptive methods as more important than focusing on unintended pregnancy as an outcome,” Swan says. “It’s not that unintended pregnancy is a positive, but I’m trying to be part of this movement to shift our focus to patient-centered family planning outcomes, like the use of preferred contraception.”
REFERENCE
- Swan LET, McDonald SE, Price SK. Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States. Health Soc Care Community 2022;30:e6487-e6499.
The negative consequences of unintended pregnancies are well documented in the literature. Research also has shown it is possible to improve women’s lives through easier and more affordable contraception access. This leaves the question: Why are half of pregnancies in the United States unplanned and/or undesired?
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