EXECUTIVE SUMMARY

Do women who do not wish to become pregnant use more effective contraceptive methods than women who might welcome pregnancy? Results of a new study examine relationships between women’s pregnancy preferences and contraceptive use, using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale.

Researchers found that women with a strong preference to avoid pregnancy were far more likely to use any contraceptive method.

However, more than 50% of the women studied who reported a low preference to avoid pregnancy used some form of birth control.


Do women who do not wish to become pregnant use more effective contraceptive methods than women who might welcome pregnancy? Results of a new study examine relationships between women’s pregnancy preferences and contraceptive use using the Desire to Avoid Pregnancy (DAP) scale.1

Researchers found that women with a strong preference to avoid pregnancy were far more likely to use any contraceptive method. However, more than 50% of women who reported a low preference to avoid pregnancy used some form of birth control.

Among women who had sex in the last 30 days, about one-fifth reported not using any contraceptive method, while 17% used intrauterine devices or implants. About one-third used reversible contraception such as the pill, and 20% used condoms. Thirteen percent of women with a high preference to avoid pregnancy did not use contraception.1

While women’s preferences about pregnancy contribute significantly to their use of birth control, features other than contraceptive effectiveness also play a part in their decision-making and use, say researchers.

The DAP scale prospectively evaluates a range of women’s preferences and feelings about pregnancy and childbearing, and the degrees to which they prefer to avoid pregnancy. The scale examines three domains relevant to women’s conscious and unconscious pregnancy desires, including cognitive desires and preferences, affective feelings and attitudes, and anticipated practical consequences.2

The scale includes current thoughts and feelings about the idea of becoming pregnant in the next three months and having a baby in the next year. Each of the 14 statements in the scale is ranked by the woman from “strongly agree” to “strongly disagree.” (The DAP scale can be found at: https://bit.ly/30gBEXy.)

Scale Active in Research

The DAP measure is being tested and used in over a dozen studies with diverse populations, including students at community colleges, women in substance use treatment centers, individuals involved with the justice system, and immigrant women living near the United States-Mexico border, says Goleen Samari, PhD, assistant professor of population and family health at Columbia University Mailman School of Public Health and co-author on the current study. Outside of the United States, the scale is being translated and used in Kenya, Botswana, Ghana, the Philippines, and the United Kingdom.

The team that developed the measure, led by Corinne Rocca, PhD, MPH, associate professor and epidemiologist at the University of California, San Francisco, is using the DAP measure in the Attitudes and Decision-making After Pregnancy Testing (ADAPT) Study, states Samari. This study is recruiting about 2,000 women from reproductive and primary care health centers in four states, she explains. Women who become pregnant, as well as a subset of women who do not become pregnant, will be surveyed over two to three years.

“ADAPT’s unique prospective study design and use of DAP will enable researchers to document women’s pregnancy attitudes, decision-making processes, and experiences seeking prenatal or abortion care over time,” Samari explains. “Comparing the health and well-being of women who have more and less intended pregnancies, as well as women who avoided unintended pregnancies, will illuminate the effects of unintended pregnancy on women’s lives.”

In talking with women about their desires to avoid pregnancy, two questions come to mind: Do women know what their real risk of pregnancy is? Do they know there are differences in method efficacy? Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA, considers these questions.

“This lack of knowledge also might help explain the mismatch in method effectiveness and strength of desire to avoid pregnancy,” observes Nelson. “Perhaps more education about this fundamental issue should be addressed in addition to the other features the authors recommend we explore.”

REFERENCES

  1. Samari G, Foster DG, Ralph LJ, et al. Pregnancy preferences and contraceptive use among US women. Contraception 2019; doi: 10.1016/j.contraception.2019.10.007.
  2. Rocca CH, Ralph LJ, Wilson M, et al. Psychometric evaluation of an instrument to measure prospective pregnancy preferences: The Desire to Avoid Pregnancy Scale. Med Care 2019;57:152-158.