Pregnancy Plans Change Over Time

Pregnancy Plans Change Over Time

Pregnancy intentions change over the course of a year and are affected by partner status, household income, and employment status. Changes in life circumstances are linked to pregnancy intentions. Health care providers must assess pregnancy intentions and the resulting contraceptive or preconception needs on a regular basis.

Deciding when to start or expand a family is a deeply personal and complex decision. When someone starts using a contraceptive, it may appear that they do not intend to become pregnant anytime soon. However, a recent study published in PLOS ONE discovered that pregnancy intentions frequently change over as little as a 12-month period and that they vary specifically with partner status, household income, and employment status.

“When we think about whether or when people want to become pregnant, people often assume that there is one big life plan,” said Claudia Geist, associate professor and associate Dean for Research in the University of Utah’s School for Cultural and Social Transformation and the study’s lead author. “However, we know that things change over time.”

A study found that pregnancy intentions often change over as short as a 12-month time period and that they specifically vary with partner status, household income, and employment status.

While some studies have identified potential factors that influence pregnancy decisions, few studies have examined how these decisions may change or shift over time, as well as which personal circumstances are associated with the change. The purpose of this study was to assist providers in becoming more adaptable and responsive to the needs of contraceptive clients. Understanding how much a woman’s pregnancy intentions can change in a year contributes to ongoing efforts to de-stigmatize and support the common practice of switching and discontinuing various contraceptive methods.

The researchers followed a group of people who took part in the HER Salt Lake Contraceptive Initiative, a prospective study that recruited participants from four Salt Lake County family planning clinics between September 2015 and March 2017. Participants had to be between the ages of 18 and 45, and they had to be starting a new contraceptive method or switching to a different contraceptive method. In addition, they had to intend to avoid pregnancy for at least a year.

Dynamic pregnancy intentions

The study included 2,825 people who provided information about their pregnancy intentions at both the time of enrollment and the 12-month follow-up. The question, “What are your future pregnancy plans?” was posed to participants. Response options included:

  • “I am currently trying to get pregnant” (only available at 12-month follow-up)
  • “I would like to get pregnant in the next year”
  • “I would like to get pregnant in the next 2-5 years, but not in the next year”
  • “I would like to get pregnant in the next 5-10 years, but not before then”
  • “I am uncertain if or when I would like to become pregnant” (only available at enrollment)
  • I do not plan on getting pregnant at any time in the future
  • “Other”

The majority of participants (79 percent) maintained their pregnancy timing intention at the 12-month follow-up, while just under 20% reported a change. Over the course of a year, 22% of those who initially said they didn’t want a pregnancy changed their minds. Approximately 10% of participants shifted their pregnancy timing in order to desire a pregnancy sooner than at the time of enrollment.

“I expected change, but not as much change as we discovered,” Geist said. “We discovered that economic stability, such as increased household income and/or full-time employment, appears to put people in a frame of mind where they consider pregnancy after previously stating that they do not want a pregnancy.”

Aside from economic stability, researchers took into account relationship status, sexual identity, educational status, and aspiration. Researchers hope to provide insight to clinicians who provide contraception by investigating the relationships between changes in personal circumstances and shifts in pregnancy intentions. “The rapid changes we discovered over a year are a stark reminder that health care providers need to check in on their patients’ pregnancy desires on a regular basis,” Geist said.