The Meaning of Pregnancy Among Women Seeking Emergency Contraception: A Qualitative Exploration

Purpose: Nearly half of all pregnancies in the United States are classified as unintended, and is highest among low-income women with less than a high school degree and minorities (Finer & Henshaw, 2006). Children from an unwanted pregnancy are more likely to have low birth weight, and to die within the first year of life (Brown & Eisenberg, 1995). Unintended pregnancy is also positively associated with mental health issues such as anxiety and depression among women, and an increased risk of physical abuse (Gipson, Koenig & Hindin, 2008; Goodwin, Gazmararian, Johnson, Gilbert & Saltzman, 2000). Research indicates that further investigation is needed to distinguish between a woman's pregnancy intention and attitudes towards pregnancy (Sable & Libbus, 2000). Understanding women's conceptualization of pregnancy will better inform health practice and interventions aimed at decreasing unintended pregnancy. This qualitative study explores the ways women accessing emergency contraception (EC) at family planning clinics view pregnancy.

Methods: Participants enrolled in a larger prospective clinical trial about the use of the copper IUD versus oral EC were recruited. Semi-structured individual interviews were conducted with 28 women (14 IUD users and 14 EC pill users) aged 18-30 accessing family planning clinics for EC within 120 hours of unprotected intercourse in a Western US city. Interviews included questions regarding a woman's knowledge of contraceptive methods, past experiences with EC, and the meaning of pregnancy. Interviews were audio-recorded, transcribed, and independently analyzed by two investigators. Transcripts were read and reread, and categories and themes were identified and coded (Marshall & Rossman, 2006). Line-by-line analysis was also conducted on large paragraphs of data to gain a deeper understanding of the interview information (Charmaz, 2006).

Results: Participants view unintended pregnancy as having specific negative financial, emotional, and mental health consequences, such as forfeiting educational and career goals and not being able to provide adequate emotional support for a baby. However, participants view pregnancy itself in positive terms. Women want to avoid pregnancy, yet the consequences may not outweigh the barriers she identifies to consistent contraceptive use such as the high cost of contraception, lack of health insurance, sporadic sexual activity, and negative health side effects from contraceptive methods. Women continue to engage in risky sexual behavior and may minimize their personal risk of unintended pregnancy.

Conclusions and Implications: This study provides deeper understanding of the complex consequences of unintended pregnancy and the ways a woman defines pregnancy. Health practitioners should be aware of the barriers women continue to face in obtaining consistent contraception, and the possible negative mental health outcomes due to these barriers. Unintended pregnancy prevention programs should focus on multi-pronged approaches to minimize a woman's risk of unintended pregnancy and its negative consequences, such as sexual and reproductive health education, help-seeking behaviors, and assisting an increase in communication between women and their sexual partners around contraception. Future research is needed to further our understanding of the impact of unintended pregnancy, and changes in individual behavior and perceptions over time.