Elsevier

Contraception

Volume 73, Issue 5, May 2006, Pages 520-524
Contraception

Original research article
Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion

https://doi.org/10.1016/j.contraception.2005.12.009Get rights and content

Abstract

Background

Most pregnancies ending in therapeutic abortion are assumed to have been unintended. In the developed world, most arise from inconsistent or incorrect contraceptive use. Ambivalence about pregnancy might be associated with less effective contraceptive use.

Methods

Three hundred sixteen women undergoing abortion in Scotland were interviewed about contraceptive use at the time of conception. A modified measure of pregnancy intendedness was used to determine ambivalence.

Results

Pregnancy appeared to be clearly unintended for 92% of women. Sixteen percent were not using contraception and had higher intendedness scores (p<.001) than those using a method. Forty-four percent were using contraception inconsistently or incorrectly, almost always condoms or oral contraception, but method choice was not linked to pregnancy intendedness.

Discussion

Women who are ambivalent about the desire for pregnancy are less likely to use contraception. The challenge for reducing abortion rates lies in improving contraceptive use among the much larger group of women who do not intend to get pregnant but use contraception imperfectly.

Introduction

An estimated 22% of all conceptions worldwide end in induced abortion [1]. Over 12,000 abortions are performed each year in Scotland [2]. While some pregnancies result from the failure of a contraceptive method, in developed countries, most arise either because no contraception was used or because the method was used inconsistently or incorrectly [3], [4], [5]. Contraception in the UK is free of charge and easily available, and most people who are trying to avoid pregnancy claim to be using it [6]. Most women who present for abortion counseling say they had no desire to get pregnant [7], and almost all have information about and have access to a choice of contraceptive methods. Providers find it hard to understand why such women appear to have difficulty in using contraception effectively. Evidence from UK on the determinants of consistent contraceptive use and their interaction with broader social factors is scarce [8].

Not all pregnancies that end in induced abortion are clearly unintended at the time of conception, and it has been suggested that women who are ambivalent about childbearing may be less motivated to use contraception consistently [9], [10]. A simple measure of pregnancy intention has been devised and validated by Barrett et al. [11]. We report the use of this measure of “pregnancy intendedness” in a group of women in Scotland requesting abortion. Using semistructured interviews, we have related the intendedness scores to sociodemographic characteristics, to the method of contraception used (or not used) at the time of conception and to the consistency and correctness of contraceptive use in an attempt to identify any associations between intention and contraceptive behavior.

Section snippets

Methods

The study was undertaken at the Royal Infirmary of Edinburgh, Scotland, during the period November 2001 to June 2002. Women requesting termination of pregnancy were invited to participate in a survey of contraceptive practice as part of a larger randomized controlled trial of individualized contraceptive advice and provision during admission to a hospital. Women undergoing termination for fetal abnormality, women whose command of English was poor and a small number of women who were felt to be

Results

There were no differences between the three groups of women invited to participate in the main study (declined, control and intervention groups) with respect to age distribution or deprivation score.

All but 72 of the 316 women interviewed were aged under 30 years, and 44% of them had never been pregnant (Table 2). Nineteen percent had had one or more previous abortions. Deprivation scores (based on postal code of home address [12] and educational status) are shown in Table 2. Over half of the

Discussion

Although we omitted one question from the original survey instrument, the findings of this study demonstrate that for 75% of women undergoing abortion, pregnancy was very unintended (score 2 or less), and that for 92%, it was fairly unintended (score 3 or less). There was a tendency for more educated women to have higher intendedness scores. Intendedness was measured at the time of the abortion; however, some time will have elapsed since a woman first learned that she was pregnant. Many women

Acknowledgments

The study was funded through a grant from the Scottish Executive for the Scottish Health Demonstration Project, “Healthy Respect.” The authors would like particularly to thank the staff of the abortion unit of the Royal Infirmary of Edinburgh for help in recruiting the subjects, Dr. Rob Elton for help with the analysis and Fiona Cowan for administrative support. We are grateful too to Dr. Geraldine Barrett for allowing us access to her intendedness measure before publication.

References (22)

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