Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnancy.

CONTEXT Although pregnancy ambivalence is consistently associated with poorer contraceptive use, little is known about the sexual, social and emotional dynamics at work in pregnancy ambivalence. METHODS During in-depth sexual and reproductive history interviews conducted in 2003, 36 women and men were asked about the relational and emotional circumstances surrounding each pregnancy, as well as their thoughts about conceiving a baby with both current and previous partners. An ethnographic, inductive approach was used to analyze the data. RESULTS Half of respondents had experienced at least one unintended pregnancy. Respondents described three categories of pleasure related to pregnancy ambivalence: active eroticization of risk, in which pregnancy fantasies heightened the charge of the sexual encounter; passive romanticization of pregnancy, in which people neither actively sought nor prevented conception; and an escapist pleasure in imagining that a pregnancy would sweep one away from hardship. All three categories were associated with misuse or nonuse of coitus-dependent methods. CONCLUSIONS For some individuals, the perceived emotional and sexual benefits of conception may outweigh the goal of averting conception, even when a child is not wholly intended. Future behavioral studies should collect more nuanced data on pregnancy-related pleasure. Clinicians and patients would benefit from clearer guidelines for assessing ambivalence and for linking ambivalent clients with longer-acting methods that are not coitus-dependent.