Considering planning salience in women's pregnancy intentions.

Despite widespread availability of and knowledge about contraception in the USA, nearly half of all pregnancies are unintended.1 Recent evidence suggests that many women are ambivalent about avoiding or trying for pregnancy.2 With ambivalence about getting pregnant linked to inconsistent contraceptive use,3 scholars have called for greater understanding of the complex dimensions of pregnancy intentionality in order to reduce negative outcomes associated with unintended pregnancy.4 Extant research has not explored the importance of pregnancy intentions or plans – what we defi ne as ‘planning salience’. Using data from structured interviews and surveys of pregnancy intentions and behaviours of 56 women of childbearing age in a South-central city, we examined women’s opinions about the importance of planning their pregnancies and the factors that infl uenced pregnancy intentions and behaviours. Participants discussed the importance of pregnancy planning in three distinct ways. A slight majority of the women (n=29, 52%) reported that planning their pregnancies was very important. These women discussed the importance of planning other major life events in addition to pregnancy or framed the importance of planning in terms of being in control of their lives. One woman said “I’d like to plan it; I’d like to be in control. I’m kind of a control freak when it comes to, you know, just almost everything”. Other women (n=15, 27%) reported that planning their pregnancies was moderately important to them. These women had some plan for pregnancy and childbearing, but it was vague or involved a loose timeline. One woman said “Who cares? What’s 3 or 4 months? ... It isn’t that big of a deal”. A smaller but substantial number of women (n=12, 21%) reported that planning pregnancies was of very little or no importance. These women made statements such as “We haven’t been actively trying, but we haven’t not tried either. It was kinda [sic] if we get pregnant kind of thing” and “I’m just like, ‘If the universe wants me to have a kid, then I’ll have a kid’”. A descriptive analysis of our sample shows higher percentages of multiple unplanned pregnancies and living in or near poverty among women with low planning salience (Table 1). These fi ndings suggest that women’s planning salience may be critical to explaining the frequent mismatch between pregnancy intentions and behaviours. Given that unintended pregnancies are associated with negative maternal and child outcomes, this study suggests a need for practitioners to initiate discussions about pregnancy intentions with women of childbearing age in order to improve maternal and child health outcomes. Practitioners and policymakers should be aware that some women do not believe that planning for pregnancy is very important, as this might have notable implications for contraceptive and healthrelated behaviours. Policies or programmes aimed at reducing unintended pregnancies should go beyond making contraception affordable and available and perhaps offer information about how women and families benefi t by preparing for and planning their pregnancies. Programmes that empower women to develop reasons to plan pregnancies may be more effective at preventing unintended pregnancies than those that merely inform women about planning methods. While further research is needed to verify the relationship between the importance of pregnancy planning and subsequent behaviours with a representative sample and longitudinal study, we argue that an important explanation for pregnancy ambivalence or lack of correspondence between pregnancy intentions and contraceptive behaviours in the USA may be women’s planning salience of their pregnancy intentions.