Traditional epidemiologic measures of pregnancy intention are fraught with psychometric and conceptual limitations. Measures focused on whether pregnancy was intended or optimally timed omit emotional aspects of pregnancy, do not account for fluctuating or uncertain intentions, and may neglect the reproductive experiences of significant segments of the US population for whom pregnancy planning may not be salient or feasible, including socially and economically marginalized populations. Furthermore, there is emerging evidence that the associations between pre-conception intentions and reproductive health outcomes may be relatively weak. Extensive qualitative work suggests that women?s responses to existing pregnancies within the complex contexts of their lives may drive pregnancy-related decisions and reproductive outcomes more than pre-conception intentions. New measures are needed to more fully assess the cognitive, affective and circumstantial factors that influence orientations toward, or ?acceptability? of, existing pregnancies and affect downstream outcomes associated with these pregnancies. In this proposal, we aim to develop a multidimensional, quantitative measure of post-conception pregnancy acceptability (the Post-CAP).
Our specific aims are to: 1) create a comprehensive conceptual framework of post-conception pregnancy acceptability via in-depth interviews with diverse women of reproductive age; 2) generate quantitative items based on Aim 1 qualitative findings and existing measures, with subsequent refinement and evaluation using Delphi methods with lay and academic experts and cognitive interviews; 3) test the Post-CAP in a large, longitudinal cohort of women seeking abortion or prenatal care, to assess psychometric properties including factor structure, reliability and validity. Completion of these aims will produce a novel, psychometrically sound measure which will facilitate a critical expansion of our understanding of associations between pre-conception intentions, post-conception orientations, and reproductive health outcomes.
The proposed research directly responds to calls from researchers, public health officials, and women?s health advocates for new measures that better capture what individuals wanted for themselves before and after a pregnancy became a part of their lives. By producing a novel measure of post-conception pregnancy acceptability, we will expand our understanding of the links between the contexts in which pregnancy occurs and reproductive health outcomes. Ultimately, measures of pregnancy acceptability can be incorporated into epidemiologic surveillance of the US?s ability to meet its citizens? reproductive needs in ways that intentionally center individuals? lived experiences and inform development of more effective, evidence-based and person- centered interventions to improve reproductive health outcomes and equity.
