Evidence-Based Advocacy: Addressing Pregnancy Ambivalence in Both Women and Men
Instead of only emphasizing that couples should use contraception consistently and correctly, we have to figure out how to help them clarify their feelings about pregnancy, even if those feelings are messy and complicated.
Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new research that activists may not otherwise be able to access.
There is no shortage of panic about teen pregnancy. Despite reports that teen pregnancy is on the decline, the mainstream media is still filled hand-wringing clips about babies having babies and causing the downfall of American society as we know it. But statistics tell a different story: it’s not teens that have the highest unintended pregnancy rates, but young adults, those of us ages 18 to 29. A new study by Jenny Higgins, Ronna Popkin, and John Santelli investigates this statistic by going beyond linking unintended pregnancy to demographic factors like poverty and education, and instead asks: what are young men and women’s levels of pregnancy ambivalence?
The researchers define pregnancy ambivalence as “unresolved or contradictory feelings about whether one wants to have a child at a particular moment.” Pregnancy ambivalence is a term that blurs the lines between intended, unintended, and mis-timed pregnancies. Measuring pregnancy ambivalence allows us to capture complex or not fully formed ideas and feelings about pregnancy. Some of our most-often cited statistics in the pro-choice movement use the binary language of “intended” and “unintended” pregnancy. This simply does not fit the complex reality of experiences with and feelings about pregnancy, especially for young women and young men.
Over the last decade, studies have picked up on the need to address and explore pregnancy ambivalence, but these studies have almost exclusively focused on women. Higgins et al. used data from the National Survey of Reproductive and Contraceptive Knowledge, a survey commissioned by the National Campaign to Prevent Teen Pregnancy and carried out by the Guttmacher Institute. The research team looked at questions relating to pregnancy ambivalence and contraceptive use, and their findings are quite startling. About 45 percent of respondents exhibited ambivalence towards pregnancy, and men were significantly more likely than women to be ambivalent (53 percent of men compared with 36 percent of women). People who expressed ambivalence about pregnancy were more likely to have used no birth control method in the past month.
Why is this significant? Because current pregnancy prevention models put the emphasis on addressing women’s experiences and feelings about pregnancy, while ignoring their partner’s needs. Men in this study had nearly three times the odds of women of being ambivalent about pregnancy, and this ambivalence was associated with reduced contraceptive use for men.
The researchers suggest that different types of contraception may be related to how couples express pregnancy ambivalence. For example, couples using condoms may have a different relationship with pregnancy ambivalence than couple using an IUD—one method is “user-dependent,” and could be impacted by the heat of the moment, while another method is “user-independent,” and takes away a couple’s ability to decide if they want to use contraception every time they have sex. The research team also implores others to investigate the context in which pregnancy ambivalence occurs—are socially disadvantaged young women and men more or less likely to experience pregnancy ambivalence than privileged young women and men? Why? How does this impact their contraceptive use? Knowing the answers to these questions can help us have a more robust understanding of pregnancy ambivalence, and move beyond only “intended” or “unintended” pregnancy.
In addition to advocating for researchers to consider tough questions that go beyond binary thinking about pregnancy and contraception, the researchers propose that women alone cannot remain the only focus of pregnancy prevention efforts. Women do not engage in pregnancy decision-making alone, and their partners’ emotions must be addressed, perhaps not in the context of “pregnancy prevention,” but in interventions that help couples explore their intentions, attitudes, and feelings regarding pregnancy.
Instead of only emphasizing that couples should use contraception consistently and correctly, we have to figure out how to help them clarify their feelings about pregnancy, even if those feelings are messy and complicated. Encouraging couples to process their complex feelings about pregnancy may even improve contraceptive use, but that can’t be our only goal. In moving beyond a “pregnancy prevention” frame and encouraging open dialogue about the many emotions that pregnancy brings up for both women and men, we can engage and empower both partners to be active participants in reproductive decision-making.