TOPLINE:

Among reproductive-aged women across nine US states, only 3% with high Desire to Avoid Pregnancy (DAP) scores became pregnant annually compared with 25% of those with low DAP scores. Pregnancy outcomes varied significantly by age, parity, education, employment, and racial and ethnic identity.

METHODOLOGY:

• Analysis included 9565 unique participants (age, 18-44 years) who contributed 18,603 annual longitudinal observations from nine US states (Alabama, Arizona, Delaware, Iowa, Maryland, New Jersey, Ohio, South Carolina, and Wisconsin) between November 2016 and June 2023.
• Participants were reproductive-aged women who could experience pregnancy (not pregnant, no tubal ligation, and not infertile) at the start of each 1-year observation period.
• Researchers measured pregnancy preferences using the DAP scale, which assessed feelings about potential pregnancy within 3 months and childbearing within 1 year.
• The primary outcome was self-reported incident pregnancy over the year following DAP scale completion, with differences examined by sociodemographic characteristics using model-estimated probabilities.

TAKEAWAY:

• Weighted analysis showed 21% of observations were among participants with low DAP scores, 31% with midrange DAP scores, and 49% with high DAP scores.
• Among participants with high DAP scores, those with a bachelor’s degree or higher had lower probability of pregnancy than those with high school education or less (95% CI, 1%-3% vs 3%-7%).
• Black, non-Hispanic participants (95% CI, 3%-8%) and Hispanic participants (95% CI, 2%-7%) with high DAP scores had higher probability of pregnancy than White, non-Hispanic participants (95% CI, 2%-3%).
• Participants living with partners showed higher pregnancy probability than those not cohabiting for low DAP scores (95% CI, 25%-31% vs 10%-18%) and midrange scores (95% CI, 7%-11% vs 4%-8%).

IN PRACTICE:

“To our knowledge, this is the first population-based, longitudinal cohort study to employ a rigorously developed measure of pregnancy and childbearing preferences. By capturing preferences across different conceptual domains and not requiring participants to specify a clear pregnancy desire, this measurement approach is likely to more accurately and precisely capture individuals’ true feelings about pregnancy than standard approaches to pregnancy orientation measurement,” the authors of the study wrote.

SOURCE:

The study was led by Brooke W. Bullington, PhD, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City. It was published online on October 9 in JAMA Network Open.

LIMITATIONS:

The Surveys of Women relied on self-reported incident pregnancy data, with likely underreporting of pregnancies, particularly those ending in abortion. The study’s timing across different years in nine states prevents generalization to any specific year or accounting for fluctuations between 2017 and 2023. Additionally, while the states were geographically diverse, they were not randomly selected, limiting generalizability to all reproductive-aged women in the US.

DISCLOSURES:

The research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (Award No. R01HD105764). The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.