Pleasures of pregnancy ambivalence: A qualitative analysis of intermittent contraceptive use and unintended pregnancy among U.S. women and men

Background: Over half of all pregnancies in the U.S. are unintended, and exposure to unintended pregnancy (UP) also increases vulnerability to HIV and other STIs. The conceptualization and measurement of UP have evolved in recent years. However, gaps in the research remain. Furthermore, rates of UP among the most socially disadvantaged women have worsened rather than improved in the last decade. Objective: In this presentation, we use qualitative data to investigate an unexplored phenomenon that could contribute significantly to UP: that both women and men can want and not want a pregnancy at the same time, and this sometimes pleasurable ambivalence contributes to intermittent contraceptive use and UP. Methods: Data come from in-depth, sexual history interviews with 24 women and 12 men from Atlanta, 50% of whom had experienced at least one lifetime UP. Results: Over two-thirds of respondents had experienced pregnancy ambivalence with a partner at some point in their sexual history, which influenced their use of barrier methods. Men's pregnancy ambivalence was especially correlated with sporadic male condom use. A minority of women and men described fantasizing about pregnancy during sex, even though they did not want a child; this "eroticization of pregnancy risk" was strongly associated with misuse or non-use of barrier methods. Conclusions: Pregnancy ambivalence, as well as the eroticization of pregnancy risk, seem to influence both contraceptive/condom use and unintended pregnancy. Research and programs in UP prevention could be strengthened by addressing their existence and influence.