Life Stability and Unintended Pregnancy: How Social Context Shapes Women's Fertility Experiences

Despite copious data documenting the vast disparities in unintended pregnancies (UIPs) among sub-groups of women, substantive discussion as to the reasons for these disparities is rare. Interventions that target women at high risk for UIP, specifically young, minority and low-income women, continue to fall short of their goals, and this may be partly due to an overemphasis on individual-level behavior change in isolation of women's life circumstances. This qualitative study used ethnographic interviews with ten women at high risk for UIP to explore how the social context of women's lives influences whether they experience an UIP and, if they do, how they manage it. Data were analyzed using content analysis. Participants described the stable circumstances necessary for them, either in the present or the future, to optimally become pregnant. Their ability to manage external, non-individual level factors in their lives impacted their capacity to become upwardly mobile to improve their existing life circumstances. Participants perceived delaying or avoiding pregnancy to be the primary means by which they could achieve life stability. However, paradoxically, participants were ambivalent about how they would achieve this goal. These women's narratives provide evidence that current program and policy resources for addressing UIP are misdirected. Acknowledging the impact that social context has on the experience and management of UIP and further exploration into the pregnancy ambivalence expressed by these women are necessary next steps that public health professionals, clinicians and policy makers must undertake to reduce negative social consequences of UIP and improve population-level pregnancy outcomes.