Defining new categories of pregnancy intention in African-American women

Roughly half of U.S. pregnancies are unintended at conception, with higher rates among never married, low-income and African American women. The association of unintended pregnancy with multiple adverse outcomes makes this an important issue for those interested in eliminating health disparities. Concerns persist, however, how pregnancy intention is measured, such as whether existing categories adequately reflect the range of reproductive preferences, and whether they have similar meanings across groups. Our study goal was to inductively refine the definition and measurement of pregnancy intention, focusing on young low-income African American women. Data were collected using Q-methodology, a technique for systematically eliciting subjective viewpoints. 143 African American women who were age 15-25 and at risk for pregnancy were recruited at clinics serving low-income populations. They sorted statements (reflecting attitudes and preferences regarding future pregnancy) into a fixed distribution on a continuum from “least true for me” to “most true for me”. By-person factor analysis yielded new categories of pregnancy intention. These include a “pregnancy seeking” perspective; one reflecting ambivalence and lack of perceived control over reproduction; and four reflecting “pregnancy avoidance”, each with a unique focus on social support, value of planning, control over reproduction, and desired timing of future pregnancies. Factor distributions differed by age group, as well as for women who did and did not become pregnant during the course of the study. We see our categories as providing a more nuanced reflection of women's points of view about future pregnancies. They should prove useful for future clinical, surveillance, intervention and policy applications.