“If it happens, it happens” vs. “It was planned”: Conceptualizing the ways people approach the possibility of pregnancy

Background: The concepts of pregnancy intention and decision-making are important in public health with regard to reducing unintended pregnancy. However, these concepts have proven difficult to validly measure, largely due to the inherent assumption in current measures that individuals approach pregnancy solely in rational or cognitive ways. Methods: The Social Position and Family Formation (SPAFF) study involved cross-sectional, qualitative interviews from a community–based sample of 200 men and women (ages 18-35). Individuals were recruited from public venues in New York City and northern New Jersey, and were sampled from select neighborhoods to reflect the racial/ethnic, educational, and income distribution of the larger city. A semi-structured interview guide was used to explore ‘decision-making' around childbearing. Interviews were coded, however, to identify all descriptions about the possibility of becoming pregnant. Results: Preliminary analysis indicates that many respondents refer to ”rational” approaches to pregnancy (“making a mindful choice”, “it was planned”, “a mutual decision”). However, many responses reflected two non-rational themes, which we refer to as Naturalistic (“just be natural”, “an organic thing”) and Chance (“God will give it to me, I just don't know when”, “there's only so much you can control”, “if it happens, it happens”). Conclusions: Assumptions that individuals' approaches to pregnancy are universally rational have impeded our understanding of the phenomenon of pregnancy and our ability to develop effective public health programs. The Naturalistic and Chance themes identified may tap into the emotional aspects of becoming pregnant and lead to improved measurement of this important construct in public health.