The Misclassification of Ambivalence in Pregnancy Intentions: A Mixed-Methods Analysis

CONTEXT Researchers have developed various measures of pregnancy ambivalence in an effort to capture the nuance overlooked by conventional, binary measures of pregnancy intention. However, the conceptualization and operationalization of the concept of ambivalence vary widely and may miss the complexity inherent in pregnancy intentions, particularly for young people, among whom unintended pregnancy rates are highest. METHODS To investigate the utility and accuracy of current measures of pregnancy ambivalence, a mixed-methods study was conducted with 50 young women and their male partners in northern California in 2015-2016. Survey data were used to descriptively analyze six existing pregnancy ambivalence measures; in-depth interviews addressing pregnancy desires and plans were deductively coded and thematically analyzed to understand why some participants appeared to be ambivalent from the survey data when their interview responses suggested otherwise. RESULTS Eighty participants would be considered ambivalent by at least one measure. After assessment of the interview data, however, these measures were deemed to have misclassified almost all (78) participants. Qualitative analysis revealed several themes regarding misclassification: conflation of current pregnancy desires with expected postconception emotional responses; acceptability of an undesired pregnancy; tempering of survey responses to account for partners' desires; perceived lack of control regarding pregnancy; and, among participants with medical conditions perceived to impact fertility, subjugation of pregnancy desires in the interest of self-protection. CONCLUSIONS Current approaches to measuring pregnancy ambivalence may fail to capture the intricacies of pregnancy intentions and may be ineffective if they do not account for young people's experiences, especially when used to inform clinical practice, programs and policy.