Change and consistency in US women's pregnancy attitudes and associations with contraceptive use

Objectives: This study examines the cognitive and affective dimensions of pregnancy attitudes in order to better recognize the role of each in pregnancy ambivalence as well as the relative importance of each in understanding contraceptive use. Study design: Data from a national sample of 2894 women aged 18-39, gathered at baseline and 6 months later, were used to examine a measure of pregnancy avoidance (cognitive) and a measure of happiness about pregnancy (affective), both separately and jointly. I used bivariate and multivariate analysis to examine associations between attitudinal measures and consistent contraceptive use. I also examined changes in attitudes over time and associations between changes in attitudes and changes in consistent contraceptive use. Results: While a majority of women, 53%, indicated that it was very important to avoid pregnancy, a substantially lower proportion, 23%, would have been very unhappy to be pregnant. In logistic regression models that included both measures, only pregnancy avoidance was associated with consistent contraceptive use. Cognitive attitude was less likely than affective attitude to change over time; additionally, change in pregnancy avoidance, but not happiness, was associated with change in consistent contraceptive use. Conclusion(s): Pregnancy avoidance appears to play a more important role in understanding consistent contraceptive use. Findings from this study provide support for the idea that positive feelings about a pregnancy do not contradict a desire to avoid conception and that feelings and intentions may be distinct concepts for many women. Implications: Health care providers should assess patients' pregnancy avoidance attitude but also recognize that this can change over a short period of time for some women and should be evaluated regularly. (C) 2017 Elsevier Inc. All rights reserved.