UCSF

Background: The pregnancy desires of adolescents and young adults are not well understood, as researchers and health care providers have traditionally assumed that individuals in this age group want to prevent pregnancy. Efforts to promote reproductive autonomy and promote contraceptive use may have been misguided as they relied on research data based on this assumption. Traditional methods for assessing pregnancy intention use retrospective and binary measures that do not capture the range of feelings around pregnancy. Development of a new validated measure, the Desire to Avoid Pregnancy (DAP) scale, allows for a more holistic perspective, representing a range of pregnancy preferences. Methods: This dissertation study is a secondary analysis of data from the Attitudes and Decision After Pregnancy Testing (ADAPT) study, which recruited participants from March 2019 to October 2022. Using the subset of participants aged 15 to 24 years old at enrollment (N= 1,020), pregnancy preferences were measured with the DAP scale and various demographic, contextual, and economic participant characteristics were analyzed in relation to these preferences and contraceptive use. This dissertation research described the range of youth pregnancy preferences and investigated factors associated with these preferences. The degree to which pregnancy preferences are aligned with contraceptive use was studied and whether these preferences mediated the effect of contextual factors on contraceptive use. Subsequent analysis investigated participants whose pregnancy preferences did not align with their contraceptive use, to identify individuals who may be at risk of compromised reproductive autonomy. Results: Young people had a range of pregnancy preferences, including a high desire to avoid pregnancy, ambivalence, and a low desire to avoid pregnancy. Factors significantly associated with greater desire to avoid pregnancy were identifying as White (compared to Latine), having depressive symptoms, being enrolled in school, having a mother with higher educational attainment, and not having a main partner (compared to being in a high quality relationship). Factors significantly associated with more openness to pregnancy were having one child (compared to none) and being religious. Contraceptive use was more likely among youth who wanted to prevent pregnancy. Interestingly, both youth in high quality relationships (compared to no relationship) and religious youth were more open to pregnancy yet more likely to use contraceptives. As pregnancy preferences acted as a suppressing mediator for these two variables, the degree to which these participants are more likely to use contraception becomes more notable. At some points during the study period, participants’ pregnancy preferences did not align with contraceptive use and a few participants’ characteristics were associated with these discordant relationships. Contraceptive use declined by increasing age for both those who wanted to prevent and those open to pregnancy. Among those with a greater desire to avoid pregnancy, those not in school or not in a relationship were less likely to use a contraceptive. Among youth open to pregnancy, multiparous participants were more likely to use a contraceptive. Conclusion: Having a more nuanced understanding of how youth pregnancy preferences are impacted by contextual factors and how in turn these pregnancy preferences impact contraceptive use, can help to direct policy to help meet the reproductive needs of this population.