Impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population

ObjectiveEvaluate the impact of the COVID-19 pandemic on access to contraception and pregnancy intentions.DesignNationwide prospective cohort study.SettingUnited Kingdom.ParticipantsWomen in the UK who were pregnant between 24 May and 31 December 2020.Main outcome measuresAccess to contraception and level of pregnancy intentions, using the London Measure of Unplanned Pregnancy (LMUP) in women whose last menstrual period was before or after 1 April 2020. While the official date of the first UK lockdown was 23 March, we used 1 April to ensure that those in the post-lockdown group would have faced restrictions in the month that they conceived.ResultsA total of 9784 women enrolled in the cohort: 4114 (42.0%) conceived pre-lockdown and 5670 (58.0%) conceived post-lockdown. The proportion of women reporting difficulties accessing contraception was higher in those who conceived after lockdown (n=366, 6.5% vs n=25, 0.6%, p<0.001) and continued to rise from March to September 2020. After adjusting for confounders, women were nine times more likely to report difficulty accessing contraception after lockdown (adjusted odds ratio (aOR) 8.96, 95% CI 5.89 to 13.63, p<0.001). There is a significant difference in the levels of pregnancy planning, with higher proportions of unplanned (n=119, 2.1% vs n=55, 1.3%) and ambivalent pregnancies (n=1163, 20.5% vs n=663, 16.1%) and lower proportions of planned pregnancies (n=4388, 77.4% vs n=3396, 82.5%) in the post-lockdown group (p<0.001). After adjusting for confounders, women who conceived after lockdown were still significantly less likely to have a planned pregnancy (aOR 0.88, 95% CI 0.79 to 0.98, p=0.025).ConclusionsAccess to contraception in the UK has become harder during the COVID-19 pandemic and the proportion of unplanned pregnancies has almost doubled.

Patterns of changing pregnancy intentions among women living with HIV in Canada

Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

Changing lives, dynamic plans: Prospective assessment of 12-month changes in pregnancy timing intentions and personal circumstances using data from HER Salt Lake

Objectives To explore the association between changes in personal circumstances and shifts in pregnancy intentions. Study design New start contraceptive clients, who desired to prevent pregnancy for at least one year enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative (September 2015 –March 2017) and responded to the question “What are your future pregnancy plans?” at enrollment and 12-month follow-up. We estimated multivariable binary logistic fixed-effects regressions to examine the association between changes in personal circumstances and a change from never desiring a pregnancy at enrollment to considering one in the future at 12-month follow-up. Results The majority of the 2825 participants (2246, 79%) maintained their pregnancy timing intention over the 12-month study period. Multivariable analyses of the 208 participants who changed from never desiring a pregnancy to considering pregnancy in the future at 12-month follow-up indicated that entering cohabitation (aOR 3.14, 95% CI 1.30–7.58), increased household income (aOR 1.06, 95% CI 1.00–1.13), and changes from unemployment to full-time employment (aOR 5.94, 95% CI 1.29–27.36) are associated with increased the odds of desiring a future pregnancy after never wanting one a year prior. Conclusions Pregnancy intentions are dynamic over twelve months and covary with partner status, household income, and employment status. Pregnancy intentions are linked to changes in life circumstances. Health care providers need to frequently assess pregnancy intentions and resulting contraceptive or preconception needs.

Unintended pregnancy resolution among parous women in twelve low- and middle-income countries

Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women’s pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women’s propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.

The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions

Context Standard pregnancy intentions measures do not always align with how people approach pregnancy. Studies that have investigated beyond a binary framework found that those with “ambivalent” feelings towards pregnancy are less likely to use contraception consistently, but the reasons for this are unclear. We sought to gain a nuanced understanding of pregnancy desires, and how perceptions about pregnancy are associated with contraceptive use. Methods We used non-probability quota sampling based on sex, age, and geographic region for a web-based survey of heterosexual men and women, aged 21–44 years, who could become pregnant/impregnate and were not currently pregnant (n = 1,477; 51% female). The survey was created using unique items informed by recent literature. Bivariate and multivariable analyses explored relationships between various perceptions about pregnancy with pregnancy desires categorized as: wanting a pregnancy, not wanting a pregnancy, and not trying but would be okay with a pregnancy. We conducted a sub-group analysis of those who were not trying but would be okay with a pregnancy (n = 460), using descriptive statistics to examine how consistent contraceptive use was associated with emotions and beliefs about avoiding pregnancy. Results After adjustment, those who felt that pregnancy may not always be avoidable, but instead determined by fate/higher power, or a natural process that happens when it is meant to, were significantly more likely (aOR: 1.83, 95% CI: 1.05–3.36; aOR: 2.21, 95% CI: 1.29–3.76, respectively) to report not trying but being okay with pregnancy, whereas those with negative feelings about a pregnancy were less likely to feel okay about a pregnancy (aOR: 0.11, 95% CI: 0.08–0.15), versus not wanting a pregnancy. In the sub-group analysis, those who felt pregnancy was determined by fate/higher power or a natural process were more likely to report not using contraception consistently (70%, 68%, respectively). Conclusions Those who state they are not trying but would be okay with pregnancy may not use contraception consistently because of beliefs that pregnancy is predetermined. Our findings support less categorical and more multidimensional approaches to measuring fertility intentions, with important implications for reproductive health service provision.

Lifestyle and Psychological Factors of Women with Pregnancy Intentions Who Become Pregnant: Analysis of a Longitudinal Cohort of Australian Women

Preconception lifestyle and psychological factors are associated with maternal and offspring outcomes. Both are important considerations for women planning pregnancy. The aim of this study was to explore associations between lifestyle/psychological factors and long-term pregnancy intentions in women who go on to become pregnant. Data from the cohort born 1973–1978 from the Australian Longitudinal Study of Women’s Health were utilised. Women were included if they had a new pregnancy occurring between Waves 3 and 5, resulting in 2203 women for analysis. Long-term pregnancy intentions (aspirations for children in 5–10 years), demographic, anthropometric, lifestyle (sedentary behaviour, physical activity, diet quality, smoking, alcohol use), and psychological factors (depression, anxiety, stress) were assessed at Wave 3. Multivariable logistic regression was employed to evaluate the associations between pregnancy intentions and lifestyle/psychological factors, adjusting for other explanatory variables. Younger age and being married were associated positively with pregnancy intentions, while living with obesity was associated negatively with pregnancy intentions. No lifestyle or psychological factors were significantly associated with pregnancy intentions. Our findings highlight potential opportunities to identify women who have longer-term pregnancy intentions during clinical care, offering a pivotal moment for preconception care relating to lifestyle health, psychological wellbeing, and family planning.