Evidence from the 1995 National Survey of Family Growth. The findings of Trussell, Vaughan and Stanford raise serious questions for public health researchers who are seeking information about factors that affect maternal and child health outcomes. In trying to understand how women's pregnancy attitudes affect their well-being and that of their children, we have relied on measures of intention status as a proxy for feelings about pregnancy. Studies have linked unintended pregnancy to behaviors such as inadequate use of prenatal care or smoking and drinking during pregnancy and to negative birth outcomes such as low birthweight. Yet if one-quarter of women with contraceptive failures classified as unintended pregnancies are happy or very happy to be pregnant, we may need to consider what survey questions on pregnancy intention are actually measuring, and whether the responses provide a useful proxy for pregnancy attitudes.
Several issues undermine the validity of intendedness as it is currently measured.
First is the recall bias implicit in retrospective questions about intention. Once a woman has a baby, she may be more likely to say that the pregnancy occurred at the right time, regardless of how she felt when she became pregnant. And perhaps, in retrospect, it did occur at the right time, even though the conception may not have been intended. Second, because pregnancy intention involves human emotional and psychological factors, it is an extremely complex concept. Contraceptive failure is due in large part to failure to use a method consistently or effectively, and contraceptive risk-taking may reflect ambivalence about becoming pregnant.