This longitudinal study of sexually active adolescents gives us a unique perspective on adolescent beliefs, attitudes, values, intentions and behaviors surrounding the complex issue of pregnancy intention. Pregnancy intention has been studied retrospectively through interviews with women who are currently pregnant [4
], who have recently given birth [17
], or who present for pregnancy testing [13
]. The value of the current study is that nonpregnant adolescents were interviewed at baseline about their plans and likelihood of becoming pregnant and they were prospectively followed for a 6-month period to assess whether they suspected that they might be pregnant, whether they took a pregnancy test and the results of that test. The analysis helps to estimate the value of pregnancy intention (characterized by pregnancy plans and likelihood) in predicting actual pregnancy. In the relatively short study follow-up interval, 45% of the female adolescents sampled reported they suspected they might be pregnant during the past 6 months, 26% were suspicious enough to take a pregnancy test, and almost 10% had a positive pregnancy test in the 6-month period.
Despite a majority of the teens expressing no plans to become pregnant in the next 6 months, there was tremendous variability in their assessments of the likelihood that they would become pregnant in the next 6 months. Although both planning and likelihood have been considered means by which pregnancy “intentions” are measured [6
], it is clear that they do not represent unitary constructs to adolescent females before conception. It is possible that questions regarding female adolescents’ plans
for pregnancy reflect their sense of internal control regarding their reproductive intentions, whereas questions of adolescents’ assessments of likelihood
of becoming pregnant reflect their perceptions of external forces’ influence on their immediate reproductive futures. One study of adolescents’ judgments of vulnerability to pregnancy found that locus of control acted as a moderator of such judgments [30
Another possibility is that those who indicate a disjuncture between their pregnancy plans and pregnancy likelihood are more ambivalent about their pregnancy intentions and are more comfortable indicating that it is likely to occur than that they are planning to become pregnant [31
]. A recent study found that adolescents’ ambivalent pregnancy “attitudes” were associated with subsequent occurrence of a pregnancy one year later [32
]. An alternative view is that inconsistency in responses between planning for pregnancy and likelihood of pregnancy does not reflect ambivalence about getting pregnant but about what is required to prevent pregnancy. In this view, the “inconsistent” adolescents are not necessarily wanting to get pregnant more than the “no planning, no likelihood” group, but are cognizant that they may not be as likely to use contraception for a variety of reasons. Thus, the same behavior (not using contraception effectively) may reflect lack of motivation to avoid pregnancy or lack of commitment to using contraception. Additionally, there were differences in reported pregnancy plans among those from various ethnic/racial groups with African-American and Latino/Hispanic adolescent girls reporting more pregnancy plans than Whites and Asian Americans. It is possible that these differences reflect cultural expectations for taking on adult roles and the different perceived future options for adolescents in these groups [33
The variables that distinguished those who indicated pregnancy intentions from those who indicated no such intentions can be considered “markers” of stronger pregnancy intentions among adolescent females who are not currently pregnant and may represent targets of intervention.
Prediction of Pregnancy Outcomes
Using the combined measure of pregnancy intention (plans and likelihood) revealed differences in the intention groups on the outcomes of suspected pregnancies and positive pregnancy test results in predictable ways. Those who indicated clear pregnancy intentions (“Planning and Likely”) were more likely to report suspected pregnancies and positive test results than those with inconsistent pregnancy intentions (“Not Planning, but Likely”). Those with inconsistent pregnancy intentions (“Not Planning, but Likely”) were, in turn, more likely to report these pregnancy outcomes than those who clearly indicated no intention to become pregnant (“Not Planning and Not Likely”). Importantly, more than two-thirds of those with positive pregnancy test results, who reported inconsistent pregnancy intentions at baseline, indicated during the 6-month follow-up interview that they planned to, or had already aborted their pregnancy.
Interpretation of our findings should take into account a number of limitations. We relied on self-report data that can be influenced by social desirability. In particular, the outcomes of interest (suspected pregnancy and positive pregnancy test results) may have been underestimates owing to self-report biases. Additionally, because our study sample was a sexually experienced adolescent group who attended an urban STD clinic or adolescent medicine clinic in an AIDS-epicenter, our results may not generalize to other adolescent populations who are not yet sexually active or who live in other geographical areas. Finally, because the original aims of the larger study did not include a focus on pregnancy intentions, per se, we were not able to characterize the adolescents in our sample with respect to all of the issues that might have influenced their pregnancy intentions (e.g., past experiences with pregnancy and/or abortion).
Given that the responses to questions of pregnancy plan and pregnancy likelihood were not always the same, assessing pregnancy intentions using a number of questions is important to capture the meaning of these different concepts for adolescent girls who are not yet pregnant, but at risk for pregnancy. Clearly, if clinicians or counselors simply ask adolescent girls if they are planning to become pregnant, they are likely to be missing important aspects of pregnancy intentions that might be captured in also assessing their perceptions of likelihood regarding pregnancy.
Because those adolescents with inconsistent pregnancy intentions (i.e., not planning, but likely to become pregnant) report more suspected pregnancies and more positive pregnancy test results than those with clear intentions to avoid pregnancy, it is important to consider and intervene with this “at risk” sub-group of adolescent females, especially with respect to issues of the need for available emergency contraception, consideration of pregnancy termination, and/or preparation for a healthy pregnancy, delivery and baby. Adolescents who suspect they may have been pregnant in the past 6 months are at risk for becoming pregnant. Therefore, discussions regarding pregnancy plans and pregnancy likelihood may help focus counseling and educational efforts directed at these young women. Pregnancy likelihood and lower use of contraceptives at follow-up were strong predictors of positive pregnancy test results, suggesting a counseling intervention focused on adolescents’ perceptions of the life circumstances that influence conception and contraceptive use may be beneficial.
Interventions to alter pregnancy intentions ought to focus particularly on the modifiable influences on pregnancy plans (i.e., attitudes toward condoms and pregnancy) and on assessments of pregnancy likelihood (i.e., self-efficacy to use condoms and attitudes toward pregnancy). Interventions aimed at enhancing condom and contraceptive self-efficacy and attitudes, providing more realistic views of the realities of pregnancy and childbearing, and encouraging greater contraceptive use in sexually experienced adolescent females could to reduce the occurrence of adolescent pregnancy.