A considerable proportion of unmarried young adults in current sexual relationships exhibited contradictory desires about having a baby, indicating that adolescents are hardly the only ones to experience pregnancy ambiva-lence.11,12
Young men were especially disposed to lack clarity about pregnancy desire; men had nearly three times the odds of women of being ambivalent even when other associated variables were held constant. One possible explanation for these findings is that because childbear-ing and childrearing are less associated with masculinity than with femininity,28
men may be less certain about entering into parenthood. In addition, the work of chil-drearing continues to be disproportionately performed by women.29–31
Thus, women may have a better sense of how their lives would be limited by a baby, and therefore may have clearer intentions to avoid pregnancy, while men may feel that pregnancy is ultimately their partner’s choice and primary responsibility, and therefore may not have coherently formed opinions on the topic.
Pregnancy ambivalence was associated with reduced likelihood of contraceptive use for all respondents, but the association was statistically significant only for men. Unfortunately, the size of our sample did not allow for analyses by individual contraceptive methods, but we encourage future researchers to perform such analyses whenever possible. Reliance on user-dependent methods, particularly those used in the heat of the moment (e.g., condoms or withdrawal), is likely to have a different relationship with pregnancy ambivalence than reliance on user-independent methods (e.g., IUDs or implants).
We were surprised that ambivalence was not signifi-cantly associated with contraceptive practices for women in multivariate analyses, even though the relationship was in the expected direction. We suspect that differences in measurement or study sample can explain why other studies have found statistically significant associations.3,4,11,12
Our inclusion of certain psychosocial variables (such as pregnancy fatalism or perceived likelihood of having a baby with one’s partner) may have soaked up some of the variance accounted for by pregnancy ambivalence in previous studies. Our conceptualization of pregnancy ambivalence, a hybrid of prior approaches to this topic, also may have affected outcomes. Among women, certain definitions of ambivalence may be more strongly associated with lack of contraceptive use than others. We strongly recommend continued dialogue and research on the benefits and drawbacks of various approaches, as well as a comparative analysis of which approaches seem to reveal the strongest associations with contraceptive use, method choice and unintended pregnancy. Given the strength of the association of pregnancy ambivalence with contraceptive practices among men in this study, and women in a number of oth-ers,3,4,11,12
further examinations of this topic would be highly worthwhile.
Future research should also examine pregnancy ambivalence within the context of the social and demographic variables that are linked to a heightened likelihood of unintended pregnancy. For example, socially disadvantaged women and men may be more susceptible to pregnancy ambivalence than the socially privileged; this disparity may add to the other reasons behind lower contraceptive use rates among the former group.17
Much more work is needed to translate findings relating to ambivalence to the programmatic or policy level. What, if anything, can we do to help people clarify their pregnancy desires?
Our study suggests that women should not remain the sole targets of pregnancy prevention programs or interventions. Findings confirm prior qualitative research indicating that men’s pregnancy ambivalence may be related to contraceptive use.9
If further research indicates that clarifying one’s desired time for pregnancy and parenthood helps improve contraceptive use, then programmatic and policy efforts should include both men and women. We strongly encourage public health practitioners to explore whether helping men as well as women clarify their pregnancy desires—and align pregnancy attitudes and plans with contraceptive practices—could help improve contraceptive use and reduce unintended pregnancies.
At the same time, research on pregnancy ambivalence underscores the tremendous difficulty people may have in clarifying their pregnancy and parenting desires. Our findings highlight several psychosocial variables that may contribute to such reproductive ambiguity. For example, a substantial proportion of respondents expressed some degree of pregnancy fatalism. Such culturally fueled atti-tudes32,33
contribute to an environment in which a lack of clarity regarding desire for pregnancy may be normative, rather than exceptional. Thus, while we encourage pregnancy prevention programs to involve men and to potentially help young adults to define their pregnancy desires, we simultaneously ask public health practitioners to understand and support the idea that clarifying such desires can be difficult. Young adults and older adults, men and women alike, can struggle with determining exactly when, how or with whom to have a baby.
Our findings should be considered in light of study limitations. For example, our measurement of pregnancy ambivalence incorporates definitions that were previously used in some studies,6,10,14
but it is inconsistent with others.16
Our definition captures individuals who had conflicted, indifferent or wavering attitudes and feelings about pregnancy. We believe that this definition is an improvement over ones used in previous studies because it captures a broader range of pregnancy ambivalence; however, a narrower measure would likely yield different results.
Another limitation of our analysis is that respondents’ reports of their partners’ contraceptive methods may not have been accurate. In particular, men may have incorrectly assessed what method their partner used in the last month, because use of hormonal and long-acting methods is undetectable. This shortcoming is hardly limited to our study; inherent data dangers exist whenever individuals report on their partners’ method use. A number of researchers have interviewed both members of couples in their samples,34
but comparing couples’ reports was beyond the scope of this study.
An additional challenge of our analysis was our inability to assess ambivalence about contraceptive use. Many women and men are conflicted about contraceptive methods’ benefits versus their side effects, both real and per-ceived.23
We suspect that contraceptive ambivalence, like pregnancy ambivalence, may have strong associations with contraceptive practices, and we strongly encourage future research on this topic.
Finally, survey design precluded our ability to control for relationship duration. The longer couples have been together, the more open they may be to the possibility of having a child, even in the absence of explicit desire for a pregnancy.9
Future studies should explore associations between pregnancy ambivalence and relationship length, quality and context wherever possible.
These analyses document the pervasiveness of pregnancy ambivalence among unmarried young adults and its link to contraceptive use among young adult men. Findings underscore both the vulnerability of young adults to pregnancy ambivalence and the need for men’s involvement in pregnancy prevention research, education and interventions.